Social Care Funding

Paul Burstow Excerpts

Thursday 10th November 2011 Westminster Hall

[Tony Baldry (Banbury) (Con)]

I am very pleased to be able to take part in this debate as co-chair of the all-party group on carers, and I have a couple of simple requests for the Minister.

It is crucial that all political parties—both Government and Opposition—work together on the White Paper on social care. We have been waiting for the document for some time, and I understand that the Government have committed to introducing it next spring. It would be very helpful if the Minister cheered us all up in his concluding comments by confirming that there will be a White Paper on social care in spring 2012. He will make us all the more happy if he can confirm that it is the Government’s intention that the document will introduce proposals to ensure that we are able to deliver sustainable long-term funding to tackle the existing care crisis and provide for growing demand.

We must recognise the scale and nature of the growing demand. The Department for Work and Pensions produced a wonderful report earlier this year called, “Number of Future Centenarians by Age Group”. Someone is either a centenarian or not, so I do not know why the DWP has to classify them by age group: it is one of those wonderful “Yes Minister” things. The report forecasts that 11 million people alive today will live to 100—a huge number. However, the number of working-age adults who will suffer from age-related conditions will rise by almost a third over the next 20 years. It is predicted that between now and 2030, 30,000 more people over the age of 80 will be living in the typical shire county of Oxfordshire, which is the equivalent of a town the size of Bicester being added to it. From 2025, the population aged 60 and over in the county is expected to be greater than the population of under-19s, including students. In a county such as Oxfordshire, nearly 70% of people aged 85 and over are living with a long-term illness, and the Medical Research Council’s cognitive function and ageing study shows that 26.5% of men and women between the ages of 80 and 84 suffer or experience age-related dementia. At over 85, the figure suffering from age-related dementia goes up to 68.5%, which is a significant increase. That means that the number of carers is expected to rise from 6.4 million today to 9 million by 2037, which is a substantial increase.

That is all against a background—in the House, we have discussed this in a number of debates since the general election, and I will not read out the speeches I have made in the past—of local authorities having to deal with serious financial circumstances, which has led them to increase charges for care services and raise eligibility criteria. The percentage of councils providing support to those with moderate needs has decreased from about half in 2005 to less than a fifth, as eligibility criteria are raised to substantial or critical needs only.

If he has time in his concluding comments, will the Minister update the House on what his Department considers to be the impact of the Sefton ruling in the High Court yesterday? The ruling seems to indicate that it is unlawful for local authorities to freeze care home fees unless they have consulted care home managers fully and properly assessed the risks of decisions to care homes and their residents.

The vice-president of the Association of Directors of Adult Social Services and others have calculated that the ruling will add a substantial amount to local authorities’ budgets, which have already been set for this year. We have some fairly tight figures for both local authorities and for care homes.

[The Minister of State, Department of Health (Paul Burstow)]

The key point in the High Court’s decision was the consultation. That was also a finding in the Birmingham case earlier this year, when the issue turned on whether the consultation was adequate and whether the authority had had due regard to various statutory duties. The issue now for local authorities is to satisfy themselves that they have had proper regard to the matters that the courts have directed them to consider.

[Tony Baldry]

That is a helpful update for the House, and I am grateful to the Minister.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate. By doing so, she has demonstrated the breadth and depth of her interest and expertise, and the breadth of interest across the House, in the issues. Such debates are not always as well attended as this one. As you rightly noted, Mr Bone, the Leader of the House also attended for a while to listen to our deliberations, which speaks volumes about the importance that the Government attach to the issue.

I am delighted that so many members and officers of all-party groups took part in the debate. This is the second time this week that I have had the pleasure of the company of the chairs and other officers from a number of those all-party groups. Earlier in the week, I hosted an event in the Department of Health with APG chairs to discuss with them their thinking about the way in which we need to respond to the challenging agenda and to input into shaping the White Paper that we will publish—in answer to the hon. Member for Banbury (Tony Baldry)—next spring. When I was asked at the meeting, I confirmed that we are aiming for April—that is what we mean by spring for this purpose—and I can reconfirm that today.

I very much agree with the remarks of the hon. Member for Worsley and Eccles South (Barbara Keeley), which were echoed in many contributions in this debate, about the need to have cross-party discussion and secure a cross-party agreement. One reason why we need to do that is that social care law has been very overlooked and neglected. The Law Commission report that came out this May quite rightly pointed out that our social care legislation has evolved over 60 years in a haphazard and piecemeal way. The confusing legal system is one of the reasons why social care has such a complex system, and why so many judicial reviews take place. We need a consensus to secure a legal reform that will last the test of time.

First, I would like to respond to some of the points made about the current situation of social care funding. I find it heartening that some of the points rehearsed in the debate acknowledged that the fragility of our social care system is not new—it did not start 18 months ago but is the pattern of many years, which we, as the coalition Government, are trying to address now.

I am not going to deny that things are tough, or that no council has had to make difficult decisions; it has not been an easy time for anyone. Difficult decisions have had to be made across Government because of the economic situation that we currently find ourselves in. However, the funding landscape is not as simple as I think some would like us to believe. The headline story of a Government intent on slashing social care services no doubt makes good copy, but it is not borne out by a closer examination of the facts.

In the previous spending review, which we announced last October, we provided an extra £7.2 billion over four years up to 2015 to protect social care, partly through councils and partly through the national health service. The aim was to alleviate the potential pressures on the adult social care system in what would be a challenging overall funding settlement for local government; that point has been rehearsed quite clearly by a number of colleagues in this debate.

We recognised that this year would be particularly tough. We have front-end loaded the funding for the first two years to insulate social care from cuts to local authority budgets, on which I will amplify a bit. Combined with a focus on efficiency, we believe that the additional funding that we have provided will enable councils to protect people’s access to care services. That is not just our view but the Local Government Association’s view, put forward in its submissions to the spending review. The King’s Fund also said in its report, “Social care funding and the NHS”, that central Government have put enough money in to protect adult social care services, provided that there are rigorous attempts to improve efficiency.

However, as the hon. Member for Leicester West (Liz Kendall) and other hon. Members have said, spending is falling. Budget data collected by the Department for Communities and Local Government from local authorities suggest that social care budgets are around £200 million lower than last year, which is a reduction of just over 1.5%. However, it is not inevitable that reductions in spending lead to cuts in front-line services. The hon. Member for Worsley and Eccles South quoted the Association of Directors of Adult Social Services, which had an interesting survey of their members that was published earlier this year. Boil it down a little further and what we find is that for every £1 that has been saved or taken out of spending in social care by local authorities, 70p can be attributed to efficiency savings. It is not about taking services out from the front line, but service redesign.

Yesterday, the Local Government Association released a prospectus inviting councils to take part in its productivity programme for adult social care. It said that there is scope for efficiency. In its foreword it said that if councils develop plans in line with policy objectives such as prevention and personalisation, they will minimise the impact of reduced funding for the front line, which is why I welcome the work that it is doing to recruit councils to its programme. From there, best practice can be shared with other councils to ensure that they are not making bad decisions when it comes to their budget choices.

[Barbara Keeley]

I understand the issues about efficiencies and the need to make changes such as the move to personalisation. However, from my experience—as I have said, I am in a local authority that is protecting social care—efficiency savings have caused our primary care trust to give up active case management for people with long-term conditions. Personalisation of personal budgets has meant that Age UK has not been able to conduct similar active case management for older people or to run drop-in centres for carers of people with dementia. Sometimes the change and the churn also cause loss. We have not touched today on the reorganisation of the NHS, but that has had an impact on things, too. I understand that we are in a system in which certain changes are good but can result in a loss of services that really impacts on people.

[Paul Burstow]

I am not seeking to hide or resile from that. What I am trying to do is demonstrate that the picture is not uniform or consistent. I want to quote some further evidence that supports that point of view, but first let me make it clear that of the £900 million that the ADASS survey identified as having been taken out of social care spend, 70p in every pound came not from cuts in front-line services but from service efficiencies and redesign. That very point was made by a number of hon. Members in the debate.

[Heidi Alexander]

The Minister is talking about efficiency savings within adult social care services, but would he accept that as every day goes by, demand for those services is increasing because of the needs within the existing population? May I press him a little more on the point made by my hon. Friend the Member for Leicester West (Liz Kendall)? Does he not think that his colleagues should be making greater protestations about decisions taken within local authorities? Rather than focusing on the bins, as my hon. Friend said, we should be talking about the needs of the elderly population and perhaps giving local authorities a bit more direction. Will the Minister tell us his views on that?

[Paul Burstow]

I do not believe we should micro-manage the decisions of every local authority. We should not dictate to local authorities about how to manage their resources. One message that came from local government before the election, which we, as a coalition, have responded to, was the desire to remove ring fences from budgets to give councils maximum flexibility. Total Place is exactly what that is about. It is about using budgets smartly to meet local needs in the best way to fit the community’s circumstances. In the past, such flexibility was constrained by the number of ring fences.

I have also picked up on some scepticism in the debate about the additional funding that is being provided through the spending review for adult social care via the NHS. There was some question as to whether or not that money was getting through. Of the £648 million for this year, nearly half has already been transferred—we know that from surveys that we have conducted—and agreements are in place to transfer the remainder. As to the reference to the money for carers, that was not part of this social care transfer; it was a separate requirement under the NHS operating framework. I am more than happy to debate that at a later stage, but right now I need to try to cover the main points in this debate.

Both primary care trusts and local authorities are positive about the development of these particular funds. They have seen them as a lever for more joint planning and co-operation. The feedback that we have had to date shows that the money is being spent on what it was intended for—prevention and rehabilitation, re-ablement, early supported hospital discharge schemes and integrated crisis response services. I am saying not that the money is a panacea but that those funds are making a difference in the communities in which they are being used smartly by the NHS and social care organisations. Times are tough and I am not going to pretend otherwise. Although I can present a relatively positive picture nationally, there are areas where cuts to front-line adult social care services are really beginning to bite.

Although some councils have coped with the cuts by tightening their eligibility criteria, it is not fair to suggest that that started in May last year. The trend started back in 2005. The way in which councils define and apply eligibility criteria is not consistent from one borough to the next. We will address those issues of definition as part of the review that we are taking forward in the White Paper.

[Kelvin Hopkins]

Even squeezing at the margins means that more people will suffer and not get the care that they need. In other fields we spend more freely, relatively, and yet we are squeezing in this area. The Minister said that 70% of the cuts in spending is to deal with inefficiencies, but 30% is real front-line spending, which means that some people are suffering.

[Paul Burstow]

I am trying hard to be reasoned and respond positively to the points that have been made. I am not trying to dismiss things. I am not making a speech that pretends that everything is perfect. I am trying to engage seriously with the real problems that local authorities are having to grapple with. I am also trying to set out that there are different ways of doing things. Some councils are choosing to do things differently and in ways that allow them to protect the quality of the service and the outcomes for the individual. That is the test that is most important to me.

In regard to eligibility, the hon. Member for Worsley and Eccles South asked about portability. It is one of the 76 recommendations in the Law Commission report. In the “Vision for Adult Social Care” that we published last November, I said that we are minded to progress the idea of portability in assessments. There is further debate to be had about how we translate that into portability of outcomes and services, and that is one of the issues that we are considering in the White Paper.

As I have said, we have a mixed picture across the country. It does not bear out the simplistic formula of “less money equals more cuts.” Age UK and WRVS are publishing a report which I will read with interest when it comes out. An illuminating report was published in September by Demos and Scope, which looks at how disabled people have been affected by budget changes in local authorities. We might expect to find that the biggest cuts in front-line services are made by the councils that face the most dramatic cuts in their income, but that is simply not the case. Demos’s report suggests that there is no direct cause and effect. The councils that it applauds for coping the best have not enjoyed the most generous settlements, and they are not concentrated in the most affluent areas. Rural and urban areas and rich and poor areas are found in equal measure at both the top and bottom of the table.

There are tough choices to be made in every town hall as well as in every part of Whitehall and in the national health service, but we need the choices to be smart, too, Places such as Tameside have invested in re-ablement services that help people back to independence after a period of illness and ultimately reduce their care needs. Tameside estimates that that saved it £2.3 million, which it then reinvested. Somerset county council has commissioned a number of projects that use volunteers to help people with low and moderate care needs to run their own groups, form friendship circles and keep in touch with activities available in their local community.

The West Sussex-based Carewise service was recognised by Which? magazine as a model of best practice. It helps older people who pay for their care to plan their futures. Planning, which is all too often absent, has been a theme of the debate. The organisation ensures that people get good financial advice. We are talking about improving services through integration, which is another important theme of the debate as is the use of personal budgets. Those budgets are now being rolled out through the trail-blazer pilots for direct payments for social care, for personal health budgets and for personal budgets in respect of Supporting People. Such changes begin to give the individual the opportunity to have a Total Place approach to the way in which they use resources and allow resources to be used to best effect.

When I went to Knowsley last year to see what was being done on integration, the most powerful aspect of the approach used was the fact that it involved thinking about “the Knowsley pound.” And in Torbay, which I also visited, the approach there was to look at everything through the eyes of “Mrs Smith.” It may not be appropriate in every community to look through the eyes of a “Mrs Smith,” but in Torbay it was thought appropriate. Officials in Knowsley and Torbay made the leap in the approaches that they took to see money not as theirs—to be held within the boundaries of their institutions—but as their community’s money, to be spent wisely on behalf of their community. That is the essential ingredient in delivering effective use of public money in times of austerity.

That brings me to the case for reform. Despite the funding challenges, there are steps that councils are able to take now to improve social care services and I hope that they will take those steps.

I will talk about reform in detail. I have been in the House for 14 years, so I am now entitled at least to have a sense of déjà vu about this debate, like some other Members who have been in the House for a long time. However, I think we are at a different stage in the debate. We are building on the work that has been done—the listening that has happened and the engagement that has taken place—over many years. Indeed, in framing the terms of reference for Andrew Dilnot, we set him the task of looking at everything that had been done in the past 13 years to ensure that we did not just reinvent the wheel and that we learned from what had been heard already. I am keen that we continue to do just that.

I am also keen that in this debate we address a very important issue about understanding, which is the issue about the nasty little secret at the heart of social care. It is a secret that we MPs all share and know about, but seven out of 10 people in this country do not know about it. It is that social care is not free and in fact has never been free. At the moment, we are in a situation where people look at the proposals that Andrew Dilnot has put forward and he is judged not against the standard of the reality of our experience of social care, which has been so well described in this debate, but against a fantasy of social care that is free, just as the NHS is free. All of us in this Chamber and all of us who have an interest in reform in this sector need to ensure that we do not allow that fantasy to get in the way of judging Andrew Dilnot’s proposals fairly.

That is a key part of how we can ensure that we make progress in this area. Indeed, it is key because of the catastrophic costs that people face. Those costs have been touched on by my hon. Friend the Member for Southport (John Pugh), and by the hon. Members for Lewisham East (Heidi Alexander) and for Luton North (Kelvin Hopkins). They talked about the anger that people feel that they have saved, worked, invested in their lives and been thrifty, only to have it all snatched away at the point that they are in need of support from the system. That issue of fairness is part of what we asked Andrew Dilnot to look at.

I want to make two more comments before I sit down for the concluding speech. There has been talk about the cap, about whether it does anything for carers and about changing the way that the system works. I want to make a suggestion that people need to think about. The cap has to be metered. People have to enter the system and then move towards the cap. The way that we design the meter is the way that we incentivise prevention; the way that we design the meter is the way that we build carers in and respect and value what they contribute. I hope that people will think about that in the weeks remaining before we conclude our process of debate and deliberation, leading up to the White Paper next year, because that is one of the ways in which we can redesign the system to be a system that is about supporting what people can do, that is about enabling communities to support people and that is about enabling families to contribute in the way that they want to.

My final comment is that I have found this debate to be very helpful and a useful airing of the issues. I hope we shall continue to debate these issues in Parliament and continue to have the debate in the community. But it is not just an open-ended debate; it has to be a debate that is closed and that comes to conclusions. That is what the White Paper is about. The White Paper is the conclusion of 14 years, as far as I am concerned. It is about how we get to the next stage.

I was asked about legislation. Let me just say that it is well above my pay grade to be the one who announces what will be in the next Queen’s Speech; I probably would not be a Minister for much longer if I were to do that today. However, when the decisions are made we will have looked at this process and the White Paper outcomes, and I hope we will be in a position to legislate at the earliest opportunity. Social care has languished and rested in the “too-difficult-to-do” box for far too long. We are the Government who are committed; we see the urgency and the need. I hope that together we can get the cross-party lead that results in the changes that are long, long overdue.