Local Government and Social Care Funding

James Cartlidge Excerpts

Wednesday 24th April 2019 Commons Chamber

[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.

[James Cartlidge (South Suffolk) (Con)]

rose—

[Andrew Gwynne]

If the hon. Gentleman is going to apologise for the cuts he has forced on our local communities, I will give way to him.

[James Cartlidge]

Very kind of the hon. Gentleman. He was referring to what has happened since 2010. Let us just remind ourselves that the 2010 Labour manifesto said that certain areas would be prioritised and protected. Will he remind us whether that included local government?

[Andrew Gwynne]

I remind the hon. Gentleman that the 2017 Labour manifesto said that we would put money back into our public services, something that he has failed to do in the almost three years since that general election.

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[Andrew Gwynne]

Of course, individuals and families are taking the hit from all the cuts, and they are having to step in.

[James Cartlidge]

rose—

[Andrew Gwynne]

Let me answer the right hon. Member for Wokingham (John Redwood) first. We have to have a sensible discussion about how we are going to fund social care. Yes, it is about money, and we have pledged to ensure that there is £8 billion for social care—that was in Labour’s manifesto in the 2017 general election—and we need to make sure that that commitment remains in our future manifesto and is updated, because it needs that immediate cash injection to start with. However, we also need to look very seriously at how we provide adult social care. I really do wish that we could try to break down some of the politicking that has gone on for far too long—[Interruption.] Members can heckle, but it is a fact that before the 2010 general election, Andy Burnham, the then Health Secretary, sat down with the Liberal Democrat health spokesperson and the Conservative health spokesperson to try to work out a way forward. We went into that 2010 general election with poster boards about Labour’s “death tax”. That serves nobody. We need to make sure that we will have something that is sustainable for the long term, and I hope that we can genuinely get to a place where we can do that and talk about how we fund adult social care and children’s services going forward.

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[James Cartlidge (South Suffolk) (Con)]

It is a pleasure to follow the right hon. Member for Exeter (Mr Bradshaw). He spoke about a blueprint; I have read that report and I remain unconvinced that it absolutely nails down who would pay and how much, which is of course the toughest part of these decisions. None the less, it is a very good proposal and I respect that.

Like the Labour Front-Bench spokesman, the hon. Member for Denton and Reddish (Andrew Gwynne), the right hon. Gentleman referred to cuts in local government funding since 2010. I hate to labour the point—it is a political point—but we cannot avoid asking ourselves why those cuts were necessary. The motion mentions sustainability, as does the Independent Group’s amendment, or what we might call the TIG amendment. But the cause of our problem was unsustainability in the public finances and the economy, with a huge growth in all kinds of borrowing, including private borrowing, mortgage borrowing and public borrowing prior to the crash, and public spending commitments based on unsustainable tax income from, for example, city bonuses. That was never going to be sustained. It was always going to end in a big crash, and—guess what?—it would always fall to us to step in and fix the problem.

Labour MPs may deny that. I asked the hon. Member for Denton and Reddish whether Labour’s 2010 manifesto protected local government. As he did not answer, let me remind the House what the manifesto said:

“Labour believes we should protect frontline spending on childcare, schools, the NHS and policing, and reform our public services to put people in control.”

Note the absence of local government funding. It goes on to say—this is the key line:

“We recognise that investing more in priority areas will mean cutting back in others.”

In other words, if an area of spending was not protected, it would get a right old shellacking, which is what happened under us. We did the same thing. We had priority Departments that we protected, but at a time when the deficit is very high, if we protect some Departments—which is perfectly justified, as we did with the NHS—others will take a disproportionate hit. That would have happened under Labour. I honestly do not say that for the purpose of political point scoring. It is to underline the reality that there is no parallel universe where there would not have been a significant hit to the grant given from central Government to local authorities after 2010.

[Norman Lamb]

To go back to trying to find solutions to the problem that we face, the hon. Gentleman mentioned the joint Select Committee report. Does he agree that we need a new funding stream, as the Select Committees suggest, and that the best way to achieve a sustainable solution is to work cross-party, as the Select Committees did, to come up with a solution? Even if they do not have all the detail yet, that is clearly the right way to achieve a sustainable settlement.

[James Cartlidge]

That is a good point, and I will come to that. I make what is essentially a political point about Labour’s manifesto because we have to get into our heads the idea that there will never again be a time when local authorities do not have to make difficult decisions and look for efficiencies and innovation. The idea that there will always be a cavalry that can come over the hill and, with the wave of a magic wand, summon up central Government funding—which, by the way, does not grow on trees, but also has to come from taxpayers—is wrong.

Colleagues are right to mention good examples of best practice and innovation. In my constituency, I have two district councils and two wards of West Suffolk. West Suffolk is a newly merged council of St Edmundsbury Borough Council and Forest Heath District Council, and savings have been made through that process. Babergh district is entirely contained within South Suffolk. It is not a merged district council. There was a referendum on whether Babergh should merge with Mid Suffolk. Babergh voted to remain independent from Mid Suffolk, but they merged their back offices, and there have been huge efforts to achieve savings and efficiencies. Babergh has left its head office in Hadleigh in my constituency and is now based in Ipswich, outside the district, which has been unpopular but has saved money. It has set up a joint venture to renovate and restore its old headquarters and make them a commercial asset. The point is that those sorts of changes by district councils will always be required.

Suffolk County Council has seen huge innovation in relation to social care, as my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is on the Front Bench but cannot speak in the debate, will know. Councillor Beccy Hopfensperger has done great work as the cabinet member for social care in Suffolk. Through the use of technology, the council is saving money, driving down costs and improving care. For example, sensory apps are being used, so that families can know whether their loved one who is able to stay at home is moving around and mobile—in short, that he or she is well. Such technological innovations can help to reduce the cost of care and deliver better care.

On the broader question that the right hon. Member for North Norfolk (Norman Lamb) raised about the sustainable funding of social care, I feel passionately about this issue. The biggest issue in British politics begins with b, and it is not Brexit by a long chalk; it is Beveridge. The welfare settlement we have in this country covers the whole of the state pension, the NHS, social care and every aspect of the contract that we all thought we had entered into, but the system is not remotely sustainable. If we look at the Office for Budget Responsibility’s forecasts for just NHS spending 50 years from now, we see that it estimates we will be spending the same again in real terms as we do on the NHS now because of changing technology, demand and so on, so we have a huge challenge ahead of us.

On the specific point about paying for social care, I recently had a constituency surgery at which an elderly lady came to see me because her husband has a very difficult condition and she wanted to know what support was available to her. She felt she was in that category of my constituents who are neither so poor that they receive lots of help nor wealthy enough to be able to afford to fund a good lifestyle. I asked her, “What about your house? Do you have housing assets?” She said, “Yes. We have a house worth about £700,000, with no mortgage.” However, in her eyes, she has no money.

This issue of housing and assets is always going to be the most controversial point, as we discovered to our cost at the last general election. The residential housing assets of those aged over 65 is worth between £1 trillion and £1.4 trillion, depending on which estimate we look at, and that is a staggering sum. We have to accept that at the core of this issue—and this is the reason why it is so controversial—those entering the workplace today will not have occupational pensions and will not build up such a level of housing equity. That is highly unlikely because, in my view, we will not see such a period of high house price inflation again; it is not sustainable. We are reaching a point where those paying into the system are seriously questioning whether they will get the same benefit as those who retire today.

This intergenerational issue is no one’s fault; no one designed it that way. In fact, the welfare system I have mentioned, the Beveridge system, was built with the very best of intentions for a post-war country. However, the thing we need—and I will conclude with this key point—is honesty. That was said by my hon. Friend the Member for Lewes (Maria Caulfield), who is a nurse, and I greatly respect the expertise she brings to this issue. In this populist, Trumpian era, the one thing that will make this work is all of us being open and transparent about the tough choices we are going to have to make. No one is going to have a free option. There is no free option: every option available is going to cost.

I happen to think that the best option will involve some use of housing equity, perhaps with a choice for people to pay through an alternative method if they do not want to bind themselves into that. In relation to those entering the working population, I think we should look at the success of auto-enrolment. How many people here have had emails from constituents complaining about the rise in pension contributions from their salary from auto-enrolment? I have not had a single email because people believe it is a contribution from which they will benefit. It is not like the old, pay-as-you-go system, and I think we could link the social contributions of the young generation through a premium to such a system, as the Select Committees have suggested.

It will be very difficult to come up with a solution for social care. It may take consensus, or it may take a future Government with a large majority being pretty tough and disciplined. It will take one or the other, not what we have at the moment. However, we can make a start, and we have to be open and transparent about the fact that there is no easy option, but there can be an option through which we get much better care for the next generation.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

Today, we have heard from many hon. Members about the disastrous impact of the Government’s relentless and short-sighted cuts to council budgets from Hull to Westminster North, from York to Nottinghamshire, from West Ham to Lewisham, from Birmingham to St Helens, from Sheffield to Exeter, Burnley, Hartlepool, Tyneside, Chesterfield and many others. Nowhere, as we have heard in the debate, has that disastrous impact been felt more acutely than in social care. I congratulate my hon. Friends the Members for Kingston upon Hull West and Hessle (Emma Hardy) and for Crewe and Nantwich (Laura Smith), whom we heard from in the past hour, on presenting such powerful stories about family carers and the role of care staff, the absolutely vital two parts of the backbone of social care.

Social care is one of the most important pillars of support for vulnerable people up and down the country. I pay tribute to all our dedicated and hard-working care staff, many of whom are in the dilemma my hon. Friend the Member for York Central (Rachael Maskell) just talked about. It is sad that the cuts mean we are in a situation where care staff have to go on strike for their pay, because many of them go above and beyond in the most difficult of circumstances to make sure that older people and disabled people get the help they need. We think a lot about NHS staff, but let us face it: without our 1.4 million care staff the care system would simply collapse. My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) raised the crucial fact that there are 110,000 vacant posts in the care workforce. That vacancy rate is deeply concerning, because it makes the situation for the staff who are doing the job much, much worse.

The Government should be shouting from the rafters about the value of social care, but most of the time there has instead been a wall of silence. It is only by securing this Opposition day debate today that we have been able to raise this issue. There is very little coverage of the issue elsewhere. My hon. Friend the Member for Redcar (Anna Turley) talked about the vacuum around Government policy on social care, and she was right to do that. Ministers seem not to want talk about a vision for social care. That is not surprising, I guess, following the Government’s litany of broken promises about reform. Let me just touch on some of them.

The Government dropped the cap on care costs, due to come into effect in 2016—we had legislated for a cap on care costs—leaving thousands of people unexpectedly having to pay for their own care. Then, at the general election in 2017 we had the so-called dementia tax, a disastrous proposal which lasted only four days before being abandoned. I have met family carers who are still desperately worried about that policy, because they think it is still around. Now, more than two years after promising a social care Green Paper, with the hope of better support for families across the country, the Government are still no nearer fixing the crisis that they have made. Let there be no doubt about it: this crisis has been made so much worse since 2010. We were told there would be a Green Paper in summer 2017 and then by the end of 2017, but it never arrived. It was then delayed till summer 2018 and then autumn 2018. Winter came and still no Green Paper. The Secretary of State told us at the start of the year that it would arrive by 1 April. It has not arrived and there is still no sign of the Green Paper. Perhaps the Minister will tell us when we are going to see it.

Now, when councils need an extra £1.5 billion to close the funding gap, the Government have offered derisory short-term funding. Last winter, the Government offered a measly £240 million for adult social for winter pressures. That would pay for only three months of home care for the older people the Secretary of State said it would help, but that is not enough. That was hardly enough for the harsh conditions of last winter, which, if you remember Mr Speaker, lasted very much more than three months. This year, councils will receive a further £410 million to be shared between older adults, working-age adults, and children’s social care services. The Secretary of State is leaving councils and councillors to make the invidious choice between caring for the most at-risk children, vulnerable adults with disabilities, and our most frail and isolated older people. Throwing small, one-off pots of money at this problem every year will not deal with the crisis in the long term. As my hon. Friend the Member for St Helens South and Whiston said, it is a sticking plaster on a gaping wound.

[James Cartlidge]

Will the hon. Lady set out her preference for how we should pay for long-term care?

[Barbara Keeley]

We get this every time we have a debate on social care—although we do not have many such debates—from Government Members who have no ideas whatsoever. I have just run through all the abandoned ideas and the abandoned promises that the Government have made on the Green Paper. I am really surprised that any Government Member actually has the cheek to stand up and ask Opposition Front Benchers what we would do. We laid out what we would do in 2010. We had a White Paper, not a Green Paper. We laid out all our proposals in our manifesto. We are the side with ideas and proposals on taking forward social care. This Government have no ideas and no vision, and I am amazed that an hon. Member really has the cheek to do that.

[James Cartlidge]

It is very kind of the hon. Lady to give way. I spoke in the debate and said that we have some very difficult decisions to face. We need to be open with the public, and I said that we need to look at, for example, equity in residential property. I think that is unavoidable. Does she think we should do that?

[Barbara Keeley]

We have laid out our proposals and we said how we would fund them. As I say, most of what we are debating today relates to the short-term crisis. Once we got past the short-term crisis, I think the hon. Gentleman would have difficulty. There has been talk about involving the public in this. At the moment, the public are faced with the type of care that my hon. Friends have discussed and debated and with the care staff and workforce in the situation that they are in. At no point, in the middle of a crisis, would we be saying to the public, “Use the value of your property. Let’s go for this type of funding or that type of funding.” That is cloud cuckoo land. I wonder whether the hon. Gentleman listened to my hon. Friend the Member for Kingston upon Hull West and Hessle talking about that absolutely crucial example. What would he say to those people who need care? That is the question for him to answer.

Councils need sustained investment that undoes the damage of years of austerity and cuts, but the Government’s choice—[Interruption.] The hon. Gentleman is sitting there smirking at me at the moment. The Government have made a choice to pursue ideological cuts to council budgets that have seen £7 billion lost from adult social care spending since 2010. Let us think about what that has meant: 400,000 fewer people getting publicly funded social care between 2010 and 2015; 100,000 fewer people getting taxpayer-funded social care in the last four years alone; and 90 people a day dying before they receive the public social care for which they have applied.

It is not simply the most disadvantaged who are losing out either. Many of those who are having to foot the bill for their care are being exploited by a broken care system where private care providers can act with impunity and where vindictive care homes can evict older people whose families dare to complain about their standard of care. That is a very serious matter, as we discussed in the debate, given the level of closures of care homes and the loss of care home beds we have had, as touched on by my hon. Friend the Member for Chesterfield (Toby Perkins). The hon. Member for Totnes (Dr Wollaston) also talked about being in a part of the country where it is impossible to get care. That is the position we are in. If care home owners can evict older people, that is a drastic situation. Opportunistic home care agencies are overcharging vulnerable people for care visits that are too short and endangering their health by forcing staff to work when they are sick. We heard about the care staff who are too scared to take time off sick.

I want to make clear to hon. Members the human impact of not getting the right amount of support, although those who have bothered to attend this debate—I am thinking particularly of Government Members—might have heard some examples. Simply put, it means people going without the support that they need to live with basic dignity. Not having needs met means going unwashed and undressed. It can mean waiting for hours to go to the toilet because no help is available. It can mean a person going thirsty because there is no one to pour them a glass of water and going hungry because there is no one to prepare them a proper meal. This is the experience of many thousands of older people who are going without care or who have insufficient care. I am glad that many hon. Members have talked about a care visit being the only contact that many older or vulnerable people have in the day.

The consequences of inadequate support in the community for working-age people are also horrifying. In recent months, we have seen many reports of vulnerable autistic people and people with learning disabilities left to languish for years in private in-patient units—vulnerable, detained, secluded and neglected in long-stay units. These units, many of them private, are funded by the NHS at great cost to the taxpayer because councils simply have not been given the money to move people from these units to be supported closer to home. My hon. Friend the Member for Stroud (Dr Drew) and the right hon. Member for North Norfolk (Norman Lamb) both raised that issue. I have stood at this Dispatch Box before and called this a national scandal, and I make no apology for doing so again.

Back to Government promises: after Winterbourne View in 2011, the Government promised to close inappropriate units for good within three years—by 2014. It did not happen. Indeed, eight years later, there are still 2,260 people detained in hospital settings when they need not be there. The number of adults trapped in these units has fallen by only a fraction. Worse still, the number of children in these units has actually increased.

Where this Conservative Government have done nothing, Labour will act: rather than years’ more cuts, we will invest £8 billion in social care; rather than 90 people a day dying waiting for care, we will provide more people with the support they need; rather than care staff being pushed to the brink, we will pay them a real living wage; and rather than more delay, we will build a national care service that supports older and disabled people when they need it. This is our message to people across the country, young and old, desperate for care and support: a Labour Government will give you the support you need and deserve. That is why I urge Members to support our motion tonight.