Social Care

Liz Kendall Excerpts

Wednesday 25th October 2017 Commons Chamber

[Jackie Doyle-Price]

I need to make progress. I apologise to my right hon. Friend.

On delayed transfers of care, the Government are clear that no one should stay in a hospital bed for longer than is necessary. Doing so removes people’s dignity and reduces their quality of life. It leads to poorer health and care outcomes, and it is more expensive for the taxpayer. I will set out in more detail the work we are doing to reduce delayed transfers of care. That is critical, because a well-functioning social care system enables the NHS to provide the best possible service.

We are clear that we must make much faster and more significant progress well in advance of winter to help to free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments. Last year, there were 2.25 million delayed discharges, up 24.5% from the 1.81 million in the previous year. Just over a third of those delays were attributable to social care. The proportion of delays attributable to social care increased over the last year by four percentage points to 37% in August 2017.

We have put in place an agile and supportive improvement infrastructure, and I have been very clear about priorities. First, in this year’s mandate to NHS England we set out a clear expectation that delayed transfers of care should equate to no more than 3.5% of all hospital beds by September. Those in the system have worked extremely hard to agree spending plans and put in place actions to make use of the additional funding, and they deserve real congratulation for their efforts. Since February, there have been significant improvements in the health and care system where local government and the NHS have worked together to tackle the challenge of delayed transfers of care, with a record decrease in month-on-month delayed discharges in April 2017.

[Liz Kendall (Leicester West) (Lab)]

Will the Minister give way?

[Jackie Doyle-Price]

I must make progress. Secondly, we put in place a comprehensive sector-led support offer. In early July, NHS England, NHS Improvement, the Local Government Association and the Association of Directors of Adult Social Services published a definitive national offer to support the NHS and local government to reduce delays. This package supports all organisations to make improvements and includes the integration of better care fund planning requirements to clarify how this and other aspects of the better care fund planning process will operate.

[Liz Kendall]

Will the Minister give way?

[Jackie Doyle-Price]

I have limited time, and I really must get this improvement on the record.

The package also includes joint NHS England, NHS Improvement, LGA and ADASS guidance on implementing trusted assessors; the introduction of greater transparency through the publication of a dashboard showing how local areas in England are performing against metrics; and plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds. The package sets out clear expectations for each local area, reflecting the fact that reducing such delays in transfers of care must be a shared endeavour across the NHS and social care. Those expectations are stretching, but they are vital for people’s welfare, particularly over the winter period.

Thirdly, we have asked the chief executive of the Care Quality Commission to undertake 20 reviews of the most challenged areas to consider how well they are working at the health and social care boundary. Twelve of the reviews are under way and a further eight will be announced in November, based on the performance dashboard and informed by returns from July. Those reviews commenced in the summer, and the majority of them are due to be completed by the end of November. They are identifying issues and driving rapid improvement.

Fourthly, we have provided guidance on best practice, including how to put in place “trusted assessor” arrangements, which can allow more efficient discharge from hospital by avoiding duplicative patient assessments by different organisations. All areas have now submitted their better care fund plans, which include their trajectories for reducing delays.

Finally, in October we asked NHS England to extend the GP and pharmacy influenza vaccination service to include all paid careworkers in the nursing and residential care sector. They will be able to access the service via local GPs and pharmacies free of charge.

I know that the hon. Member for Worsley and Eccles South is concerned about the provisions for those that fail to improve, and I want to tackle head-on the suggestion that there will be fines. We are not talking about fines at all. The money that has been earmarked will continue to be retained by local authorities.

[Liz Kendall]

Leicestershire County Council fears that it could have £22 million removed from its budget because of fines for delayed discharges, when the Government have cut its funds. The Conservative deputy leader, Byron Rhodes, says:

“I can’t think of anything more stupid.”

The Conservative leader, Nick Rushton, says:

“How long can we put up with the Secretary of State?”

That is the reality of the policy. What is the Minister going to do about it?

[Jackie Doyle-Price]

I reject the suggestion that there will be any kind of fine. The £22 million that the hon. Lady talks about will be retained for spending within Leicestershire. That funding has been allocated for a specific purpose, and where local authorities are not showing the improvement that we expect, we will work collaboratively with them and advise them how best to use that money.

Let me put on record exactly what we are going to do. There is significant variation in performance across local areas. We know that 41 health and wellbeing boards are collectively responsible for 56.4% of adult social care delayed transfers of care. That cannot be right, when other local authority areas have none. In particular, Newcastle has no adult social care delayed transfers of care, and if it can do that, other areas can as well, provided we have good partnerships and good leadership. I trust that I have demonstrated the extent to which the Government are supportive of the best performing systems where local government and the NHS are working together to tackle this challenge. However, we are clear that we must make much faster and more significant progress in advance of winter to help to free up hospital beds for the sickest patients and to reduce pressures on our A&E departments.

It is right that there should be consequences for those who fail to improve. Earlier this month, we wrote to all local authority areas informing them that if their performance did not improve, the Government may direct the spending of the poorest performers—it is not a fine—and we reserve the right to review allocations. It is important to note that the allocations will remain with local government to be spent on adult social care. It is not a fine; this is about making sure that public money delivers the intended outcomes.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to follow the Chair of the Health Committee, and I shall pick up on some of the themes she raised.

During the election, Conservative Members were no doubt dismayed that their manifesto proposals were dubbed a “dementia tax”, conveniently forgetting their “death tax” assault on Labour in 2010. While some of us could be forgiven for experiencing more than a little schadenfreude, the truth is we face a fundamental problem. Our population is ageing, more people need help and support and our care services desperately need more money to cope, yet any party that comes up with a significant proposal for funding social care risks their political opponents destroying them.

We could carry on like this for yet another Parliament, and yet another election, or we could face up to reality: we will only get lasting change if we secure a cross-party approach. That is why I have joined the hon. Member for Totnes (Dr Wollaston), the right hon. Member for North Norfolk (Norman Lamb) and other Select Committee Chairs in calling on the Prime Minister to establish a cross-party commission on the future funding of health and social care. We cannot allow this issue to be kicked into the long grass any longer. More than a million people are not getting the help and care they need. Many end up in hospital, and are getting stuck in hospital for longer. That is not good for them, and it costs the taxpayer far more.

It is not just the people who need care who face a daily struggle. Six and a half million people in this country now care for an older or disabled relative; 40% of them have not had a break for a year, and a quarter have not had a single day away from caring in five years. What is the result? A third of unpaid carers have to give up work or reduce their hours, so their incomes are reduced, the cost of benefits increases and the economy is denied their talents and skills. The failure to deal with the funding problem has not just created a care crisis—it has created a crisis for families and our economy.

Alongside a significant and immediate injection of cash, which we must see in next month’s Budget, three long-term questions must now be addressed. First, what is the right balance between the contribution made by individuals and the state? Do we leave all the extra costs of care to individuals who are unlucky enough to need it, and who might end up seeing all their savings wiped out as a result, or do we pool our resources, share the costs and risks and create a fairer system for all?

Secondly, what is the right balance of funding across the generations? The Conservative manifesto proposals were deeply flawed, but with the longest period of wage stagnation for 150 years and rising personal debt, I do not believe the working-age population can pay for all the additional costs of caring for our ageing population. Wealthier older people will need to make a contribution, too.

Thirdly, how do we get rid of the inequities between the NHS and social care, and make the fundamental reforms we need to provide a single joined-up service and shift the focus of care and support towards prevention? The Barker review for the King’s Fund rightly calls for a single budget for the NHS and social care, and a single body to commission services locally. It also says that we must face up to the deep unfairness that while cancer care is provided free at the point of need on the NHS, if you suffer from dementia, you may have to pay for all your care yourself.

These are inevitably difficult and controversial questions, but the Prime Minister’s experience during the general election campaign and Labour’s experience in 2010 simply reinforces the argument that we need a cross-party approach. The Government must now act.