Social Care Funding

Liz Kendall Excerpts

Thursday 10th November 2011 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone, and a pleasure to follow the thoughtful speech by the hon. Member for Meon Valley (George Hollingbery). I agree with many of the points that he made and I will come on to discuss them. I also thank the hon. Member for Truro and Falmouth (Sarah Newton) for securing this debate, and all other hon. Members who have spoken.

I will begin not with how we are going to fund the future system of social care, but with the “crisis in care” that older and disabled people, and their carers and families, are experiencing. Those are not my words but those of the Care and Support Alliance, which is an alliance of 52 major organisations representing older people, disabled people, their carers and families. It is important that we are clear about the state of the current system and the scale of the task we face. It will mean difficult decisions for all political parties.

I will begin with a point that has already been made by several hon. Members. Under the current system, there are substantial levels of unmet need. Although the Association of Directors of Adult Social Services is right to say that that need is difficult to quantify precisely, the King’s Fund has estimated that the unmet need gap in the current system is around £1.2 billion.

Those unmet needs are increasing. To a large extent, that is because of our ageing population. That is a good thing, but it means that more people are living to a very old age with one, two or perhaps three long-term, chronic conditions, such as dementia. We simply have not seen that in the past, and it is happening at a time when budgets for both the NHS and social care are being squeezed and they are not changing sufficiently fast to meet the changing needs of our population.

However, unmet need is also growing, because councils are tightening and restricting their eligibility criteria for services. Eight out of 10 councils now provide services only for people with substantial or critical needs, and as my hon. Friend the Member for Lewisham East (Heidi Alexander) said, those are people with very real and serious care needs, not simple needs. “Substantial” means very serious needs.

Mencap says that 83% of councils are meeting only substantial or critical needs for adults with learning disabilities. That is up from 73% only one year ago. Nine out of 10 councils have increased their charges for both residential and domiciliary care. Many councils are restricting the time allowed for home visits. Help At Home, one of the biggest home help providers in Leicestershire, told me at my surgery last Friday that Leicestershire county council is paying for blocks of 15 minutes of care, down from 30 minutes previously. It told me that if the carers go just over that, the council rounds down the time for which it will pay. That is causing huge problems, first and foremost for older people. In many cases, it is simply impossible to get an older person up, washed, dressed and fed in such a short time. It is also causing a problem for staff who, once unpaid travel times are taken into account, are not even earning the equivalent of the minimum wage in the course of a working week. As a result, Help At Home is losing staff and finding it very difficult to recruit new staff, which the organisation simply has not experienced before.

It is clear that one of the fundamental reasons for tightened eligibility criteria, increased charges, and reductions not only in preventive services but in services such as day care centres is the cuts to local council budgets. The Government say that they are providing £2 billion of additional funding for social care in the course of the spending review period. The Association of Directors of Adult Social Services says that the reality is that social care spending has been cut by £1 billion this year, with even bigger cuts likely next year. Analysis by the House of Commons Library shows that, according to Department for Communities and Local Government figures, there will be a real-terms cut of £1.34 billion to adult social care in the Government’s first two years once inflation is taken into account; £1.3 billion is being cut from social care spending for those over 65.

The figures are based on the assumption that councils receive every single penny of the money that the Government say is being transferred from the NHS to local councils. In many cases, that is happening, but I have been told by several leads for adult social care that they are not getting all the money, and that that applies particularly to money for carers. The reality is that local council budgets are being cut by 27% during the spending review period and that that will have an effect on adult social care, because social care budgets are the biggest discretionary spend for local councils.

The Government say that there is no reason why local councils should end up cutting social care services because of the cuts in council budgets. I just point out that the Government have readily said that councils need extra money to pay for weekly bin collections. I ask hon. Members to reflect on that sense of priorities.

The consequences of the decisions are being felt by older and disabled people, who, as my hon. Friend the Member for Lewisham East also said, have been denied the up-front preventive services and support that could keep them healthy and independent in their own home. Older people, whether that is the old old or people aged 65, like my father, do not want to be reliant on any kind of help. They want to be independent. Our goal is not to be dependent on any kind of help from the state, but to live independently for as long as possible. However, the help and support that people could receive to achieve that independence is not happening. The consequences of the cuts and decisions are being felt by families and carers. Many hon. Members have talked about the pressures on carers, many of whom are at their wits’ end struggling to make ends meet, at grave risk to their own physical and mental health.

Something that has not been mentioned in the debate is the fact that the consequences are also being felt by businesses and the wider economy, as companies lose the skills and experience of carers who are forced out of the labour market because there is not enough affordable, good-quality and flexible social care to allow them to stay in their job. That problem will only get worse as people are required to work longer before they retire, and care longer at the same time.

The consequences are also being felt by taxpayers, as older and disabled people end up using more expensive hospital services when they do not need to. Several hon. Members have rightly said that delayed discharges from hospitals are up by 11% in the latest month for which data are available compared with the same time last year. That is because we are not getting the right system in place, which costs us all more in the long run.

I want to be clear: I firmly believe that we can make far better use of existing resources if we genuinely bring together health, social care services and other services such as housing and shift the focus not only more towards prevention, but much more towards a personalised service. I am grateful that the hon. Member for Meon Valley talked about the Total Place work under the previous Government. We must begin to see all these local budgets as one pot of money that can be used.

Hon. Members will have many good examples from their constituencies of ways in which preventive services have saved money. One example from the time of the previous Government is the partnerships for older people projects, which brought together health and social care around individuals’ needs. Overnight hospital stays for people in the projects were reduced by 47%; accident and emergency attendance was reduced by 29%; and once all the other services such as occupational therapy and physiotherapy were taken into account, £2,166 less per person was spent, so there is huge potential.

Even if we get those big shifts in the way in which services are run, more funding will be needed for the system in future. That is why the Labour party has offered cross-party talks on the proposals set out by the Dilnot commission. As hon. Members have said, there is widespread, although not total, consensus in favour of the commission’s proposals. We are serious about engaging in meaningful talks on the Dilnot proposals as a step towards a better system in future. We have set aside our experiences before the last general election, when very unhelpful comments were made, which wasted an opportunity for cross-party consensus.

If talks are to be serious, meaningful and successful, four key things need to happen. We have written to the Secretary of State setting them out, and I will outline them now. First, all relevant Departments must be engaged in the process. Securing agreement on the funding and implementation of the Dilnot proposals goes far beyond the remit of the Department of Health and the Health Secretary. The engagement of the Treasury is particularly important in the process.

Secondly, we have suggested that there should be an independent chair for cross-party talks, as we believe that that would make a successful outcome more likely. Thirdly, we think that an agreement is far more likely to be reached if there is transparent access for all parties to policy advice and information. We have suggested having an independent secretariat to provide equal access to the negotiating teams as required. Finally, we have requested that the leaders of the three main parties meet to agree a clear timetable for talks, with a view to securing a successful outcome and a joint statement before the publication of the White Paper next spring.

I think that many organisations representing users of social care and carers would agree that such steps are vital. If we are serious about cross-party talks to get all parties to sign up to big future public spending commitments, the talks need to be serious, and they need to have a serious process. I need not say this: such an agreement will be extremely difficult and challenging to reach in our antagonistic and combative political environment.

[Kelvin Hopkins]

I am listening with interest to my hon. Friend, but I am slightly concerned that there might be—if one likes—a conspiracy between the Front Benchers of the different parties to keep down expenditure rather than do what is needed. It might mean the Labour party saying, “We are going to have to spend more,” and raising the revenue to pay for it.

[Liz Kendall]

I am under no illusion about the scale of the funding challenge to meet the needs of our ageing population. Funding the current, unfair and ineffective system of social care will cost £12 billion by 2025. The Dilnot proposals, on top of that, cost more than £3.5 billion. Dilnot is an important step that we want to have genuine talks about, but it will not solve the entire problem that we face about the future of social care. Yes, we can make a big difference by looking at how we join up health, social care, housing and other spending, but there are clear implications for all parties in taking the matter forward, and we all need to be aware of them.

[Barbara Keeley]

My hon. Friend is making a good argument, and I am heartened by what she is saying. However, if the implications that she has just helpfully outlined exist, the debate has to be taken out to people. If there are implications for taxpayers, they have to know what they are. Many Members who have spoken today have said that it is quite clear that people do not understand or plan for care, and then the costs hit them. The debate out there, in addition to the essential cross-party talks, is important.

--- Later in debate ---

[Liz Kendall]

I could not agree more. The deal must not be done behind closed doors. There has to be a discussion between political parties, but most importantly, there has to be a discussion with the public—not just the current users of the system and their carers, but people who are not in the care system and younger people, who are working now and who will have to understand the issue. We have to have a full and proper debate.

[John Pugh]

During the previous general election, we all had a number of hustings meetings. Whenever the topic cropped up, a theme that came across forcibly from all members of the public was that they wanted the parties to discuss the issue together and that they were rather saddened by what happened immediately before the election.

[Liz Kendall]

I was not a Member of Parliament then, but from my own experience in hustings, I think that people feel let down when such an important issue becomes a political football. The hon. Member for North Norfolk (Norman Lamb), who was the health spokesperson for the Liberal Democrat party at the time, did not engage in that kind of behaviour. I do not want to go over old ground.

We need to discuss the matter, but it will be difficult. We all know what politics is like, and how parties use things to get at the other side. The issue will not be easy—it is about public spending and implications for individuals. What will they and taxpayers have to pay? We would be kidding ourselves if we thought that the issue would be an easy one.

I agree with all hon. Members who have said that the issue is one of the biggest challenges that we face, even if that is a cliché. We all think about it for our constituents and in our own families. I think about it, as many other hon. Members do, for myself, as I hope to live to a ripe old age. It will be a difficult challenge, but I hope that today’s debate shows that we are at least prepared to engage with the difficult issues to take the debate forward.