Social Care (Liverpool)

Steve Rotheram Excerpts

Tuesday 7th March 2017 Westminster Hall

[Steve Rotheram (Liverpool, Walton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman), my constituency neighbour, on securing this important debate and on her speech, during which she laid bare any claim by the Government that they have any intention other than passing the buck for the health and social care crisis.

The Minister will be aware that, in the past few weeks, one of the main local hospitals in Liverpool has reported that an almost unprecedented 20% of its capacity has been taken up by people who do not need to be there. That, of course, has a knock-on effect and reverberates across the whole NHS system. The Government’s myopic approach has led to cancelled elective surgery, delays in A&E and ambulances backing up at hospital entrances, resulting in an incredibly inefficient use of already overstretched NHS resources. More importantly, it is not in the best interests of patients and patient care.

Keeping people who do not need to be in hospital in expensive NHS beds, instead of making provision for their illnesses to be treated at home or through other resources, is a wasteful and nonsensical way to spend taxpayers’ money. The Secretary of State has claimed that delayed discharge is not just about social care funding. Perhaps when the Minister responds, he would care to identify a single local authority that has had the same Government funding cuts inflicted on it as those in Liverpool and yet has managed to avoid a delayed discharge crisis. I await his response with anticipation.

A recent report by the Chartered Institute of Public Finance and Accountancy and the Institute for Government identified that people were waiting longer for critical hospital services such as A&E and cancer treatments. It highlighted the fact that delays in transferring people from hospitals into social care have risen by 40% since 2014. The Government cannot wash their hands of the crisis that has been created in Downing Street. They cannot simply shift the blame for the shambles they have presided over for the past seven years on to the shoulders of councils such as those in our area.

I should declare an interest in what I will say next, as a candidate in the Liverpool city region metro Mayor contest. If I am elected in May, I offer to work with the Minister’s departmental officials and the leaders of the six districts in the Liverpool city region to convene a health and social care summit, to examine the current situation and look at how we might work together across the piece at what could be done better. As my hon. Friend said, there are some innovative approaches and best practices in our area, and the Government might even learn something if they took part. Councils in our area have already shown the leadership on social care that the Government are singularly failing to, so that summit is a chance for the Government to answer their critics, see for themselves the pressures that local authorities are having to contend with on a daily basis and work to tackle the problem at source.

We have a duty of care to ensure that health and social care work is as seamless and joined up as possible within the current structures of responsibility and funding restrictions. However, the Government need to accept their duty in relation to health and social care. In our area, the so-called social care precept would not even go close to backfilling central Government cuts to date, as we have heard, and it is seen as a scam to shift the burden of funding on to the shoulders of local taxpayers. Liverpool has a predominance of terraced streets—what we used to call two-up, two-downs—so the imbalance of band A and B properties means that for every 1% increase in council tax in our area, we raise about £1.4 million to £1.5 million. However, with a similar 1% increase in some of the leafy suburbs down here, councils can raise more than £5 million. That situation perpetuates the growing gap between the haves and the have-nots, and we will see tomorrow whether the Chancellor recognises that the cuts being inflicted on councils such as Liverpool, Halton, Knowsley, St Helens, Sefton and Wirral have gone too far, and whether a fairer settlement is offered.

We are doing our bit in our city region. The Government now need to accept their responsibility to the elderly and their families and carers. They have often tried to use a sticking plaster to offer a solution, but they know that a sustainable solution must be found to this growing problem. I hope that all the relevant factors—including demographic, socioeconomic and health inequality data—are included in any formula that the Treasury uses to calculate additional funding need. Perhaps tomorrow’s Budget will see yet another sticking plaster applied to the crisis in social care and in our hospitals, but mark my words: it will be no more than a temporary measure at best. At worst, it will be more smoke and mirrors that will fall apart just days afterwards upon further scrutiny. I cannot believe the Government will allow that to happen.

At Prime Minister’s Question Time, the Leader of the Opposition mentioned that Liverpool’s director of adult social care, Samih Kalakeche, had handed in his notice because he was tired of being held responsible for axing services for the elderly and vulnerable in our city. Mr Kalakeche told The Observer:

“Frankly I can’t see social services surviving after two years. That’s the absolute maximum. If we don’t do something within the next six months, I believe social services will not exist by 2018-19. This isn’t scaremongering, this isn’t me asking you to feel sad for me—whoever is making decisions out there has looked at social care as the Cinderella of the service…People are struggling, people are suffering, and we’re really only seeing the tip of the iceberg.”

I think those comments are directed fairly and squarely at the Government’s door.

However, it is not only Samih who claims that. Last month, the Conservative chair of the Local Government Association, Lord Porter, said that services supporting the most vulnerable people in our communities were at breaking point. He said that

“extra council tax income will not bring in anywhere near enough money to alleviate the growing pressure on social care both now and in the future. The social care precept raises different amounts of money in different parts of the country. Social care faces a funding gap of at least £2.6 billion by 2020. It cannot be left to council taxpayers alone to try to fix this crisis. Without genuinely new additional government funding for social care, vulnerable people face an ever uncertain future where they might no longer receive the dignified care and support they deserve. This is not only worse for our loved ones but will also heap further pressure and wasted expense on the NHS.”

Opposition Members could not agree more.

I know that our area, like the other 150 councils in England, will not get a sweetheart deal from the Government—sorry, I of course mean a memorandum of understanding allowing for a pilot of business rate retention. In any case, such deals are yet another example of the Tory approach that “to those that hath shall be given”. For example, Westminster City Council raises so much money in business rates that it could probably afford to actually pay its residents to live there instead of taxing them. However, there are certainly limits to what can be achieved in our area at a local or even sub-regional level with the current inadequate resourcing.

I slightly disagree with my hon. Friend the Member for Garston and Halewood (Maria Eagle), who welcomed the Government’s social care commission. I do not think we need another commission; I think we all know what is happening in our areas. The Government need to start listening to people—to patients, carers and families who have to go through terrible circumstances on a daily basis. It is time for action, not for commissions. Our elderly family members and our overstretched and all-too-often under-rewarded social care workers deserve nothing less. I hope the Minister will talk about action in his response.

--- Later in debate ---

[David Mowat]

I was just making the point that the figure the hon. Member for Liverpool, Riverside used was £130 million and the figure I have is £194 million. I accept that that number is not for today, and I also accept, as I have said many times in the Chamber, that the social care system is under pressure throughout the country, and Liverpool is part of that.

[Steve Rotheram]

I am trying to be helpful to the Minister. I quoted a former director of adult social care in Liverpool, Samih Kalakeche, who said:

“If we don’t do something within the next six months, I believe social services will not exist”

by the time that the Minister believes we will get the additional funding.

[David Mowat]

Today is not Budget day. I accept that the systems are under pressure. The precept has raised something, and Liverpool’s budget for social care is increasing next year, but it is fair to ask whether it is increasing enough given the pressures we are under—that is a reasonable point. My point about the £194 million figure was in response what was said earlier. Although I and the Government accept that there are pressures, it is important that we share accurate numbers with each other.

The hon. Member for Liverpool, Riverside also made the good point that there is now an increasing tendency for care to be provided in people’s own homes. If we look at the care home market over the past decade, we see that roughly speaking there are the same number of beds today as there were 10 years ago, and that is clearly in the face of a considerable increase in demand. That is because far more people are now being looked after through domiciliary packages in their own home, and that is the market we need to get right and make effective.

The hon. Member for Garston and Halewood (Maria Eagle) raised the potential issue of councils being punished in the Budget for being efficient. I will be very disappointed if that is the case—it is not my understanding of what will happen—but it is a fair challenge, and we will have to see about that when the Budget comes out.

The hon. Lady raised a number of points about the STP. We all share the STP area, and there is work to do on it. I will make this point, however: she talked about cuts of £908 million, but those are cuts against an increase in demand—they call it the counterfactual—of 4% or 5% over the next period. The truth is that Cheshire and Merseyside will be getting real-terms increases in funding for every year up to 2020. Nevertheless, that does not mean that there are not challenges, for some of the reasons we have heard, such as demographics and all that goes with that.

The hon. Member for Liverpool, Wavertree (Luciana Berger) asked for a glimmer of light and hope; hopefully, between myself and the Chancellor tomorrow, we can achieve that. She also raised the cases of Sobia and Veronica and their care packages. It is difficult for me to respond to that, other than to say that the Care Act 2014 set out statutory requirements for what councils need to do. If those statutory requirements are not being met, and the way she described those cases implied that might be the case, that is clearly against the law and there is recourse either to the local authority itself or to the ombudsman. I would be happy to talk to her about that in more detail.

The hon. Member for Liverpool, Walton made a number of points and started by talking about delayed transfers of care. He rightly said that I have talked on a number of occasions about variations between councils in delayed transfer of care performance. I will say that DTOC is not the only measure of the effectiveness of a social care system; it just happens to be one the easier ones that we can get a metric around. The fact is that if we look at the 10% worst and the 10% best councils in the country—Liverpool is round about the middle—the level of delayed transfers differs by a factor of around 20 or 30. I absolutely concede that social care systems work better with more money, but it is not just about money, because that is about different working practices and different people doing things in different ways. It is right that we have the debate about that, as well as about the need for more money.

The hon. Gentleman challenged me to name some councils that were much better than Liverpool in terms of delayed transfer of care, within a similar budget environment. I do not know what the budget environment is, but I have a list I can give him of councils that have fewer delayed transfers of care. As I said, Liverpool is not a particularly bad council, and I do not want to imply that it is, but Durham, Kirklees, Sunderland, Barnsley, Newcastle-upon-Tyne and St Helens all have at least 10 times less delayed transfers of care than Liverpool. I was taken to task at a recent Conservative councillors meeting, in which people said that having a good social services department is not just about delayed transfer of care; it is to do with a whole lot of other things. I absolutely accept that, but in a sense the hon. Gentleman started it, so I wanted to give him those figures.

[Steve Rotheram]

Will the Minister therefore pay tribute to Liverpool for what it has done and its innovative approach? My question was about councils that have had similar cuts to Liverpool of around 60%. None of the councils that he mentioned has had the same degree of cuts as Liverpool City Council.

[David Mowat]

The hon. Gentleman mentioned some councils that were in the south and I picked some that were not, but fair enough—I accept his point. He mentioned that, depending on the result of his election, he would have a summit. I would be delighted to attend, if he were to invite me—although who knows where I will be by then.

[Steve Rotheram]

It’s only in May!

[David Mowat]

Indeed. On Thursday, I am going to Liverpool to give a talk at a care conference. I would be very happy during that visit to come along and talk to the council about some of the issues raised here today. As the hon. Gentleman rightly said, I am sure that the Government can learn from Liverpool. Frankly, we can all learn from each other. When I went to Whiston hospital and saw discharges to St Helens and to Liverpool, I saw some wonderful things happening there. Anyway, the offer stands.