Adult Social Care

Debate between Liz Kendall and Kelvin Hopkins

Monday 16th July 2012 Commons Chamber

[Liz Kendall]

I want to make some progress, then I will give way.

Labour proposed better information and national minimum standards to tackle the postcode lottery in care. We also proposed that everyone should have the right to have a personal budget—which we introduced—that people should be able to take their care package with them if they moved to a different area, and that carers should have the right to have their own needs assessed and met independently of the person for whom they cared.

The difference between the Labour Government and the present Government is that we set out the difficult decisions about how those changes would be paid for. The absence of that information is the gaping hole at the heart of this Government’s plans. There is a risk that their promises of new rights and services will be meaningless without the ability to fund them properly. Indeed,

“this White Paper is not worth the paper it's written on.”

Those are not my words, but those of the Alzheimer’s Society, which has damned the White Paper as a massive failure. Similarly,

“the key test for this White Paper was to deliver an urgent timetable to reform social care funding. The Government has failed this test.”

Again, those are not my words. They are the words of the Care and Support Alliance, which consists of more than 65 organisations that represent and support older and disabled people.

[Kelvin Hopkins (Luton North) (Lab)]

I entirely support the principle of a national care service, but will my hon. Friend go slightly further and be as bold as Nye Bevan in suggesting that it should be free for all at the point of need?

[Liz Kendall]

I know that my hon. Friend is passionately committed to this issue, and he will know that we remain determined to ensure that there is a fair, affordable and sustainable system for care and support in future.

The Government have failed to take proper action to tackle the immediate care crisis, and they have failed to confront the difficult funding decisions that we need for the future. Last week we heard nothing but complacency from the Government about the desperate care crisis that faces people throughout the country. Ministers repeatedly claim that there is enough money in the system, but the truth is that the Government’s savage cuts in council budgets have pushed an already pressurised care system to breaking point.

Adult social care accounts for about 40% of council budgets—it is up to 60% in some areas—and for the largest elements of councils’ discretionary spending. When council budgets are slashed by a third, it is inevitable that care services will be cut. Figures from the Government’s own Department for Communities and Local Government show that more than £1.3 billion has been cut from older people’s social care provision since the coalition came to power. Fewer people are receiving the support that they desperately need as councils raise eligibility thresholds. Charges for vital services such as home help are soaring, with huge variations across the country. That is a stealth tax on the most vulnerable members of society. At the same time, the quality of care is being put at risk as councils are forced to pass on cuts in their budgets to care providers. [Interruption.] From a sedentary position, the hon. Member for Truro and Falmouth (Sarah Newton) asks what we did in 13 years. We increased spending on adult social care by 53%, we invested £1.2 billion in the carers’ grant, we provided new rights for carers to have their needs assessed and to request flexible working, we introduced the Supporting People programme, and we spent £227 million on extra care housing. I rest my case.

According to the United Kingdom Homecare Association, one in 10 home care visits now lasts for only 15 minutes. That is a completely inadequate amount of time if frail, vulnerable people are to be helped to get up and to be washed, dressed and fed. Residential care is under huge pressure too. Nine out of 10 home care providers say that low council fees are creating a two-tier system, with new investment being directed only towards wealthier parts of the country. Unpaid family carers are suffering as well as they are forced to give up work, and their own health suffers because they cannot obtain the help that they need to look after their loved ones. Yet the Government repeatedly deny the scale and urgency of the care crisis.

--- Later in debate ---

[Liz Kendall]

The hon. Gentleman raises a serious point. I know from shadowing care home assistants in my constituency that commissioning by the minute can cause considerable problems. For instance, it does not allow the staff to meet the individual needs of those who are most desperate for help and support. As I have said, we welcome many of the proposals in the White Paper, but they need to be properly funded, and that is why I am so concerned that the issue of long-term care funding has been kicked into the long grass.

The second reason why the Government have failed on this issue is that the Health Secretary’s obsession with reorganising the NHS has been a disastrous distraction. Two years have been wasted on an unwanted and unnecessary reorganisation, when everyone should have been relentlessly focused on the key challenge of our ageing population: meeting rising demand for care at a time of unprecedented financial pressure.

The third reason is the most fundamental of all. Many Conservative Members have still not grasped the basic principle that we must collectively and universally pool the risks of facing catastrophic care costs, as we do in the NHS, in order to make things better and fairer for us all. A voluntary system that leaves it up to individuals and their families alone will not work. The only way forward is through an effective partnership between individuals and the state.

[Kelvin Hopkins]

I agree with what my hon. Friend is saying. The Government keep on talking about consensus, but the problem is that we say yes to Dilnot, but they do not. If they were to say yes to Dilnot, we might have a basis for consensus.

[Liz Kendall]

We remain serious about trying to achieve cross-party consensus. If one party comes forward on its own and proposes a controversial and difficult decision, that always leads to a political fight; we saw that only too clearly before the last general election. However, we need cross-party consensus because this is a long-term challenge. We have to try to get agreement so that, whichever party is in power, people know there is a system that they can understand and pay for in future.

Government Members have criticised Labour’s record in government, but we are proud of our achievements on social care. We increased spending by 53% when we were in government. We helped drive up quality through national performance assessment of local councils and independent inspection of care services. We championed integration, with new legal powers for the NHS and local councils to pool budgets, and new care trusts jointly to commission care. Those care trusts will be swept away under the Health and Social Care Act 2012. We supported carers through the carers grant and new rights for carers. We introduced the first ever national dementia strategy, and we backed improvements in housing through the Supporting People programme and extra care housing. [Interruption.] The hon. Member for Reading East (Mr Wilson) mutters from a sedentary position that that is not real action. He should try telling that to the carers we supported through breaks that are now under threat, and the people who have benefited from extra care housing and the Supporting People programme, which his Government have cut by 12%.

We understood that we had much further to go, however. That is why before the last general election we published plans for fundamental reform, including difficult decisions on how care should be funded. We tried to get cross-party agreement. We did not succeed, but we are determined to try again now.

A year ago, my right hon. Friend the Leader of the Opposition made an open and sincere offer of cross-party talks, and it is a matter of genuine regret that the Government unilaterally decided to publish their own progress report on funding, rather than the joint report we had wanted to agree. Labour remains committed to serious and meaningful cross-party talks.

I hope that the Minister will tell the House whether the Government will commit to addressing the current funding gap as well as future reform. Andrew Dilnot says that that is vital. Will they also set a clear timetable for reform, with legislation on funding reform in this Parliament, as Labour has called for? Will they agree to include their Treasury team in the talks, which Labour has offered from the start?

Social Care Funding

Debate between Liz Kendall and Kelvin Hopkins

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.