Social Care

Maria Caulfield Excerpts

Wednesday 16th November 2016 Commons Chamber

[Barbara Keeley]

It is indeed. The gap in my Salford local authority area is £1.1 million. We can raise only £1.6 million from the social care precept, while just paying the national living wage in the care sector is costing us £2.7 million.

Let me return to the matter of where the promised funding sits. In our motion, we call on the Government once again

“to bring forward promised funding”

for 2019-20

“to address the current funding crisis”

in social care. I am sure that the Health Secretary hears plenty about the impacts on the NHS of the missing funding for social care, but let us also think about the impacts on the people who actually need that care.

The hon. Member for Faversham and Mid Kent (Helen Whately) mentioned the thousands of patients stuck in hospital. We should be aware that keeping them there longer than necessary can have a number of detrimental effects. Long stays can affect patient morale and patient mobility, and of course increase patients’ risk of catching hospital-acquired infections.

Effects on mobility can be particularly keenly felt by older patients. As Professor John Young said in the 2014 national audit of intermediary care:

“A wait of more than two days negates the additional benefit of intermediate care, and seven days is associated with a 10% decline in muscle strength.”

As my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, observed when the Committee published its own report on discharging older people from hospitals:

“Delayed discharge is damaging the health of patients and that of the public purse.”

Cuts to the funding of social care also affect a larger group of older and vulnerable people, and those cuts are now having a major impact on family carers. Age UK estimates that more than a million older people in England are living with unmet social care needs. I was struck by what the Unison staff told me about the many people they see during their care visits who are lonely and isolated.

Social care services have clearly failed to keep pace with increasing demand. Carers UK tells us that the drop in social care support, in the context of the increasing needs of our ageing population, is having a profound impact on the unpaid family carers who are stepping in to provide more care than ever before. It also tells us that the increase in the number of people providing care, and the increased number of hours of care that they provide, are being delivered at a huge personal cost to those family carers if they are not well supported—as, in all too many cases, they are not.

[Maria Caulfield (Lewes) (Con)]

The hon. Lady is making a case for more funds for social care. May I ask how the Labour party would raise that money? Would it give more to local authorities, or would it increase council tax precepts further?

[Barbara Keeley]

Our motion asks for promised funding that is backloaded to 2019-20 to be moved forward. The LGA and ADASS wanted it to be moved last year, and that is what we keep asking for.

--- Later in debate ---

[Maria Caulfield]

I thank the hon. Lady for giving way again; she is being extremely generous. Will she tell me, however, whether she is committing her party to delivering that money to local authorities directly, or to allowing them to increase their precepts?

[Barbara Keeley]

We do not even know what the Chancellor is going to do next week. The hon. Lady has invited me to make a declaration today, and it was a nice try, but we did not hear a word from Ministers about their plans during Health questions yesterday. I will, however, make what I think is an important point to the hon. Lady and to any other Member who raises the same issue. Labour would not have put our councils in this position to start with. If the hon. Lady looks back at our spending plans, or looks at the analysis by the Institute for Fiscal Studies relating to the different parties, she will find that our plans meant that we did not have to make the cuts that her party has made. This Government’s cuts will take £5 billion out of social care. I will send her the link to the IFS analysis if she wants to read it.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I shall not be supporting the motion. While I agree that there are pressures on social care, the answer is not just financial. As many Members have pointed out, notably my hon. Friend the Member for Totnes (Dr Wollaston), we need to change the system and combine health and social care.

I have worked in the NHS for more than 20 years, and I still work as a nurse. I have always found it odd that health and social care are delivered separately, funded separately, and seen as separate entities. When I trained over 20 years ago, we were taught to treat people as a whole, not to treat them in terms of their social care needs or their health needs. I have spent most of my time working as a nurse in a hospital, and it is very different there. If someone needs personal care—if they need washing or feeding—we just get on and do it because we are looking after that patient as a whole. When patients are discharged home, they get their healthcare needs and medication delivered by the NHS, but if they need feeding, washing or dressing, they have to wait sometimes for many hours for someone else to provide that separately. I find that increasingly difficult to see.

Healthcare and personal care in hospitals is delivered by trained nurses and healthcare assistants who have had much training and are very well respected and valued. Personal care, however, is often delivered by people who are paid less than the living wage and who very often have had little or no training. Is it any wonder that this goes wrong, and that people are readmitted into hospital after ending up at home with healthcare problems? It is no wonder at all that we are facing this issue, and that is because the system is not working, not necessarily because there is not enough finance.

We need to appreciate the skill involved in social—or what I call personal—care. Washing someone is not just washing someone; if a person’s health needs are being looked after properly by a highly trained nurse who washes them, they will be checking whether they have eaten and taken their medication, and whether they are a little more confused today, and if so, why? Is a urinary tract infection brewing? Are their opiates too much? Are they hypoxic or constipated? There might be a whole host of reasons, and that nurse gets on top of those things and keeps that person well. Without that knowledge and skill, delivering social care on the cheap is never going to work.

We have seen hard evidence of this today from a pan-European study that says that the risk of a patient dying in hospital increases by a fifth for every nurse replaced by a healthcare assistant. I am sure if that study were extended to social care and into the community, those figures would be even worse. There has been an historical undervaluing of social care, which has been the Cinderella service in the care sector. I believe we should stop referring to healthcare and social care and just call it care.

The answer is not just to throw more money at the problem. I agree that money is needed, but the answer is to combine both things: health and social care need to be jointly commissioned, jointly paid for and jointly delivered. Currently, social care does not work for patients. They often have multiple visits—four or five visits in a day by four or five different people, with one person who can give them their medication but is not allowed to wash them, and the next person who has to say, even if they need medication, “Sorry that’s not my job. You’ll have to wait for your next visit.”

We heard from a previous Labour Secretary of State, the right hon. Member for Leigh (Andy Burnham), that attempts have been made to join health and social care together, but these have not made progress. I congratulate the Government on bringing forward sustainability and transformation plans and the better care fund in an attempt to make that difficult transition to merging health and social care. We are hearing about the progress that is being made, and the Secretary of State said that in places where this is starting to work admissions are dropping by 40%, which is welcome.

I passionately believe health and social care need to be combined. That will improve outcomes and reduce spending and admissions, but most of all it will improve patient care. The only way forward now is to be bold and brave, and when we have groups such as the King’s Fund with its Time to Think Differently programme recommending this as a new model of care, we have to move swiftly.

I cannot support this motion. While I believe that social care is under huge pressure, finance is not the only answer; we need a combined service, and we need to free up healthcare professionals to look after their patients holistically and free up bodies such as CCGs to commission services jointly. I support the Government’s efforts in trying to do that.