Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Debate between Luciana Berger and Marcus Fysh

Monday 2nd July 2018 Commons Chamber

[Mr Marcus Fysh (Yeovil) (Con)]

It is a pleasure to follow the hon. Member for Crewe and Nantwich (Laura Smith), who made some interesting points about adult social care. I have similar issues in my constituency, where one of the main care providers increasingly sees private clients effectively subsidising local authority provision. The gap between the costs has been getting wider and wider. The concern of many of my constituents is whether they will be able to afford private care if public provision is not forthcoming.

It is also a pleasure to follow the hon. Member for Dulwich and West Norwood (Helen Hayes), who spoke about King’s College Hospital. My father was a registrar in neonatology—he is a paediatrician—at King’s in the 1980s, so it is a hospital that I know well, and I am sympathetic to the challenges of an inner-city area. In my area we have a rural district hospital, which is very high quality and gets very good results, and the people there do an outstanding job. The hospital is in deficit and has been part of the vanguard transformation initiative, which has meant extra costs. Sometimes the benefits of working in new ways do not show in the money saved initially, because we have to wait for wider population health outcomes to be able to judge that.

[Luciana Berger]

The hon. Gentleman raises the important issue of how we transform care to ensure that we do the very best for patients. Does he share my concern—this was raised by the National Audit Office only last Friday—that the vanguard programme has not delivered the depth or scale of transformation in service that was intended? Part of the reason is that there are not enough funds in the rest of the NHS to ensure that the transformation that we want to see can actually occur.

[Mr Fysh]

The hon. Lady makes a good point. It is about trying to understand when the effects will show up. Often what we have to do in the meantime is to run two parallel systems, in order to get one up and running, and that can be challenging. I welcome the extra money for healthcare but, as I said on Wednesday, we really should not allow it to crowd out other types of spending, particularly local government spending, which we have heard about in relation to social care.

In Somerset, the Conservative county council has undertaken nine years of efficiency savings. It has cut a lot of money out of its budget, but we are getting to the point where further cuts will make a significant difference to people’s lives and the provision of services. The Liberal Democrats left the county with nearly £400 million of debt. The repayments are £100,000 a day, which is really disappointing because we would much rather spend that money on services for the public. The county really needs about another £20 million. Ministers should look at whether the virements in the estimates are enough. I would like the amount in paragraph (2)(c) to be increased by £20 million to fund the very serious gap the county will otherwise have to make up through serious cuts to real people’s services.

It is worth highlighting the plight of children’s social care. The county has made great strides to deal with issues and modernise the service—it has spent a lot of money doing so—and that is an ambition we should all espouse. The difference between children’s social care and adult social care is essentially that adult social care gets cross-subsidised by private clients, as I said, and to some extent by its integration with the healthcare system. What does not really happen in children’s social care is the same level of integration or thought about how the education service integrates with it. In Somerset, we have very high transport costs for children who wish to be educated in Somerset but are placed outside it, for example in Bournemouth. That is something that we need to address.

The reality is that overall Somerset needs more funding. It needs fairer funding, because it is still massively underfunded relative to urban and other areas. On how to pay for that, we have heard good points about why we should not automatically look to tax rises. Public spending has come in under estimate, so there is scope at the moment for a bit of extra deficit funding. Given the fiscal and monetary tightening around the rest of the world that is taking some of the heat out of western economies, I think that would not be frowned upon. Local government funding in Somerset would be a very worthy recipient of such flexibility.