Social Care

Derek Twigg Excerpts

Wednesday 16th November 2016 Commons Chamber

[Derek Twigg (Halton) (Lab)]

I am afraid it was the same old story from the Secretary of State: no response to the funding crisis. It is a national crisis and a national disgrace that social care is not being funded properly.

The social care system should of course become more efficient, but much work by local authorities and local health providers to make it more efficient and bring about improvements has already taken place. The simple fact, however, is that there is just not enough money. My local authority, Halton Borough Council, works closely with local NHS providers, but it has suffered a 50% cut in its budget, so how can it be expected to sustain and grow support for adult social care?

In the time I have, I want to quote parts the Care Quality Commission “State of Care” report of 13 October. It states that demands are increasing on health and social care, but that

“despite increasingly challenging circumstances, much good care is being delivered”.

We know that, but it goes on to say:

“However, the sustainability of this position is in doubt…The financial challenges in the NHS have been extensively documented…there has been evidence of a deterioration in quality…and some providers…are struggling to improve their rating beyond ‘requires improvement’.”

By the end of 2015-16, NHS providers had overspent their budgets by £2.4 billion. Local authorities were reported to have overspent by £168 million. Delivering high-quality care while achieving good financial management is therefore more important and more challenging than ever before.

The fragility of the adult social care market and the pressure on primary care services are now beginning to impact both on the people who rely on these services and on the performance of secondary care. The evidence suggests we may be approaching a tipping point. Profit margins are reducing because of pressures on fees and cost pressures that include the national living wage. Some providers are already starting to hand back home care contracts as undeliverable. Local authorities predict more of that to come.

The Treasury allowed local authorities to raise an additional 2% above the existing threshold, but this amounts to only £790,000 in 2016 for Halton Borough Council. That is well short of meeting the increased cost of adult social care. In addition to the costs, the council is facing its sixth year of austerity measures and has to find a further £30.3 million by 2020. Adult social care has delivered £17.4 million in savings from 2011 to 2017, but this level of savings is no longer sustainable given the pressures on the service. That pressure is compounded by increasing demand and financial constraints from health services, which can have a direct impact on social care services. Halton has to find an additional £2.9 million, while the additional precept it has received amounts to only £790,000. The council tells me that the adult social care and funding reform allocations in the Care Act 2014, which moved into the settlement funding assessment, are insufficient to meet the requirements of part 1 of the Act.

The national living wage is the greatest financial pressure at present facing adult social care, and the Government are not funding it. The ageing population of Halton is increasing, and that is part of a general change in demographics. The number of residents aged 65-plus will increase by 43% by 2037. Care providers, on the other hand, are exerting pressure on the council for increases in rates over and above inflation. The expectation appears to be that local authorities should fully fund the additional costs. I pay tribute to our care workers, who work under great pressure with a greater workload and fewer staff. Things do go wrong from time to time and they have to be addressed, but the care workers do a fine job. I was struck by the findings in the Unison “Care in Crisis” report. In answer to the question, “Have budget cuts affected your work or workplace?”, 70% said there was a greater workload and over 60% said there were fewer staff.

I have been in touch with my local hospitals, too. Warrington and Halton Hospitals NHS Foundation Trust says it is currently engaged in the challenge of trying to achieve the four-hour A&E target, as well as an improvement programme. As part of that, an independent audit was recently carried out under the emergency care improvement programme. On the Warrington site, it reviewed 241 patients across 15 in-patient wards where the length of stay was longer than six days.

The feedback received was that 58%, or 140, of the 241 patients reviewed were deemed medically fit—in other words, did not require a bed in an acute hospital. Of these, 91 required the intervention of an agency external to the hospital, such as local authority, social care or community care providers. The top three delays identified were: waiting for external agency assessments; waiting for a community hospital placement or other bedded intermediate care; and waiting for the start of social domiciliary care packages. The hospital of course acknowledges the difficulties that local authorities and commissioning bodies face around social care.

On the subject of Warrington hospital, the Minister will be interested to know that I asked the chief executive of Halton CCG whether, as part of the STP programme, consideration had been given to reducing the opening hours of Warrington A&E, but he refused to answer the question and gives no reason for that. I hope that the Minister will look into the matter and ensure that I get the information I should be entitled to.

The Government cannot go on ignoring the fact that there is not enough money. We heard the Secretary of State again today ignore this fact. He spent most of his speech not talking about the crucial point, which is funding, and that is clearly the feedback from all parts of the service. The CQC says that the system is fragile and at a tipping point. This is not Labour MPs or Labour councils; this is the CQC. I ask the Minister to tell the Secretary of State that he and the Chancellor need to come forward with a proper plan for funding social care. If they do not, the crisis will continue and deepen, and the Government will be responsible.

[Several hon. Members rose—]