Social Care: Nottinghamshire

Debate between Tom Randall and Ben Bradley

Monday 21st February 2022 Commons Chamber

[Ben Bradley]

My hon. Friend knows the challenges in Nottinghamshire social care as well as anybody—I am sure they come across his desk in Broxtowe all the time—and he is right that this work has to be locally led. I welcome the opportunity in the White Paper to build from the community upwards through our integrated care strategy and to work together with health partners around the county. In the long term, locally led and community-based provision will help us to tackle the challenges we face.

This debate is on social care in Notts. As the Minister knows, among those in this place I am unique in being responsible for the direct delivery of social care services in my county and in my Mansfield constituency, so this is a unique opportunity for me to raise the key issues that affect those services with her and with the Government—from the coalface, so to speak. That is part of why I have argued that my dual role can benefit my constituents and the Government. I hope that proves to be true.

The Minister will not be surprised to hear that workforce capacity is far and away the biggest challenge that we face in Nottinghamshire. We have seen a further 5% decline in staffing levels in a sector that was already understaffed. I am grateful that a crisis was averted by the revocation of the mandatory vaccination plans, because they would have seen thousands more leave the sector in Notts. That change of policy was absolutely the right decision.

We estimate that the turnover of staff in home care is around 26%, which is a massive and ridiculous proportion. That reflects the fact that there is significant competition for pay; that people can earn more in other sectors locally; that we are struggling to recruit; and that staff who have been through the ringer in recent years in incredibly tough circumstances are increasingly deciding to retire early or take a break because of the pressures.

We are doing a lot locally to try to combat the amount of turnover, including through new apprenticeships and big recruitment campaigns with market providers, and by incentivising collaboration between providers and offering incentives for them to invest in staff wellbeing or training, but more is needed. We need a national workforce strategy and recovery plan with sustainable funding that recognises the disparities in pay and conditions in the sector, and that needs to be part of the “fair price for care” reforms, which is not currently the case.

We need to understand what more can be done to increase the stature and status of care workers and the care profession. The workforce plan needs to include clear and defined pathways into health services, so that people see social care as an entry pathway to wider health and NHS careers, where the range and scale of opportunities for different jobs and long-term careers is massive. Care is often perceived to be a low-skilled, low-paid job with little scope for progress or promotion, but that is absolutely mad when we consider the fact that the skills and qualifications are directly transferable into one of the world’s biggest employers, the NHS, which covers every health role under the sun.

The pathways should be obvious and we need to make them obvious and overtly available to care workers and young people in schools and colleges. I hope we can plan some of this work locally, perhaps through the devolution of skills funding in the coming years. We are already working on some of that with West Nottinghamshire College and Nottingham Trent University, which are trying to build the pathways from school directly into the health services in my Mansfield constituency. A national pathway for integrated health and care careers would be fantastic.

The shortage in home care has meant that an additional 10 people a day are waiting to be discharged from my local hospital and much higher proportions of people end up being discharged to care homes when they could and should have gone to their own home. That is not good for long-term outcomes or those people’s wellbeing and also means that our reablement services—those that support people to get back on their feet and be independent in their own home—are overwhelmed. These are observations from Notts, but the trend is regional and national, not just ours. In fact, we have fared better than many other areas.

I thank the incredibly hard-working and dedicated staff in Nottinghamshire’s social care services for everything they have done to manage incredibly difficult circumstances. I include among them our council’s service director, Melanie Brooks, who directly delivered care packages and was on call over Christmas to try to mitigate the pressure. A huge thank you to her and her teams.

We have a lack of housing stock for care provision, and investment in things such as supported accommodation has slowed down, obstructed by covid, construction and supply chain issues and other factors. It often seems like the link between health and housing is not made clear, and it does not seem to feature much in some of the recent proposed legislation, but good housing can reduce social care needs, prevent hospital admissions and support people to remain active and sociable in their own homes and communities.

Homes England funding could be devolved to support local areas to meet their needs. Housing needs to be a key part of care reform. In our two-tier area we are working hard on collaboration among councils and providers to ensure that housing and health services talk to each other, but that is an option rather than something that is automatically built into the system. That needs to change. Similarly, if we have accountable local leaders—the Government have made clear through the Department for Levelling Up, Housing and Communities their intention to devolve significant powers—could we not have more local control over how powers are managed and delivered? That would help us to integrate our local services. Children’s services are also key to this. I question whether all this needs to be linked to the children’s care work that seems to be in the pipeline, through the Josh MacAlister review and the special educational needs and disability review that is happening in the Department for Education. Children’s care services and adult care services are linked, quite clearly, and they need to be integrated just as health and care do. I know that this is complex as it spans multiple departments, but it is also sensible and it needs to happen.

Our local integrated care systems will seek to draw all these things together to offer the best start in life and the right preventive interventions, just as Nottinghamshire County Council is doing with a significant investment in the transformation of our children’s services. More proactive and preventive services will be announced in our budget on Thursday. That is something of which I am incredibly proud and it will, I think, change lives. If local plans across the country seek to integrate adult care services and children’s care services then, clearly, national ones must do so, too.

Financially, Nottinghamshire has some capacity to use adult social care precepts this year, but continued rises in council tax without major reform are also unsustainable, especially when we consider that some London boroughs pay half the council tax that many people do elsewhere, including in my own constituency. That is not fair, but, as an authority, it means that we do have some funds to draw on this year. Our social care budget for 2022-23 will rise by around £12 million compared with last year. That extra funding is very welcome, but, again, we need to understand that that is not sustainable in the current system. Fairer funding for local government needs to be a priority to make sure that we have that level playing field across the country.

There will be a significant challenge in terms of resources and staffing capacity as we try to tackle both the day-to-day care issues that I have touched on—pressures of services and staffing—as well as delivering the significant reform that we are being asked to deliver. Although it is welcome and right, it will present its own challenges and pressures. The Government must ensure that sufficient capacity exists if they want us to do both at the same time.

[Tom Randall (Gedling) (Con)]

I congratulate my hon. Friend on securing this Adjournment debate; it is on a very important subject. I am sure that most Nottinghamshire MPs have spoken to people such as Terry Galloway who has some very interesting ideas on this subject. I am talking in particular about people who are of working age but who are leaving the care system—reintegrating into life as it were. They face particular challenges that are almost akin to a benefits trap in terms of leaving care and then having to meet certain costs. Does he agree that, when we talk about resources, it is important that we give these people the resources that they need to bridge that gap? In the longer term, that will benefit both them and the wider system as it will help them to get back to a normal life.

[Ben Bradley]

I thank my hon. Friend for that intervention. Terry Galloway is fantastic. He is a real advocate for some of our children’s services—our care leavers’ services in particular—in Nottinghamshire. I am pleased that my hon. Friend has raised his case here today. This is a prime example of where children’s services and adult care services need to talk to each other, and where we need to have those clear pathways into additional support. Some of those children will get support until they are 25 under the current system, but that is not all funded. Equally, we need to do more at a county level to plan for the lifetime of these children. We know that they are there. We know that when they are in children’s services, they are likely to come into adult services, and we need to make sure that we are planning for that in the long term. The same applies to SEND and other local challenges—my hon. Friend is absolutely right about that. We know that the outcomes for care leavers are not great, which is partly why we are investing £14 million over the next three years at County Hall in transforming those proactive and preventive services, starting with our children’s services, making sure that we are delivering the best possible support and offer to them.

I am pleased that the Government are finally grasping the nettle of social care reform and integration, because, just like the never-ending increases in the NHS budget, it is neither right nor affordable for spending to go up and up every year and for that to be accepted by Government or by anyone else. That is not a solution. We must do it differently. If we cannot tackle the growth in cost and demand under the current systems, then those systems need to change—whether they be care services, health services, children’s services, or all of it. In some ways, covid provides us with that opportunity to draw a line, to think again and to reform. I hope Government will take that opportunity, and I look forward to hearing from my hon. Friend the Minister.

Devolution for the East Midlands

Debate between Tom Randall and Ben Bradley

Wednesday 14th July 2021 Commons Chamber

[Ben Bradley (Mansfield) (Con)]

I am pleased to have secured this important debate on devolution in the east midlands region. I understand that the forthcoming levelling-up White Paper will set out the Government’s plan for further rounds of local and sub-regional devolution. If so, it seems a pertinent time to examine the opportunity in the east midlands to put an ambitious levelling-up and devolution package at the heart of a sustained recovery for our region. I have had some exploratory discussions with other council leaders across the region and have been met largely with enthusiasm and a commitment to explore our options in more detail. There is a genuine will and a drive to get on with things in the east midlands. We need the Government to give us the tools to do the job at hand for UK plc.

I pay tribute to the great work of leaders across the region who have come together in recent years on projects such as HS2, our development corporation and our freeport. Those leaders, from across the public and private sectors, have shown courage and commitment to the region, bringing forward ambitious plans despite the pressures of the pandemic. In my conversations with those colleagues, there is a strong ambition to bring power and resources closer to their councils, universities and businesses. In a post-pandemic world, it is vital that we harness that enthusiasm, and commit to rebuilding the east midlands economy, improving the living standards of local people and bringing high-value jobs, sustainable employment, training opportunities, growth and prosperity to the region.

I also thank Sir John Peace for his leadership of the midlands engine. A devolution package for the east midlands would complement and strengthen the work of the engine and Midlands Connect, and help him to deliver on some of the ambitions that he has for the region. It can support the huge effort and resource that he gives to our key priorities.

The east midlands is home to more than 5 million people and over 175,000 businesses. It has a diverse mix of counties and cities, market towns, countryside, and distinct culture and communities. It contains world-class business, innovation and manufacturing excellence. The east midlands economy has untapped potential for growth. Despite this critical mass and potential, the east midlands has received some of the lowest levels of Government investment over many years compared with other parts of the country.

Ours is a region of undoubted attributes and proud heritage. What is often overlooked, however, is its strategic location, creating, as it does, a bridge between the south and the north of the country. It also has strategic transport links that help connect the Union as they go north through England and up into Scotland. For that reason, the east midlands is vital. It is a hub for our nation, but for too long it has been seen instead as a place that people drive through to get from one place to another. It is so much more than that and we must capitalise on that potential.

The resurgence of the east midlands is critical for the renewal of the UK economy as a whole. Given our position at the bottom of those rankings for investment, we must therefore be at the centre of a levelling-up agenda. An east midlands combined authority, under a unified vision and plan that is complementary to the midlands engine and the Government’s devolution and recovery ambitions, would be levelling up in its most literal sense. Other regions with devolution packages, such as the west midlands, Greater Manchester and Teesside have more local powers and more powers to make a real impact. A package for the east midlands would equalise those things and bring us up to a level of equal opportunity with those other areas.

[Tom Randall (Gedling) (Con)]

I congratulate my hon. Friend on securing this debate. It is great to hear the east midlands being debated in this House. As he knows, I am a member of the Public Administration and Constitutional Affairs Committee, and we have been looking at the evolution of English devolution. Tomorrow we will be hearing from the excellent Ben Houchen and also Tracy Brabin. Last week we heard from Jamie Driscoll, the North of Tyne Mayor and Andy Burnham, who spoke about their experiences. Andy Burnham says that the entities that have been created can help to bring

“coherence to areas that may have felt a little disparate”.

In the context of the east midlands, does my hon. Friend agree that devolution or some sort of authority is the best thing that we can do to bring that region together and get the investment that we really need?

[Ben Bradley]

I thank my hon. Friend and Nottinghamshire neighbour for engaging in this debate. He is absolutely right, particularly when it comes to a region such as ours, which does not have that metro centre—an obvious urban hub. We are three cities, three counties with different spatial geographies, different transport links. We need that hub and connectivity to have a single vision for how we plan that across the region, otherwise we will all head off in our own different local directions and will not be able to make a coherent argument to Government. Such a hub is really important for that unity of purpose and delivering that investment.

The unprecedented financial, economic and social challenges facing our area require a more ambitious and dynamic response, which we cannot achieve operating within the status quo. A regional devolution of powers and resources is key to enabling us to be competitive, and ambitious for our people and places. The conditions created by a combined authority would enable us to pool sovereignty and capacity on an unprecedented scale.

The benefits could include a coherent, planned focus on delivery for our economy, a focus on achieving the greatest public value for residents and places, more efficient and effective spatial planning in the region, including transport, and dealing with some of the challenges that my hon. Friend the Member for Gedling (Tom Randall) mentioned.

A unified approach, which would be more attractive to the Government, could work to make sense of the many complex structures that exist in our region—the midlands engine, strategic partners, councils, businesses and investors—bringing a clarity of purpose, strength through unity, and confidence to those who want to invest in our region. Councils could come together to create a mayoral combined authority. That body would complement the West Midlands Combined Authority to the west, the northern powerhouse to the north, and Cambridgeshire and Peterborough Combined Authority to the south—in many ways we are the hole in the middle of the doughnut, without the powers that everybody around us seems to have.

Building on our excellence in high tech and advanced manufacturing companies, an east midlands authority could take the regional lead, for example by promoting action on climate change or carbon reduction to be a catalyst for our green economy and artificial intelligence industries of the future. Governance of the authority could be inclusive to provide strategic co-ordination of regional policy, with councils joining forces with industry, higher and further education, and wider public sector partners.

Across the three cities and counties of Nottinghamshire, Derbyshire and Leicestershire, there are 28 local councils. Through the levelling-up White Paper, there is an opportunity to lay down enabling legislation requiring the vast majority of councils, rather than all, to sign up to a combined authority, so that we can be confident of consensus for a new combined authority and move at pace. An alternative option could be to discuss and negotiate a geography for a mayoral combined authority that could incorporate all partners—the vast majority of local authorities within the region—that wanted to be part of it in the first instance, perhaps with a system of affiliation for others that might want to join. In short, there are options; much of the work and planning for them has been done, much of the documentation exists, and now is very much the right time to explore them.

An east midlands combined authority would create a single voice in the region. A clear and focused channel of communication would improve services to communities and generate additional gross value added, creating new jobs, supporting businesses and promoting radical public sector reform. It would give us localised powers to genuinely tackle inequalities in skills and health in a way that is bespoke and that fits with our communities. That cannot be done from Whitehall; it needs a local drive.

In the past, the Government have challenged the east midlands to work together, and there has been progress. Our new interim development corporation is working to generate nearly £5 billion a year of GVA for our regional economy, 4,500 homes and 84,000 net additional jobs. Transport for the East Midlands provides collective leadership on strategic transport issues, agreeing major investment priorities. There is joint work on strong political consensus across the region on a coherent vision for HS2 around Toton. Partners are working on a business case for an inland freeport, centred around East Midlands airport. We have secured two sites on the longlist for the STEP fusion programme. We are working together on developing defined economic corridors for the A46 and the A50, and partners are working across the region on our covid-19 response.

There are other great projects under way: the Space Park in Leicester, pioneering world-leading research and engineering in space technologies; work in Derby and Derbyshire on future fuels such as hydrogen in partnership with Toyota; and a recently announced partnership with Thomas Heatherwick to reimagine the future of Nottingham city in a post-covid world.

These examples demonstrate the huge potential and the collaboration happening across the region, but the current system is constraining. A combined authority would change that, giving a new mechanism for devolution, pan-regional determination of strategic priorities, dialogue with Government and a credible delivery partner. For all the many boards and bodies that we now have and all the work we are doing together, none has the financial clout or the legal powers to deliver. This is the next step that we need to take.

The initial priorities for the east midlands authority could include a strategic approach to working with industry on a zero-carbon future and full-fibre connectivity for the east midlands, establishing it as one of the most digitally enabled regions of the UK. It could manage a co-ordinated and targeted plan for transport infrastructure that supports our wider growth, particularly through delivering the benefits of HS2, the development corporation, the freeport and our wider spatial vision. It could help us to put together a skills system aligned to our region’s future economic landscape and in tune with the needs of our residents, with more people in employment in higher-skilled jobs, to support business growth and productivity and ensure that all our communities can benefit from that growth.

A joined-up east midlands-wide tourism, culture and heritage strategy could help us to showcase our region and its assets to the world, including our world-class destinations—the Peak district, Sherwood forest, Bosworth battlefield—our vibrant cities and our rich heritage. Bringing partners together in this way offers enormous potential to tackle the great challenges of our times, including climate change. We have begun that journey through initiatives such as the midlands engine 10-point plan for green growth, but there is much more that we can do by working together, pooling capacity, innovation and resources. We are famous for our invention and innovation and can become a world leader in green growth with the right incentives.

In summary, I believe that this is the right time to create a strongly governed east midlands combined authority. Any successful reform is a combination of strong central Government direction and locally led implementation. The current covid-19 crisis demonstrates that: the best of our response has been where central Government have provided the policy and local areas have implemented it. We know from our joint work on HS2, the development corporation and the freeport that there is latent potential for inward investment. The east midlands has a low level of private capital and now more than ever, with Government funds strained by covid, we need to attract investment to our region to fuel that recovery, growth and prosperity. We have so much to offer, and bringing our undoubted potential to the market in a unified and coherent way will pay dividends now and for future generations.

If the UK economy and society are going to move forward quickly, decisions must be made at the right level, freeing us up locally to work across wider areas and to get on with the job of securing growth and prosperity. I am asking the Government to look at this carefully, to work with local stakeholders in the region and to support us in trying to make it happen.