Social Care Funding

Tony Baldry Excerpts

Thursday 10th November 2011 Westminster Hall

[Tony Baldry (Banbury) (Con)]

I am very pleased to be able to take part in this debate as co-chair of the all-party group on carers, and I have a couple of simple requests for the Minister.

It is crucial that all political parties—both Government and Opposition—work together on the White Paper on social care. We have been waiting for the document for some time, and I understand that the Government have committed to introducing it next spring. It would be very helpful if the Minister cheered us all up in his concluding comments by confirming that there will be a White Paper on social care in spring 2012. He will make us all the more happy if he can confirm that it is the Government’s intention that the document will introduce proposals to ensure that we are able to deliver sustainable long-term funding to tackle the existing care crisis and provide for growing demand.

We must recognise the scale and nature of the growing demand. The Department for Work and Pensions produced a wonderful report earlier this year called, “Number of Future Centenarians by Age Group”. Someone is either a centenarian or not, so I do not know why the DWP has to classify them by age group: it is one of those wonderful “Yes Minister” things. The report forecasts that 11 million people alive today will live to 100—a huge number. However, the number of working-age adults who will suffer from age-related conditions will rise by almost a third over the next 20 years. It is predicted that between now and 2030, 30,000 more people over the age of 80 will be living in the typical shire county of Oxfordshire, which is the equivalent of a town the size of Bicester being added to it. From 2025, the population aged 60 and over in the county is expected to be greater than the population of under-19s, including students. In a county such as Oxfordshire, nearly 70% of people aged 85 and over are living with a long-term illness, and the Medical Research Council’s cognitive function and ageing study shows that 26.5% of men and women between the ages of 80 and 84 suffer or experience age-related dementia. At over 85, the figure suffering from age-related dementia goes up to 68.5%, which is a significant increase. That means that the number of carers is expected to rise from 6.4 million today to 9 million by 2037, which is a substantial increase.

That is all against a background—in the House, we have discussed this in a number of debates since the general election, and I will not read out the speeches I have made in the past—of local authorities having to deal with serious financial circumstances, which has led them to increase charges for care services and raise eligibility criteria. The percentage of councils providing support to those with moderate needs has decreased from about half in 2005 to less than a fifth, as eligibility criteria are raised to substantial or critical needs only.

If he has time in his concluding comments, will the Minister update the House on what his Department considers to be the impact of the Sefton ruling in the High Court yesterday? The ruling seems to indicate that it is unlawful for local authorities to freeze care home fees unless they have consulted care home managers fully and properly assessed the risks of decisions to care homes and their residents.

The vice-president of the Association of Directors of Adult Social Services and others have calculated that the ruling will add a substantial amount to local authorities’ budgets, which have already been set for this year. We have some fairly tight figures for both local authorities and for care homes.

[The Minister of State, Department of Health (Paul Burstow)]

The key point in the High Court’s decision was the consultation. That was also a finding in the Birmingham case earlier this year, when the issue turned on whether the consultation was adequate and whether the authority had had due regard to various statutory duties. The issue now for local authorities is to satisfy themselves that they have had proper regard to the matters that the courts have directed them to consider.

[Tony Baldry]

That is a helpful update for the House, and I am grateful to the Minister.

[Barbara Keeley]

Does the hon. Gentleman share my concern—this may be the theme that he is developing—that there is a conflict between localism, the removal of ring-fencing and ensuring that a local authority delivers adequate social care? I find it hard to see, when exhortations are clearly not working with local authorities, how we can ensure that some authorities do not just cut their social care budgets to the bone and give people inadequate services. It is quite clear, with £1 billion in cuts this year, that they are not doing as the Minister would like.

[Tony Baldry]

I see the situation rather differently from the hon. Lady. Local authorities such as Oxfordshire are committed to delivering good-quality social care for elderly people. The challenge for them is to ensure that the increasing number of elderly people, often with increasing needs, receive appropriate care, whether at home or in residential care. A tight budget presents them with a significant challenge, but it is a challenge to which they are committed.

I appreciate that the hon. Lady comes from a unitary authority, but for two-tier authorities in shire counties such as mine, social care is now their most significant contribution. Increasingly, schools and education are running themselves, so authorities are going to be judged on the quality and the way in which they deliver social care.

[Kelvin Hopkins]

One thing that concerns me is local accountability. In a sense, the hon. Gentleman is making an argument for more local control, because democratic local accountability means that people in a local care home will have immediate recourse to elected local representatives, rather than having a simple national scheme such as the national health service. Perhaps if the national health service had more local accountability, we might not see some of the things that are happening at the moment.

[Tony Baldry]

I am not entirely sure where the hon. Gentleman is going with that point, so if the House will excuse me, I will not follow him down that particular line.

I do not think there is any lack of local accountability as far as the national health service is concerned. The Oxfordshire joint health overview and scrutiny committee is meeting today and will consider, for example, possible service changes at Horton general hospital in my constituency. The committee will, I am sure, vigorously interrogate the senior management from the Oxford University Hospitals NHS Trust and from the Oxfordshire and Buckinghamshire PCT cluster.

In the debate on social care, we must not underestimate the burden or the toll on carers of the task of looking after elderly people with age-related difficulties. Carers UK has found that carers providing significant amounts of care are twice as likely to suffer from ill health as non-carers. In 2008, a survey of heavy-end carers showed that more than half of those caring were in debt, and nearly three quarters were struggling to pay household bills. A large number of carers, about 1 million, have given up work or reduced their working hours because of caring. The peak age for carers is between 45 and 65, which is often the age at which they would be at the peak of their training, skills and career experience. That can be a cost not only to the carer, but to businesses and employers as they lose key people who have to care for relatives.

We have seen some excellent organisations such as Employers for Carers, which was set up by Carers UK and seeks to bring together numerous employers, generally larger ones, to promote flexibility and workplace support for employees juggling work and care, but that is not always possible for small and medium-sized employers. There is also a cost to the NHS. Sometimes, if we are not careful, there is a trade-off between the quality of social care, the provision of sufficient beds in nursing homes and residential care homes, and the need to prevent delayed discharges and bed blocking in hospitals. We had a debate on that not long ago, to which I contributed. In Oxfordshire, we are grappling with the issue of delayed discharges. If we are not careful, the cost to the NHS of delayed discharges will be significant, particularly at a time when more and more hospital treatments can be offered as elective day treatments. Generally, people are spending less time in hospitals, so delayed discharges add particular cost to the NHS.

[Barbara Keeley]

I thank the hon. Gentleman for giving way again; he is being very generous with his time. Does he have any thoughts on the point that I made earlier about the Dilnot commission and the £35,000 that must be paid out by the individual in the shared-costs model, which does not recognise informal care? He is making the point that people are giving up work to become carers, which has a huge financial cost. They may be struggling to pay bills but, even so, when their loved one goes into a care home, they will still have to pay £35,000. There is no recognition of everything that they have done that has helped the state save money. Does he agree that that is not fair?

[Tony Baldry]

We all have to recognise that there is only so much, on a cross-party basis, that Ministers will be able to do in the White Paper, which I hope will come out next spring. If the White Paper contains a sustainable funding process for residential care, we will all consider that to be a substantial step forward. We must not forget, however, that a number of issues will still be relevant to carers, particularly because, in order to maintain costs and keep them down, most local authorities are trying to keep people at home for as long as possible. For example, in my constituency and in those of many of the other Members who are present, it was previously the case that frail, elderly, but mentally alert people lived at home, but that has become increasingly true of people with age-related illnesses such as dementia or Parkinson’s, and it will continue, because however much the funding for residential care is increased, there will still be that population at home.

Another point that I want to reinforce to the Minister—I am sure that he will take it on board—is that a number of organisations concerned with social care are in consensus in supporting the recommendations from the Dilnot commission, particularly the recommendation on protecting families from catastrophic care costs by capping lifetime care bills because, at present, families coping with long-term conditions can face bills of tens or hundreds of thousands of pounds to pay for home and residential care. There are fears of unaffordable bills forcing families to provide round-the-clock care, and two thirds of carers end up spending their own income to pay for the care of the person for whom they care.

Those of us on the all-party group on carers welcome the Dilnot commission’s clear recognition of the need for additional resources for social care, to overcome an historic shortfall and to recognise the growing demand. We need a new national system of eligibility and portable assessments to create a more standardised system across England and to remove some of the uncertainty that families face as they deal with different systems in different council areas. We also need a new awareness, advice, information and advocacy strategy, to help families plan for care and access private, state and voluntary sector support. I think that there is strong consensus on those points, and I hope that the Government will adopt the proposals in the forthcoming social care White Paper.

[Sarah Newton]

My hon. Friend has been incredibly generous in giving way, and I am grateful to him. He is making an important point and I would like to underline it. As we have heard, the scale of the challenge facing the Government is so immense that we need short, medium and long-term solutions. At present, the Government face the challenges of deficit reduction and of other huge reforms taking place in our country, but it would be welcome if they set out in the White Paper a direction of travel and suggested proposals that could be achieved in the short term and that addressed some of the issues while not seeking to solve the whole problem all at the same time. We would take a paced, building-block-type approach.

[Tony Baldry]

I agree entirely with my hon. Friend, but I think that we have all slightly lost track of the number of Green Papers, discussion documents and other things that we have had in relation to social care. What will be really important next spring is that we get a White Paper that has a summary that everyone can understand and that makes it very clear what will be the basic system for funding residential social care for the future. I think that that would be greeted in the House by a quick rendering of the “Hallelujah Chorus”.

Following my hon. Friend’s point, if the White Paper can set out the direction of travel for the rest, that would be good news. What we have seen all too often in the past is a discussion paper that concludes that the issue is so huge and so difficult that we have almost lost the will to live. Spring 2012 has to produce a White Paper with a clear commitment to the funding of long-term residential care, and then direction of travel for the rest is important.

Finally, I agree with the need to enhance the status of care workers. In my experience, the model adopted by many residential care homes has often been to recruit people from the Philippines or eastern Europe. The deal was that they came over, got trained, were often paid the minimum wage and, having been trained, worked in the national health service. Because the Government, perfectly understandably and quite rightly, are capping immigration from outside the European Union, it is no longer possible for nursing homes and residential care homes to recruit from the Philippines or outside the European Union, so we have to enhance the status of care workers, both in the NHS and in residential care homes.

On my patch, I have suggested to the chief executive of the Oxford University Hospitals NHS Trust—I am glad that he has responded positively—and others that we should consider setting up in Oxfordshire one of the new Government’s work academies, specifically for care workers. We need to ensure that far more people see care and working in the care sector as a valued profession that makes a real contribution to society. It needs a career path, with a national vocational qualification, training and proper involvement from further education colleges. The issue is of as much interest to the national health service as it is to residential care homes, because if those care homes have sufficient care workers it will be easier for discharges into them to take place. Moreover, we often need to ensure that the NHS has sufficiently well-motivated and well-qualified nursing care assistants. I hope that we will begin to see centres of excellence around the country that will train people as care workers, to ensure that we do not find ourselves in difficulties because nursing homes and residential care homes have to close because they cannot recruit qualified staff.

[John Pugh (Southport) (LD)]

Would not the consequence of that be that care homes would have to pay better wages than they do at present? The hon. Gentleman has mentioned people from the Philippines. I had some in my constituency who were allowed to stay provided that they were paid for their qualifications, but the care homes refused to do so in some cases.

[Tony Baldry]

The management of any sensible care home will want to ensure that it invests in its staff. It has a duty and responsibility to do so. It has to play its part in ensuring that it, like any employer, helps with the required skills, qualifications and training of those people. This is an important issue and one that we have to get right if we are to have proper levels of care in the community, of residential nursing home care, and of care in the NHS.