Respite Care for Vulnerable Adults: Teesside

Susan Elan Jones Excerpts

Monday 12th March 2018 Commons Chamber

[Alex Cunningham]

I certainly do agree. I opened my speech by talking specifically about this being not just a Teesside issue, but an issue across the country, and it is a tremendous challenge to Government to plan for the future; I will also be developing that later in my speech.

I know that the team members at the CCG dealing with respite and wider provision are dedicated to their jobs and that they too have been distressed as we have gone through this process, and I for one appreciate the strains of dealing with such sensitive issues. They are trying to do their best within what they say are the ring-fenced resources available, although I personally could have hoped that they would have kicked the Government for failing to provide the resources needed.

Currently, respite is provided in two NHS centres of excellence, Aysgarth and Bankfields, but what are they planning to do now? The best of the options available to carers is this perceived reduction in residential care provided by the expert and nursing staff for their family members, and then the provision of a menu of alternative choices, largely without nurses. The choices include beds in care homes, hotel rooms, adapted caravans and even in carers’ own homes. Could we really see a vulnerable adult accommodated in a caravan somewhere and looked after by people in whom their parents may struggle to have confidence? What about the risk assessments for that menu of provision? Who is going to check that all the new people caring for these vulnerable people are both trained and suitable for this role and that the premises are suitable? What respite is it for a carer if they have the respite worker under their own roof? That is not much of a break for the carer or the family member.

To be fair to the CCG, it has promised that there will always be appropriately trained staff to offer the care and support required. Sadly, however, it is yet to provide the families with the reassurance they need, and the uncertainty is torture for them. So much more needs to be done to drive understanding. We also have to ask whether changes that cause such disruption are really appropriate in 21st-century Britain when carers do not know what the future holds. Our provision should be improving, not deteriorating in practical terms nor in the eyes of the carers.

[Susan Elan Jones (Clwyd South) (Lab)]

My hon. Friend is making a powerful case. Does he agree that this country needs to be doing a great deal more to support carers? I think back to the 1997 Labour Government, when national insurance contributions towards carers’ pensions were introduced. Is there not a case for looking at things in the round and doing more to support carers?

[Alex Cunningham]

I am a member of the all-party parliamentary group on carers, so I spend a bit of time on this subject. I do not know whether we will ever get to a point at which we are content that we have done enough, but we need to do much more.

I recently wrote to the Hartlepool and Stockton-on-Tees CCG regarding the consultation that was taking place at the time. It confirmed that it is committed to retaining the full £1.5 million fund for this provision, but it highlighted that the money will have to be spread further to reach more families. That confirms that provision is being diluted, and when provision is diluted, it is cut, and it will be the carers who will pick up the extra responsibility.

I accept the CCG’s point that more people need respite services, but the answer is surely to increase funding and provide the services that are needed, not water down what is available and provide a poorer-quality service. Demands for such services will continue to increase over the coming years as more vulnerable, high-needs young people grow into adults, live longer and need the kind of comprehensive support given by the people I have been speaking of today. The cost of meeting the services will therefore go up and, yes, although the cost may in some cases be shared between the NHS and local authorities, neither of them can sustain quality services for a growing cohort of people when the income simply is not there.

According to the National Audit Office, Stockton Council has had its budget cut by 52% since 2010 and spends around 57% of its money on social care. Does the Minister realise that we are facing a potential crisis? Does she understand the tremendous role that carers take on? Does she appreciate the need for comprehensive respite care to give them a few days’ break, or does she think that they will get by and manage? Well, while some may, others will not and will face the difficult decision to hand their loved one over to the health service full time because they simply cannot cope any more. What short, mid and long-term planning are Government doing to ensure that we have a strategy in place not just in Teesside but across the country to cope with increased demand and provide the increased resources required to deliver appropriate provision?

My colleagues on Teesside—my hon. Friends the Members for Stockton South (Dr Williams), for Hartlepool (Mike Hill), for Middlesbrough (Andy McDonald) and for Redcar (Anna Turley)—have all listened to carers’ stories and recognise that they are facing tremendous anxiety over what the changes will mean to respite care. Others have listened, too, including the scrutiny committees of our local authorities. The joint health scrutiny committee, a cross-committee of local councillors, stated that it could not endorse either of the two options or any other that would reduce provision. None of the councillors believe that the CCG has covered itself in glory in its handling of the matter, and they can see why those dependent on these services for a decent quality of life have lost all trust in the organisation, feeling that it has ignored their pleas and failed to understand their needs.

There is another dimension to this. I applaud the CCG for the comprehensive consultation exercise—and it has been comprehensive. Sadly, the CCG has failed to get its messages of reassurance across to these needy families, who interpret that as its having failed to recognise the anxieties created by the process. Carers tell me they have no understanding of any new criteria that will determine who gets what services. They feel that they are being left in the dark. Yes, I praise the public consultation by the CCG, but at the end of day the options were severely limited. I repeat that there is no extra cash to cope with increased demand.

I have heard that at one meeting with councillors, the CCG said that carers cheered when option 2 was chosen over option 1, which would have ended all provision at the two nurse-led residential units. Naturally, the carers cheered the better of two bad options. There was no option at all to extend the current provision or provide resources to cater for the additional needs of new adults coming into the system, which is something that Ministers need to reflect on. The CCG also stated that this was not a cost-cutting exercise. I know that the money is ring-fenced, but with the need to look after more people with the same money, there are fewer resources per person in the system. While I remain critical of the CCG and the way in which it has handled this issue I recognise that in many ways it has been backed into a corner. It know the demands on its service, but does the Minister? It knows that there are more people needing services, but there is no additional funding to provide that.

We all know that we have a health and social care crisis in our country, and while local authorities can shift the burden on to local council tax payers as Government cuts bite deeper, it is not something that our local NHS commissioners can do. They cannot tell local tax payers that they are sticking an extra 3% on their bills to try and alleviate the shortage of funds in areas such as respite care. That leaves the buck well and truly in the Chamber, with the Secretary of State for Health and Social Care and the Minister. My plea to her is simple. Will she take an interest in what is happening on Teesside with respite care for vulnerable adults? Will she examine the proposals, which parents see as a cut to provision for families in the area?

This is much bigger than Teesside. Yes, I know that there are CCGs up and down the country facing the same issues, so perhaps it is time for Ministers to consider the whole policy area of supporting carers such as those I have talked about this evening and find ways of providing the NHS and, for that matter, local authorities with the resources that are needed. Will the Minister instigate a much-needed policy review to see how we can do much better as a country to support carers?

Many families—I have talked to several—are living on the edge, struggling to cope with the needs of their loved ones. They have no intention whatsoever of handing them over to the state, but they need comprehensive respite care services to give them a little of their own time and space. We as a nation owe them no less.