Local Government and Social Care Funding

Emma Hardy Excerpts

Wednesday 24th April 2019 Commons Chamber

[Andrew Gwynne]

My hon. Friend is absolutely right. We used to have something called Total Place, which was all the public sector bodies working together towards a single strategy for a local area. What we have seen as a consequence of the austerity since 2010 is a complete breakdown of that collaborative working. It is worse than that, however, because rather than public bodies working together collaboratively, pooling resources and getting the best possible levels of services for communities, we have seen cost-shunting. For the sake of saving money on youth services, we are seeing a rise in crime that is pushing up costs for the police. Because of the cuts to police budgets, those costs are shunted on to other public bodies. That is not a common-sense approach to dealing with people’s needs and services, to building stronger communities or to spending public money wisely.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

On cost-shunting, just this morning we heard from representatives of families with children with special educational needs and disabilities. They were talking about their needs not being met through the education budget, the high needs block from local government or the health needs budget, because each is trying to get the other to pay the bill. Children with special needs and disabilities are falling through the gap and remaining unsupported.

[Andrew Gwynne]

My hon. Friend is absolutely right. There are too many instances across the public sector where cost-shunting is resulting in precisely what my hon. Friend says: vulnerable people falling through gaps that should not exist. I think that in their heart of hearts, Conservative Members, who clearly deal with casework that is similar to ours, will know that that is happening in their areas too.

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[Andrew Gwynne]

My hon. Friend is absolutely right. I pay tribute to Labour councillors like those in his constituency who are making incredibly difficult decisions. They are the last line of defence for many of our communities, and they are doing what they can, but with both hands tied behind their backs by a Government who simply do not understand the basic economics of the areas that we represent.

[Emma Hardy]

Will my hon. Friend give way?

[Andrew Gwynne]

I will give way shortly, but I want to deal briefly with the issue of social care before I begin my concluding remarks.

The largest of the pressures on services remains the pressure on adult and children’s social care. According to the Local Government Association, adult social care services face a £1.5 billion funding gap next year, and £2 billion is needed for children’s services.

Given that the Cabinet are too interested in internal machinations, and given the absence of any leadership from the Prime Minister, we have yet to see the much promised social care Green Paper. In fact, this year’s April Fool revealed himself to be the Health Secretary after he missed his own new deadline of 1 April for the Green Paper—but no one was laughing, because that was the fifth missed deadline, following the summer of 2017, the end of 2017, the summer of 2018, and the autumn of 2018. Despite those delays, it seems that little progress has been made.

There is so much concern in the sector that last month 15 key organisations—including the LGA, the Society of Local Authority Chief Executives and Senior Managers, and NHS organisations and charities—were forced to write to the Government expressing their concern that Brexit was becoming a distraction from any action to deal with the real crisis that is affecting the services on which people rely.

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[James Brokenshire]

I say gently to the hon. Gentleman that Birmingham is one of the authorities with the highest funding per capita. Equally, I am looking carefully at the representations that he and other Birmingham MPs have made to me. The ongoing strike action in Birmingham, with the non-collection of rubbish and the impact that that is having on communities, clearly has not helped. I therefore urge him to support the council in dealing with the challenges caused by the industrial strife that is being felt very firmly in Birmingham, with all the manifestations that that is creating.

[Emma Hardy]

Hull City Council has seen a reduction in its funding of 37.8% since 2010. That is having an impact on children with special educational needs and disabilities. Historically, no account has been taken of the number of children with SEND in an area and the amount of funding that it receives for the higher needs block. If the Government are serious about reviewing the way that local authorities are funded, surely that should be something they take into account.

[James Brokenshire]

I am working closely with the Secretary of State for Education as we look towards the next spending review. I will come on to the support that is being provided for adults’ and children’s social care, as well as how we are investing further on a number of other fronts. Therefore, we have recognised and reflected on a number of the pressures that we have seen. Clearly, in the further review of relative needs and resources, and as we look towards the next spending review, I will look at the data and the evidence very closely and carefully.

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[Dr Whitford]

The hon. Gentleman talks about the workforce, but in both the NHS funding settlement and the forward plan we see a big injection into NHS England, but no extra funding for Health Education England or for public health. Preventing illness is the cheapest thing we can do yet, for decades, Governments of all colours in all places have failed to do that. Unfortunately, the long-term plan does not do it, either.

Age UK talks about 1.5 million people being left without sufficient care and support at home, and it describes the number of people needing elderly social care increasing by almost 50% since 2010, but local authority-funded patients in England are down by a quarter over that time. A third of patients depend on family support, but 2 million carers are over 65 themselves, and 400,000 of them are over 80. Look at the burden we are putting on elderly people to care for their elderly partners, often without respite or support.

[Emma Hardy]

I recently spoke to an elderly couple. The lady was caring for her husband who had Alzheimer’s, which was having such a devastating impact on her health that she ended up having to go into hospital, too. She was not worried about being ill and having to go into hospital; what was upsetting her was that her husband was left without anybody to care for him in an environment he did not know or understand. Surely this situation needs to change.

[Dr Whitford]

Absolutely. We should value family carers and the care and work they do, right across the United Kingdom, for people who need help in all our communities, yet they are so poorly valued. Carer’s allowance does not even equal jobseeker’s allowance, which is something we have tried to repair in Scotland, but obviously we do not know whether that money will simply be clawed back by the Department for Work and Pensions in other benefits. That is always the problem. We are supporting carers so poorly. Not only do they have the physical burden and the lack of time to look after themselves, but often they are in financial difficulty.

Scotland is the only one of the four nations to provide free personal care, which we have been providing since 2002. Having integrated health in 2004, we have been working since 2014 to try to integrate health and social care, which is a lot more difficult. The social care environment is different. It has multiple companies and different set-ups. It is means-tested, rather than being provided free. Social care is a real challenge, and therefore local authorities and the health structures within any local health system will require support and funding to work out how to achieve it so that they are wrapped around the patient, not bitching about whose purse the money will come out of. As we have heard today, the problem is that there simply is not enough money in the purse to start with.

In Scotland, we now allocate half of our health funding to integrated joint boards, which are made up of health and local authorities, to look at how we provide primary healthcare, mental healthcare, social care and children’s services so they are driven locally and take account of all the support that is required.

There are three main groups that require social care. First, the elderly. Many of us are heading that way ourselves, and the No. 1 important thing is to maintain people’s independence for as long as possible. That is the importance of not rationing surgery for hips, knees and eyes. If we can keep people seeing and walking, and if we can give them a bus pass so that they are out and about with their cronies down the town, they will stay independent and functional for longer.

Of course we have the frail elderly, who require to be looked after in comfort and support. By their own choice, that would be in their own home if at all possible. In Scotland, home care hours have been increased from six hours to 12 hours a week, which has allowed us to keep people with greater dependency at home. Looking at A&E attendances and emergency admissions over the past five years, we can see that Scotland’s increase—we are all facing increased demand—has been only one third of that in England. That is why we have had our best performance against the four-hour target since March 2015. It is a combination of supporting people not to arrive at the hospital door and not to be stuck at the other end, because we have driven down delayed discharges every year.

When we talk about numbers such as four-hour targets, it is important that we remember that they are a thermometer taking the temperature of the acute system. They look at how we bring people through. Everyone in hospital wants to get home. They do not want to be stuck there.

The next group is people facing end of life, and they would like, if possible, to be cared for with dignity at home. They want to be with their family but, equally, they do not want to be a burden to their family. If they need respite, they want to have access to it. Since 2015, the Convention of Scottish Local Authorities agreed that even people under 65 will be provided with free social care if they are defined as facing end of life, which means they will not be stuck in hospital facing a means test that fritters away their remaining weeks and days of life. A quarter of us will die in a care home, and we want to make sure that we would be happy with the quality of care in that care home, rather than living in squalor or being mistreated.

The third big group is the working-age disabled. For them, quality of life, mobility and, particularly, participation in society are critical. Both in England and Scotland, almost half of local authority social care spending is on people of working age. We tend automatically to think that social care means the elderly. Two thirds of the working-age disabled told a survey that they are not given any help or signposting, and a majority said they are not given enough hours to help them live independently.

Frank’s law comes in this month in Scotland, which means that those under 65 with dementia, motor neurone disease or multiple sclerosis will also be eligible for free personal care. The law is named after Frank Kopel, the footballer who unfortunately developed dementia very early.

Workforce is a challenge for all of us. Our workforce has gone up 12% in the past three years, but all care providers report difficulties in recruiting, and Brexit is only making that worse. We need to value care, and we need to let it develop as a career. People should be paid the real living wage, not the pretendy living wage, for all the hours they work, including at night. A carer coming into a patient’s house for 15 minutes to throw them out of bed, particularly a carer that patient has never seen before, is not providing quality of care. We need continuity between the patient and the carer. Caring needs a career structure to ensure that people stay in the profession and develop, grow and lead others.

It was said that the UK Government Green Paper would give us a chance to rethink funding, but we still have not seen it to enable us to debate the options. Will that be done by a rise in national insurance, or by continuing national insurance after retirement for better-off pensioners? People have mentioned the German and Japanese systems, but we need to look at the pluses and minuses of both. By 2030, the number of 85-year-olds will have doubled. We need to prepare to look after them, and to give them independence and dignity, so that they do not end their lives in complete misery and squalor.

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[Mr Betts]

Absolutely. The joint Committee report made the point that the quality of care is so important, and we have to think about the quality of the workforce and how much we pay them. The average social care worker gets paid 29% less than someone doing a similar job in the NHS. That figure demonstrates the challenge that we face.

What are we looking at, then? We have recently had a few welcome sticking plasters of funding from the Government; but next time, we will need a very large bandage, not just a few sticking plasters, to put this issue right. We look forward to the Green Paper, at some point on the horizon. Perhaps the Minister can tell us about the timing for that when she replies, but even now time is now too short for there to be a fundamental change in funding arrangements. We are going to need a lot more of the same.

The two Select Committees recommended that, at the funding review, we take the £7 billion extra that will be in the local government system from the 75% business rates retention and, instead of using it to replace public health grants and other forms of grant, we put it back into the system to deal with the problems of social care. That money can be there and we will not have to change the system. That can be done. We also proposed changes to make the council tax system fairer and less regressive. We can do those things for the next spending review and make sure that a quantum of money—around £7 billion— is available for social care. That would then relieve the pressure on other council services.

We then looked at what the longer-term system should look like. Of course, we need better integration at a local level between the NHS and social care. This is not about a national system of care that replaces what local authorities do; it is about better integration at local level. We must bear in mind that, while it is important that the health service and social care are linked together, the other great join-up that we must have is between housing and social care. The majority of people receiving social care live in their own home, and it is vital that we get those services linked as well.

[Emma Hardy]

Does my hon. Friend agree that we also need to include education on support for children with special needs and disabilities?

[Mr Betts]

Absolutely. We need integration on that level as well. The point is that these services are better joined up and delivered at a local level. It is an important role that local government has to play, and it is why local government’s hand should be strengthened in these matters.

In coming to our conclusions about long-term arrangements, the joint Select Committee inquiry looked at two very important bases. We went to Germany to see what existed there. Essentially, Germany’s model involves an extra percentage on the insurance payments that it gets from the public. There was a cross-party agreement 20 years ago, and the rates in Germany have been raised with no dissent from the public or the parties. It is a system that works and that people agree with, because they know that the money goes into social care. That is what we looked at, and it helped form the basis of our conclusion.

We had a citizens assembly—it was a great experience. We selected around 50 people from all over the country. They met for two weekends in a hotel in Birmingham, and came to unanimous views about how we should deal with social care funding. The principles were clear: we should have a system similar to that of Germany, with a social care premium, as we recommended, but very importantly—the Treasury hates this—the money must be dedicated for social care. People are willing to pay more if they know where the money is going. That was a fundamental principle that was laid down. There was also the principle of universal and high-quality care, and the point was made that a well-paid and well-trained workforce was needed to deliver it.

We also said that there had to be fairness between the generations and that the social insurance premium should be paid only by people over 40. However, we thought that it was fair to say that people of pensionable age who work should also pay. Another issue that we felt needed to be dealt with was the unfairness of people losing their homes in some cases and of all their assets going to pay for social care. The suggestion was that we could bring in a floor and cap system to make sure that people do not pay anything up to a much higher level and do not pay any more beyond the cap. We can pay for that by simply taking a percentage of inheritance tax, so that everybody pays a bit towards the system. We thought that that was fair.

We also said that, ultimately, we want to work towards a system where social care—personal care—is actually free. We did not think that we were there yet, which was why we recommended these changes to begin with, but we thought that we could get there eventually. We said that the extra money coming in had to be on top of the existing local government system.

This is a very good report. Two Select Committees unanimously agreed how we should raise the money for social care in the future. I say to Members on both Front Benches: why bother with the Green Paper? They should produce the White Paper and get on with it. The solution is there. We have given it to Ministers and shadow Ministers. This is a very good proposal. Please get on and deliver it now for the future.

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[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Glasgow North East (Mr Sweeney), who is a tireless and passionate campaigner for his constituency—and a member of the wonderful 2017 intake.

Areas with the greatest needs, the lowest tax base and the least other resources seem to be suffering a much greater reduction than their wealthier counterparts, and Hull is no exception. I am not the only one saying that; the National Audit Office is saying it, too. The NAO has produced powerful information showing a disproportionate impact on Hull, which is creating the need for painful decisions. The situation is compounded by reductions in the central funding on which Hull relies for 81% of its budget and which it is unable to replace through local taxation. To illustrate, a local tax increase of 1% in Hull raises only £2.90 per head, whereas a local tax increase of 1% in the City of London raises £7.08 per head. Our situation is completely different. Hull, which is reliant on central Government, receives less money than ever from central Government.

Even though statistics are important, and much of our debate focuses on statistics and the percentage loss for each local area, we are forgetting the human element. To be honest, the people at the heart of it who are being affected do not care which Government introduced a measure; they do not care whose fault it is. They do not like politicians who point fingers at each other and say, “It wasn’t us. It was you.” What these people care about is what is happening to them there and then, on the ground.

I would like to talk about a couple I met recently, and to protect their anonymity, I will refer to them as Lily and Paul. Paul came to see me at my constituency office, and he was extremely upset and quite distressed. He told me about his wife. They were quite a young couple, only in their early 50s, but his wife had developed tumours on her spine. The tumours had appeared from nowhere, and no one had any idea she was ill. It started with back ache, and she ended up in hospital, needing to have the tumours operated on.

From that moment, her husband became her carer and had to do everything for her. They went from having a fit and active life, both in work, to him looking after his wife, who was bedbound. He was practically at breaking point as he told me how they met when they were 14 years old. She was the only woman he had ever been in love with, and he still loved her, even though at that moment she was lying in bed in their house unable to leave the bedroom or get down the stairs because occupational therapists had not been round to install a handrail, and they could not get a stairlift fitted because it was the wrong kind of staircase. She had been discharged from hospital without a care plan or an adult social care package available. All she was doing was lying in their bed.

Paul brought his daughter round to look after his wife so that he could come and tell me about the problems they were facing. Unsurprisingly, he said that she was suffering problems with her mental health. I said, “Well, of course; I would suffer problems with my mental health if I was unable to leave my bed and was left there in constant pain.” She was left in pain from the operation on the tumours on her spine, and the drugs were making her drowsy and incoherent.

To make matters worse, the Department for Work and Pensions informed them that she needed to attend a healthcare assessment—a woman who was bedbound, having had operations on her spine. He was dealing with this on a day-to-day basis, while seeing the woman he had loved from the age of 14 and still deeply loved in such pain and such a desperate situation. Eventually the DWP relented, and someone came to do an assessment of her. Paul said that his wife could not answer the questions properly because the amount of opiates she was on to deal with her pain meant that she would not fully understand all the questions, but he was told by the person doing the assessment that, as her husband, he should not be answering for her and should allow her to answer the questions herself, even though she barely understood what was being said.

He came into my constituency office just yesterday to tell me that his wife has not been declared sick enough to qualify for the mobility component of the benefit. He has been left unable to work, and his wife, who he is desperately in love with, is unable to get the support she needs and is being turned down for enhanced benefits. Goodness me! How sick does someone have to be to get enhanced benefits if they are on drugs that make them incoherent and are laid in their bed, unable to move? I asked Paul, “What about you? Are you getting any respite or care?” He said, “I can’t, because what happens to her if I become ill? What happens to her if I’m not there? She doesn’t fully understand because she’s on pain medication.”

This is what people are facing. When we hear from those on the Front Benches, let us not point fingers at each other and say, “Your Government did this,” and, “Your Government did that.” Let us look at what is happening to people like this right now. Let us look at the fact that life expectancy is dropping in my constituency. Tell me then that this Government’s reforms have been successful and that it is not time to change. Do not give me a quote about the amount of money. Tell me about the people whose lives are being changed because they are not getting the support they need. Until I see a real difference on the ground, all the rest of it is just spin. Please, Minister, come to the Dispatch Box and tell me you have listened and that people like Paul and Lily will get the support they need and not be left to suffer any longer.