Adult Social Care

Helen Morgan Excerpts

Wednesday 8th March 2023 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

It is lovely to see you back in the Chair, Madam Deputy Speaker. I thank the hon. Member for Sheffield South East (Mr Betts) and the right hon. Member for Ashford (Damian Green) for their excellent speeches. I draw the House’s attention to the fact that I am a vice-president of the Local Government Association.

When the Government announced their local government funding settlement for the upcoming year and the additional £2.3 billion in grant funding at the autumn statement designated for social care, I welcomed that additional funding, despite concerns that much of the rest of the money will come from increased council tax. We are passing the buck from Government to local councils and, ultimately, as the hon. Member for Sheffield South East outlined eloquently, to local taxpayers who may not immediately see the benefit of the tax they are paying.

That funding will plug in the short term the gap in budgets caused by inflationary pressure, but we need to be mindful that 542,000 people are already waiting for care package assessments or direct payments and there are thousands of vacancies in England, according to the Association of Directors of Adult Social Services. The County Councils Network warns that councils and care providers are facing a perfect storm, as I am sure we are all aware, of rising demand, fewer care home beds, chronic staff shortages and acute inflationary pressures.

Shropshire is certainly no exception to that scenario. My meetings with local care providers have consistently shown that the sector is becoming fundamentally unstable, with some providers left facing a choice between losing money, or handing their contracts back to the council and restricting themselves to private work. We should acknowledge that social care is becoming a two-tier sector, where people who can afford a large amount of care in their home every day receive a very good service from skilled and caring workers who come and attend them, but those who are left with only a short visit in their own home see a much worse situation. I have seen that first-hand on an ambulance shift. It is heartbreaking to see people whose carers have popped in on a rushed schedule. They clearly care and have written everything down in the book—in one case, they had called the ambulance—but they do not have time to ensure that those individuals are living in the dignity they deserve. We need to ensure that that variation and those dual standards are addressed in the solutions we propose.

We have also seen that a shortage of care options is a factor in the acute emergency department and ambulance response crisis that Shropshire has faced, because people who are unable to be discharged home are restricting the patient flow through hospitals and ultimately stopping people coming in through the front door.

Today, I would like to raise in particular the challenges faced in the long-term learning disability and autism sector. In this sector, where people with learning disabilities need long-term care, the providers often do not have private clients from whom they can cross-subsidise their council-funded packages. My attention was drawn to that just before Christmas when I was alerted to the fact that three individuals in my consistency, who have lived in a care home together and been cared for by the same care home manager for more than 20 years, faced being split up and rehomed just three weeks before Christmas. Worse than that, because their levels of need were high and the care in North Shropshire met this need, they had come from across the United Kingdom and were funded by different councils. If their care home closes because of cost pressure, they will most likely be split from each other. As I am sure we can all imagine, the impact on those individuals would be extremely severe. I was grateful in this case that their provider was able to reassess their situation and keep them together in the same location, but the funding in this sector is so precarious that there is no guarantee that will be maintained.

As I understand it, the fair cost of care exercise excluded many social care services for people with learning disabilities, autism or severe mental health problems. In learning disability and autism services, a recent survey showed that 71% of providers have handed back a contract, declined to deliver a service or considered doing so in the past 12 months. Some 83% are subsidising services as charitable organisations that should be paid for in full by the state. We can all recognise that is fundamentally unsustainable, and I urge the Minister to consider some of the excellent suggestions from colleagues to stabilise this growing sector caring for our most vulnerable people.

Part of the cause of the instability across the whole sector is the fact that rising minimum wage levels have not been matched by funding from central Government to local councils, and therefore from those councils on to the providers. The national living wage increased by 6.6% from 1 April 2022, and it will go up by a further 9.7% from 1 April 2023. Clearly, that is necessary to deal with the cost of living crisis, and I am not here to begrudge care workers that increase. The staff in the sector are providing caring, highly skilled support, and they deserve to be recognised with a fair pay packet for the work they do.

In rural parts of Britain, such as North Shropshire, home care and community-based services are also seeing pressure from high fuel costs, and the council funding they receive does not take into account either the additional fuel they use travelling around such a large area, or the additional dead time there is between visits to people in rural places. In October 2022, Shropshire Partners in Care, an organisation of care providers in Shropshire, conducted a survey of its members, in which only 18% of respondents said that they felt the fees provided by the council covered their costs on a weekly basis. More than half confirmed that they have reduced the number of council-funded packages or places they are willing to accept.

When I meet care providers in my constituency and carers at work when I am on the doorstep, I am struck by their passion for providing high-quality care for their clients, but I have also been struck by the distress that the cost and recruitment pressures are placing on providers, because they are affecting the quality of service they deliver. The problem is nationwide, too. A Liberal Democrat councillor and friend in Cambridgeshire told me they are seeing an urgent crisis in adult social care there, too. They are facing an estimated 40% projected rise in funding for the elderly, but they have not got the Government funding to match, so they are looking at a £23 million funding gap going forward. They have nursing homes with 50% vacancy rates at peak points during the winter.

I urge the Minister to commit to looking at the long-term settlement for councils, because these costs, as colleagues have already described in great detail, will only increase. We need to ensure that we are fully funding the cost increases for care providers, so that people can receive the care they need and deserve, whether in a care home or, ideally, in their own home. The settlement also needs to take rurality into account and reflect the additional costs incurred when carers are travelling such long distances between homes. It is critical that councils have the flexibility to spend the funding they have been allocated in the most appropriate way for their own area and the requirements of their local demographic.

The Minister will be aware that the Liberal Democrats have called for a fully funded carers minimum wage set at least £2 above the national average, and paid for by a tax on online gambling platforms, to address the recruitment and retention challenges that are knocking into other areas of social and NHS care. Our increased wage would be centrally funded and it would ease the pressures on councils to find savings from elsewhere to meet their social care needs. The Care Quality Commission’s 2022 state of care report stated that

“our health and care system is in gridlock and this is clearly having a huge negative impact on people’s experiences of care.”

It went on to say:

“At the heart of these problems are staff shortages and struggles to recruit and retain staff right across health and care.”

I urge the Minister to consider the points that we have raised, to consider the crucial nature of ensuring that care workers are paid fairly so that they can be recruited and retained, and to consider that whatever the plan is going forwards, it needs to ensure that councils have certainty about their future funding. I urge him to take note of the pressures and to work with his Treasury colleagues to address some of the huge challenges that we have outlined today.

--- Later in debate ---

[Lee Rowley]

As I think the hon. Gentleman is aware, substantial additional funding has gone into the system. I am always happy to discuss the best way that that should be structured—obviously that is a multi-departmental discussion—but I hope there is an acknowledgement that additional funding has gone into the system and continues to go in. The additional information given in our announcements about the remainder of the spending review, over the coming financial year and the year after, demonstrates our commitment to do that. We hope that will have a positive impact on the challenges that have been articulated.

Finally, I want to talk about the long term, which hon. Members from across the House raised in their speeches. We acknowledge that there is a desire, and it is important to try to plan for the long term. We will bring forward a plan for adult social care reform in the spring. I hope that will answer some of the questions that hon. and right hon. Members have raised and assuage some of their concerns locally. To answer the challenge from the hon. Member for North Shropshire (Helen Morgan) about a long-term settlement for councils, while some of the long-term nature of that is debatable, I hope that the broader policy statement, which the Government announced several weeks ago with the local government finance settlement, demonstrates our intent to move forward with a longer-term understanding of what councils can expect to receive from Government, where we are able to do that. As I have highlighted, in the long term we are also seeking to introduce new elements to government, such as the office for local government, which hopefully will provide information not just about what is happening, but information that explains in more detail how local government is spending that money.

[Helen Morgan]

rose—

[Lee Rowley]

I have detained the House, but I will be happy to give way briefly.

[Helen Morgan]

I am grateful to the Minister. The point about long-term funding is so important. Until a couple of weeks ago, care providers in Shropshire did not know by how much their rates would increase in the new financial year, and they were considering handing their contracts back. It would have cost the council a fortune just to find someone who was willing to fulfil some of those care packages. Councils need long-term funding for their own financial stability and to find care packages at an achievable cost.

[Lee Rowley]

I am happy to confirm that the Government are trying, where we are able, to offer greater visibility of what is coming and greater long-term understanding. We will continue to try to do that across the local government finance settlement, and I hope this policy statement is an indication of that.