Queen’s Speech

Lord Smith of Leigh Excerpts

Tuesday 15th May 2012 Lords Chamber

[Lord Smith of Leigh]

My Lords, this is the first occasion for more than a year that I have spoken in your Lordships’ House, because in March last year I was taken seriously ill. Thanks to excellent medical care from Wigan Infirmary and particularly the Christie Hospital in Manchester I am back and in reasonably good health. I have always taken an interest in health in your Lordships’ House because of my role as a local authority leader. I declare that interest as well as my vice-presidency of the LGA. Of course, my own experiences have reinforced my belief in the need for good healthcare. This was my first time in hospital since I had my tonsils out at the age of four, and the passion I feel now for the NHS was reinforced by the experience.

I was pleased that the Queen’s Speech had something in it about social care; I thought that at last we were tackling the issue. Of course, when the details came out we saw what was involved in the proposal—a draft Bill on eligibility. We know that it is necessary, but given the scale of the problems and the financial crisis in social care, it is woefully inadequate. I hope that the coalition will not hide behind this approach and try to dodge the issue of long-term funding in healthcare.

The current system of social care is not fit for purpose. As the noble Baroness, Lady Tyler, said, its operation is incoherent and a mystery to many people. Clients and families do not understand the system, what they are entitled to and why there are so many unacceptable variations between different areas. For one in 10 people who need social care, it has a catastrophic financial impact. We need to make sure that we do something about that. The fears that people have about growing old are something that we ought to tackle in a proper manner.

Clearly, the financial squeeze on local authorities is the main problem. The increase in the budget for social care that we have seen over the past decade has lagged well behind the increase in the whole NHS budget. This increase meant that more went to people with physical and learning disabilities—and quite right, too. However, there has been a 6% increase in the number of old people over the period. Therefore, the amount of money available for the care of the elderly has reduced in real terms. As other speakers said, the number of those aged 85 and over has increased by 25%, with associated costs because people have much more complex needs at that age.

Given demand pressures, it has been extrapolated that by 2024, all of local authority budgets will go on care. Clearly, 12 years ahead is a long time for Ministers to think; their timescale is much shorter. However, I hope that your Lordships’ House will still be in operation at that time. We cannot avoid facing up to this financial pressure. Local authorities faced grant reductions of some 25% to 30%. The LGA reckoned that in the past year about £1 billion was taken out of social care budgets. The symptoms of this financial pressure are all around us. We remember the collapse not long ago of the Southern Cross care homes. The fact that local authorities have again not increased the fees they pay to care homes has created huge financial pressures there. The noble Baroness, Lady Tyler, mentioned the home care system. When I got into local government, it was there as a backstop to give support for people to stay in their homes. Now the criteria and the allocated time levels have been reduced and it is inadequate to support many local clients in their own homes.

The greatest danger of the squeeze on social care is its impact on the NHS. If you look at the NHS, you can see an increase in the number of emergency admissions for older people. It is 12% and rising since 2005, but for people over 85, the increase has been 48%. Because people are unable to get proper care support, the length of stay in hospital is increasing. On the acute ward where I was, I observed a patient who was kept there simply because he was unable to feed himself properly. Therefore he was kept on an acute ward—with all its costs—because he could not manage at home.

Over the past decade we made considerable progress with the problem of bed blocking. We are now tipping the other way. My observation was that people are beginning to block beds because the NHS is facing its own financial crisis. Although the settlement in the comprehensive spending review has flat-lined, because of this inexorable rise in the elderly population, the NHS must find productivity savings of some £5 billion a year. Unless we get social care right, the NHS will not be able to achieve those savings. The inadequacy of the treatment of old people already in hospital was revealed by the recent Care Quality Commission report about the poor quality of care that many old people get in the NHS. It will get worse as an increased burden is put on it by the inability of local authorities and others in the social care field to do it.

We cannot continue to patch up this failing system. We have to make radical change. Many noble Lords have mentioned Dilnot and so I will not go into that. More resources are necessary but that is not sufficient to deal with the problem. We have to look at the problem in a different light and in different ways. I have been a councillor for a fair number of years and we have all talked about the need to integrate health and social care. We talk about it, but it has never happened properly. Only 5% of budgets are properly pooled across the NHS and local authorities. We need to do much more about that. We also need much more innovative approaches if we are to deal with the crisis before us.

Integration with health budgets needs to be done. We could have a single pot of health and social care budgets sent to a locality based upon assessment of need, which would not simply be age-related—although that would clearly be an important factor—but also related to the needs of the population. We need a much more joined-up approach in the way we deliver services. I suggest that the NHS needs to engage with local authorities much more in the community budget pilots, which look at innovative ways of delivering. If we want to avoid that meltdown in social care, we all as politicians, whether at national or local level, need to work together to find a solution. It is urgent and cannot go into the long grass.