Local Government and Social Care Funding

Philippa Whitford Excerpts

Wednesday 24th April 2019 Commons Chamber

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

I associate myself with the comments of the other two Front Benchers about the events over the weekend. I had the honour of being in Jerusalem for Easter and was shocked on Thursday and then on Sunday to hear of such horrific events. I was sitting in a site that is so precious to the three monotheistic faiths when I heard that, after the terrorist attack in New Zealand, we had had violence in Northern Ireland and then the horrific attacks in Sri Lanka.

Turning to this afternoon’s debate, I echo the comments of the hon. Member for Denton and Reddish (Andrew Gwynne). Here we are yet again. The Green Paper that we should be debating to consider sustainable funding for social care has been kicked into the long grass five times, and there is no sign of it coming forward. Is that just because the House, the Government and the civil servants are too busy with Brexit, or is there really a lack of ideas on how to solve the situation? The problem, however, is that we should urgently be thinking about a way forward.

The NHS five year forward view was based on game-changing public health changes and funding and increased social care funding and provision, because otherwise all we will see is increased demand at the front door of the NHS and then a blockage and leakage of funds at the back end. The four-hour target that we often talk about does not just measure A&E performance; it is about the flow of patients through the system. If patients cannot get home at the other end, the system simply breaks down.

Local government in England has seen an average 28% cut in funding, and I have been shocked by some of the figures that Members have mentioned, which range from 46% to 75% to 97% cuts in central funding. Obviously, everyone has faced cuts to their budgets, but there has been only a 5% reduction in local government funding in Scotland despite a 7% cut in the resource budget. The situation has been much more protected than has been the case in England. In Wales, there has been an 11% cut.

I welcome the long-term NHS plan because it unpicks some of the damage done by the Health and Social Care Act 2012, particularly by reforming section 75, and it tries to drive integration, which I think Members on both sides of the House would recognise is the only way forward. However, it was disappointing to discover yesterday on the Health and Social Care Committee that local government was not involved, almost at all, in putting together the long-term plan, yet it will be expected to deliver more and stronger social care to relieve pressure on the NHS.

[Norman Lamb (North Norfolk) (LD)]

Does the hon. Lady agree that it should have been a long-term health and social care plan if we actually believe in joined-up, integrated working and that the funding settlement for the NHS, very tight as it is, simply will not work without addressing the underfunding of social care?

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[Dr Whitford]

I utterly agree and, obviously, the Department’s name was changed to the Department of Health and Social Care to reflect that need for integration, yet that is not the discussion we are hearing.

[Mr Jim Cunningham (Coventry South) (Lab)]

The hon. Lady is making a valuable contribution. One of the big problems in social care is the lack of social workers, which local authorities cannot fund because of the gigantic cuts conducted over the years by this Government. It is about time we faced up to the fact that austerity has gone on far longer than the second world war and, quite frankly, rationing.

[Dr Whitford]

The hon. Gentleman talks about the workforce, but in both the NHS funding settlement and the forward plan we see a big injection into NHS England, but no extra funding for Health Education England or for public health. Preventing illness is the cheapest thing we can do yet, for decades, Governments of all colours in all places have failed to do that. Unfortunately, the long-term plan does not do it, either.

Age UK talks about 1.5 million people being left without sufficient care and support at home, and it describes the number of people needing elderly social care increasing by almost 50% since 2010, but local authority-funded patients in England are down by a quarter over that time. A third of patients depend on family support, but 2 million carers are over 65 themselves, and 400,000 of them are over 80. Look at the burden we are putting on elderly people to care for their elderly partners, often without respite or support.

[Emma Hardy]

I recently spoke to an elderly couple. The lady was caring for her husband who had Alzheimer’s, which was having such a devastating impact on her health that she ended up having to go into hospital, too. She was not worried about being ill and having to go into hospital; what was upsetting her was that her husband was left without anybody to care for him in an environment he did not know or understand. Surely this situation needs to change.

[Dr Whitford]

Absolutely. We should value family carers and the care and work they do, right across the United Kingdom, for people who need help in all our communities, yet they are so poorly valued. Carer’s allowance does not even equal jobseeker’s allowance, which is something we have tried to repair in Scotland, but obviously we do not know whether that money will simply be clawed back by the Department for Work and Pensions in other benefits. That is always the problem. We are supporting carers so poorly. Not only do they have the physical burden and the lack of time to look after themselves, but often they are in financial difficulty.

Scotland is the only one of the four nations to provide free personal care, which we have been providing since 2002. Having integrated health in 2004, we have been working since 2014 to try to integrate health and social care, which is a lot more difficult. The social care environment is different. It has multiple companies and different set-ups. It is means-tested, rather than being provided free. Social care is a real challenge, and therefore local authorities and the health structures within any local health system will require support and funding to work out how to achieve it so that they are wrapped around the patient, not bitching about whose purse the money will come out of. As we have heard today, the problem is that there simply is not enough money in the purse to start with.

In Scotland, we now allocate half of our health funding to integrated joint boards, which are made up of health and local authorities, to look at how we provide primary healthcare, mental healthcare, social care and children’s services so they are driven locally and take account of all the support that is required.

There are three main groups that require social care. First, the elderly. Many of us are heading that way ourselves, and the No. 1 important thing is to maintain people’s independence for as long as possible. That is the importance of not rationing surgery for hips, knees and eyes. If we can keep people seeing and walking, and if we can give them a bus pass so that they are out and about with their cronies down the town, they will stay independent and functional for longer.

Of course we have the frail elderly, who require to be looked after in comfort and support. By their own choice, that would be in their own home if at all possible. In Scotland, home care hours have been increased from six hours to 12 hours a week, which has allowed us to keep people with greater dependency at home. Looking at A&E attendances and emergency admissions over the past five years, we can see that Scotland’s increase—we are all facing increased demand—has been only one third of that in England. That is why we have had our best performance against the four-hour target since March 2015. It is a combination of supporting people not to arrive at the hospital door and not to be stuck at the other end, because we have driven down delayed discharges every year.

When we talk about numbers such as four-hour targets, it is important that we remember that they are a thermometer taking the temperature of the acute system. They look at how we bring people through. Everyone in hospital wants to get home. They do not want to be stuck there.

The next group is people facing end of life, and they would like, if possible, to be cared for with dignity at home. They want to be with their family but, equally, they do not want to be a burden to their family. If they need respite, they want to have access to it. Since 2015, the Convention of Scottish Local Authorities agreed that even people under 65 will be provided with free social care if they are defined as facing end of life, which means they will not be stuck in hospital facing a means test that fritters away their remaining weeks and days of life. A quarter of us will die in a care home, and we want to make sure that we would be happy with the quality of care in that care home, rather than living in squalor or being mistreated.

The third big group is the working-age disabled. For them, quality of life, mobility and, particularly, participation in society are critical. Both in England and Scotland, almost half of local authority social care spending is on people of working age. We tend automatically to think that social care means the elderly. Two thirds of the working-age disabled told a survey that they are not given any help or signposting, and a majority said they are not given enough hours to help them live independently.

Frank’s law comes in this month in Scotland, which means that those under 65 with dementia, motor neurone disease or multiple sclerosis will also be eligible for free personal care. The law is named after Frank Kopel, the footballer who unfortunately developed dementia very early.

Workforce is a challenge for all of us. Our workforce has gone up 12% in the past three years, but all care providers report difficulties in recruiting, and Brexit is only making that worse. We need to value care, and we need to let it develop as a career. People should be paid the real living wage, not the pretendy living wage, for all the hours they work, including at night. A carer coming into a patient’s house for 15 minutes to throw them out of bed, particularly a carer that patient has never seen before, is not providing quality of care. We need continuity between the patient and the carer. Caring needs a career structure to ensure that people stay in the profession and develop, grow and lead others.

It was said that the UK Government Green Paper would give us a chance to rethink funding, but we still have not seen it to enable us to debate the options. Will that be done by a rise in national insurance, or by continuing national insurance after retirement for better-off pensioners? People have mentioned the German and Japanese systems, but we need to look at the pluses and minuses of both. By 2030, the number of 85-year-olds will have doubled. We need to prepare to look after them, and to give them independence and dignity, so that they do not end their lives in complete misery and squalor.

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

It is a privilege to follow a very moving speech by my hon. Friend the Member for Crewe and Nantwich (Laura Smith), who outlined the severe problems faced by our social care service.

On a slightly different note, last year I had the pleasure of attending the launch of renovation works to an historic old primary school in my constituency. Derelict for several years, the school lies at the heart of the Parkhouse district of my constituency of Glasgow North East. The Wheatley Group—the inheritor of Glasgow’s municipal housing stock—acquired the school for conversion to new sheltered social housing. The name Wheatley and the history of the school itself evoked a reflection on the long and proud heritage of municipal socialism in Glasgow, and what the prospects might be for that tradition to re-emerge in the future.

Parkhouse was one of the first districts to be developed for municipal housing by the Glasgow Corporation after the passing of the historic Housing Act 1924, led by Glasgow Labour MP John Wheatley, during the first Labour Government. These state subsidies for house building led directly to the creation of Glasgow’s municipal housing department, and saw the large-scale building of some 57,000 new homes in Parkhouse and other districts such as Riddrie and Carntyne in my constituency during the inter-war period. Indeed, the pressure to develop suitable land for new municipal housing led to Glasgow more than doubling in size, from over 5,000 hectares to over 12,000 hectares during the 1920s and 1930s.

At that time, the gas supply, water, electricity, subway, hospitals, tramways and even the telephones were all in direct municipal ownership, and there was much talk of Glasgow as a European model for municipal socialism. Indeed, at the international conference on workers’ dwelling houses in Paris in 1900, Glasgow Councillor Daniel Macaulay Stevenson, after learning that the municipal control of housing was regarded as impractical by delegates, remarked that, far from that being the case, it had been carried out to an ever greater extent for 29 years in Glasgow. He elucidated the Glasgow Corporation’s extensive portfolio of services under municipal ownership, which the delegates regarded as

“nothing short of rank socialism”.

It is interesting to see that some sentiments do not change, even more than a century later.

The scale of that sort of intervention to address the city’s social problems is scarcely imaginable today. There is simply no capacity or scope within local government to undertake the sort of mission-driven improvement that can massively improve quality of life. Today in Scotland, after two decades of devolution, we now have the most centralised system of government of any country in Europe. We have the absurdity of the Glasgow city region’s wealthiest suburbs carved up into self-contained enclaves, where the residents enjoy relatively low rates of council tax, while the residents of the urban core of the city—home to the poorest communities in the region—must carry the burden of maintaining and operating all the core services and amenities enjoyed by its wealthier suburban free riders. Not only has Glasgow been stripped of its residential tax base through historical depopulation and the relatively recent gerrymandering of its suburbs; the advent of the Scottish Parliament has seen a continuing war of attrition against the power of local government.

This year, the Scottish Government are set to impose cuts on Glasgow that are unprecedented in recent times and will lead to a further decline in public services in the city. According to the Scottish Parliament’s information service, the local government revenue budget was cut by 6.9%, whereas the Scottish Government’s revenue budget fell by just 1.6%, between 2013 and 2018. Over the same period, Glasgow City Council’s core budget has been cut by 12.8%. That is almost twice the average cut to Scotland’s 32 council areas, and seven times the cuts to the Scottish Government. The Scottish Government are proposing a further disproportionate cut to Glasgow of 3.6%—or £41 million—this year.

Although there is no question but that the Tories are to blame for cutting the block grant of the Government in Edinburgh by 1.6%, to multiply the percentage cut by four to 6.9% for councils—and by even more than that in Glasgow—is a deep injustice. The only conclusion we can draw is that local government, and Glasgow in particular, has been targeted disproportionately. Our city is having to absorb a cut to its budget proportionately seven times greater than the cut being absorbed by the Government in Edinburgh. That is £233 per head for each Glaswegian between 2010 and 2018.

Already 30,000 Scottish council jobs have gone, swimming pools are being closed, community health projects face non-renewal, class sizes are rising, pupil attainment is stalling, high streets are declining, community groups are losing grants, youth clubs are closing, grass is being left uncut, litter is piling up, roads and pavements are in serious disrepair, and social workers face ever-increasing case loads. In Glasgow North East, we face the potential closure of a local swimming pool, a sports centre and numerous municipal golf courses that were only spared cuts this year after a determined local campaign to save them caused such embarrassment that the council reversed its decision.

Glasgow is unfairly bearing the brunt of decisions to scale up the cuts as a share of its overall budget compared with the Scottish Government. Labour will end Tory austerity at source when the Leader of the Opposition steps into No. 10 Downing Street, but in the meantime Glasgow simply cannot take a further hit that is so disproportionate to that being taken by the Scottish Government. I am continually being contacted by spontaneous local campaigns coming into existence to fight the cuts that Glasgow is making because of the severe retrenchment it has been asked to make. We are facing the closure of entire facilities and services, and the council’s withdrawal from non-statutory quality-of-life provision in my constituency, which is one of the poorest parts of this country. Indeed, last year, the SNP tried to pass the burden of cuts on to working parents by doubling childcare fees, and was only forced to retreat after a determined local campaign.

The Scottish Government need to recognise that Glasgow’s settlement should be no worse than the 1.6% cut that the Scottish Government block grant has suffered since 2013. I plead with the Scottish Government and the UK Government to combine to ensure that, at a bare minimum, they rescind this negative multiplier effect.

[Dr Whitford]

The resource budget of the Scottish Government has been cut 7% since 2010, not 1%. The idea that they have faced only a 1% cut is nonsense.