Social Care Funding

Philippa Whitford Excerpts

Wednesday 17th October 2018 Commons Chamber

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

Here we are discussing this issue again when we discussed it just before the summer recess. That shows not only its importance but the fact that we are not making progress. We were promised the Green Paper last year. Then it was late last year, then early this year, then autumn 2018. I gently point out that it is now autumn 2018.

The five year forward view talked about managing demand in the NHS if there was an absolute game changer of an increase in public health to try to reduce the demand at the front door of the NHS, an increase in funding and provision of social care to stop funding haemorrhaging out the back door of the NHS. Unfortunately, what we have seen over the past five years is ongoing cuts to social care. I am sure that the £240 million for the winter from the Secretary of State is very welcome, but it is not nearly enough, and we will just keep on having this debate unless we can move forward and have a serious debate around the Green Paper.

As was mentioned earlier, Age UK estimates that more than 1.2 million people are not getting the care that they require. Need has increased by almost 50% since 2010, and yet there has been a decrease of 26% in England of local authority funded places. One third of people needing care are totally dependent on their family. It is estimated that 6.8 million people—that is one in 10 of the UK population—are involved in caring for a loved one, either full-time, part-time, or topping up care. Age UK also estimates that one third—700,000 people—receive no care whatever.

Despite an almost 9% cut in their budget, the Scottish Government spend £163 per head more on health than the UK Government—the Minister might actually want to listen to that, having made snide remarks about the Scottish Government—and £157 per head more on social care. Scotland is the only country in the UK that provides free personal care, and we have sustained that since 2002. That has led to less than one third of the increase in A&E attendances and emergency admissions in Scotland over the past five years compared with England. The system is really expensive and it is challenging, but it reduces delayed discharges and it reduces emergency admissions, and the estimate is that it is still cost-effective. I suggest that the Government might want to look at that in the Green Paper.

[Mr Paul Sweeney (Glasgow North East) (Lab/Co-op)]

In my constituency, the Barchester Alexandra Court Care Home has closed, with 53 residents losing their places. That was because Glasgow City Council’s funding has been cut by 10%, yet the discretionary spend for Scottish companies has been cut by only 5%. Surely that is a disproportionate cut in social care in Scotland. Although the objectives are laudable, we have seen continued pressure on social care in Scotland as in the rest of the UK.

[Dr Whitford]

There is no question but that there is pressure. There is no question but that all the systems face the pressures of increased demand, workforce and money, but if the hon. Gentleman would like us to match funding down here, then we will remove £881 million from our health budget and, obviously, that £157 a head from our care budget. We spend more per head of population in Scotland—considerably more. [Interruption.] That is one of the mantras that is always heard down here, but may I point out that, for a Barnett consequential of 9.3%, the Scottish Government have to manage one third of the UK landmass—that is roads, rail, GP practices, hospitals and schools.

[Several hon. Members rose—]

[Dr Whitford]

No, I am sorry, I will not give way. Members want to make speeches, but if they intervene on me, there will not be any.

In Scotland, we have been working for the past five years on integrating health and social care. I can say that it is an awful lot harder than the job that we did of integrating primary and secondary care, simply because one side is tax-funded and the other involves multiple private companies and is means-tested. We are already working on that. Our integrated joint boards manage one half of our health budget along with local authority funding. It is about shifting money from hospital into primary care, mental health, community care and social care.

There are three particular groups who need social care. The frail elderly mentioned by the Secretary of State, the number of whom will escalate massively in the coming 20 years, need support and comfort, and most of them would like to be at home. The home care hours in Scotland have doubled over the past seven years, which allows people with more complex needs to be cared for at home, so as not to end up in a care home or to land acutely in hospital.

As was mentioned by the hon. Member for Bridgend (Mrs Moon), who is no longer in her place, end of life is a critical issue; it is a point at which time is of the essence. Since 2015, all Scottish local authorities have provided free personal care to people defined as having a terminal condition—facing the end of life—even when they are under 65. The Government should look into such a measure, as it provides dignity.

Working age disability accounts for a huge chunk of social care funding. These people want to be mobile and to be allowed to participate in society, and it is important that that is what they do—that they are not just stuck away somewhere, as might have been the case many years ago. From April, under Frank’s law, which was named after the footballer Frank Kopel, under-65s with degenerative conditions, not just disability, will be able to receive free personal care. That includes people with early dementia and multiple sclerosis. We ask that the DWP does not then rob these families of that money by cutting other disability allowances.

I mentioned the workforce, which is an enormous challenge in the health service and one with which every local authority, integrated joint board, company and care home is struggling. Despite the workforce in Scotland increasing by 11% over the last three years, it is becoming harder to recruit. Brexit only makes that harder because a significant proportion of social care staff are from Europe.

We need to make social care a career—to be decent to carers by paying them the real living wage, not the pretendy one, and by paying them for all the hours they work, even at night. It is important to treat people with dignity if we want them to treat our loved ones with dignity. Carers should have job satisfaction from having time to care. Having 15 minutes to flit in and out does not provide job satisfaction, and it does not provide satisfaction or continuity for the patient or the carer. There needs to be a career structure. Caring should be looked upon like nursing, with training, investment and a way of staying in that career. It should not just be some job that people do until they get a job on the checkout at Tesco because that pays better.

We have talked about being able to discuss the Green Paper, but unfortunately there is no sign of it. It is meant to offer an opportunity to rethink care. The Nuffield Trust suggests looking at the Japanese system or the German system, which has already been mentioned. It is noticeable that levers have been built into the Japanese system so that demand can be controlled, and that means that eligibility may well change. On the plus side, the system is Japan is a holistic one and it looks at the global wellbeing of the older population—so if we do look at these other systems, we should look at them in their entirety.

The German system is based on social insurance. Well, does that not ring a bell? We used to have national health insurance, but then the “health” was dropped. Maybe we should think about whether national insurance should really stop when people retire. Perhaps we might set a level above anyone who is living only on the state pension, because there are pensioners who are very well off and who suddenly stop paying national insurance exactly at the point when their health, care and social needs start to increase. We need to look at all these options, but it is crucial that there are no sudden changes—that we do not have a WASPI situation, whereby the goalposts suddenly move with only a couple of years’ notice, and that we do not have a measure like the one in the Conservative manifesto last year that was then labelled the dementia tax.

We need to discuss this issue as adults, to look around the world and to look at the demands ahead. Older people and people with disability across the UK need to be able to live a life of decent quality, with dignity.