Social Care Services

Emily Thornberry Excerpts

Tuesday 17th May 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I do not believe I have served under your chairmanship before, Mr Brady, and it is a pleasure to do so.

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate, and on his excellent contribution and the moving examples that he put before us. The truth is that not enough time is spent in the House on this fundamental issue, which is vitally important to many of our constituents; but we have had a very good debate today.

There seem to be two issues here: the structural problems and the cuts. My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) touched on standards of care and on ensuring proper status for social care workers. My hon. Friend the Member for Blaydon (Mr Anderson) made a very important political analysis of the ongoing problems, and my hon. Friend the Member for Nottingham South (Lilian Greenwood) demonstrated her great expertise in this area.

My hon. Friend the Member for Wolverhampton North East (Emma Reynolds) yet again raised the importance of ensuring a long-term solution and expressed our continued regret that this issue was essentially bombed before the last election by the Conservative party, which decided that it was better to make cheap political points than for us all to work together. I assure the Minister that when the Dilnot commission reports we will not be emulating the behaviour of the Opposition at that time and that we will approach the matter with an open mind. We need a fair and sustainable solution, and we want to be able to work together on that. In the end, the issue is more important than party politics, and we must work together not just to find a solution but to implement it.

During the comprehensive spending review, the Government flourished the fact that they were giving an additional £2 billion for social care, but a few months later, local authority budgets were slashed by 8%. Given that social care is top-tier councils’ biggest area of discretionary spending, it was simply inconceivable that it would not be hit.

The Local Government Group and the Association of Directors of Adult Social Services both raised concerns about the implications for social care of the CSR local government settlement, warning that the extra £2 billion was simply not enough to meet demand. They argued that the spending gap during the period was likely to be between £3.5 billion and £4 billion due to increasing demand from our ageing population, which will add another 4% a year to social care costs in upcoming years.

Of course, some efficiency savings can be made, but they will never be enough to meet the shortfall. Personalised budgets and various reforms might be able to save some money, but the Minister should listen to those who know, such as ADASS and the Local Government Group, when they say that they will be billions of pounds short when it comes to social care. In those circumstances, they will not be able to protect the most vulnerable in our society. The much-vaunted £2 billion is simply not enough, especially as it is not ring-fenced. Will the Minister tell us whether the whole £2 billion, half of it or a quarter will be spent on social care? Can he do anything if not all of it is? Furthermore, can he confirm that he does not know whether it will be spent or not?

Not only are the Government cutting back on social care through local authorities under the cloak of localism, they are no longer doing centralised assessment of adult social care provision. In other words, they simply do not know what is going on. It is extraordinary that unprecedented cuts are being made at a time when local authority provision of social care is no longer being monitored, yet the Government steadfastly maintain that there need be no cuts to front-line services.

The Secretary of State for Communities and Local Government said that

“cutting front line jobs and hitting front line services isn’t inevitable—it doesn’t have to be an option at all”,

and the Minister said:

“It is wrong to scare people about cuts. The coalition Government has prioritised social care—the spending review announced significant extra funding for social care for each of the next four years, increasing to an extra £2 billion investment in 2014-15…This extra money means no councils need to reduce access to social care”.

It is simply not good enough for the Minister to put his fingers in his ears and sing “La la la.” The truth is that cuts in social care are being made now. Although he might not know about them, I can tell him, because ADASS, the BBC and I have done surveys. Last month, I surveyed directors of adult social care in England and got 61 replies, representing a 40% response. I appreciate the detailed responses by 27 Conservative councils, 29 Labour councils and four Liberal Democrat councils; that was, obviously, before the last local elections. The responses showed that 88% were increasing their charges, 16% were increasing eligibility criteria and 7% were considering charging more in the longer term. Many were closing day centres and care homes, 54% were cutting the voluntary sector and a further 24% were considering it for the future.

As predicted by everyone who knows, cuts are happening. Councils have not been able to meet increasing demographic pressure, which ADASS believes amounts to £425 million in 2011-12 alone due to the rising number of older people and people with learning disabilities needing substantial support. The ADASS survey shows that, far from increasing spending to meet rising needs, local authorities in England have cut adult social care spending by £1 billion.

We have heard in this debate about the terrible consequences of cuts to front-line services for the most vulnerable in our community. The fact of the matter is that as a result, an elderly woman might no longer get up at breakfast time but at lunch. She might not have an advocate, but we have a duty to ensure that such people are protected. It is not good enough for the Minister to remain in Whitehall saying that there need be no cuts to front-line services. He must listen to the reality of what is going on. Not to address the funding shortages in local authority social care is reckless and wrong.

Funding cuts also mean that local authorities cannot invest in preventive services, so the cuts being made now will have knock-on effects in the long term. If someone does not have a regular visit—if their shopping is not done for them, or if they are not got up in the morning on time—they are more likely to go downhill faster and to end up in hospital. Some 52% of respondents to my survey said that the cuts adversely affected the development of new preventive services. Services that could reduce the need for long-term care and promote independence are among the first to go, but that only increases the strain on health and social care services in the long run.

It is irresponsible of the Minister to continue to say that no cuts need be made to front-line services. Will he admit that he was wrong not to listen to the warnings and to say that front-line services would not be cut? Will he also admit that efficiency savings alone cannot deliver the huge cuts being forced on local authorities? What is he doing to increase the provision of social care now that he has heard the truth about what is going on?

The holy grail, as we all agree, is integration of social care and health, but the difficulty is that the Government are, on one hand, cutting local authorities extensively and, on the other, taking the health service by the ankles, turning it upside down and shaking it hard. Those are not ideal circumstances for the two bodies to integrate properly. The Bill calls itself the Health and Social Care Bill, but it contains precious little social care. There is a great deal of talk about integration, but words are not enough.

When it released the results of its survey recently, ADASS recommended that, as the Government are pausing to reconsider the Health and Social Care Bill, perhaps they might pause long enough to hear the results of the Dilnot inquiry and radically reconsider their plans for long-term care. If they want to be radical on health and social care, that is the area of need. We do not need the fundamentally misguided Health and Social Care Bill as it is drafted. We do not need competition driven into the heart of the NHS. What we need is co-operation and collaboration. We need health and social care to work more closely together.

If the Government are to pause, let them pause and think about that. Let them pause and ensure that, for example, we can keep the elderly out of hospital for as long as possible by allowing social services to provide proper social care, and that once someone is in hospital, they can get out quickly. That is the only fair way to treat people. Frankly, it also saves a great deal of money. If the Government spent more time, energy and resources on solving such issues and a little less on introducing competition into the national health service, we would all be a lot better off. I know that in his heart, the Minister agrees, but he has unfortunately found himself in the difficult position of having to defend this extraordinarily awful Bill.

I may have argued those points when the Bill was discussed in Committee, and I am glad to hear that ADASS now agrees with me in general. I am also glad to hear that the right hon. Member for Charnwood (Mr Dorrell), never one to allow a bandwagon to pass him by, said that the legislation should be rethought:

“A clear commitment should be written into the Bill to achieve full institutional and managerial integration of the NHS and adult social care in England.”

The Select Committee Chair agrees with us as well.

I ask the Minister to reconsider funding and the reality and to give us an undertaking that he will no longer make false claims that there need be no cuts to front-line services and that he will do something about the matter. I also ask that the Health and Social Care Bill be worthy of its name, if it is not killed off completely. It needs major change so that social care can be integrated properly into health care. Worthy words are simply not enough to achieve that.

--- Later in debate ---

[Paul Burstow]

Yes; we can build on that point. The Government recognise the importance of social care and the fact that it lets people live independently, which is what it should be about. It should be about enabling people to live well, to be safe, to continue to do things that we take for granted and to be active participants in civic life.

As has been rehearsed in this debate, there are big challenges. There are demographic challenges and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has outlined some of those facts. The hon. Member for Wolverhampton North East (Emma Reynolds) has rightly said that, while we should be concerned about the challenge, we should not be so concerned as to forget to celebrate the fact that we have an ageing population—a population that is living for longer and, in many cases, living healthily for longer as well. We also have changing societal expectations and a greater expectation of being able to make choices for oneself, to be in control of one’s own life and to be able to have high standards of support to facilitate that. We have financial challenges. We have a structural deficit. For every £4 that this Government spend today, £1 is borrowed, and we are spending £120 million every day on interest charges.

Reference has been made to the survey by the Chartered Institute of Public Finance and Accountancy for the BBC. I have to say that, of the many surveys that have been produced, including that of the hon. Member for Islington South and Finsbury, it is probably the least robust of the lot. There we go—I give the hon. Lady credit that her survey must be more robust than that of CIPFA, which did not provide a great deal of detail and did not ask the right questions. Indeed, those who answered the questions were not all social services authorities, and they included things in their figures that are not part of social care. Even the Association of Directors of Adult Social Services has criticised that piece of work.

On attempting to address and mitigate the impact of the reductions that the Government have had to make in formula grant over the past year, we have strived to mitigate it in those areas with the greatest needs to make sure that we have increased the support in those areas, relative to others.

The hon. Member for Stockton North talked about high mortality figures in constituencies such as his own. Again, we have to dwell on why that is still the case after so many years, why we still have that legacy, why we have to continue to address those challenges, and why this Government, through their commitments in public health and elsewhere, are determined to make progress.

Despite the deficit legacy, we have taken some decisions. Members have forecast that I would refer to them, and I make no apology for that. We set out in the spending review in October how we would ensure sufficient resource in the system to allow decision makers at a local authority level to protect social care, if they decide that that is their priority. We have a good settlement in that context. An additional £2 billion will come to social care by 2014-15, and that money is getting through. In January, £162 million was put into social care via the national health service, which is something that we were asked to do and which we have done to ensure that social care gets additional support. Moreover, there is £648 million of additional funding from April this year. That money is going to social services departments and is being transferred by the NHS for that very purpose. A further £1.3 billion is supporting the transfer of funding for the commissioning of learning disabilities.

Those sums constitute the biggest transfer of hard cash from the NHS to social care ever. It is not only about supporting social care, but about breaking out of silos. It is about using cash to get people to start having those dialogues that are so important to achieve the collaborative behaviour and integration that are essential to delivering better services for our citizens.

On top of that is the £530 million that will come through the formula grant. I will not micro-manage, from this Chamber or my desk in Whitehall, every single social services authority and tell them how to use that money. It must be their decision, based on need, and they are accountable for such decisions.

[Emily Thornberry]

The Minister has anticipated what I am about to say. First, if money is being transferred from the health service to social care, I presume that it is being done by primary care trusts, which are at the same time being abolished. Is he confident, therefore, that that money is properly accounted for by the Department of Health, given the current chaos reigning within the health service? Secondly, will he tell us how much of the money given to local authorities is actually being spent on social care in the way in which it is supposed to be?

[Paul Burstow]

The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.

I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.

Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.

Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.

The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.

The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.

--- Later in debate ---

[Emily Thornberry]

On the issue of confusion, the Minister spoke earlier about the King’s Fund and said that its view is that cuts will not be made to social care. I have just checked that, and I believe that the King’s Fund has said that there will be a shortfall of £1.2 billion by 2014-15.

[Paul Burstow]

The King’s Fund has stated that but, if one reads on, the document concerned states that if efficiencies of 3.5% are made, there is no need for a funding gap to open up.

On social care law reform, our current legislation is the product of 60 years of piecemeal legislation that looks back to 19th-century poor law principles. A Law Commission report makes 76 recommendations and provides a firm foundation on which we can build. The Government intend to publish a White Paper later this year and to introduce a Bill in the second parliamentary Session.

Our intentions are clear. During the life of this Parliament, we want both the law on social care and its funding to be reformed. We want that reform to be based on a vision in which there is a greater personalisation of social services, a more preventive focus on how those services are provided and a real attempt to deliver around outcomes. We want services that are more innovative and that are based around growth, telecare and involving other providers. There also needs to be a partnership between the individual, the state and health and social care providers. That is how we can secure the future of social care and make a real difference for every one of our constituents. I thank the hon. Member for Stockton North for initiating the debate, and I hope that we will have more debates about social care than have taken place during the past 13 years.