Social Care

Norman Lamb Excerpts

Wednesday 25th April 2018 Commons Chamber

[Barbara Keeley]

Indeed they cannot, and given the fragility in some of these private care providers, I wonder what on earth councils are supposed to be able to do.

[Norman Lamb (North Norfolk) (LD)]

Does the shadow Minister agree that Allied Healthcare looks like the tip of the iceberg? So many care providers are contemplating getting out of the publicly provided social care market or have already done so that we run the real risk of drifting towards a situation in which people with money can get good care privately but those who do not have the money could be left without.

[Barbara Keeley]

That is almost the situation we are in at the moment. It is worth thinking about why we seem to have this issue with Allied Healthcare, given that the problem has occurred in the last few days. It was reported that Allied Healthcare’s cash-flow problems had been triggered by increases in the national minimum wage for care staff and by an £11 million bill for back pay owed to sleep-in care staff. However, Allied Healthcare is not the only provider that is facing a large back-pay bill for care workers on shift. Learning disability social care providers have warned that they will have to withdraw services or close altogether to pay the bill for back pay, placing the care of even more people in jeopardy and putting care staff jobs at risk.

This trend of closures and contract cancellations is set to continue. A recent report into residential care by the Competition and Markets Authority painted a bleak picture of the current care home market.

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[Caroline Dinenage]

What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.

[Norman Lamb]

The hon. Lady is right to pay tribute to informal carers, and indeed to paid carers, but does she not feel uncomfortable with the fact that she and all her colleagues on the Conservative side legislated with us to introduce a cap, committed in 2015 to implement the cap, then abandoned it, thus abandoning the very informal carers she says she cares so much about?

[Caroline Dinenage]

We have not abandoned the cap. The Prime Minister said very clearly that we would continue to consult on the cap, and that will come forward as part of our plans for the Green Paper later in the year. We in this Chamber often hear about Labour’s recession and how it led to some hard decisions about public spending to get the country back on track, but we often forget—

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[Caroline Dinenage]

I hope my hon. Friend will not mind, but I want to make a little progress. The fund has helped to join up health and care services so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible.

Another area where we have made significant progress is quality and safeguarding. The Care Act 2014 placed adult safeguarding on a statutory footing for the first time and established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England. Last year, local authorities in England advised more than 500,000 people how to access services to meet their care needs—this includes services provided by leisure, housing, transport and care providers, as well as voluntary groups.

Everyone is entitled to, and deserves, quality care, and we are working to improve the terms and conditions for people accessing care, to ensure that their rights are protected.

[Norman Lamb]

On the sleep-in allowance, is it reasonable to expect providers to fund these back-pay claims, given that at the time the liability was incurred commissioners and providers entered contracts on the basis of what the Government said was right in terms of the minimum wage? When the Government change the position, surely it is not fair on organisations, private or third sector, retrospectively to expect them to pay.

[Caroline Dinenage]

I understand and share the right hon. Gentleman’s concerns on sleep-ins, and will be addressing this a little later in my comments.

We have established adult safeguarding boards to help to protect vulnerable adults in our society from abuse or exploitation. They can also act as an important source of advice and assistance for those using the adult safeguarding system. This Government also introduced the toughest system of care home inspection in the world. Eighty-one per cent. of adult social care providers are good or outstanding according to the CQC, which is a testament to the many hard-working and committed professionals working in care, to whom we owe a huge debt of gratitude. The CQC regime is already having a positive impact and 82% of providers who are rated as inadequate go on to improve.

Regardless of that, there is too much variation in the quality of care. Neighbouring local authorities can have radically different success rates on care quality and we are taking steps to address that. We are working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.

We welcome the Competition and Market Authority’s recent market study on care homes. It makes difficult reading, but we have welcomed it and as part of developing the Green Paper the Government are carefully looking at all the issues identified. What is more, we have published a package of measures to improve consumer protections in the social care sector after the CMA raised concerns about unfair consumer practices in homes, including the charging of unfair fees to residents and the lack of contractual and pricing transparency.

Those measures, which include working alongside industry to develop model contracts and supporting the CQC to better hold providers to account, aim to put the power back into the hands of residents and their families. We are clear, however, that if improvements are not seen we will look to change the law to strengthen protections so that people can be treated with the dignity and respect they deserve.

That leads me to the third aspect on which I want to focus. Ultimately, the social care workforce are the backbone of the care sector. We know that there are challenges and that is why we need to ensure that they are supported to deliver the best-quality care now and in the future. Part of that endeavour involves respecting not only the compassion and dedication of care workers but the vast range of skills they have. Alongside social workers, occupational therapists and nurses, we have many care workers who could benefit from or be inspired by new career progression ladders. We need to ensure that we have enough people within all those skilled roles to support individuals and families in living their best possible lives. That means ensuring that new routes into social care professions have as much variety and value as those developed by the NHS. Apprenticeships are part of that story. I am proud that in 2016-17 more than 90,000 social care apprentices began their training. That is up more than 40,000 compared with in 2010.

Of course, pay remains a constant and often emotive issue. Care workers deserve a wage that reflects the true value of their work. The national living wage is, in part, a reaction to that and the average salary for a care worker in the independent sector has gone up by 4%, with those full-time staff on the minimum wage seeing a pay rise of up to £2,000 since 2015. We are not complacent about the economic pressures faced by many in the system, but that is a good place to start.

A couple of hon. Members have spoken about sleep-ins and they are absolutely right to raise that. The Government are committed to creating an economy that works for everyone, ensuring that workers are paid fairly according to the law, including through the national minimum wage, but we recognise the pressure that has been placed on the sleep-in sector by historic liabilities for back pay. We are carefully exploring options to minimise any impact on the sector caused by this and have been engaging with the European Commission to ensure that any response would be legal. The Government will continue to work with representatives of the social care sector to strengthen the evidence base, building on the work we began over the summer. I will, of course, keep the House informed when we have made progress.

There are thousands of care workers in England, and we need many more, but it is true that we already have hundreds of thousands of carers out there—the unpaid hidden army of family, friends and community volunteers without whom the system would simply grind to a halt. We know that about 60% of us are likely to become carers at some stage in our lives. As it is today, one in eight of the adult population is a carer. That is why carers will be a fundamental part of the Green Paper. A sustainable settlement for social care will simply not be possible without focusing on the support we provide to them. Ahead of the Green Paper’s publication, we will shortly publish an action plan on carers, setting out a cross-Government programme of targeted work to support carers over the next couple of years.

Another principle that the Secretary of State has spoken about in the context of the Green Paper is control. We know that the greater control people have over their care, the better the outcomes. The only people who have a specific right to have a personal health budget are adults in receipt of NHS continuing healthcare or children receiving continuing care, which is why earlier this month we launched a consultation on extending the right to personal health budgets and integrated personal budgets to achieve better outcomes for those with the greatest ongoing social care needs as well as health needs. Those are some of the principles that are guiding the Green Paper. The goal is that, whatever a person’s age, they can be confident in our care and support system, not just for their own health and care needs but for those of the people close to them.

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[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It seems no time since we were discussing this topic in the autumn. There are three groups of people who require social care. The first and the one commonly thought about are the frail elderly. There is expected to be a rise of 25% in those aged 85 and above between 2015 and 2025. By 2030, that proportion will have gone up 63%. Therefore, this requires us to make urgent preparations. Elderly people requiring social care need support and comfort.

The next group comprises those who are facing the end of life. They want dignity and, if possible, to be at home. If their family is looking after them, they want their family to have respite. The third group, as has already been mentioned in the debate, are younger people with disability. For them, it is the quality of their whole life, their mobility and their ability to participate in society. This last group is expected to rise by 9.2% between 2010 and 2020.

The five year forward view for the NHS and the amount of money requested were based on a game-changing approach to public health and a strong increase in social care funding. In actual fact, the opposite has happened and social care has lost almost £5 billion. Age UK says that 1.2 million elderly people have a social care need that is not being met—up 48% since 2010. In England, there has been a 26% drop in local authority-funded patients getting social care—that is 400,000 people —despite an increase in the ageing population.

One third of the elderly population are looked after by their family. Those carers have been paid tributes here, but they need a bit more than tributes; they need support and, in particular, they need respite, because many of them are literally working all the hours of the week. There will be 2 million carers who are themselves over 65. At the moment, carers’ allowance is only £60 a week; it is not even the same as the jobseeker’s allowance. In Scotland, this is one of the benefits that we now have control over, and it is rising to meet the level of the jobseeker’s allowance. That is little enough tribute to these people who, frankly, are saving the state millions.

Some 700,000 people were identified by Age UK as getting no help whatsoever. The Green Paper is looking at options in the long term, but the problem is that social care needs funding now, and it is estimated that the gap will be £2 billion by 2020. The social care precept has been identified, allowing local authorities to raise council tax by 2% to 3% over the next few years. That will bring in £1.8 billion, but it will be the richer areas that will be able to raise more money.

The better care fund has been put forward for the integration of health and social care, which we should all welcome. It is estimated to raise £1.5 billion by 2019-20. The problem is that some of it—£800 million—has been raided from the new homes bonus, and when we are not here talking about social care, people are at the Dispatch Box talking about the lack of housing and the lack of affordable housing. The problem is that if we do not get away from silo thinking, we will never reach a point of health in all policies.

At the same time, the local authority funding grant will be cut by £6.1 billion by 2019-20, so we are talking about giving with one hand and taking away with the other. As has been touched on, the cuts to local authority funding of social care are causing providers to close. In the first half of 2016, one third of local authorities had at least one home care provider—and half had a care home or nursing home—that closed due to becoming bankrupt. Anyone who has had a relative supported by these services will know how traumatic it is, particularly if it is a residential care home, for someone who may have lived somewhere for years suddenly to be moved to a strange place.

Perhaps some consideration should be given in the Green Paper to combining health and social care, and to looking at some of the different approaches in order to consider whether it is actually safer to provide social care publicly. In Scotland, we have been increasing the funding into the community in primary care, which will rise to 11% of the health budget, and in mental health, community care and social care. The aim is to rebalance the budget over the coming years to 2021 until half the health budget is going to the community. We have been funding integration joint boards since 2014, and the care, design and planning is by health and social care partnerships. This is already joining up health and social care, so that we do not have the situation that I experienced when I worked in a hospital, with the social care side and the health side bickering over where Mrs Jones would be best served. With integration, we should just be able to work out what is best for Mrs Jones.

[Norman Lamb]

From what the hon. Lady is saying, I get the impression that she rather agrees with me that the Government will never come up with a solution by focusing in their Green Paper on one part of one part of the problem—in other words, older adult social care. We need to look at the whole system across the NHS and social care.

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[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I think the Opposition are quite right to want to debate this issue, and I also think strongly that the long-term solution to the problem of funding care—particularly for the frail elderly—will require cross-party agreement, so I hope that the debate can take place in a relatively non-partisan way.

I agree with the hon. Member for Worsley and Eccles South (Barbara Keeley) that radical change is needed, but I gently put it to her and her colleagues that in this long-term and complex area, indignation is not enough. Simply saying, “We must spend more money,” at the same time as saying, “But we must restrict the amount of money we take from other people,” which I understood to be the import of part of her speech, does not cut it.

[Norman Lamb]

Will the right hon. Gentleman give way?

[Damian Green]

I will certainly give way to the right hon. Gentleman in a moment, because I am about to mention him, but I am conscious of time.

There needs to be radical change, and the Green Paper needs to be radical and brave, because although in this debate, as in the wider debate on this issue, a lot of people talk about the fact that we live in an ageing society, we have not remotely adjusted as a society to what that means yet. Our population is projected to grow by around 10 million over the next 40 years. Almost all that growth comes from older people, and particularly those in the oldest age group. There are 5.3 million people over 75 in Britain today. That number will double to more than 10 million in 40 years. This is not just a looming problem; it is a problem today. There is a short-term and a long-term problem to solve. Frankly, in the spirit of non-partisanship, no party has a record unblemished by using social care as a political football. Phrases such as “death tax” or “dementia tax” make good copy and can affect the outcome of elections, but they do not help rational debate or, more importantly, help us improve the lot of the increasing millions of older people.

[Damian Green]

I think that the phrase “death tax” dates back to the previous Labour Government’s attempt to solve the problem in 2008, and I am sure that the hon. Lady used the phrase “dementia tax” during the last general election campaign. I hope that she will reciprocate my attempt to be non-partisan—so far it does not feel like it.

In the short term, the challenge for the Government is one of capacity and quality of care. Both problems will become more difficult in the long term. There is a range of things that we must do as a society before people need social care. For example, we need to keep people active for longer, we need to keep them in the workforce for longer, because that is good for their health, and we need to make changes to the planning system so that we can keep them in appropriate housing of their own for longer. In the end, however, the nub of the issue will be funding.

I want to address a point raised by the hon. Member for Central Ayrshire about joining the whole thing up with health funding. I agree with the broad thrust of the 10 principles proposed by the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Grantham and Stamford (Nick Boles) yesterday, particularly the idea of hypothecation, whose time is coming, but I think there is a problem with the idea of simply integrating all health funding and all social care funding.

It is a no-brainer that, organisationally, social care and healthcare need to be much better integrated, so that the individual is not trying to negotiate a very complex system, as the hon. Member for Central Ayrshire said. If we simply roll all the funding together into one pot, however—a sort of national health and social care fund—there are two serious dangers. The first is that social care takes over from mental health as the Cinderella of the health system, never quite at the top of the priority list when money is allocated. The second is that nobody feels that their contribution is related to their personal needs. The effect is that some of the sources of funding that could be made available—I agree with all those who say we need more funding—such as the £1.7 trillion of equity in residential property, of which more than two thirds is held by the over-65s, would be in danger of being permanently excluded, which I think would be a great mistake.

[Norman Lamb]

The right hon. Gentleman is making a thoughtful and reasonable contribution. He suggests that if there was a completely combined united funding stream for health and social care, social care would be relegated and disadvantaged. Of course, social care already loses out here and now—under Labour, the coalition and the Conservatives—compared with NHS funding. He complained about people just using indignation, and he made the case for cross-party working. Does he share my frustration that those of us who have tried to make the case for working together are constantly rebuffed by the Government? Will he join us in pressing the Prime Minister actually to engage in this, so that we can make it a reality?

[Damian Green]

I agree with the right hon. Gentleman that cross-party working is necessary. I gently point out that when I was a member of the Government, I met him and the hon. Member for Leicester West in a cross-party group to discuss precisely this—I was responsible for this policy area at the time—because I wanted to work with them. I thought that was the only way forward when I was in government, and I still do.

There is not time today to go into detailed funding proposals, but I think we have to accept that in the long term the funding of social care will need to be not only more generous than it has been in recent years, but fair, and seen to be fair, to every generation. I make the point, which is not often made in this context, that intergenerational fairness means being fair to older people as well as younger people. The view has taken hold in some circles that being over 60 means being over-privileged. I strongly challenge that view. The current generation of 50 and 60-somethings is the first in which people are often simultaneously trying to help their children with housing and their parents with care needs. This is not special pleading for a particular cohort. It is important to remember the obvious but salient point that young people themselves will grow old. Setting one generation against another is not only a bad basis for policy making but very short-sighted for the individuals most affected. Instead, we need to find a solution that will provide stability for decades to come.

I suspect that Members on both sides of the House would be united by the proposition that, however much better we get at using technology and housing design to keep people in their own homes for longer, the sheer growth in the number of people needing some kind of care will mean that we need to find more money. Precisely because that will be a problem for decades, not just for the rest of this Parliament, it is vital that the solution has cross-party support. Social care is a challenge for all parties.

The fundamental issue of whether social care should be a national or local service is often ignored. I am struck that 44% of Kent County Council’s budget goes on adult social care. That number will only rise. I am also struck that, in contrast with almost every other area of policy that involves local government, when I talk to local councillors about this issue they say, “Maybe this should be dealt with at a national rather than a local level.” They almost do not want it to be their responsibility any more. That is practically unique. I hope that Ministers will address that.

I urge Ministers to include staffing needs, the importance of which has been mentioned by Members on both sides of the House, in the Green Paper. Given what the wider situation will be post Brexit, we need to find ways of using technology, being much better at training care workers from the British population, and raising the status of care work. Labour Members mentioned that, and I agree. Looking at care purely as a business sector, it seems to me a classic case of somewhere that both technology and the human touch are vital. That combination is vital to providing high-quality care. To put it starkly, a robot may be able to do the lifting part of the work, but it cannot provide the equally necessary words of encouragement and comfort. I think social care will be an employment growth sector in the decades ahead.

Getting social care right is clearly one of this Government’s biggest challenges, as it will be for every Government for many decades to come. Over the next couple of years, we will have the chance to reset the debate so that it becomes calmer and more realistic. I know that my right hon. Friend the Secretary of State and the Minister for Care want to provide that calm and realism, and I hope that those of us contributing to this debate from the outside will live up to that, too. I very much look forward to the publication of the Green Paper.