Social Care Provision and the NHS

Peter Grant Excerpts

Thursday 3rd May 2018 Westminster Hall

[Peter Grant (Glenrothes) (SNP)]

I am pleased to be able to speak in the debate. For obvious reasons, I will not do a traditional summing-up, because I could not sum up the contribution of the hon. Member for High Peak (Ruth George) anything like as eloquently as she delivered it. I am pleased that she made it to Westminster Hall, and I thoroughly commend the decision to use discretion to allow the debate to go ahead. It would have been sad if the important points that she has made had not been heard. It is unfortunate that a number of circumstances mean that very few people are here, and that the debate will probably get very little publicity, because she has raised an issue of significant concern to a great many people throughout the United Kingdom.

Social care and health are wholly devolved to the Scottish Parliament, so it is not my place to tell or suggest to the Government what they should do, but I will make some comments about what is happening and what appears to work in Scotland in the hope that the Westminster Government will consider it. I do not do that by way of the “We’re good and you’re bad” kind of politicking that we see too much of, but as an attempt, in goodwill and good faith, to allow our experiences north of the border to help address the situation down here. The hon. Lady has raised issues that apply in all four countries of the UK and, I suspect, in a lot of other countries as well.

When I was a wee boy, my granny was an old lady. She hardly ever went out, but occasionally she managed to walk up to the wee shop to get some shopping. She was a very devout Catholic, and when she was fit, she would walk the half mile or so to the local church to attend mass. That was about it. She would be picked up and taken out to family events and then taken back home again. At that time, my granny was five years older than I am now. She was younger than a significant number of Members of Parliament—nobody in this debate, obviously, is over 60.

That is an illustration of how much the world has changed for the better. When people get to be 60, particularly women who are widowed, as my granny and far too many women were at that age in the old days, they are no longer expected just to sit at home and wait to die, or drink tea and watch the television. People of all ages expect to be allowed to lead a full and fulfilling life. People with significant medical conditions and disabilities are entitled to expect the same. As a society, it is incumbent on us to help them achieve that. To do that, we have to accept that there will be consequences; that sort of quality of care does not come cheap.

It is sad that when we debate healthcare or social care in almost any form anywhere in the United Kingdom, it can far too quickly turn into the usual Punch and Judy politics. Often we do not have the chance to have an open and honest debate about what changes are needed to make the system fit for purpose in the 21st century, and what the consequences are in relation to how much we are prepared to pay for it.

Positive changes in medical technology mean that people who would have been lucky to live to five years old some 40 or 50 years ago now live to 80. That is a great success story, but it also creates challenges. For example, a lot of adults with Down’s syndrome will outlive their parents. We cannot expect mum and dad to be lifetime carers, because they will not always be there. The fact that so many people are living so much longer is a great success story, but we have a responsibility to accept the consequences of that success.

There has been a lot of progress. In 1998 I started working with the then Fife health board. Fife has a population of about 350,000 people. At any time, about 1,000 of those people would be in-patients in a psychiatric hospital or in a hospital for people with learning disabilities. Today, rather than being in four figures, sometimes that number does not even get to two figures—it is usually in the tens and occasionally it is down to single figures. There has not been a reduction in the number of people with those significant mental health or mental disability problems—if anything, there has been an increase—but they are looked after in a much more appropriate way. They are looked after as human beings at home, or in an environment that feels as close to being a home as possible, rather than in a massive institution with hundreds of in-patient beds.

That is overwhelmingly what elderly people and people with long-term illnesses, and their families, tell us they want. That should be the gold standard. We should aim to fund and support services—whether we call them social care or healthcare services does not matter—that allow people to live in their own home, beside their own family and friends, for as long as possible. A critical factor in succeeding in that aim must be breaking down the boundaries that we have artificially created between different services. The hon. Member for High Peak rightly pointed out that if any one part of the system starts to come under pressure, that very quickly has a knock-on effect elsewhere.

In Fife there have been some quite surprising, and surprisingly wide, cultural differences between the council and the health board, which we have had to work on to ensure that the approach to looking after people and doing the job, rather than worrying about bureaucracy, was consistent. That means that there has to be an absolute, publicly stated and oft-repeated commitment from leaders at the very highest levels in our services, whether they are political, managerial or clinical, that the person receiving the service is the person who matters most. We should be prepared to change our organisations, to change the way we work and to change the way we ask our services to work, so that they suit the patients, rather than expecting patients to squeeze into the artificially narrow boxes we sometimes try to create for them.

The model used in Scotland has been known as local health and social care partnerships, which give a direct voice not only to the statutory agencies, but to voluntary third sector organisations and commercial providers, because they have a part to play, however uncomfortable some of us might feel about that. The model also gives a voice to staff organisations and staff representatives in trade unions, and to representatives of patient groups, who are the people who know best what does and does not work. That is done so that decisions are taken in the round and solutions can be found regardless of whether a service will be provided by the council, the health board or somebody else. What matters is that the service is provided and that we never forget who the service is being provided for.

Although today’s debate is entitled, “Social Care Provision and the NHS”, that could equally well have been turned the other way round, because if there is a problem in health service provision, social services and the local council will come under pressure very quickly as well. That could be extended further, because one of the reasons why social services are under so much pressure is that a lot of the unofficial support services are under pressure now. A lot of people are isolated from their families, as family members can live a long way apart. Local services, such as libraries, are also closed, so that old folk do not have a library to go to one or two days a week, just to have a chat, whether or not they borrow a book. Post offices are also closing; people are being expected to do things anonymously online instead of having a wee chat with someone down at the post office. Our dear and much-lamented friend, Jo Cox, was very keen to emphasise the scourge of loneliness in our society. I think that loneliness, in all its forms, is creating a lot of the pressures on the public services that we are talking about today.

Those services face enormous challenges in all our nations, but if we still really believe in providing a good standard of living for all our people—a standard that I am fortunate enough to enjoy and that I would always expect—we must be prepared to make hard choices. And people like me, who are on well above average earnings, must be prepared to pay a wee bit more in order to achieve that good standard for all. In Scotland, for example, for a number of years we have had a guarantee of free personal and nursing care for any elderly person who needs it. From 2019 that guarantee will also apply to younger people with long-term and serious disabilities. That change is known as Frank’s law, after Frank Kopel, a former professional footballer with Dundee United, whose case became the focus of a long and successful campaign in Scotland.

We need to be honest and admit that these things do not come for free. Demographic changes mean that even if we think we are increasing spending above inflation, we might not be doing enough to keep up with an increase in the number of people who need such support and, very often, an increase in the complexity of that support. However, almost every time we talk about social care or healthcare services, whether in this Parliament, the Scottish Parliament or council chambers, it turns into a Punch and Judy show. That happens far too often, and it is just not what people need. Whether it happens here or in council chambers the length and breadth of the land, opposition parties and politicians will always quote stories of things that have gone wrong, as well as the official statistics, and it is surprising how often the official things we measure in the health service are measurements of failure. Why do we not measure success instead of failure?

Opposition parties will come out with the stories to prove that things are going badly; Governments and council administrations will cite numbers to prove that they are spending lots of money on a problem; and all too often nobody actually talks about whether the services—the care that we are providing—are of good quality or not, and nobody talks about the difference that we are making and should be making to people’s lives. That kind of debate is happening, often in less high-profile and less public forums than this one, such as think-tanks or universities. Sometimes councils and health boards have discussions that are not particularly open to the public, to try to tease out these problems.

We need to be prepared to have an open debate about our individual and collective political philosophy. For example, how do we establish the balance between universal provision and means-testing? What standard of care and support do we think every single citizen of these islands is entitled to receive? What quality of life, or what compromises or reductions in quality of life, do we think it is acceptable to impose on somebody simply because of a disability or long-term illness? If the answer is, “We’re not prepared to accept imposing any reduction in quality of life,” then we, as Members of one of the Parliaments of these islands, have got to find ways of ensuring that there is no reduction.

If Members want to see how not to have a debate about the difficulties that our health and social care services are facing, they should look at Prime Minister’s questions yesterday. Frankly, I thought it was appalling that, although very serious issues were being raised, on one side it was all about how bad things were and how many failures there have been, and on the other side it was all about how much money is being spent, and nobody seemed to be talking about what we need to do to sort these issues out.

I enjoy a good political barney as much as anybody. With this subject, however, and possibly more than with any other subject, we need to stop being politicians and remember that we are human beings and we are here to represent human beings. The people who rely on these services, whether they are provided by councils, health boards or anybody else, are entitled not only to get the services they deserve, but to hear an open and honest debate. That will not necessarily come up with all the correct answers, but at least people will know that we have the courage to face up to some difficult questions.

I look forward to the House having the opportunity to have such a debate in the near future, and I sincerely hope that all 650 Members in the House will take that opportunity and have the kind of debate that the public need, rather than the kind of debate that all too often politicians like to deliver for them.