Adult Social Care

George Mudie Excerpts

Wednesday 21st January 2015 Westminster Hall

[Mr George Mudie (Leeds East) (Lab)]

It is a pleasure to see the Minister here for this debate as well as you, Mr Robertson. I thank the Speaker for this opportunity to discuss the present and future state of the adult social care sector. This area of local government covers a vital service for the most vulnerable people in the country, with the elderly, the disabled and those with mental health difficulties being among its most prominent users. In the past four years, its future has become more of a concern.

We are weeks away from a general election and the Government are anxious that their fiscal plans are seen to be successful. Central to those plans is the fact that cuts to public services are unavoidable and necessary and that they must continue for the next four years. Before we blindly accept that doctrine, the debate gives me an opportunity to spell out briefly the extent of the damage those cuts are having on the lives of hundreds of thousands of vulnerable people who use the adult care service.

The Government have ring-fenced the health and education budgets, so, with those two huge Departments free from cuts, money has to be found from other Departments. In local government, adult social care services is the next largest budget. The Government have claimed to understand the sensitivity of that work, but nevertheless the 40% cuts in local government spending have made it impossible for the service to escape unscathed.

Age UK, the leading charity in this sphere, states that the sector has lost more than £1 billion since 2010—and that is at a time when, because of demographic changes, with people living longer, the services requires more money, not less. It is good that people are living longer, but when they eventually ask for help, because they are older, their needs are more complex and expensive.

[Mr David Ward (Bradford East) (LD)]

Does the hon. Gentleman accept that cutting that spending is a false economy? If quality care is not provided at the right time—in particular in the home environment—more expensive care will often need to be provided later in hospitals and other care support centres.

[Mr Mudie]

The hon. Gentleman is quite right. I will touch on the sheer lack of connected thinking in the Treasury—I do not think that the Department of Health has much to do with that.

The National Audit Office, which is usually pragmatic and non-political and accepted as objective, pointed out in its review of the service that total spending on adult social care—covering the whole gamut of, I suppose, 18 to death—fell 8% in real terms between 2010-11 and 2012-13. Older adults experienced the greatest spending reduction at 12% in real terms. Interestingly, the NAO stated:

“Rising needs, reducing local authority spending, and reductions in benefits may be putting unsustainable pressure on informal carers and acute health services.”

Chillingly, it went on to say:

“National and local government do not know whether the care and health systems can continue to absorb these cumulative pressures, and how long they can carry on doing so.”

That is from its review last year, yet the cuts have continued.

[Mr Jim Cunningham (Coventry South) (Lab)]

To substantiate the point that my hon. Friend has just made, I can tell him that about a fortnight before Christmas we met local GPs who were voicing concerns about bed blocking in particular, caused by cuts in local government expenditure for social care. That is reminiscent of what happened under the previous Conservative Government.

The other affected area is meals on wheels. When a visitor goes to an old person’s house, they see what condition they are in and often they are able to help but get only 15 minutes to do so.

[Mr Mudie]

My hon. Friend is quite right. When I was a trade union official, I looked after what were termed home helps and I always appreciated that point—as I did as a councillor, just like him. They were invaluable people who went into old people’s homes, met them and formed relationships, and if they were handled and trained properly, they would report back on any change in condition they saw. That was often valuable for the old people.

If the Minister read the excellent newspaper The Independent this morning, he will no doubt have seen the article reporting the comments of the chief executive of Age UK, Caroline Abrahams. The article states:

“Care of the elderly is in a state of ‘calamitous, quite rapid decline’…with…thousands fewer people receiving care than five years ago.”

She spelled out the fact that the number of people receiving home care has fallen by a third since 2010.

Places in day centres, where lonely, vulnerable adults could find warmth and companionship and escape cold, empty homes are down 66%. Incredibly, in the area that my hon. Friend just mentioned—equipment and adaptations such as rails and stair lifts—40% fewer people now receive help. I say that is incredible because everyone accepts that such adaptations and aids help old people stay in their homes. Often, they save their lives, but they are certainly a method of preventing them going prematurely into residential homes or hospital beds, yet the money has been cut and 40% fewer are being helped.

The article continues:

“Ms Abrahams said that hundreds of thousands of older people were being left ‘high and dry’.”

It goes on:

“‘The lucky ones have sufficient funds to buy in some support, or can rely on the good will of family, neighbours and friends. But there are many who are left to struggle on entirely alone,’ she said.”

I remind the House that that is the chief executive of Age UK, the leading charity for old people.

The Care and Support Alliance pointed out that population changes mean that more people need care, but, as we know, fewer people receive it. There have been further cuts to adult social care budgets in recent years, and a 26% reduction in the number of older people receiving state-funded services, despite the Personal Social Services Research Unit having predicted that demand would increase by 17% between 2000 and 2020.

The picture is the same among working-age disabled people, 90,000 of whom lost access to state support for their care needs between 2008 and 2013. The alliance says that there is a “chronic underfunding” of care. With local authorities having had to find significant savings owing to reductions in Government grants, there have been further cuts to social care budgets in recent years. The Association of Directors of Adult Social Services and the Local Government Association estimate that about £3.53 billion has been taken from adult social care budgets during the past four years. In the last year alone, 40% of the total savings made by local authorities were achieved through reducing adult social care services. That is quite an alarming figure, but perhaps understandable. That has resulted in a tightening of eligibility for care at local level and of the size of care packages for those who remain eligible. When discussing the Barker commission’s recommendations for more funds and the options that had been set out, the CSA commented:

“What is no longer an option is to continue the current chronic underfunding of care.”

I hope that in the short time available to me, I have allowed the voice of representatives to be heard and put on the record—not partisan politicians but those working in the service full time, who know the people, the finances and the difficulties. What it all adds up to is something that has been known in this place for some considerable time—the service is underfunded, at a time when it is recognised that there are additional pressures and that there is a need for more money, not less. We all know that. It has been known in this building for at least 10 years, covering two Governments. People told us until they were blue in the face that more money was needed, because there were more older people who were living longer and had greater needs. Yet because of elections, I presume, everybody dodges the column and no one has made the difficult decision about how we put money into the service. There should have been a public debate along those lines, to show people the quiet neglect of vulnerable people that is happening every day, in almost every street in our communities.

[Mr Cunningham]

The situation is a little worse than that. We are really going back to about 30 years ago, when local authorities were forced into doing deals with the private sector for old people’s care homes. Recently, we have witnessed some of those care homes going bankrupt, which means closure and a lack of places for people.

[Mr Mudie]

It is clear that my hon. Friend has read my speech; I was just coming on to the privatisation of adult care services.

I hope that I have highlighted in my remarks the important role of local authorities in the sector. As an ex-councillor, I instinctively have much sympathy with the difficulty they face in having to take some very difficult decisions about priorities in the face of the Government onslaught on their budgets. Leeds, my home authority, has faced a tremendous task in running a city when it has had to find £250 million in cuts during the period of the first spending review. Having achieved that, it is now dismayed to hear the Chancellor threaten—indeed, promise—further cuts until 2018, if he gets back in office. In fact, Leeds has been told that it will face a budget cut of £46 million in 2015-16. Other councils face similar problems, and I simply do not know how the Chancellor feels he can order those huge cuts and still have our major cities being run and our elderly and disadvantaged being properly cared for.

I was alarmed when I was informed that a dementia residential and daycare home in my constituency, The Green, was being closed, and that many hundreds of home care workers were also losing their jobs. When I looked into things, I discovered that, chiefly as a measure to keep the city intact financially, the council had had to act in line with other big cities and had taken two unfortunate steps.

The first, which has been mentioned in passing, was to raise the criteria level at which help should be given. This meant that new applicants would have to meet higher eligibility thresholds than before. Parkinson’s UK and the National Autistic Society are two organisations that have pointed out how the new criteria put their members at a disadvantage when it comes to receiving help. The Government have legislated on that point in the Care Act 2014, and although that meets the Government objective of ending postcode unfairness, it also legitimises local authorities, or rather strengthens them, when they have to turn people down because they have needs that are lower than the criteria require. Those organisations have given evidence on how the quality of life of individuals with either Parkinson’s or autism has been diminished. I hope that the Government’s decisions will be reviewed in happier times.

What is more difficult to review is the point that my hon. Friend the Member for Coventry South (Mr Cunningham) touched upon—the decision to outsource adult care services. That has been done to help meet the shortfall in Government grant. Perhaps I am paranoiac—I probably am, because I think paranoia keeps us safe—but I wonder whether that is what the Government intended. Many people have been outraged by the Government’s propensity to privatise much of the NHS, but thanks to the love that the British public quite rightly have for that unique and wonderful organisation, the Government have backed off from adopting a full-frontal approach and are now taking a more subtle, if not devious, approach.

So quiet has the handing over of care homes and home care staff been that it has rarely been picked up by the general public, except by the clients of those homes and the ex-local government staff themselves. There is a growing awareness of 10-minute visits and the failure to provide elderly people with the same carer; providing the same carer is an important part of home care, so that people can build a relationship with them and trust can develop. The former staff are aware of the loss of local government wages, the use of zero-hours contracts and the loss of payment for travelling time, which accounts for those 10-minute visits.

I will just depart from my script to say that that situation is not surprising. If a council outsources contracts and there is a duty to save money, given that those contracts primarily involve labour, the only way in which money can be saved is to hand them over to a private company. That company would have no compunction in offering lower wages, no travelling time, worse holidays and worse sickness schemes. That is what has happened in the majority of cases.

[Mr Ward]

Does the hon. Gentleman accept that, in many cases, the private sector businesses are effectively offering wages that are below the national minimum wage, as a result of the commissioning process? In some cases, they are being given only enough money to offer no more than £12.50 or £13 an hour, which cannot cover all the costs of travel, transport, uniforms and training. That means that the private sector businesses are often almost being forced out of business.

[Mr Mudie]

I totally agree with that. Now that the local authorities have pocketed the money, it is clear that they are pressing down on the private firms, and we are a step away from the disaster of the private firms just going, “There—that’s it.” What happens when we have closed all our residential homes? There is a real problem building up.

I am sad that financial pressures have forced councils to do that. The care of the vulnerable elderly is a service that, just like hospitals, should remain in the public sector. The various scandals in care services have underlined the temptation—indeed, often the necessity—of people in business to do more than cut corners when looking after people who are helpless. I am less than convinced that the Care Quality Commission, with its proposed risk-based regulation, is any better than its predecessor, which turned out to be disastrous.

In Leeds, thanks to the protests by staff and unions, the public unhappiness over the closures and the sagacity of the council leader, Councillor Keith Wakefield, the decision on care is under review. I understand the pressures that the council faces, but I hope that it makes the right decision.

I will end my remarks by asking the Minister three questions, which, if past debates in this place are anything to go by, I will not receive answers to; I am referring not to this Minister but to his disreputable colleagues. I know that this Minister is a man of honour.

First, is any discussion taking place about putting adult social care, which is closely affected by and connected to hospital care, inside the ring fence? Secondly, are councils under any instruction about privatising or outsourcing adult services? Thirdly, is any Government legislation preventing councils, in commissioning work, from inserting provisions stating that wage and working conditions should be at a specific level?

I know I am crowding the Minister’s time, but I shall take just half a minute more. I was once in a group of people in sheltered housing discussing some problems, and I met an old lady of 90. She said, “I’m 90 and I haven’t had a bath for two years.” I started back. She said, “No, I do my best to wash myself standing up, but every time the door opened and the home care worker came in to bath me, I was getting a stranger. I may be 90, but I have my self-respect and my dignity, and I want to keep it.” That is happening to too many of our older people. They are vulnerable, they are being treated badly and they are neglected. It is about time that not the Minister, but the Chancellor woke up to this.