Social Care Funding

Dan Poulter Excerpts

Tuesday 1st October 2019 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Sir Charles.

It is also a pleasure to participate in this debate, albeit briefly, and I pay tribute to the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for her very well-founded comments and to the right hon. Member for Twickenham (Sir Vince Cable) for securing this debate. It is indeed good to be talking about something other than Brexit.

This issue is the biggest piece of unfinished business not just of this Government or the coalition Government, but of the Governments of Gordon Brown and Tony Blair, because the concept of social care reform has been discussed in this place and more broadly in the country for many years. The right hon. Gentleman was right to recognise that many care providers face serious structural and numerical challenges in providing adequate numbers of people who want to work in the care sector. He was right to highlight the funding challenges that the care sector faces, which began about 15 years ago but have increased over the last few years. He was also right to highlight the fact that there is often a vocalised mantra of political consensus in this area but that when it comes to legislation or any sensible, proposal being made there is a failure in practice to deliver that political consensus, so as to deliver reform to the people on the ground who actually need care.

The care sector faces short-term funding pressures. I know that the Government will want to address some of those challenges by putting extra money into the system and supporting local authorities in providing better care, because we know that we have put local authorities into a position whereby they, and indeed the care sector, have faced very straitened financial circumstances for many years.

At the same time as talking about extra funding, however, we should talk about what sort of care system we want to see, because far too often the debate boils down to the funding discussion, when the reality is that we should also talk about how we want to deliver care. We should understand and put right the commissioning of care services. It seems extraordinary to me, given that we often talk about the benefits for people with long-term medical conditions of better integrated health and social care, that we have two different commissioning systems: local authorities commission local care; and the NHS commissions the health service. In their interventions today, many contributors have made the point that we are dealing with the same people with the same problems, but they are being dealt with in a fractured manner by two systems.

We must fundamentally deal with that issue of how we commission services, and the only way we will deliver improved care—care that is centred on the whole person—and dispense with fractured care is by having one point of commissioning. Unless we have that, we will end up putting more money into a system that, yes, needs to continue doing what it is doing at the moment, but it will still be a system that fundamentally is not the right one to deliver the right care for the people whom we care about.

At the moment, social care often duplicates the functions of the NHS, even when we are dealing with the same person. It is very difficult for families to understand why, on the one side, someone has undergone a life-changing medical event such as a stroke or severe dementia, yet some of their care is delivered not by the NHS but by social care. So, yes, let us put more money into the system, but let us also consider how we can have a better commissioning system and unified commissioning for the benefit of patients.

--- Later in debate ---

[Caroline Dinenage]

I will make some progress, if the hon. Gentleman does not mind.

As a result of our investment in social care, 65% of local authorities were able to increase home care provision in 2017-18. Local authorities have increased the average fee paid for older people’s home care by 4.7% in 2018-19, bringing some much-needed stability to the provider market. I am very pleased that the Care Quality Commission has rated 84.1% of social care settings as good or outstanding.

I am delighted to say that in our most recent spending round we announced further investment in adult social care. We will provide councils with access to an additional £1.5 billion for adult and children’s social care next year, including £1 billion in new grant funding over and above the £2.5 billion of existing social care grants. In the spending round, we confirmed that all the existing funding streams would be maintained next year—hard-wired into the Budget, if you like. The Government will also consult on a 2% adult social care precept that will enable councils to access a further £500 million. This increase in funding is part of the biggest increase since 2015 in overall core spending power for local government: it will increase by 4.3% in real terms next year.

The new funding from the spending round will support local authorities in meeting the rising demands that they face, while helping them to continue to stabilise the wider social care market. This additional funding is the first step towards putting adult social care on a fairer and more sustainable footing. We have already started preparing for the multi-year spending round due next year.

The challenges facing social care are not purely financial, as hon. Members across the parties, including my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter) and for Newton Abbot (Anne Marie Morris), have said. It is important to point that out, because stakeholders across the sector tell MPs: “Even if money were no object, we would not necessarily continue to provide this service in the current system.” The current system is not working in so many respects, and it is not working properly for some of our most vulnerable citizens, which is why we are continuing to support the system through a programme of sector-led improvements to help councils to make better use of funding to deliver high-quality personalised service, with more than £9.2 million committed by the Department in 2019-20.

We are also breaking down barriers to encourage much better integration of health and care, and we are looking at what more we can do to support the workforce and carers, as I have mentioned. In terms of integration, the better care fund has helped to enable much better co-operation between health and social care partners at a local level. It has also been instrumental in reducing delayed transfers of care, which has been mentioned: they have decreased by 2,147 since February 2017. We are looking at how we can use the fund to drive better integration.

My hon. Friend the Member for St Ives (Derek Thomas) spoke about bed vacancies and people stuck in hospitals. There is a lot more integration going on between care providers and health settings that are using those beds to provide the step-down care and discharge to assess that we want to see.

[Dr Poulter]

The better care fund and how it is applied on the ground locally varies across the country. Overall, the impact has been disappointing in terms of the ambition for that fund. I urge my hon. Friend to look at why there are two different commissioning systems for the NHS and social care. Unless we get that right, we are not going to drive improved integration or more personalised care.

[Caroline Dinenage]

My hon. Friend is right to say there were teething problems, but in the most recent reporting cycle, 93% of local areas agreed that joint working had improved as a result of the better care fund. We want to use it to drive much better integration and to look at how we undertake more joint commissioning in future.

We are committed to working alongside all partners in adult social care to attract and support a growing workforce with the right skills and the right values to deliver quality and compassionate care. Earlier this year, we launched the “Every Day Is Different” national adult social care recruitment campaign to raise the profile of the sector. We have secured a further £3.8 million for the next wave of that campaign, which will start later this month. We fund Skills for Care to support the sector in recruitment and retention.