Social Care (Liverpool)

Philip Hollobone Excerpts

Tuesday 7th March 2017 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Would those who are not staying for the next debate please be kind enough to leave quickly and quietly? I see we have some of Liverpool’s finest in the Chamber.

[Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)]

I beg to move,

That this House has considered social care in Liverpool.

It is a great pleasure to serve under your chairmanship, Mr Hollobone. This is the third occasion on which I have raised the issue of adult social care in Liverpool in this place over the past two months. That is because major cuts in Government funding combined with rising needs are creating a situation where too many people are left feeling vulnerable in their own homes. Scarce hospital beds are occupied by people who are clinically fit to be discharged but cannot leave the hospital because social care is not available. That is bad for those individuals and for the national health service.

I realise that this is a national issue, but the debate puts the focus on the specific challenges that Liverpool and the Liverpool city region face. Mayor Anderson and Liverpool City Council have done their very best to protect the people of Liverpool from the impact of unprecedented Government cuts, but adult social care has not escaped the consequences of the Government’s actions over a long period.

Adult social care covers a wide range of services, including domiciliary support—helping to dress, feed and bathe people in their own homes and, where appropriate, ensure that the correct medication is taken. Depending on the individual situation, that could involve several visits a day to an individual’s home. In other cases, it might require one visit a day, but whether it is one visit or several, it is absolutely essential to allow that individual to lead an independent life. The provision of adequate adult social care enables many people to remain safely and confidently in their own homes, rather than feeling vulnerable or having to move to more expensive and much less satisfactory residential care. Adequate adult social care can bring peace of mind and provide a lifeline.

Let us look at what has been happening to Liverpool City Council’s funding. Liverpool has now lost 60% of revenue support from the Government since 2010, and by 2020 that figure will have risen to 68%. Furthermore, having looked at revenue support systems, the Government plan to eliminate revenue support entirely under a new funding settlement. That will have serious consequences for a city with a low tax base and with 80% of its population in council tax bands A and B.

Liverpool council is a very responsible authority and has already identified £90 million of additional cuts that it is required to make in the coming financial year. The council continues to do its best to protect services, but it has not been able to stop substantial cuts to its spending on adult social care, which has been reduced from £220 million in 2010 to £154 million in 2016. It is anticipated that that figure will be reduced to £130 million by 2020.

Yes, the Government have their better care fund and yes, the local authority has a limited ability to raise an extra precept. The better care programme is expected to allocate £39 million to Liverpool when its funding is due to be reduced in such a significant way, but that will still leave a massive gap. Neither the Government’s better care fund nor the council’s ability to raise extra tax can fill the gap caused by the withdrawal of central Government funding. The scale of that withdrawal is unprecedented.

At the same time as the Government are reducing support, demographic pressures and costs are increasing. The Office for National Statistics estimates that the percentage of people in Liverpool aged 65 years or more will rise from 14.6% in 2015 to 16.1% in 2024. It is wholly unrealistic to expect people in the fourth most deprived local authority in the country to fill the gap. The sums simply do not add up. To illustrate the situation, a 1% increase in council tax in Liverpool will raise £1.4 million; a 1% cut in central Government funding means a loss of £3 million. That is a totally unacceptable situation and one that cannot continue without inflicting severe cuts on services that are very important to the people of Liverpool.

I said that Liverpool was the fourth most deprived local authority in the country, which is correct, and there is great poverty in the city, but Liverpool City Council, through its pioneering spirit, its enterprising approach and its ability and willingness to innovate and work with others has been able to move Liverpool from being the most deprived local authority in the country to that No. 4 position. It is bad to be the fourth most deprived authority, but it is a tribute to the city council and its partners that they have been able to make progress in Liverpool. Furthermore, that progress has been made without proper funding from Government—indeed, Government funding has reduced, and that is the critical feature.

Social care packages in Liverpool have already been cut from £14,000 to £9,000, which has affected many vulnerable people, and many more are anxious. Many people in great need are being reassessed to see whether the care they receive can be maintained, which often induces great anxiety and apprehension, even if ultimately their care remains similar to what it was. That, too, is an important factor that is not always considered.

On the day that I visited the Royal Liverpool university hospital, 135 patients who were clinically fit to be discharged remained in their beds because social care was not available for them at home. That was in spite of the efforts of hospital and local authority staff to find suitable care packages for them—the money was simply not there. That figure, the accurate one for the day I visited the hospital, reflects the general situation and shows one of the problems caused by the cuts to social care in Liverpool. Those cuts have arisen solely because of cuts in Government funding.

The situation affects many people, and it can only deteriorate unless action is taken. What should be done? Let us look at what is happening now. Mayor Joe Anderson, cabinet member Paul Brant and Liverpool City Council as a whole must be commended for their work to promote partnership with the NHS and innovation, which involves new work with the clinical commissioning group and GPs to integrate health and social care. “Step Up” centres for intermediate care are being pioneered and the council plans to promote innovatory joint work with community health services. A joint working party is considering new ideas.

All those things are extremely important and demonstrate the city council’s willingness to innovate and work with other partners. Such work should be supported better by central Government. Whatever innovation takes place in Liverpool and however much the council is willing to work with other people and for integration, Ministers cannot escape the fact that more funding is needed. The issue is long term, but the crisis is now and immediate action is required. It is a crisis that Liverpool City Council cannot resolve on its own, nor can the people of the city fill the financial gap unaided.

I call on the Government to recognise their responsibilities and to announce an immediate allocation of targeted funding for adult social care in Liverpool. I recognise that that must be part of a national approach, but funds must be targeted to meet the needs of local communities. That will enable vulnerable people to live independently and safely in their own homes, as well as enabling the NHS to deploy its resources efficiently. Liverpool City Council should be congratulated on the resilience, innovation and flexibility that it has displayed, but it cannot resolve the crisis alone. I call on the Minister to act as a matter of urgency.

[Mr Philip Hollobone (in the Chair)]

I am required to call the Front Benchers at 5.40 pm and the debate may run until 6.03 pm. That gives us 32.5 minutes of Back-Bench time and three Members have given me their names, the first of whom—who wrote a very nice letter—is Maria Eagle.

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[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I apologise for being a moment late in coming over from the Select Committee on Health. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on securing this important and timely debate on behalf of all our constituents.

[Mr Philip Hollobone (in the Chair)]

Order. If the hon. Lady would like to sit, she is most welcome to do so.

[Luciana Berger]

That is kind, but I am fine. Thank you so much.

This is a pertinent and serious issue that affects thousands of people across the area that my hon. Friends and I are privileged to represent. I also endorse the comments made by my hon. Friend the Member for Garston and Halewood (Maria Eagle). I will seek not to reiterate but to add to the comments that have already been made. I will raise some of the additional pressures that Liverpool has faced in the nearly seven years since the cuts were first introduced in 2010 and add some personal reflections from constituents who are experiencing those cuts at first hand. We are ultimately here on behalf of our constituents, and we should share their experiences with the House so that we understand the tragic human element and implications of the cuts. I will also reflect on my own experience of being in an accident and emergency department in Liverpool on a Friday night just a couple of weeks ago and seeing the number of ambulances waiting there. At least 10 paramedics were waiting to book people in, many of whom were older people. We know from the figures that delayed discharge is a significant challenge, and I believe that issues in accident and emergency departments are compounded by cuts to social care.

As we heard from my hon. Friends the Members for Liverpool, Riverside and for Garston and Halewood, 5,000 fewer people in Liverpool are receiving support via care packages than in 2010. I have connected with two constituents about that issue in the past week alone. One, a lady called Sobia, is paralysed. She used to receive overnight care, but despite her condition becoming worse and even though her children are now of an age when they are going to university and are not as available to care for her as they were previously, she has seen that care stopped because of the cuts to social care in Liverpool.

In the past few weeks I have intervened on behalf of one of my constituents called Veronica, who had additional support to help her with various things. She is still waiting for some of that care to be reinstated. I have every sympathy with Liverpool City Council for the difficult decisions it is having to make in the current circumstances; the council is under significant pressures, as we have heard. Those pressures do not look set to get any easier. In particular, in the Liverpool city area we have demographic pressures—as many places do across the country—with the growing, ageing population. We know that the 65-plus age group is set to grow by 50% in the next 20 years. That is a significant challenge for any area to contend with, particularly given the cuts that have been incurred so far.

Liverpool City Council faces financial pressures as a result of the introduction of the national living wage. It is to cost £13.9 million in 2017-18, rising to £24.7 million by 2019-20, which is not an insignificant sum for the council to contend with. The Law Commission is also reviewing a specific piece of legislation, and I hope that changes will come forward soon to help Liverpool City Council cope with the 400% increase in deprivation of liberty safeguards applications, which cost £1 million a year. We know that that needs some attention, and I hope that changes to the legislation will have some impact, because that is £1 million of the significantly larger sum that the council has to contend with.

The demand pressures we see locally are also significant. We know that every week Liverpool City Council is arranging care packages for up to 100 people leaving hospital, which is a 51% increase compared with last year. There are also a lot more complex home care cases, which cost a significant sum and may require two carers calling four times a day. We know that adult social care assessment requests have risen by 15% since 2010, up from 18,000 a year to 21,000, and are expected to rise to nearly 23,000 by next year. There were also 5,715 requests for support from new clients, which was a 10% increase on the previous year.

We as constituency MPs, on behalf of our constituents, are contending with the challenges today. I have shared just a few of the additional challenges—financial pressures, demand pressures and demographic pressures—that mean that Liverpool City Council faces even more challenges as the years progress. It is on that basis that I endorse the comments made by my hon. Friends. We need the Government to give serious attention to this matter.

Social care cannot be dealt with separately from our wider health service. The two go hand in hand. It is no surprise that more people are turning up to our accident and emergency departments or our GP surgeries when 5,000 fewer people get care packages today than did in 2010, given that we know need has increased. The Chancellor will give the Budget tomorrow, and I look forward to hearing in the Minister’s response what representations he and his Department have made to ensure that social care is given the attention and resource that it desperately needs and deserves on behalf of the thousands of constituents who do not receive care but deserve it and the thousands more elderly people who will need it in the future.

I have not reflected specifically on constituents who might need mental health support but are not getting what they need and deserve today and going into tomorrow. This situation cannot be allowed to continue. We see and experience in our surgeries and weekly visits constituents who have to contend with the daily realities of not getting the support they need and deserve. We anticipated something in the autumn statement but there was nothing. On behalf of all our constituents, I sincerely hope that the Minister will give us some glimmer of hope that tomorrow there will be something that positively impacts on all of our constituents’ lives.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on securing the debate and on the excellent way in which she opened it. We have heard about the real pressures on social care in Liverpool from my right hon. Friend the Member for Knowsley (Mr Howarth) and my hon. Friends the Members for Garston and Halewood (Maria Eagle), for Liverpool, Wavertree (Luciana Berger) and for Liverpool, Walton (Steve Rotheram). We have heard about the 5,000 people who have lost care packages, about cancelled surgeries and about patients stuck in hospital.

To be clear, the funding crisis in social care is, in my view, one of the Government’s own making. The Chancellor failed to recognise the crisis and provided no extra social care funding from central Government at the autumn statement. Indeed, Ministers continued what they had already started in shifting the burden on to councils and council tax payers through increases in the social care precept. I will say more about that, but we have heard very well in the debate how that is not a sustainable solution.

As my hon. Friend the Member for Liverpool, Riverside said, Liverpool still has to make a further £19 million of cuts by 2020, taking the cuts to its Government funding to a staggering £420 million—the equivalent of a 68% reduction since 2010. The cuts to grants and the increased reliance on council tax have hit cities such as Liverpool very hard; we have heard about some of the impacts. As my hon. Friend the Member for Liverpool, Walton said, a serious weakness of using council tax to fund social care is that both demand for social care and the relative value of the council tax base vary so much across the country.

[Mr Philip Hollobone (in the Chair)]

Order. I am sorry to interrupt the hon. Lady when she is in full flow, but there is a Division in the House. We will come back in 15 minutes and carry on where we left off.

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On resuming—

[Mr Philip Hollobone (in the Chair)]

Welcome back. The revised finish time is now 6.18 pm.

[Barbara Keeley]

As I said, a weakness of using council tax to fund social care is that both the demand for social care and the relative value of the council tax base vary across the country. Census data show that in Surrey 40% of over-65s have a long-term condition that limits their day-to-day activity, but in Liverpool that figure is much higher, at 62%, and there is a strong link between long-term conditions that limit day-to-day activity and care needs. A 1% increase in council tax would raise £6.2 million in Surrey, whereas an equivalent rise for the same size population in Liverpool would raise only about half that sum—£3.4 million. Therein lies the problem.

As we heard in the debate, this year the 2% social care precept raised £2.8 million in Liverpool. That is not enough to cover the £9 million that Liverpool reports is needed in the care sector just for increases in the national living wage. Liverpool’s Mayor did some months ago suggest a 10% council tax increase to pay for social care, which would have needed a referendum. That proposal was similar to the one for a 15% increase from Surrey County Council. As we know, Surrey appears to have got a sweetheart deal from the Government when it suggested that increase in council tax, so I would like the Minister, when he responds, to tell us where Liverpool’s deal is.

As we heard, last month Liverpool’s director of adult social care resigned, stating that councils are in danger of failing to meet their statutory requirements. He said:

“People are struggling, people are suffering, and we’re really only seeing the tip of the iceberg.”

Only those with the highest needs are getting help. I worry that financial pressures in social care are now leading to failures and serious reductions in the quality of care that people receive. That was underlined by the Care Quality Commission bringing prosecutions against the owners of Mossley Manor, in the constituency of my hon. Friend the Member for Liverpool, Riverside. The neglect and poor care of residents at that care home was shocking. The CQC said that there was

“a continued and serious risk”

to the lives, health and wellbeing of residents. It is welcome that the owners have been prosecuted by the CQC, but I am worried that failures such as that are now a symptom of a wider problem.

The number of care home providers forced to cease operations because of deregistration has increased from 34 two years ago to 54 this year. A recent BBC “File on 4” programme reported that 23,000 allegations of abuse had been made against care staff working in people’s homes. In the programme, the new local government ombudsman, Michael King, said that there is a growing problem with standards of home care. The CQC says that more than one quarter of care homes require improvement or are inadequate, and that figure rises to 41% for nursing homes. The King’s Fund has said that adult social care is rapidly becoming a “threadbare safety net” for the poorest and most needy older and disabled people.

Falls in the quality or availability of social care are clearly having a knock-on effect on the NHS. We heard, rightly, about examples of that from Liverpool. My hon. Friend the Member for Garston and Halewood talked about sustainability and transformation plans and the need for STPs to make savings, which is the ridiculous position we seem to be in, but as the Health Foundation has said:

“The vision contained in many STPs…on preventing ill health and deterioration of illness, of care delivered closer to people’s homes…will be impossible without a vibrant social care sector.”

As we heard in the debate, it is impossible to have a vibrant social care sector with the funding issues in Liverpool. The Government have tried to shift the burden of funding social care on to councils. In the Budget tomorrow, I hope that the Chancellor of the Exchequer takes responsibility and both makes available the £2 billion needed immediately and suggests a longer-term plan, which is needed to put social care on a more stable footing.

Those who lose out are the thousands of people who need social care in cities such as Liverpool, but are now living with unmet care needs. That also hits their families, particularly the unpaid family carers, and the thousands of people in the care workforce, who are now working under very poor terms and conditions. A very large proportion of them are on zero-hours contracts; often, they are not even paid the minimum wage, are not paid for their travel time and have very poor prospects or no pension.

My hon. Friend the Member for Liverpool, Walton has offered to convene, if he is elected Mayor—I wish him all the best in the forthcoming election—a health and care summit to look at the issues and explore solutions. I hope that he is able to do that, but I know that my hon. Friends and I are not happy to accept a threadbare safety net. We want a decent and fair social care system, and we want it to be funded.

[Mr Philip Hollobone (in the Chair)]

If the Minister would be kind enough to conclude his remarks no later than 6.15 pm, that would allow Mrs Louise Ellman three minutes to sum up the debate.

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[Barbara Keeley]

I do not know whether the Minister watched last week’s Channel 4 “Dispatches”, “Under Lock and Key”, which showed some serious cases of young people who were not better off in their institution, a private hospital. It seemed very difficult to get them moved out into the community. I know that it was a different part of the country, but there were young people in that institution from across the country. It is great to have a plan, but we see programmes week in and week out showing failures, as I have highlighted.

[Mr Philip Hollobone (in the Chair)]

In responding to the intervention, the Minister needs to make his last point.

[David Mowat]

Mr Hollobone, are we finishing at 6.18?

[Mr Philip Hollobone (in the Chair)]

You have until 6.15.

[David Mowat]

I beg your pardon. I will finish at 6.15.

I saw the programme, and it gave us great food for thought. It is a Government priority to get those people moved. We have done some 1,500, but yes, there are 3,000 left in places like the one in Northampton, and it is not good enough. It is a long process, and it is not something that any of us from either side of the House can do just by clicking our fingers.

I will now sit down. This has been a good debate. I will write to all Members here with the figures that I have given, because the figures are right. It is fair to have this discussion, but it must be had on the basis of correct numbers. Even with those correct numbers, I accept that some of the pressures that we have heard about exist.