Care Bill [Lords]

Meg Munn Excerpts

Monday 16th December 2013 Commons Chamber

[Hazel Blears (Salford and Eccles) (Lab)]

I should like to begin by quoting one of the Alzheimer’s Society’s ambassadors, Arlene Phillips. Talking about her father, who had Alzheimer’s, she said:

“I did everything I could to care for my dad when we discovered he had dementia. Unfortunately, the efforts of one person—or even a family—aren’t always enough. It soon became clear to me that while I could keep Dad safe when I was by his side, I couldn’t be there every minute of every day.”

The words of Arlene, and thousands like her, should provide all of us in the House, irrespective of party, with the greatest incentive to act to support those people who are suffering and need care and, crucially, their carers and families, who are the backbone of the social care system in this country.

A society should always be judged by the way in which it looks after the most vulnerable people in its communities, and it is safe to say that, over the years, we have all failed that responsibility. Today is an opportunity for us to acknowledge that, and to point out that, even today, in a modern 21st century developed industrial nation, we are still failing the people who ought to get a great deal more support and care from us than we are currently in a position to give.

The Bill is a small step forward, rather than the giant leap for mankind that I would have liked. One of the central issues is a lack of ambition. We face the biggest social challenge that any of us could possibly see, yet the Bill’s provisions, some of which are well meaning, do not, when taken together, add up to a whole system’s series of changes that result in a basic reconfiguration. The right hon. Member for Charnwood (Mr Dorrell) spoke about that, and I pay tribute to his championing of integration, change, re-engineering and being ambitious. I do not see that in this Bill.

Instead, I see some perverse incentives. If we are talking about the well-being duty and the duty to prevent, reduce and delay somebody’s need for care, how can we say that we are going to support only people with substantial and critical needs? How are we going to engage the system further up the chain, with people who are beginning to suffer, perhaps beginning to have memory problems and beginning to need social care? How are we going to incentivise the system to invest in the new commissioning in clause 5, which talks about diversity and shaping the market? How are we going to get the system to focus on that if all the focus, after £2.85 billion-worth of cuts in social care, is on how we might manage to look after the people with substantial and critical needs? We should be focusing far more upstream in the system.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

As my right hon. Friend has said, the backbone of care in this society is provided by friends and family. Should we not be moving towards a system that incentivises the people currently giving care to continue to do so for as long as possible by supporting them at the lowest level, not at the highest level?

[Hazel Blears]

My hon. Friend makes an extremely powerful point. I am pleased that the Bill strengthens support for carers. I draw the House’s attention to the Bill introduced by the other Member for Salford, my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), which seeks to make sure that carers have the right to stay in work and the support to be able to do that. We must consider the cost to our economy of people having to give up work in order to care. We have talked a lot today about perverse incentives and false economies, and that has absolutely been a false economy for a long time.

I wish to say a word about diversity of provision and commissioning new models of care that can help with prevention. In my city we have been working on that for a long time, and I look forward to showing the Minister some of our examples when he visits. Social adVentures is a social enterprise that helps people with mental health problems, and one of its projects is “garden needs”. It has taken control of a garden centre, and people with dementia and people with mental health problems are now attending. The way it is keeping people active in the community and able to do many more things than they would if they were isolated and at home is amazing. Unlimited Potential is another fabulous social enterprise, which stands on its own two feet, is not grant-dependent and is able to invest more money back into the community. Last week, I had the pleasure of launching a website called Really Useful Stuff, which is just what it says on the tin—it is a website where people can get aids, adaptations and kinds of social care that are modern, innovative and creative. Those are just a few examples of what is already happening in the community.

I say to the Minister that at a time when money is tight, and will be, no matter which Government are in power, the imperative to innovate and be more creative with the funds we have has never been greater. Therefore, investing, in particular, in the social enterprise sector, which often has these great ideas, and in enabling those ideas to get to scale so that provision can be made across the country, is really important. Another company in my constituency, 2ergo, has recently developed an app for the iPhone where people can see what provision is available in Salford for care, respite care and activity, and how to book it. They can book it over their iPhone—families can do that; they can help the people they are caring for. So this use of new technology is now developing apace, and, again, we have to take advantage.

I commend the Government for organising the G8 summit last week in London—an amazing event where we gathered support from countries across the world. I hope that next year we will be able to expand that to a global event examining dementia, not just one involving the G8 developed countries. Part of that G8 meeting was about how we get more research. I would like to see far more research on the quality of care. There is a lot, but not enough, research on the bioscience, but hardly any research on the interventions we do, particularly for people with dementia. We all know that “singing for the brain” has a great reputation. It helps cognitive development, as do art, drama and reminiscence work. There is no evidence base behind that, so if we are to have a better system of social care, we need better research into therapeutic interventions that work. That will enable commissioners to commission packages of care that they know will make a difference. If money is tight, we need to spend it on things that we know will be effective, and I ask the Minister to support that.

The Alzheimer’s Society has also done a lot of work on dementia-friendly communities. That is not expensive. It is a matter of mobilising the good will of local people, shops and arts centres. In Salford, a taxi firm has trained 400 drivers to look after people with dementia. Such care does not cost a lot of money if we can mobilise ordinary people in their communities. In Japan, 4.5 million people are signed up to be dementia friends. Our ambition is to have 1 million such friends. Again, I push the Government to be more ambitious to see what more we can do.

Clause 5 is about not just diversity and shaping the market, but quality, and that is an area about which we all feel passionate. How can we in this country tolerate a situation in which those who do the most difficult job in caring for our friends and family are actually some of the least regarded workers? It is utterly unacceptable to have zero-hours contracts in the social care sector. The carers who care for my dad come in for 15 minutes. They will do more if they can. They have to ring up to be assessed when they have done 12 minutes. They get no payment for travelling and no expenses for their petrol. They came out one Sunday. They started at 8 o’clock in the morning and went home at 9 o’clock at night, but because they only had five hours of 20-minute slots, they got paid only for five hours. Members should try being out on a Sunday for 13 hours and going home with five hours of minimum wage payment. It is an absolute disgrace and a scandal that we tolerate that in this country. I hope the Minister will assist in bringing such practice to an end.

I want to say something about my own local authority. My hon. Friend the Member for Worsley and Eccles South mentioned the fact that Salford has recently had to change its eligibility criteria from moderate to substantial and critical. We were the last authority in Greater Manchester to have to make that decision, and it was heartbreaking. Our social services have always merited four stars. When I was a councillor 30 years ago, cuts were bad, but we always prioritised social care and nursery care for children. The decision to change the criteria was not made lightly, and the cuts have been absolutely horrendous.

Let me again say to the Minister that we need creativity and imagination to deal with this matter. I want to draw the House’s attention to my unpaid interest in social finance, which appears in the Register of Members’ Financial Interests. We have a real opportunity to draw extra funds into the social care system. If we could have a social investment bond that aimed to keep people with dementia in their own homes for longer, we would save the NHS a fortune. People with dementia are admitted to hospital more often. They stay longer in hospital and many more of them die there. If we could mobilise social investment to offer a reward for keeping people in their own homes, funded by the savings to the NHS, we could bring in some new money, not just what we are getting from local authorities.

--- Later in debate ---

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Members on both sides of the House agree that we need to reform and improve how we provide care to those who need it. In the words of the Law Commission, our current legal framework is a complex and confusing patchwork of legislation that is in desperate need of modernisation. However, the premise on which part of the Bill is based is simply outdated. It tries to focus the debate on residential and nursing care costs, which directs our view of care on to issues of the previous century when this should be a Bill for the landscape of the 21st century.

Only a small percentage of older people need to be in residential or nursing care and, thankfully, most of them for only a relatively short period at the end of their lives. Most people want to stay in their own homes if they can. Consequently, it is right to develop care services that make that happen, such as ExtraCare homes, whose options for meals and support for residents can change as their needs change.

Our care system is there not just for when people hit crisis point; it should be preventive, ensuring that those who need moderate care and support can receive it in their own homes. Yet, as we have heard time and again in this debate, because of the Government’s savage cuts to local authority funding, 85% of local authorities now provide care only to those whose needs are assessed as substantial. If the level is also set at substantial in relation to the proposed national eligibility criteria in clause 13, people with moderate care needs will continue to be ignored. Their needs will inevitably move to severe, which will mean even greater cost to both the individual and the state. My hon. Friends have given examples of that.

As has already been said, the vast majority of care in this country is given by family and friends, who provide not just physical care but emotional support. Most do so willingly, but many would benefit from some support through the provision of low-level services, such as a sitting service to allow them time to themselves, or a cleaning service to allow them to concentrate on providing more personal help. Put simply, a small amount of support for those whose needs are at a lower level would lever in a large amount of care by families, who would also be enabled to continue to provide support over a longer period, so saving on much more expensive services.

[Robert Flello]

On the theme that my hon. Friend is developing, quite a lot of carers are almost borderline in their need for care themselves. What is her view of the fact that without that extra bit of support for carers’ needs, there may be the double hit of two people needing care from the state?

[Meg Munn]

My hon. Friend is absolutely right. I managed care services when, not the previous Government but the one before that, brought in a health and social care Act. Within the first six months, we found that every single person who ended up in residential care did so because of carer breakdown, as the carer was not getting support. That is why this support is such an important part of what we should deliver.

Care services must be personalised: they have to be about choice, as well as need. If we are to make such personalisation a reality, we need further integration of our health and social care services. The duty on local authorities under clause 3 to promote the integration of care and support with health services does not go far enough in that respect. Indeed, a recent survey of health and wellbeing boards found that most local authorities have not identified integrated care as a priority. Clearly, we must do more to drive forward the development of integrated care. Without such an approach, we will return to the days that I remember well, when there were fruitless arguments about whether a service such as bathing was required on social or health grounds.

The integration of health and social care services is crucial to ensure that we provide carers with sufficient support. As a patron of Sheffield Young Carers, I feel privileged to have seen at first hand the selfless role that even very young carers undertake in our communities, and they should be valued.

As has been said by the right hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), the Bill places a duty on local authorities to have regard to the importance of identifying carers, but that is not good enough. Some 80% of carers have contact with a health care professional, and it makes absolutely no sense to leave the NHS out of the duty to identify carers.

That matter is especially worrying as regards young carers, who quite often need a lot of support. The Children and Families Bill will strengthen young carers’ rights by providing that when a child is identified as a young carer, the needs of everyone in the family should be considered. That of course presupposes that young carers will be identified in the first place. If we do not place a corresponding duty to identify carers on health authorities, we risk young carers falling through the gaps, and we cannot continue to leave them without support.

My remarks would be somewhat lacking if I did not refer to the funding or, perhaps more accurately, the lack of funding that underpins our social care system. The proposals outlined in the Bill primarily concern redistributing the costs of care, and they will not bring any extra funding into the system.

[Bill Esterson]

My hon. Friend is making an absolutely crucial point. Does she agree that unless investment in social care is made now, it will end up costing far more in the cost of the NHS, as well as that of social care? It is the lack of ambition, as well as the lack of finance, that is really disappointing in what the Government are introducing in the Bill.

[Meg Munn]

I agree. The demand for services is now greater than ever. Our social care system is being cut to the point of breaking. As has already been discussed, should the proposed health funding reallocation for clinical commissioning groups be implemented, the situation will only get worse. South Yorkshire is due to lose £150 million by April 2014. That is staggering given that, under the proposals, other parts of the UK that already have better health outcomes and longer life expectancy will receive an increase in funding. This Bill seeks only to ration scarce resources; without a completely different approach, we will fail to meet proven need.

As a former social worker, I welcome clauses 42 to 47, which introduce a duty on local authorities to make inquiries when they suspect that an adult is at risk of or is experiencing abuse or neglect. Yet no duty is placed on care providers to report suspected abuse or neglect to the local authority. The Government contend that the present guidance is sufficient, but I disagree. In the light of Winterbourne View and Mid Staffordshire, we cannot afford to have such gaps in protection.

A recent Care Quality Commission report stated that our accident and emergency departments see 500,000 elderly victims of neglect. I am therefore far from convinced that enough has been done to address the issue. Where victims of abuse are imprisoned in their own homes by a perpetrator who denies access to adult safeguarding staff, there are no current legal means by which access can be achieved. An amendment was tabled by the noble Baroness Greengross in the other place to enable a social worker to apply for a court order to access an adult at risk. Between now and the Committee stage, will the Government reflect on that matter and introduce something to address that gap?

The Bill is an opportunity for much-needed reform of our health and social care system, but in its current form it does not make the changes that we need. For that reason, I fully support my right hon. Friend the Leader of the Opposition’s reasoned amendment.

I apologise, Madam Deputy Speaker, that I will have to leave very shortly to read in a carol service.

--- Later in debate ---

[John McDonnell]

I think Mr Kaye would like me to press that at some stage during the Bill’s progress. His view is that they should be regulated in the same way as others, and that there should be appropriate inspections as well. I understand the difficulties, particularly in terms of family relationships with regard to carers. I understand the subtleties of that, but there does seem to be a gap in the Bill as it stands. I might want to look at that in Committee, and certainly on Report.

The second point is that I believe that in the other place Baroness Greengross or Lady Greengross—I am never sure of the titles of the bourgeoisie—moved an amendment to cover the whole range of abuse. That was partly a response to the lobbying for abuse by carers to be properly covered by this Bill. I hope the Government’s attitude is that the amendment will remain in the Bill. I am happy to give way again to the Minister if he wants to respond; perhaps he will do so later.

The third point Jonathan wanted me to raise was about assessment and reassessment. I do not know what other Members find in their constituencies, but I find that the process of assessment can be extremely difficult—first, getting an appropriate person who can do the assessment, then getting that appropriately skilled person to do the assessment, and then the bizarre continual reassessment after reassessment that amounts almost to harassment. Some people with severe disabilities —with permanent conditions who, to get a cure, would need a trip to Lourdes, to be frank—get reassessed time and again. That becomes worrying for them, and some individuals can lose some element of their benefit through this process.

[Meg Munn]

I have a great deal of sympathy with what my hon. Friend is saying. In my experience there seems to be a tendency of wanting to assess people and then reassess them, rather than putting effort into providing services for them. If we quantified the time that goes into assessment as opposed to provision, I think we would see some way in which we could shift some of these very scarce resources into helping people properly.

[John McDonnell]

I was with a constituent last Friday and the issue under discussion was disabled facilities grant. Again, there seem to be more assessments and more spent on assessment than on getting the work done at times. There needs to be a clear understanding of the issue of permanent conditions and how we can make sure people do not have to go through the trauma of assessment

That brings me on to the issue that was raised by Age UK—I apologise if others have raised it before—which is about the individuals who will do the assessments and the level of their qualifications and of their specialisms. My whole community has been traumatised by what happened with the Atos assessments, and I would not want to see another process implemented in the same way under this Bill. Age UK wants us to ensure that appropriate assessments are carried out by appropriately skilled and qualified assessors.

That leads me to a further point, and I apologise if others have already raised it. Part of the issue for people who have to undertake the assessments is ensuring that they have the right advocacy support. In my area, we have DASH—the Disablement Association Hillingdon—which provides excellent support and advocacy, but it is struggling, as is every other voluntary organisation in the area, as a result of local government cuts and the demands and challenges that are placed on it. It is important that, as we introduce this legislation, we look at the role of advocacy and the importance of supporting it through appropriate funding from local government and elsewhere.

I want to talk briefly about the report from the personal social services research unit. It was mentioned by my hon. Friend the Member for South Shields (Mrs Lewell-Buck), whose superb speech set out, drawing on personal experience, exactly how many of us experience the services of carers. I am not sure whether other hon. Members have gone through this matter in depth in the debate today. If they have, please will they intervene to tell me, so that I do not need to go through it again?

The report has usefully confirmed all that we have experienced and understood anecdotally in our constituencies. Even I was shocked at some of the statistics that it contained. The report was produced by the personal social services research unit of the university of Kent and the London School of Economics, and it is an objective assessment of expenditure and of the numbers of people receiving services from local authorities between 2005-06 and 2012-13. Its findings confirm what most of us have experienced in our constituencies—namely, that there have been

“widespread reductions in the period 2005/06 to 2012/13 in both the observed and standardised estimates of number of adults receiving state-funded social care services”.

It also found:

“Across all user groups, approximately 320,000 fewer people received local authority brokered social care in 2012/13 than in 2005/06. This represents a 26% reduction in the number of recipients of care.”

If we look at the standardised assessment, we see a

“decrease of 453,000 (36%) individuals being served”.

That reflects what I am finding in my constituency. People who should be receiving a certain level of care and who would previously naturally have received it are no longer doing so. The report goes on to state:

“Reductions in the number of clients are particularly acute for older people; 260,000 or 31% fewer older people received services in 2012/13 than in 2005/06…The standardised estimate of reduction was greater: 333,000 or 39% fewer clients.”

That means nearly 40% fewer older people are receiving services now than five years ago. The report goes on:

“Approximately 37,000 or 24% fewer adults aged 18-64 with physical disabilities received social care support in 2012/13 than in 2005/06. The standard estimate showed a reduction of 50,000 or 33%. A reduction of 30,000 (21%) was observed in the number of service recipients aged 18-64 with mental health problems.”

I find that staggering but, at the same time, it reflects what is happening in our constituencies. Why is this happening? It is fairly straightforward, really. It is a result of the cuts that local government is experiencing.

Although the report covers the period between 2005-06 and 2012-13, it emphasises that the vast majority of the cuts have been made in the past two years. The coalition Government have brought forward this level of service withdrawal over a very limited period of time. According to the report,

“our analysis suggests a drop in need-standardised net social care expenditure between 2005/06 and 2012/13 of approximately £1.5 billion…Moreover, almost all reductions in expenditure are concentrated in 2010/11 and 2011/12.”

That is a cut of £1.5 billion overall. It goes on:

“The largest reduction in expenditure levels is concentrated on services for older people”.

That again reflects the anecdotal evidence that we can bring back from our constituencies. The report suggests that there has been a £1.6 billion cut in services to older people. This is not a party political point; this is independent, objective research, which we should all take on board in the debate as it goes forward.

The report continues:

“For adults 18-64 with learning disabilities”—

there has been—

“a significant increase in observed and standardised expenditure in 2012/13 relative to 2005/6 worth just above £1 billion”.

So there has been some increase in some areas but dramatic cuts in others. Worryingly, the cuts seem to be focused on older people and those with mental health problems. The interesting thing is the point made by my hon. Friend the Member for Edinburgh East (Sheila Gilmore) and others about how this is disproportionate; it is not being done right the way across the board, and the impact on areas is geographically uneven. It appears that the most deprived areas are being hit the hardest.

The report said:

“Approximately 95% of local authorities in England were observed to have reduced the number of older people receiving services in the period…Of these, the number of older people receiving services had fallen by 40% or more in approximately a third…of authorities.”

So this is focused on a limited number of local authorities, and again it appears that they are the most deprived. I find that extremely worrying.

Although we welcome the Bill as a first step, as others have said, Dilnot did make it clear to all of us that the social care crisis has to be addressed before we move on to other changes in legislation, or at least simultaneously. Introducing new legislation when the Government are introducing this scale of cuts will completely undermine the credibility of the new legislation. That is why I hope that as part of the debate as the Bill moves forward we can reach a consensus on not only the legislation—where I hope we can take on board some of the points made in the reasoned amendment—but on the level of investment required over the coming period if we are to support the most vulnerable in our society.

The study I mentioned is objective and it reflects what I am experiencing in my constituency surgery on a weekly basis—I believe it is the same for other Members of all political parties. The social care services in our areas are under intense stress and, as a result, people with even critical and substantial needs are not being addressed—those with moderate needs, which are still significant and should be within the system, are being ignored completely. We need to address this matter with some seriousness now and try to reach some all-party agreement on the way forward, not only on the Bill, but on the investment strategy for care needs.