Social Care

Kate Green Excerpts

Wednesday 25th April 2018 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

I am grateful to my hon. Friend for pointing out the very high percentage of care homes being found to be inadequate or requiring improvements—the figure is over 40% in my local authority. Does she agree that in many cases this is about care not being safe in those care settings? The real worry is not just that the settings are a bit grotty but that the care is unsafe.

[Barbara Keeley]

Yes, indeed. My hon. Friend takes me ahead in what I was going to say, but I know she has been involved with Age UK in understanding the state of care in her own local area, and I applaud her for that. Cuts have resulted in providers giving poor-quality care, and that is having a serious impact on the lives of people who need care. It means people not being washed or going hours without receiving a meal or being given a drink; it means people being left without help to go to the toilet; and in some cases, as she just said, it means people not being given crucial medication.

Care quality has become so bad that Age UK’s recent report was entitled, “Why call it care when nobody cares?” Many Members went to the launch of the report and listened to the older carers who were there. The anger of those older carers who spoke at or attended the event was palpable. Some told me that they and their families were often at breaking point, that they felt betrayed by a system of care that left them with little or no affordable support, and that they faced rising care costs which they described as crippling, although the care for which they paid was often not good enough.

I know that the Minister was present at that event. She may have talked to one carer there, Elaine from Northamptonshire, whose council is battling insolvency. Elaine gave up her job to care and has cared full-time for her husband ever since, but rather than giving her any extra help, the council recently tried to increase the weekly cost of care support at home from £88 to £178 per week. That was another battle for a carer to fight to obtain the care support that she needed at a price that she and her husband could afford.

Labour Members recognise that unpaid family carers need more support. We understand how much families are doing to look after their family members, and how hard that is for many carers but the Government have not even developed an updated national strategy for carers, having scrapped the planned strategy back in October. Since then, they have even failed to publish the action plan that was promised for January. What does that say about their attitude to carers?

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[Dr Whitford]

I utterly agree. Obviously, we recognise the change in title of the Secretary of State. I am sure that many of us across the House hope that that would mean a move towards a more joined-up approach to health and social care. The pressure on the NHS is absolutely exacerbated by problems in social care.

[Kate Green]

There is an inconsistency between funding through continuing healthcare as part of NHS provision and the funding that is available to support people through social care. Does the hon. Lady intend to suggest that that discrepancy should in some way be rectified so that there is not a difference between the routes through which someone comes into the care system?

[Dr Whitford]

Many relatives and patients complain about the fact that, depending on which illness people have towards the end of their life, they will either be supported in an NHS or hospice system or they will pay for it in the social care system. A fragmentation has resulted from the Health and Social Care Act 2012 and the change in structure. Someone’s treatment may be delivered under NHS England as a specialist service for so many days, but then they go back to the clinical commissioning group and the ongoing care is suddenly not there. It is all very disjointed. In actual fact, we require an entire approach that joins up health and social care for the entire patient pathway. We should not expect patients to navigate from one pothole to the next.

We have exactly the same challenges with an ageing population. Indeed, the Scottish population is older and ageing more quickly than the English population. In all these debates, I always say that we must not look on this as a catastrophe. Having spent over 30 years of my life trying to get people to live longer, I ask Members to remember the alternative—living shorter. However, without public health changes and a game-changing approach, we are not ageing well; and we need to age well. But that will take a long time to turn around. We need to look after the people who require care right now.

Having failures in social care traps people in hospital. In Scotland, although we have a long way to go as well, delayed discharges from hospital have dropped in every year since 2014, when the integration started. Between 2010 and 2017, the average hours delivered through home care have doubled from six to 12 per week. In future, a quarter of us will die in a care home, so what kind of quality of care do we want to have, and what kinds of palliative care skills would we like our nursing homes and care homes to have? We need to create links between the hospice movement and care homes so that those skills and that supportive approach are shared.

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[Kate Green (Stretford and Urmston) (Lab)]

It is a great pleasure, as a Manchester MP, to follow a Yorkshire Member from the other side of the Pennines, my hon. Friend the Member for Keighley (John Grogan). I am pleased to have an opportunity to contribute to the debate and want to make a few points that have not come up very much in the debate and that particularly affect my constituents in Trafford.

We have a relatively elderly population in Trafford, compared with Greater Manchester as a whole, which creates a higher level of need in the borough. We also suffer from a high level of delayed transfers of care— in February we had 737 days of delays in the system because of a lack of places in nursing homes, residential care homes or domiciliary care. We also have a disproportionate number of self-funders, which makes it more difficult for the local authority to shape the market. It also means that many self-funders have no connection with the social worker, so they do not necessarily get good advocacy to ensure that their care needs are met.

In Stretford and Urmston we have relatively few large chains supplying residential or domiciliary care; the market is characterised by small businesses, often long-established and family-owned. Those businesses struggle with a lack of reserves, and they are often in buildings that they have occupied for decades and that were not purpose built as care homes. They are now unable to raise the funds to enable them to upgrade their facilities to meet modern standards, not least because of the relative inadequacy of funding from the local authority. Only the other day another small local business decided that it will have to close its doors. As we heard from my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), that is a cause of great anxiety and stress for residents and their families.

Many hon. Members have talked about the pressures on the workforce. That is a particular problem in Trafford, where there are many job alternatives—people can work in the Trafford Centre or in MediaCity, or they can travel into Manchester to work in the many businesses in the city centre. I am sorry to say that I think that position will become worse as a result of Brexit, because we rely heavily on European Union nationals to serve our care sector.

One thing that I think the Government could helpfully do is talk of care jobs as skilled jobs. They might be low-paid jobs and they might have relatively low qualification entry requirements, but they are skilled jobs. If we have to replace workers from the European Union with more workers from our domestic workforce, we will need to make social care jobs seem attractive to them with good pay and conditions, training and career paths, and by talking up the quality and importance of those jobs.

I am sorry to say that the pressures on Trafford put us in a very bad position. According to Independent Age, we have the seventh worst CQC inspection record in the country. The CQC has found that 43% of residential care homes and 45% of domiciliary care providers in Trafford are either inadequate or require improvement.

I turn to what I hope will be in the Green Paper. Let me say first how concerned I am that the CQC system, although it provides assessments, seems to lack real bite when it comes to bringing about improvements. It seems that providers are given poor assessments and have six months to try to raise their standards, during which time the local authority has some conversations with them but there is a lack of sustained external attention and pressure to ensure that they actually improve, and that by the time the CQC comes back they have not much improved. When a care home or care setting receives a poor assessment, the local authority rightly is no longer prepared to place residents there, which of course means that its income drops further, making it even harder to improve. I would be grateful if Ministers, in preparing the Green Paper, paid particular attention to how we could make that CQC process work better so that it drove improvement, rather than simply providing a picture of what is going wrong.

We have talked about family carers. I absolutely recognise and applaud the work they do. Age UK recently held a focus group in my constituency with family carers, who said they felt it was difficult to find co-ordinated information and support. Very few people plan or choose to be a family carer, and it is incumbent on us to think about ways we can get much better co-ordinated information to them about the support that is available and how they source it. We must also recognise that family care is not always appropriate. Some family members will not be able to provide family care—someone’s needs may be too high or the family member may have other commitments. In some cases, the person who requires care will not want a family member to provide intimate care to them.

I want to draw Ministers’ attention to a second phenomenon in my constituency that is putting further pressure on the system. The south Asian community in particular has relied heavily on family care, but traditional family patterns in that community are breaking down. We must look to the point in 10, 15 or 20 years’ time when we have raised the education and aspirations of women in those communities and they are no longer prepared to stay at home and care for auntie and granny, as previous generations have. We desperately need attention to be paid to building up the provision of culturally appropriate care.

Integration has been much talked about. We are finally making progress with the health and social care partnership in Greater Manchester. I welcome that, because we have talked about integration in Trafford without many visible results for many years. Members touched on working-age adults, for whom integration with just health is missing the point. Many of them are not unhealthy, but they do need integration with employment, education, transport, housing and so on. I hope the Green Paper picks up on that point.

Let me join other hon. Members in talking about funding. We need much greater clarity about what is means-tested and what is universal. We need to think that through in a strategic and rational way. We have all said that it is not right simply to expect those who need care to bear the whole cost of it. We must begin to set up a system that properly enables us to pool and share cost and risk. I am with my hon. Friend the Member for Leicester West (Liz Kendall) in thinking that that requires us to use a range of measures through progressive taxation. I am also with my hon. Friend the Member for Keighley (John Grogan) in saying that that means that inheritance tax, and taxes on assets, have to be part of the mix. That is necessary to ensure intergenerational fairness and fairness between my constituents in the north of England, where house prices are relatively lower and all someone’s assets will be used up paying for care, and those in London and the south-east with much more valuable properties, who may be left with more assets after they pay for their care.

Finally, I say to the hon. Member for Redditch (Rachel Maclean), who sadly is not in the Chamber, that council tax can be only a very small part of the answer, because it produces a very uneven pattern of funding given the very different council tax bases in constituencies around the country.

I would be grateful if the Green Paper picked up, in addition to all the other points that have been made this afternoon, on the specific points I have made. It would make a big difference to people in my constituency who need care today, to their families and to all of us in the future if, finally, this matter was properly and strategically addressed.

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[Jackie Doyle-Price]

I think the hon. Gentleman will find that we actually have a very progressive tax paying system none the less.

I want to celebrate those areas that have continued to deliver their social care responsibilities in challenging circumstances. We have heard a lot about what has gone wrong, but let us just remember this statistic: 81% of people in care homes are in homes that have been rated good or outstanding. I think that is an achievement, and something to be celebrated. I also want to compliment those councils that have really stepped up to the plate to deliver an improved performance on delayed transfers of care. Stoke and Trafford in particular have cut their delayed discharges by more than half. This comes down to leadership and determination. Where councils show real leadership, that will deliver improvements and change—[Interruption.] I have just named those councils: Stoke and Trafford.

[Kate Green]

The Minister is right to say that we are making progress on delayed transfers of care, but the figures have been very high. It really comes down to the fact that we just do not have enough well-funded places to enable people to be discharged from hospital quickly and get into the care in the community that we all want them to have.

[Jackie Doyle-Price]

I do not disagree with that point. That is why we need to embark on a process of reform and really get it right. We are embarking on the process on that basis.

A number of Members, including the hon. Member for Blaydon (Liz Twist), mentioned sleep-ins, and I just want to restate what was said, because it seems to have been misunderstood. We fully recognise the pressure on the sector resulting from the ruling on sleep-ins and the fact that the historical liabilities could be a problem. We are working closely with providers, in liaison with the European Commission, to come up with a solution. Hon. Members will understand that the matter is too commercially sensitive for me to say any more than that—[Interruption.] We are working with providers and meeting them on a regular basis.