Social Care Services

Lilian Greenwood Excerpts

Tuesday 17th May 2011 Westminster Hall

[Alex Cunningham (Stockton North) (Lab)]

I look forward to serving under your chairmanship, Mr Brady. I am pleased that we have the opportunity to debate this important subject, which is being discussed more widely around the country by families and individuals who fear for their future.

The Government will try to boast that they are providing extra cash for social care, but that is not how people out there see things. “Hardest hit”—that is how the thousands of disabled people who marched in the streets outside this place last week described themselves. One woman from Billingham in my constituency, who has been blind since the age of 18, was among those who made the long trek to Westminster, and she told me about her anxieties and the effect that the cuts will have on her life. She and the other demonstrators had every right to be angry; they will be the hardest hit by the Government’s proposed cuts to disability benefits and the hardest hit by the swingeing cuts to council services that began this year, with more to come over the next three years. That means four years of anxiety and dread for families and individuals whose way of life depends on services with an uncertain future.

Last year, adult social care services helped 1.7 million adults to do things that most of us take for granted. Those 1.7 million adults remember the Chancellor speaking of his £6 billion cuts to local government grants and saying:

“Not a single penny will come from the frontline services that people depend on.”

How hollow those words ring today. I am sure the Minister intends to refer to the £1 billion that the Government are giving councils over four years to spend on social care services and to the £1 billion that doomed primary care trusts are supposed to spend on them over the same period—cash they are expected to take directly from the health budget, which the Prime Minister claims to be so protective of.

The trouble is that even the Conservative-led Local Government Association calculates that £4.6 billion is needed just to stand still and to maintain services as they are today. The reality is that the £530 million of additional funding that the Government have provided for social care in their first year is dwarfed by the £3 billion that councils have had to cut. According to the Financial Times and the Association of Directors of Adult Social Services, £1 billion of that has been cut from adult social care.

[Lilian Greenwood (Nottingham South) (Lab)]

Adult social care accounts for £1 in every £4 that my local authority in Nottingham city spends. Does my hon. Friend agree that it is inevitable that social care services will be affected when a local authority’s budget is cut by more than 16% in just one year, as Nottingham’s has been?

[Alex Cunningham]

It most certainly is. My hon. Friend says that social care accounts for £1 in every £4, and a 16% cut represents a considerable reduction in the amount available to spend on social care.

ADASS also concludes:

“savings on this scale simply cannot be achieved through doing the same things more efficiently or by trimming management costs”.

As for the money that has gone to PCTs, can the Minister tell us, hand on heart, that he has any idea how much of it will be spent on social care this year? Given the revolution unleashed by the Health and Social Care Bill, PCTs have had other issues on their mind as they have sought to protect services during a transition period that will see them abolished. More importantly, this transition period threatens to reverse the progress made on health and social care over the past few decades. I just wonder what guarantees there can be that we will have properly commissioned and funded care once PCTs have gone and have been replaced by consortia that do not have the expertise and understanding of our community’s wider health and social care needs.

Media reports just this weekend outlined the profits that some think can be made from the health and social care system, effectively taking hard cash from the front line. The Prime Minister’s senior adviser, Mark Britnell, told a New York conference attended by the giant private health care providers that dominate in north America that the changes over the next two years will provide a “big opportunity” for the profit-making sector. As I am sure hon. Members will know, no one can make profits without taking cash out of the system. I look forward to hearing what reassurance the Minister can give those who will be hardest hit. What is his guarantee that profiteers will not have their way with the NHS and related social care services?

I know that Ministers get fed up with MPs from the north highlighting the divisions in our country, but the BBC is highlighting them now. In a survey released last week, it identified a new north-south divide, with social care spending this year falling in the north while actually rising in the south, although I will question the value of that so-called rise later. The BBC’s findings reflect the differential impact of the cuts, with councils in the midlands and the north more reliant on central grants and thus hardest hit. The findings may also reflect demographic differences and the effect of falling property values on people’s ability to self-fund.

In the north, spending will fall by 4.7% in the current financial year alone. Then there are deprivation factors to be taken into consideration. Local authorities in the most deprived areas—many are in the north, but they are elsewhere as well—have the worst mortality figures and the highest incidence of long-term ill health, but they are suffering the deepest cuts in spending power. Front-loading the cuts means that huge changes must be brought in quickly, giving little time for consultation with staff and service users over the best way to minimise the impact on front-line services. That said, I would not like anyone to get the impression that things are rosy in the south. The 2.7% increase in spending in the south is about half the rate of inflation and does not keep pace with need. Nor will it be enough to prevent real people from losing real support—support that, in the Chancellor’s words, they depend on.

My main purpose in securing the debate, however, is to consider the human impact of social care cuts, not just to debate dry spending figures.

[Alex Cunningham]

Yes, I agree that there is a considerable risk. I should say that I have been much impressed by the role played by local authorities in health scrutiny. I hope that the Minister will answer the hon. Lady’s question directly later.

The successful judicial review against Birmingham city council’s adult social care cuts looks set to be hugely significant. The Minister might be tempted to hide behind a carefully drawn veil of localism, but does he really consider it acceptable that Birmingham should seek to withdraw support from 5,000 people? Many of those people could be in a situation where abuse or neglect have occurred, or will occur, or they could be unable to carry out the majority of their personal care or domestic routines. They will be the real losers in all this.

Does the Minister consider it acceptable that 2,145 elderly and vulnerable people in Lancashire will have all care and support removed, as part of cuts that are the subject of another judicial review? Does he consider it acceptable that desperate families are being forced to go to the High Court to try to prevent devastating damage to their quality of life or that of family members?

In West Sussex, the “Don’t Cut Us Out” campaign has brought people together to campaign against eligibility cuts. If Members visit its website, they can read testimony from Tony, who has limited mobility. He must carry an oxygen cylinder wherever he goes and he is susceptible to blackouts and periods of deep depression. He will lose all the benefits and support currently provided by West Sussex county council. He says:

“My current care package...provides for 13 hours of care support each week and has kept me out of hospital for much of the last two years, saving the Country hundreds of thousands of pounds. Before, I was in hospital for six months at a time, and once discharged was being re-admitted every two weeks or so. I can’t imagine what my life will be like without this support.”

Back in the north, local people, service users and staff have been campaigning to halt the closure of Leeds crisis centre and the threat to mental health day services in Armley and Hunslet. At a packed campaign meeting organised by Unison, a campaigning trade union of which I am proud to be a member, a service user said, “I am saving the council money by using these services; when living in London, where there weren’t these services, I had many hospital admissions; I have had none since living in Leeds.”

Mencap provided me with a graphic example of what the cuts mean for George and his daughter, who are from Rotherham. George’s daughter has profound and multiple learning disabilities. Due to her disability, she is doubly incontinent and requires the use of many disposable items of medical equipment. She lives with her dad, and as part of her care package, the council picks up all body and medical waste from the household. The waste includes faeces, urine, blood and vomit. Mencap says that Rotherham council has gone from collecting the hazardous waste once a week to once every 14 days and has reduced the amount that it picks up by 50%. The council has also stopped providing specialist waste bags for the disposal of the waste, leaving the family to cover the additional cost themselves. That bodily waste now goes into black bin bags mixed with household waste, which are sent to landfill. These stories illustrate the fundamental truth: these cuts are a false economy with devastating human, social and economic costs.

In a recent national survey by a group of charities, including Carers UK and the Alzheimer’s Society, half the respondents said that increased charges for care meant that they could no longer afford essentials such as food and heating, and more than half said that their health had suffered as a result. We must consider the services run by voluntary organisations—dare I say it?, the big society—that offer early help for people who do not necessarily qualify for assessed council support. Day care centres, meals on wheels, support groups and drop-in centres are being cut because they are losing grant funding.

Jackie Dray used to run four support groups called “Elders with Attitude”—I love that name—in Birmingham, but she was told in March that her £30,000 council grant was to be cut altogether. She now runs only one group and is desperately looking for alternative funding. She said:

“They are cutting luncheon clubs or groups like mine that could make a difference between somebody remaining in the community or sinking into clinical depression and residential care. For a small amount of money, you could delay the point at which people have to go into hospital. I see a lot of clinical depression in carers and cared-for alike. People are teetering on the brink. There’s a lot of frustration, worry, lack of sleep.”

Before we can consider the future of social care services, we have to consider the consequences fully.

While we await the Dilnot commission report on long-term funding and the Government’s response to the Law Commission review, the Government are, in effect, already re-engineering the infrastructure of care and support. As services are razed, my fear is that capacity is being lost, services are being withdrawn and staff are being lost—capacity and skills that cannot easily be recreated. The Government are seeking to soften people up and lower their expectations, to get them to accept a return to reliance on family and buying from the open market with their own funds, or a patchwork of precarious charitable provision from a third sector suffering its own cuts and challenges.

I want to turn to the ideal, which I thought all the parties shared, of personalisation in adult social care. I fear that that ideal is being lost. The cuts mean that the policy, which promised much, is fatally undermined. Social workers and care managers tell their union that they are being expected to reassess personal budgets with a view to cutting them. I know that they need to consider value for money for all care packages, but they believe that they are expected to make cuts to get the budgets down.

A forthcoming report on a survey that Unison conducted with Community Care will highlight the fact that the paperwork and bureaucracy associated with personal budgets is excessive and inaccessible for service users. I question the Minister’s decision to prescribe from Whitehall that personal budgets be provided in the form of direct payments. That appears to be at odds with his claim to be a champion of local determination and removes choice from people who wish to have a managed budget. It appears to be linked to the aim of completely withdrawing state provision. Individuals will be expected to navigate the market or take on what many will see as the onerous and stressful responsibility of becoming an employer. I urge him to reconsider the prescription of direct payments, as there is evidence that it will restrict choice, but more importantly, distress some of our most vulnerable people, who already have enough challenges in life.

As we contemplate the future of adult social care services, there can be no under-estimating the scale of the challenges that we face as a society: by 2041, the number of adults with learning disabilities, we are told, will have risen by 21%; the numbers of young people with physical or sensory impairments by 17%; and disabled older people by a massive 108%. We all know that the number of dependent older people is set to increase hugely. The Association of British Insurers says that currently 20% of men and 30% of women will require long-term care at some point. If we add to that the challenges of the increasing number of young adults with complex needs who will need very expensive care packages for decades; the 170,000 people with a learning disability who Mencap tell us live with parents and carers who are already over 70 years old; the growth in the number of people with dementia, which the Alzheimer’s Society says is set to soar by a third to 1 million people by 2025; the costs facing authorities due to alcohol misuse; and the number of people with obesity-related problems, then we can see that the Government’s proposals are destined to fall well short of what is needed.

The director of children, education and social care for Stockton-on-Tees borough council, which serves people in my constituency, says that we have to be mindful of the knock-on effect of the reduction in other funding streams that impact on adults—the independent living fund, the Supporting People programme and affordable housing funding. She tells me that some of the funding streams that have historically been linked with it are being reduced or ceasing, while her department works to maximise people’s independence.

[Lilian Greenwood]

Does my hon. Friend share my concern that these cuts come alongside the cuts to disability benefits outlined in the Welfare Reform Bill, in which Ministers talk about targeting those in greatest need? Is not there a danger that disabled people with moderate needs could lose all support and face isolation and a loss of independence?

[Alex Cunningham]

That is very much the case. A stream of people have come to our surgeries or to see us in Parliament, and there seem to be so many attacks—left, right and centre—on some of the most vulnerable people in our society. As my hon. Friend says, something needs to be done if we are to arrest this situation.

The director of children, education and social care for Stockton-on-Tees borough council says that the result of the cuts, if we have limited extra care and supported living options, will be a further over-reliance on residential provision. An integrated health and social care facility and extra care scheme in Billingham in my constituency was an important part of my council’s strategy for supporting people, but the Government refused the private finance initiative credits to make it happen. Would the Minister prefer his granny, mother or other elderly relative to be forced into residential care when they could have been supported in their own home or an extra care facility and had the independence that I know most older people want?

Another area of concern is the shortfall in funding to support carers. Yes, I know that the Government allocated a welcome £400 million for carers’ breaks, but other funding managed by PCTs to support adults and their carers is not ring-fenced in any way, and although some flexibility is needed, carers, who are often seen as the poor relation, could end up all the poorer.

The sector skills body estimates that the social care work force needs to double by 2025, yet it is a sector characterised by labour shortages, low pay, poor prospects and a poor image. Some 60% of care workers hold no care qualifications, and only 20% have a national vocational qualification level 2; only 10 % have an NVQ level 3. Before anyone intervenes on that point, I should say that I believe that previous Governments, including our own Labour Government, could have done more to address that issue. However, it is not just Governments’ responsibility; other organisations, including service providers, should play their part in driving up qualification standards and meeting the costs.

Is the provision made by such organisations being properly managed or being left to the market? In Stockton, we have over-provision of residential care places, some of which are under financial pressure, including those owned by Southern Cross, which is seeking £100 million from investors to secure its future. Surely we need some kind of controlled management or strategic planning to get this right and ensure that standards are maintained.

We must look to the future of adult social care. We need immediate action to lay the groundwork for genuine reforms to flourish. The Chancellor said that his cuts would not touch front-line services; he should be prepared to say that he got it wrong. There is an urgent need for a new plan that looks again at the local government settlement and works with local authorities to ensure that front-line services are funded to meet need. Everybody agrees that we must do more to give early help because it prevents dependence and saves money on acute care, and yet those services are first in line for the chop. Will the Minister genuinely and strenuously consider the recommendation of a duty to provide early help for adult services such as that which Professor Munro made for children’s services?

The Minister must reconsider the equation of personalisation with the transaction of receiving direct payment. Personalisation is not about ticking boxes and having the right number of people receive direct payment. Trying to make it work in the context of the cuts requires him to spend time talking to practitioners and service users about what is happening on the ground and what they think the priorities should be. We need to get it right for individuals.

We need an improved and comprehensive work-force strategy covering training, development and qualification standards as a condition of provider registration and a commitment to working towards a living wage for all care workers. We must work with work-force representatives to boost the autonomy and confidence of practitioners. I am sure that the Minister will welcome, as work-force regulators have, Unison’s duty of care handbook for health and social care staff. The handbook aims to promote awareness among workers of their duty of care and other professional duties, and of how to raise concerns about poor practice.

Costs, too, need to be addressed urgently. The Association of British Insurers says that the average cost of care in residential homes in the UK is approaching £25,000 a year, with people in England spending an estimated £420 million a year on private home care. This question was not sensibly debated during the general election. We need cross-party co-operation to reach a long-term sustainable solution to the problem.

--- Later in debate ---

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Brady.

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate on an issue of huge importance to many of our constituents, who are among the most vulnerable in society, including older people, disabled people and carers—people for whom adult social care services are an essential source of support in their daily lives.

My hon. Friends have eloquently and passionately articulated the real and serious concerns about adult social care services, but I want to focus on the importance of the social work profession in building adult social care services fit for the future.

Labour Members are pleased that the Government have proceeded with the work that Labour started on reforming the social work profession, and I welcome the Government’s decision to continue to support the work of the Social Work Reform Board. As a consequence of cuts to budgets for adult social care services, it now feels as though the very future of social work with adults is under threat. Councils across the country are proposing deep cuts to the number of registered social workers they employ, to be replaced with a range of staff employed in roles such as care co-ordinators and support workers. I know that the staff are committed and caring, but, like my hon. Friends, my concern is that this restructuring is prompted not by seeking to improve the quality of care but by the need to reduce spending on salaries. Like my hon. Friends, I am fearful of the consequences of this loss of capacity. It represents a serious loss of skill and expertise in the work force, at a time when people’s physical, mental and emotional needs and family dynamics are becoming ever-more complex.

It is hard to escape the impression that social workers in adult services are, as my hon. Friend the Member for Blaydon (Mr Anderson) said, the Cinderella service—the poor relations. The media attention given to tragic deaths of children as a result of abuse has served to sharpen public focus on children’s social work, but the consequences of social workers in adult services being poorly managed, supported, valued, trained and developed are just as critical, as my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) pointed out. Excessive case loads, defective IT systems and too much paperwork are also facets of adult social workers’ daily lives, and they get in the way of those workers’ ability to practise effectively.

The Government have said that they have given the Children’s Workforce Development Council £79.9 million for social work initiatives in 2011 and 2012. There is work to develop an advanced professional status in children’s social work to enhance the development of those who want to progress in front-line practice rather than in management, and the Munro review of barriers to direct social work with children and families has come up with some excellent recommendations—all to be welcomed. Does the Minister understand, however, that the lack of similar investment and activity in adult social work is leaving practitioners feeling overlooked, and has knock-on consequences for morale and future recruitment and retention? What plans does he have to address those concerns?

My trade union, Unison, represents 40,000 social workers and has developed a 10-point plan for social work within adult services. I support its call for a “clear political commitment” through “policy and regulation channels”:

“to strengthen the role of social work in adult services”

covering the

“central importance of social work in care and support of adults, and…halting the development of ‘social work on the cheap’.”

Is the Minister willing to give such a commitment?

A survey last year of social workers in adult services found that two thirds of respondents felt that the time they had available to spend with each service user was not sufficient to meet their needs, and that nearly a quarter felt that the time available was very insufficient. An overwhelming 96% of respondents believed that too much of their time was spent on paperwork, and only a third believed that joint working with the NHS was effective in their area. They reported structural difficulties, such as remote management, the marginalisation of social work and the duplication of paperwork required because of incompatible IT systems. Although only 3.5% of social workers in England are directly employed by the NHS, many more are seconded to the service from councils, but the status, standing and representation of social work in the NHS is virtually invisible.

Social work plays a vital role in mental health services, addressing the social needs and safeguarding the rights of patients, and hospital social work is essential in enabling rehabilitation and preventing readmissions. A recent survey by Counsel and Care stated:

“Hospital social workers are being bypassed by health professionals, who in some cases are dealing directly with the family rather than using the social worker service to plan discharge...The hospital teams can sometimes function as ‘brokers’, trying to discharge older people in to care homes themselves without proper assessments being undertaken by social workers.”

Does the Minister agree that NHS trusts should ensure that social work is represented in their management and governance structures to prevent such practices? Health employers need to engage much more closely with the social work reform agenda, accepting responsibility for playing their part in its implementation.

Adult social care services are vital and will be increasingly needed in the future, as my hon. Friends have pointed out. Social work faces a number of serious and pressing issues, and I look forward to hearing how the Minister plans to address them.