Adult Social Care

Debate between Clive Betts and Barbara Keeley

Wednesday 8th March 2023 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

I thank everyone concerned for the opportunity to lead this debate on behalf of the Levelling Up, Housing and Communities Committee. Adult social care is an important issue, which the Committee has come back to on several occasions.

Last year, we produced another report on long-term funding for adult social care. We were happy to receive letters, in the last couple of days, from the Under-Secretary of State for Levelling Up, Housing and Communities, the hon. Member for North East Derbyshire (Lee Rowley), and the Minister for Health and Secondary Care, the hon. Member for Colchester (Will Quince), both saying why they have not yet responded to the report that was produced around nine months ago.

As you know, Mr Speaker, the advice is that Government should respond to Select Committee reports within eight weeks, so eight months seems rather a long time. I know that there have been quite a few changes of Minister during that period, so perhaps that explains some of the delay. If this was just a one-off, it would probably be excusable, but the Select Committee rarely gets a response within months, let alone weeks, of a report being produced, which is a little frustrating when we have put so much effort into them. We have not even had a proper response to the joint report that we produced with the Health and Social Care Committee back in June 2018—almost five years ago, which must get near a record for non-responses to Select Committee reports. The Health and Social Care Committee has also done its own reports into these matters, as have many reputable organisations, such as The King’s Fund.

Given the nature of the debate, I will concentrate on the impact on local government funding. Although social care, as a responsibility, lies with the Department of Health and Social Care, it is ultimately delivered through funding from local councils. I want to concentrate on the challenge that that poses for councils. This is not a new matter and is not without a lot of commitments. Only last year, the right hon. Member for South West Norfolk (Elizabeth Truss) said that she would spend £13 billion raised by the levy on social care. Well, the levy seems to have disappeared into other uses, as has the £13 billion.

The right hon. Member for Uxbridge and South Ruislip (Boris Johnson) said:

“I am announcing now—on the steps of Downing Street—that we will fix the crisis in social care once and for all”.

Not to be outdone, the right hon. Member for Maidenhead (Mrs May) said that her Ministers

“will work to improve social care and will bring forward proposals for consultation.”—[Official Report, 21 June 2017; Vol. 626, c. 35.]

Let us go back a bit further. David Cameron said:

“A commission will be appointed to consider a sustainable long-term structure for the operation of social care.”—[Official Report, 25 May 2010; Vol. 510, c. 31.]

I will not just be party political in this, because Gordon Brown said:

“Alan Johnson and I will…bring…new plans to help people to stay longer in their own homes and provide greater protection against the costs of care.”

The one thing that Prime Ministers have in common over the years is that they all promise to deal with the problems and funding of social care. The other thing that they have in common is that none of them has actually done that, and that is something of concern and it is why we still have the problems today.

Let me put this in the context of local government funding. Local government has had the biggest cuts of any part of the public sector since 2010. The National Audit Office and the Library have produced some interesting figures, which are known to be authoritative. They have said that the cut in core spending power for councils in the decade after 2010 has been 26%. By comparison, the increase in funding for the Department of Health and Social Care has been 14%. So that is 26% down for local government and 14% up for the Department of Health and Social Care. I am not begrudging the extra spending on health, but, clearly, councils also do important work and that is not really reflected in the figures.

The reason for that cut in spending power is that the revenue support grant has fallen by 37% over that similar period. A 25% increase in council tax has helped cover some of that fall. Council tax spending as a percentage of total local government spend—the percentage funded by council tax—has gone up from 41% of local government spend to 60%. In other words, council tax has been going up as the Government grant has fallen, but the totality of spending has fallen as well.

Councils’ spending on social care—social care as a whole, including children’s care—has risen by 8.9% in real terms, but non-care spending by authorities has fallen by 32%. That is the knock-on effect—we must keep reminding ourselves of the consequences of this. Social care spending has now roughly risen from 50% of council spending to 60% over the period. Those are very dramatic changes in how councils spend their money.

Let us look at services such as planning. I know that they are important for the future of our country, for future growth and for regeneration. Spending by councils on planning has fallen by about 50%. That is a staggering fall. There have been similar falls in regeneration and economic development, which will be important for the levelling up agenda.

Let us look now at libraries, buses and street cleaning, which are important services that everyone tends to use in some way. They have all fallen by between 30% and 50%. The real challenge for local democracy—the Minister on the Front Bench has responsibility for local government—is that people are now finding that their council tax is going up by amounts that I have just described, but, if they or their immediate relatives do not use social care, they are seeing all the services that they receive fall. That is a fundamental challenge for local democracy—people pay more and get less. That is not defensible in the medium term, but it has been going on for 10 years now, and something has to give.

We might think, “Well, it’s alright as long as social care is sorted out,” but it is not, is it? Let us just look at the particular problems with social care and social care funding. Before the autumn statement last year, the Local Government Association said that it thought that about £7 billion was the shortfall currently. I appreciate that the Minister will no doubt advise us of all the goodies that were delivered in the settlement for the next financial year, and, clearly, there were some helpful increases of money, but not the £7 billion that local councils were looking for. The problem is that that settlement contains some of the elements of the problems that we have been experiencing for a decade or longer now. First, so much of the funding councils get is short-term. Yes, the better care grants and the social care grants are welcome, but much of it is on a one-off basis. Much of last time’s settlement was on a one-off basis, with the extra money coming in those forms of grants, together with the increases in council tax I mentioned previously.

We know there are two fundamental problems with increases in council tax: first, they raise far more money in the most affluent communities than in the poorest communities, and secondly, they are regressive—not my word, but the Secretary of State’s. I know the Minister has been charged with finding a solution to that problem. Good luck to him—we look forward to his report in due course, and we had an interesting dialogue with him in the Select Committee the other week. We are asking more from people on low incomes with proportionately lower house values, and giving less to the poorest communities through the increases. That is not the best way to fund social care in the longer term.

We know that, although funding has been going up, demand is rising. There are more unhealthy people in our communities, as we all know; we can see the figures for ourselves. Often forgotten, however, is the rising demand from people with disabilities. People with a whole variety of disabilities, both learning and physical, are living longer. Where they might have died in their 30s, they are now very often living into their 50s, to the point where parents who once looked after them can no longer help or support them. Those parents are worried sick about what will happen to their children when they no longer have that parental support available. That demand must also be met and recognised.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Will my hon. Friend reflect on the fact that, when local authority spending on social care is squeezed and the demand goes up, as he describes so well, the work of caring is then passed on to unpaid carers, such as the parents of the people with disabilities he talks about? Last week, the King’s Fund reported that the number of unpaid carers receiving direct support from local authorities fell by 7% from 2020 to 2021. Does he agree that unpaid carers are being failed by this squeeze and the inadequate local authority funding, and that the Government need to do more to improve that and ensure that carers are properly supported?

[Mr Betts]

That is a great point from my hon. Friend. We recognise that that care is generally provided with a lot of love and commitment from people who do it, but very often they will reach breaking point without the additional support from local authorities, such as respite care. Families say to me, “If only I could just have a week where I could go away and relax a bit, knowing the person I am caring for is being looked after, that would make an enormous difference.” Sometimes that does not exist anymore, so that is an important point.

Adult Social Care: Long-term Funding

Debate between Clive Betts and Barbara Keeley

Thursday 28th June 2018 Commons Chamber

[Mr Betts]

I thank the hon. Lady, the Chair of the Health Committee—I think on this occasion, my hon. Friend, because we have worked on a friendly basis on this inquiry. She is absolutely right. One of the important recommendations is about trying to extend the scope of care provision to include those with moderate needs. If we provide care for them, it is quite likely that we will stop them getting into the substantial and critical phase and ending up in hospital in the first place. In terms of the NHS, it is about stopping people getting into hospital by getting them proper care and having care available for people in hospital, so that they do not have delayed discharges. In those two ways, that can be beneficial. Of course, we can also join up services. Can the NHS district nurse who goes into someone’s home and looks at their needs not assess their care needs at the same time? Can we not get that sort of joined-up approach?

It was remiss of me not to thank the staff, as the hon. Lady did, and I will name Laura and Tamsin. The work they did on this was exceptional. To produce a report of this quality in the time available was absolutely first-class, and we should congratulate them on it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Chairs and the members of the Select Committees for their work on the report, and my hon. Friend the Member for Sheffield South East (Mr Betts) for his statement introducing it. The key points from the report for me are that in its present state the care system is not fit to respond to current needs let alone predicted future needs, and that spending on social care needs to rise. Next week is the 70th birthday of social care, as well as of the NHS, but there is no funding settlement and no celebrations for social care. Does my hon. Friend agree that the time for a funding settlement for social care is now or at least soon, not years down the road?

[Mr Betts]

Yes, I completely agree with that. We have got to get on with it. If we agreed everything now, it would probably take two or three years to put it in place. That is why we suggested the stop-gap measure of the extra business rates in 2020 being made available for local authorities. We thought that was a very important solution. If we get it right, we can have stability for the long term. The Germans did this over 20 years ago. They have a stable system and it works. They have just put extra money into it with general public support, because everyone trusts the system. That is the position we have to get to.

Social Care

Debate between Clive Betts and Barbara Keeley

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

My hon. Friend has made a key point. I have already mentioned the fragility of the care market. We shall not be able to explore that fully during my speech, but it is a serious factor. If we do not get the funding right, more and more care providers will simply walk away. At the Unison meeting, members of a Leicestershire rehabilitation team spoke of the problems that they experience when care providers walk away from a contract. When the staff are not there any more, they have to plug the gaps.

[Mr Clive Betts (Sheffield South East) (Lab)]

The Communities and Local Government Committee is conducting an inquiry into the funding of social care. We have learned that not only are care providers handing contracts back, but councils are terminating contracts because of the inadequacy of the care that is provided. Ultimately, that means that individuals do not receive the care that they should be receiving. Their appointments are cancelled, or there are flying visits from under-trained care workers who are paid less than the minimum wage.

[Barbara Keeley]

My hon. Friend is right, and I shall come to that point shortly.

Carers UK reports that insufficient support from health and social care services is leaving the carers who are doing all that extra work

“isolated, burnt-out and unable to look after their own health.”

The Richmond Group of Charities published the story of Susan. She cares for her husband Bruce, who has been diagnosed with both Parkinson’s and dementia. The struggle that Susan underwent to find quality care is one about which I have been hearing from carers for some time. She was provided with respite care from a care home which was of such low quality that her husband was unrecognisable when she returned for him:

“He hadn’t been shaved, he couldn’t walk, and his eyes were crusted…with blepharitis.”

When Susan managed to get home care for her husband, it was also poor quality. She said:

“They didn’t know what they were doing. It seemed like they’d never cared before. They turned up at five o’clock in the afternoon to put my husband to bed. Or they turned up at ten, once I’d already helped him to bed. Absolutely awful.”

It is also telling how carers like Susan feel when dealing with the challenges of negotiating complex and fragmented care systems. She “felt small” and she said:

“You go in there, and you’ve got no idea about anything, about care. It’s like going in on the first day at school.”

Susan is not a rare case of a carer battling to get respite care or home care of an acceptable quality. Carers UK tell us that three out of 10 carers in its survey have experienced a change in the amount of care and support services that they receive. Six out of 10 of those carers experiencing a change said the amount of care and support received had been reduced.

Budget Resolutions and Economic Situation

Debate between Clive Betts and Barbara Keeley

Monday 21st March 2016 Commons Chamber

[Mr Clive Betts (Sheffield South East) (Lab)]

I want to get beyond the Budget headlines, which often lead to cheers from the Government Benches, and instead consider some of the details and try to get some answers.

I want to return to the point I raised in Communities and Local Government questions earlier, in an intervention on the Secretary of State and then in a point of order, because I still have not had an answer. The Government have said that local authorities will be compensated for the change to small business rates relief, which amounts to £1.7 billion in the next financial year—2017-18—and to similar amounts in years after. He said it was mentioned on page 84, line 15, of the Red Book, but that refers to the cost to the Government of the small business rates relief changes; it does not show how local authorities will be compensated for that loss by a section 31 grant. Will someone please show me where in the Red Book the section 31 grant is described as compensating local authorities?

[Barbara Keeley]

Does my hon. Friend agree that this is a very pressing issue? In Greater Manchester, the business rates retention scheme could be put in place as early as 2017. Will the Government even have finished the consultation by then? Where are we? We need to know where we are.

[Mr Betts]

Local authorities are entitled to absolute certainty. We can welcome the help for small businesses but not at the cost of local authorities and their services. If the Minister cannot explain this today, I hope that the Secretary of State, to whom I have written, can at least give us a written answer that can be made available to everyone else through the Library.

The Secretary of State went on to say that after 2020, because no grant will be available, compensation will be provided by a reduction in devolved powers to local councils, so that they will not have as many things to spend their money on—money they now will not get through business rates relief. It is a bit disappointing that the Government’s way out is to reduce devolution. That does not seem to be consistent with their claim to be devolving more powers all the time.

More worryingly, on the change between the retail prices index and the consumer prices index, which comes into force in 2020, how on earth will the Government find a mechanism by which to compensate authorities for that change, given that it will vary year on year? How will they do it, when the only way to provide compensation will be by changing the devolved powers available to local authorities, which cannot be done on a yearly basis? Will the Minister please provide the mechanism and explain it to us?

There will be a fundamental problem here after 2020. If any future Government were to introduce the sorts of changes this Government have made to business rates, where would it leave local authorities? Their income would simply be cut, and there would be no means by which to compensate them because there would be no revenue support grant in existence. Local authorities’ devolved powers cannot be changed on a year-to-year basis. This does not just throw up the need in future to devolve receipt of business rates to local authorities; we also need seriously to consider devolving the right to set business rates and business rates assistance. If that is not done, this will be sham devolution, and it will raise the great risk of future Governments on a whim being able to change the system on which local authorities will rely for a good percentage of their income. This problem has to be thought through.

I turn now to the four-year settlement that the Secretary of State rightly offered to local councils for the rest of the Parliament. Where is that left by the £3.5 billion of efficiency savings the Chancellor announced in his Budget and the £4.4 billion of extra savings that presumably have to be found now that the PIP cuts are not being carried through? In total, it would seem to amount to an extra £7.9 billion that he will have to find. Can we have a categorical assurance from Ministers that this will not affect the four-year settlement offered to local councils? I hope that it will not once again be a case of giving local authorities certainty for the Parliament, only to come back within a few months and ask for more cuts, which would put them in an impossible position.

Moreover, are we going to see further cuts to the public health grant, which the Government have not preserved? In the last Parliament, the public health grant was initially—up to 2013—part of the health budget and ring-fenced accordingly, but it is now part of the local government budget, and already this financial year it has seen a one-off cut of £200 million. It is estimated that there will be £600 million more in real-terms cuts by 2020. Will the grant face any further cuts as a result of the Chancellor’s need to fill the £7.9 billion black hole?

Finally, the Government have announced £115 million of help to tackle rough sleeping. It is a blot on our society and it is right that extra help is being given to deal with it, but to tackle homelessness properly—apart from the prevention at one end—we need more social housing to offer to homeless people. What do the Government have to say about the Chartered Institute of Housing’s report stating that there will be 300,000 fewer social rented homes by the end of the Parliament than there were at the beginning? What about the evidence that St Mungo’s gave to the inquiry by the Communities and Local Government Committee the other day stating that, unless the Government changed the link to the local housing allowance, all its help and provision for homeless people will have been closed by the end of the Parliament? That is a situation that no one can tolerate.

Local Government Finance (England)

Debate between Clive Betts and Barbara Keeley

Wednesday 10th February 2016 Commons Chamber

[Barbara Keeley]

rose—

[Mr Clive Betts (Sheffield South East) (Lab)]

rose—

--- Later in debate ---

[Mr Clive Betts (Sheffield South East) (Lab)]

I want to try to be fair and even-handed in these matters, and I shall focus on the positive elements first. We ought to welcome the four-year settlement on offer, as it is something that local government has for some time been asking for. It is a helpful step forward, providing greater certainty for the future. We are not quite sure yet what efficiency plans local councils will need to draw up to achieve it, but it seems a good starting point.

I welcome the money for social care, too. It is reasonable, but I have some questions about how it is going to work. I have had an exchange of correspondence with the Secretary of State and with the Local Government Association. The LGA clearly says that it asked for more money than it has got on transformational spending and it states that this was not recognised.

I do not object to the fact—indeed, I welcome it—that local councils will be able to raise more money through council tax. It is right in principle for more local services to be paid for by local taxes. As a localist, I firmly believe in that.

Let me clarify the questions that still need addressing. First, the better care fund that is part of the package is very much back-end loaded in the spending settlement, but there are pressures at the front end, too. The Secretary of State claimed in his statement that the issue of the 2% council tax increase raising more money in richer areas would be addressed through the distribution of the better care fund. Will he put some clear information in the Library to explain how that is going to be done?

[Barbara Keeley]

My hon. Friend has raised a key issue. For two years, there will be hardly anything from the better care fund. There will a maximum of only £400 million this year from the 2% precept, nothing from the better care fund, and only £105 million from the fund next year. The funding gap is increasing by £700 million, and the Local Government Association’s Councillor Izzi Seccombe has asked for that sum to be released.

[Mr Betts]

That was the next point that I was going to make. The Government should consider how the better care fund money could be distributed in a way that would help more poor authorities, but it would also be helpful—I know that the LGA has mentioned this—if more of that money could be provided until at least 2017-18, if not into the next financial year. I hope that the Secretary of State will consider that, because current back-end loading is a real problem.

The LGA has drawn my attention to the fact that the council tax base—which relates to the number of properties from which council tax will be raised—is assumed to rise by 7.8%. Will the Government explain precisely how they have made that calculation? It seems a very big increase indeed.

What account have the Government taken of the ability of clinical commissioning groups to help local authorities with their social care spending? In my own authority of Sheffield, the CCG has said that it faces a substantial reduction in its funding against the anticipated level for next year, but this year it is providing the council with £9 million of transfer funding to help it with its added social care provision. If that money is removed, any element from the better care fund or increased council tax will not be a substitute. I think that that is an issue for cross-departmental work.

The settlement will clearly result in cuts. The Secretary of State will argue that they will be less severe than those made in the last Parliament, but, of course, they are in addition to those that have already been made. In the last Parliament, when most of the larger percentage cuts were made in the metropolitan areas, which had the greatest needs and the greatest problems, we never once heard mention of a transitional arrangement to provide extra help for those councils. It has only come about now because the Government have developed a core spending power which includes council tax, and the richer councils happen to be more able to raise council tax. As they have suffered a bigger reduction in revenue support grant as a result of the initial spending announcement, a transitional funding arrangement has suddenly and magically been put in place for them.

NHS Care of Older People

Debate between Clive Betts and Barbara Keeley

Thursday 27th October 2011 Westminster Hall

[Mr Clive Betts (in the Chair)]

Order. A lot of people clearly want to speak, and I do not want to stop or discourage interventions, but if they are made could they be brief and to the point so that we can keep things flowing?

[Barbara Keeley]

It is clear that what I said about culture must apply right through to things such as whistleblowing. It is a sad aspect of this case that none of the people involved with Mr D’s care or with dealing with the complaint could even rescue the situation by handling the complaint reasonably.

I understand, and we must be clear, that this case represents the NHS at its worst, but it did happen, and it happened to my constituent. I have never had a case as bad as this one again, but I have had others that have given me cause for concern, and I am currently pursuing cases with similarly bad aspects on behalf of constituents. Sometimes, however, there are cases where everything goes wrong and all the problems I have mentioned come together.

MPs’ interventions and the intervention of the ombudsman can remedy the injustice of such inadequate treatment to some extent, but we must accept that it is not possible even for such interventions, much though our constituents are grateful for them, to overcome the distress and anguish experienced by families such as my constituents. However, a swift apology would have helped, and we must have a system whereby an apology can be made swiftly, because that never happens.

The ombudsman talked about the need to listen to older people and to take account of feedback from families. One of my conclusions from having looked at this case is that it took many months—in fact, years—to get to the point where the family were anything like happy with the response to their complaint, and that made things worse.

I felt it was important to outline a case I had personal experience of, and there has not been time to touch on much else, but there are many things that could improve this situation. In the briefing for the debate, I was heartened to see a note from the Women’s Royal Voluntary Service describing ward support services it is setting up for older people, which is a wonderful idea. It wants to improve the experience of older people by using trained volunteers to support them and their families and carers. That would include training in dementia, which could be important.

Hospital support for carers is also important. The Princess Royal Trust for Carers has a carers centre in Salford, which the Minister knows, because he has met some of its staff. The centre has developed strong relationships with primary and secondary health care and works closely with Salford Royal hospital, which does excellent work—it is not the hospital I was talking about earlier; that was a different hospital. The centre supports carers in the hospital and on important issues around discharge. How could the discharge I described have happened if people had been there—even volunteers and people from a carers centre—to help the family? Such initiatives can help.

Developing awareness of family carers on hospital wards and giving them support might help to head off, or somehow deal with, dreadful situations such as the one I have described. NHS care is important, but it is important that we understand that it does not end when a person leaves hospital, particularly if they are terminal patients going home to die.

I hope the debate contributes to the improvement of NHS care for older people. As a Member of Parliament, I would never want to see another case like the one I have described.

Localism Bill

Debate between Clive Betts and Barbara Keeley

Tuesday 17th May 2011 Commons Chamber

[Barbara Keeley]

No, there is absolutely not. I thank my hon. Friend for making that point.

Hon. Members will be interested to know the extent to which there is all-party opposition to these proposals in Bradford. The Conservative group leader on Bradford council also argued against the imposition of a shadow mayor in that city. In the same article, Councillor Anne Hawkesworth said:

“My colleagues and I are not supportive of elected mayors… We do not think that the proposals are suited to the needs of…Bradford.”

Last week, the same issue was reported on again, when the hon. Member for Bradford East (Mr Ward) said:

“My view is that it should be for the councils to decide if they want to go down the referendum route. The referendum shouldn’t be imposed.”

The Opposition agree. Shadow mayors and referendums on having a mayor should not be imposed. In Bradford at least, it seems, there is Labour, Liberal Democrat and Conservative opposition to the Government’s proposals. However, there has also been opposition in other councils, including Leeds city council.

[Mr Clive Betts (Sheffield South East) (Lab)]

While my hon. Friend is running through a list of authorities, will she also refer to Sheffield—now a Labour-controlled authority, of course? There has been cross-party agreement between Labour and Liberal Democrats, and all are opposed to any mayoral system at all, and certainly opposed to shadow mayors. I am sure that were there any Conservative councillors in Sheffield—which there are not—they would be joining in the opposition as well. Is it not a strange system in which a mayor’s legitimacy comes from being elected by the public, but a shadow mayor’s legitimacy comes from being the representative of most councillors on a council? In Sheffield, that majority of councillors are opposed to the proposals.

[Barbara Keeley]

Absolutely. I was not going to go through a complete list, but I welcome hearing about what has happened in Sheffield.

It seems that Yorkshire is turning against these proposals en masse, and there has been opposition in other councils—for example, in Leeds city council. The Yorkshire Post quoted its leader, Councillor Keith Wakefield, as saying that these proposals are

“not acceptable in today’s democracy… If people decide they want an elected mayor that’s what they should have, but do it following a vote… I think the idea of a referendum is OK where people have an opportunity to say yea or nay. What’s not right is putting you in a position where there’s been no vote.”

I understand that he would turn down the position whatever happens.

I hope that the hon. Member for Bradford East and his colleagues will support our amendment 41, and vote against the imposition of shadow mayors and referendums on their local councils.