Social Care: Funding

Lord Beecham Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Beecham (Lab)]

My Lords, I refer to my local government interests and I congratulate the noble Baroness, Lady Brinton, on securing this debate. When I chaired Newcastle’s social services committee in the 1970s, we trebled the meals on wheels service and doubled home care provision. We created a welfare rights service—one of the first in the country—that is now helping citizens in Newcastle to receive £8 million of benefits, and we improved residential care. Forty years on, we see a service struggling to cope with the growing needs of an ageing population, while the council’s budget, like those of councils up and down the country, has suffered savage cuts. Never before in a long political life have I witnessed Conservative councils, and the national local government bodies they lead, being as critical as they now are about the policies of a Conservative Government and their impact on local authorities and communities.

The funding cuts have been dramatic. Critically, they include £890 million in preventive services, including measures to avoid the need to admit people to hospitals, thereby adding to the problems of a radically overstretched NHS. Yet the Government expect councils somehow to reduce the number of what are described as “social care attributable delayed transfers of care”. As the LGA points out, such delays are a symptom of the problems of pressure on the NHS, not its cause. Even if the funding gap were closed, this would still leave the service significantly less well funded than in 2010, before taking into account the increasing demand of an ageing population and greater recognition of the need to tackle issues such as mental health in adults and children, which have manifested themselves increasingly over time.

Meanwhile, the Association of Directors of Adult Social Services points out that, in addition to an extra £2 billion by 2020,

“just to stabilize the market and to enable key statutory duties to be fulfilled”,

an additional 29%—£3 billion—would be required to bring social workers’ pay into line with their NHS counterparts. The 1.5 million people working in social care, as the association states, deserve such parity of esteem and should have a common structured training programme and a defined career pathway.

There are also issues, as the LGA points out, with the public health budget, which has also been hit hard, with cuts of £200 million a year and plans for a further reduction of £331 million. Such cuts, in what is essentially a preventive service, are likely to generate more demand for the NHS and social care, in addition to impacting on the lives of those the service should be protecting and enhancing. Furthermore, the early intervention grant has been slashed by £500 million since 2014, with an anticipated further fall of £183 million by 2020.

The prevention of hospital admissions per se demands a higher focus. The LGA cites evidence from a Public Health England report on falls prevention, demonstrating that for every £1 spent on assessing the home and modifications for elderly people—I declare my interest in that respect—£2.17 is saved on primary and secondary care while reducing hospital admissions by 23%. Of course, this group is growing. As Age UK reports, 1.2 million—12.5% of the age group—are living with unmet care needs.

Alarmingly, less than a third of directors of adult social care are confident that their authorities will meet their statutory duties this financial year. Councils and other providers, including charities, have hanging over them potentially large claims for payment of the national minimum wage for care workers on sleep-in shift, with HMRC pursuing providers for up to six years’ back pay. Charities estimate that HMRC could be seeking as much as £400 million to meet this bill. Given that the Government instructed local authorities to make such payments only as recently as last July, will they meet this cost? If not, what is their estimation of the impact on councils and providers?

The sector, as ADASS has pointed out, is fragile, with the percentage of the budget of county and unitary authorities spent on social care rising from 34% in 2010 to 38% now. There is concern that the growth in the number of older and younger adults with complex needs is likely to cost an additional £448 million this year. In addition to that, the so-called national living wage will cost around £585 million—essential if quality staff are to be retained and recruited. On top of all this, the expectation is that by 2025 another 350,000 people will need high levels of social care from councils.

Moreover, although the return of public health some five years ago from the NHS to local government and Public Health England is welcome, there are profound concerns about funding. Councils suffered a £200 million cut five years ago and now face a further cut of £331 million, while the early intervention grant faces a further cut of £183 million by 2020, in addition to the £500 million cut since 2013. At the time, the Conservative-led Local Government Association protested that this risked underresourcing councils in delivering early support to the children, young people and families who needed it most. It warned that councils would be,

“less able to provide support for children and families affected by disabilities or existing/potential development delays”.

All of this will surely generate greater needs and greater costs.

In Newcastle, where we are losing £280 million a year, the number of people receiving home care has fallen from 3,000 to 2,000, while adults with learning difficulties are getting four hours less of support per week. We have 71 fewer social workers than in 2014—a 12% reduction—while there has been an 86% increase in the number of safeguarding alerts. The Government have belatedly announced an increase in funding for the NHS, albeit less than is needed. When will they realise the need to increase funding for social care substantially, which would contribute to reducing the burden on the NHS? I join Sir David Behan, chief executive of the Care Quality Commission, in,

“calling for a bold and courageous settlement for future social care because we must address the quality and experience of care that older people receive”.

I would add all other people in need of such care to that.