Social Care

Helen Whately Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

It is, and I agree with my hon. Friend that care costs are just running away with themselves, making the situation much harder for people.

The bulk of the extra funding that the Government promised to social care from the better care fund comes in 2018-19 and 2019-20. We have had six years of cuts to local authority budgets, and the extra funding promised for social care is backloaded to those later years in this Parliament.

[Helen Whately (Faversham and Mid Kent) (Con)]

The hon. Lady mentioned the most common causes of delayed transfers of care. However, I know that in hospitals in Kent near my constituency, around 30% of the delayed transfers of care are attributable to delays in social care and the majority are for other reasons. Does she not agree that it is important for the NHS to take its own steps within its own organisations to improve people’s discharge from hospital?

[Barbara Keeley]

That is what we are debating. Of course the NHS should put its own house in order, too, but delays should not happen on account of social care. People should not be stuck for weeks or months in hospital, waiting for a care home placement or a nursing home placement. I shall go on to say why.

Returning to the issue of the backloading of funding, in view of what was happening to social care, the Local Government Association and the Association of Directors of Adult Social Services appealed before the last autumn statement for £700 million of the promised better care funding to be moved forward to this year and next year. That appeal was ignored. Reacting to that, Ray James of ADASS said:

“Ministers must know that their proposals do not deliver sufficient funding to meet the growing number of older and disabled people requiring increasingly complex care and support…The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality. Councils in deprived areas will have greatest social care needs, yet they will raise less than a third of what more affluent areas do through this approach.”

He went on by clarifying that ADASS does

“not believe that the funding for the next couple of years will anywhere near meet the costs of the national living wage and the increasing demand for social care.”

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[Mr Hunt]

I want to conclude the section about the role of social care staff.

Whatever disagreements we have in this afternoon’s debate, I want the message to go out loud and clear to all social care staff that Members from all parts of the House recognise the work that they do, and that they value it and support them to do that work better. That is part of the definition of a civilised society.

[Helen Whately]

On the point about the need for a long-term sustainable health and social care system, is it not the case that the Secretary of State is driving through work in devolution deals and sustainability and transformation plans, which aim to achieve exactly that—bringing together health and social care to create a much more sustainable system?

[Mr Hunt]

My hon. Friend is absolutely right. Although this afternoon’s debate is about the social care system, the sustainability and transformation plans are a critical part of the long-term solution for financial efficiency and for improving the quality of care.

I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on introducing this debate, which is the first Opposition day debate that she has led. I also pay tribute to the fact that she has had a long-standing interest in these issues. She has asked me questions about the social care system on many occasions. She was particularly right to focus on the impact on the NHS, which is real, and on the impact on family carers, which is also real. She talked about Susan and about the impact on people who are finding that they are giving more hours of care than they were planning or are sometimes even able to give. That is something of which we must all be aware. She asked me to answer a direct question: do I recognise the scale and seriousness of the issues faced by the social care system? The answer is, yes, I do. I want to try to address, as comprehensively as I can, some of the substantive issues faced in the social care system.

Let me start by saying that, although today’s debate and the majority of the hon. Lady’s comments were around funding, the issue is not only about funding. The hon. Member for Chesterfield (Toby Perkins) mentioned that social care is not just about older people. In 2011, we had the shock of what was uncovered at Winterbourne View by a BBC “Panorama” programme. We have had a number of examples of horrific abuse at care homes. The Ash Court Care Home case in Kentish Town was one that came to light in 2012. The abuse there was filmed by a relative on a hidden camera. Those issues were primarily not about funding, but about cruelty—a strong word—that we have tolerated in our system. We have had some very significant policy responses since then, which are making a real difference. The first is that this Government, under the coalition, introduced the toughest system of care home inspection in the world.

We often talk in this House about the work of the chief inspector of hospitals, but I wish to pay tribute today to the work done by the chief inspector of adult social care, Andrea Sutcliffe, and her team. She has completed the inspection of nearly 90% of care homes and domiciliary care services. It is encouraging that, despite the pressures that we have been talking about this afternoon, 72% of the places that she inspected were good or outstanding. More importantly, the 28% that are not are the 28% that we know about and are therefore able to do something about.

I take issue with the way the shadow Health Minister presented her findings. She said that a quarter of the inadequate places were unable to improve following re-inspection. However, the reality is that more than three quarters of places that got an inadequate inspection did improve, which is a huge step forward from where we were a few years ago when we did not know where those places were and when there was no change happening at all.

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[Helen Whately (Faversham and Mid Kent) (Con)]

A while ago, I spent a week in intensive care—not, I assure Members, as a patient—and I remember well how the unit was unable to admit a seriously sick patient because there were no beds free, and there were no beds free in the intensive care unit because there were none free in the hospital. The ward sister told me that that was because patients, particularly elderly patients, could not be discharged because there were no care home places for them. She described that as bed blocking. That is a familiar story, particularly to hon. Members in the Chamber, but I should tell the House that that was 20 years ago. Delayed transfers of care, as we now call them, are nothing new.

The fact that this is nothing new is a reminder that the problem will not be easily solved; there are no easy answers, but that is not to say that we should not try. In fact, I believe that we should and must try. We must address the problem of delayed transfers of care, not only because NHS hospitals need to use their beds for acutely sick people who need acute hospital care, but because hospital is a very bad place for patients to be, particularly older patients, if they are ready to go home. It is absolutely the worst place for older patients, when they could be at home regaining their mobility, as opposed to losing it stuck in a hospital bed. A few weeks confined to a bed in an acute hospital can mean that an older person never walks again, even though they went in perfectly able to walk and live independently. I say that from the experience of my own grandmother.

I appreciate the efforts being made across the system to solve this problem. I know that hospitals and the social care system across the country are working together to speed up discharges; to put in place packages of care; to identify who needs single-handed versus double-handed care; and to try to make best use of limited resources. I know that that work is being done in Kent in my constituency. A few months ago, I convened a meeting between East Kent NHS hospital and Kent County Council specifically to talk about what they were doing to reduce the number of delayed transfers of care. I should give Kent some credit, as this year the number has fallen significantly: it approximately halved between last June and this June, so it really is possible to make progress, even in a tight financial situation.

At the regional level, the STPs, the devolution deals in places such as Greater Manchester, emerging accountable care organisations and vanguards such as Encompass in east Kent are really working on how to bring health and social care together and how to improve the situation with delayed transfers of care. They must prioritise this and they have to go beyond questions of whose budget the money comes from, whose money it is, whose problem it is and whose patient it is. Instead, they need to look at the problem as a whole and take account of the patient as an individual. They should simply look at what care the patient needs, not whether it is part of one system or another. I would like to thank all those working on this across the country for their efforts. They are working not just to free up much needed beds, but for the sake of individual patients who need better care outside hospital.

That brings me to the question of money. As a society, we face the challenge of people living longer, needing more care and rightly expecting better care. Thanks to the work of the CQC inspecting care homes and care providers, we are seeing some transparency in the quality of care, and we are identifying where there is poor care. Thankfully, the vast majority—70% or so—of care providers are either good or outstanding, but a significant minority is not good enough. It is good to see, though, that the majority of those are, in turn, improving.

I welcome the improvements to care, driven in part by the CQC and greater transparency, but we cannot get away from the need for more money in the system. We all know that the Government have recognised that. Despite the large deficit and debt left by the Labour party in 2010, the Government have committed to funding the NHS through the five year forward view and to increasing funding to social care. Social care funding is rising in real terms. I enormously welcome the social care precept—the extra 2% that Kent and other councils are levying to increase the funding for social care. I have not heard a single person in my area complain about that levy—that increase in the amount of council tax that has to be paid—which I think shows widespread support for funding more care.

It is good to spend money where we can on social care as well as to maintain the commitment to funding the NHS, but there is a case for work to be done so that we know what any extra money spent on social care will achieve. To what extent might it achieve savings for the NHS? When I asked the experts questions in this area, I encountered a lot of vagueness about what could be achieved for the NHS by increased spending on social care.

Finally, I emphasise the importance of having a system that truly joins up health and social care, so that each pound is spent most effectively across both those areas and so that each person gets the right care for them. It should not depend on whether they are in the NHS or social services spheres; it should be the right care for every individual person.