I beg to move,
That this House
notes the serious concerns expressed about the social care system, including by the Local Government Association, The Association of Directors of Adult Social Services and the Care Quality Commission;
calls on the Government to urgently bring forward promised funding to address the current funding crisis and to put in place a longer-term settlement to ensure that the social care system is sustainable going forward;
and further calls on the Government to ensure that the most vulnerable in society are guaranteed the adequate and sustainable care they deserve.
The Government amendment
“commends the work and dedication of those in the social care sector”.
I join the Government in that. It might be the only part of their amendment I support. It is right that we praise our care staff. Unison the union had a meeting here today with care staff from a London borough and from Leicestershire. They talked about the difficult financial situation facing care services. Some care providers are not paying a decent wage. I heard all about that from the care staff from the London borough. Care staff receive less than the national minimum wage. They are not paid for travel time and they are not paid the correct rate if they sleep over. We should value our care staff more highly, we should pay them properly, we should train them, and they should know that they do a valued job. I pay tribute to the care staff I met today. I hope that other hon. Members also attended that event and met the same care staff and that they read Unison’s report, which is called “Care in Crisis”.
Social care is “in crisis” owing to a lack of funding. So says the Conservative leader of the Local Government Association’s community wellbeing board, Councillor Izzi Seccombe, who says that
“it is no exaggeration to say that our care and support system is in crisis.”
Richard Humphries, of the King’s Fund, talks of
“a deeper existential crisis of care”.
The Care Quality Commission says that the sustainability of social care is seen as “approaching tipping point”. Ray James, of the Association of Directors of Adult Social Services, says that
“the Government must face up to the reality that social care is in crisis now and provide immediate funding to stabilise the sector.”
“there is a strong argument that were extra funding to be available…we should be arguing that it should be going to social care.”
I could go on. Googling the words “social care funding crisis” returns 2 million results.
It is stating the obvious to say there is insufficient money going into the system, yet we have private companies taking huge profits out of the system as well. Will my hon. Friend join me in commending Stockton-on-Tees Borough Council for setting up a not-for-profit organisation to ensure that the money goes into services instead of shareholders’ pockets?
I certainly will join my hon. Friend in commending the council. It is one of the things we talked about to the care staff today. Why should people be paid vast profits from public money, when care staff are so badly paid?
The reasons for the social care funding crisis are clear: insufficient funding in the face of growing demand and a fragile market in the provision of social care. We know that people are living longer and that demand on social care services continues to increase. People aged 85 and over are the group most likely to need care, and their numbers are projected to rise sharply in the coming years. Moreover, the gap between need and funding has grown wider since 2010.
According to the sustainability and transformation plan for Staffordshire, some of which has been leaked to me, NHS England and NHS Improvement having categorically refused to make it available to Members of Parliament, shows a deficit for Staffordshire over the coming years of more than £250 million. Is that not appalling?
It is dreadful. The deficit in Greater Manchester is £1.75 billion, so the problem is the same up and down the country.
We have had six years of Government cuts to local authority budgets, and that has seen local authority spending on the care and support needs of older and disabled people fall by 11% in real terms. In fact, the number of people getting publicly funded support has plummeted: 400,000 fewer now than in 2009-10. Such facts are shocking, but behind the statistics are real issues: the impact that cuts to social care are having on the NHS, on people who need care and on unpaid family carers.
First, I will deal with the issues that the crisis in social care causes for the NHS. As the Nuffield Trust states:
“Hospitals have struggled to meet the needs of the older age group in a timely way, in both emergency departments and inpatient admissions”.
The most visible manifestation of the pressures caused by cuts to social care budgets is the rapid growth of delayed transfers of care from hospital. The September figure of over 196,000 delay days is another record—the highest figure for six years—and it comes not in winter but at the end of summer. That means for the NHS 6,700 patients stuck in hospital. The most common causes are waiting for a care home placement and waiting for a nursing home placement.
The funding that was supposed to help with these issues is the better care fund, but there is no extra funding for social care in the fund this year and only £100 million next year.
My hon. Friend is making an excellent speech. Does she agree that it would be useful to remind Conservative Members of the Conservative party manifesto? Page 65—I do not want anyone to struggle to find it—outlines the promise to the people concerned. It says that they would not have
“to sell their home to pay for care”,
and that there would be a cap on charges to give people “peace of mind” and protection. All that is in the Conservative party manifesto—“peace of mind” and protection “from unlimited costs”. It amounts to a cruel disservice to that generation that the Government went back on that promise just two months into this Session.
It is, and I agree with my hon. Friend that care costs are just running away with themselves, making it much harder for people.
The bulk of the extra funding that the Government promised to social care from the better care fund comes in 2018-19 and 2019-20. We have had six years of cuts to local authority budgets, and the extra funding promised for social care is backloaded to those later years in this Parliament.
The hon. Lady mentioned the most common causes of delayed transfers of care. However, I know that in hospitals in Kent near my constituency, around 30% of the delayed transfers of care are attributable to delays in social care and the majority are for other reasons. Does she not agree that it is important for the NHS to take its own steps within its own organisations to improve people’s discharge from hospital?
That is what we are debating. Of course the NHS should put its own house in order, too, but delays should not happen on account of social care. People should not be stuck for weeks or months in hospital, waiting for a care home placement or a nursing home placement. I shall go on to say why.
Returning to the issue of the backloading of funding, in view of what was happening to social care, the Local Government Association and the Association of Directors of Adult Social Services appealed before the last autumn statement for £700 million of the promised better care funding to be moved forward to this year and next year. That appeal was ignored. Reacting to that, Ray James of ADASS said:
“Ministers must know that their proposals do not deliver sufficient funding to meet the growing number of older and disabled people requiring increasingly complex care and support…The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality. Councils in deprived areas will have greatest social care needs, yet they will raise less than a third of what more affluent areas do through this approach.”
He went on by clarifying that ADASS does
“not believe that the funding for the next couple of years will anywhere near meet the costs of the national living wage and the increasing demand for social care.”
In my Hull constituency, not only have we seen massive cuts to the local government budget since 2010, but the precept that we can raise—2%—is much smaller than the gap in the budget for social care. By comparison, wealthier areas of Yorkshire such as East Riding are able to raise far more, so this is a double whammy for deprived areas.
It is indeed. The gap in my Salford local authority area is £1.1 million. We can raise only £1.6 million from the social care precept, while just paying the national living wage in the care sector is costing us £2.7 million.
Let me return to the matter of where the promised funding sits. In our motion, we call on the Government once again
“to bring forward promised funding” for 2019-20
“to address the current funding crisis” in social care. I am sure that the Health Secretary hears plenty about the impacts on the NHS of the missing funding for social care, but let us also think about the impacts on the people who actually need that care.
Helen Whately mentioned the thousands of patients stuck in hospital. We should be aware that keeping them there longer than necessary can have a number of detrimental effects. Long stays can affect patient morale and patient mobility, and of course increase patients’ risk of catching hospital-acquired infections.
Effects on mobility can be particularly keenly felt by older patients. As Professor John Young said in the 2014 national audit of intermediary care:
“A wait of more than two days negates the additional benefit of intermediate care, and seven days is associated with a 10% decline in muscle strength.”
“Delayed discharge is damaging the health of patients and that of the public purse.”
Cuts to the funding of social care also affect a larger group of older and vulnerable people, and those cuts are now having a major impact on family carers. Age UK estimates that more than a million older people in England are living with unmet social care needs. I was struck by what the Unison staff told me about the many people they see during their care visits who are lonely and isolated.
Social care services have clearly failed to keep pace with increasing demand. Carers UK tells us that the drop in social care support, in the context of the increasing needs of our ageing population, is having a profound impact on the unpaid family carers who are stepping in to provide more care than ever before. It also tells us that the increase in the number of people providing care, and the increased number of hours of care that they provide, are being delivered at a huge personal cost to those family carers if they are not well supported—as, in all too many cases, they are not.
The hon. Lady is making a case for more funds for social care. May I ask how the Labour party would raise that money? Would it give more to local authorities, or would it increase council tax precepts further?
Our motion asks for promised funding that is backloaded to 2019-20 to be moved forward. The LGA and ADASS wanted it to be moved last year, and that is what we keep asking for.
I thank the hon. Lady for giving way again; she is being extremely generous. Will she tell me, however, whether she is committing her party to delivering that money to local authorities directly, or to allowing them to increase their precepts?
We do not even know what the Chancellor is going to do next week. The hon. Lady has invited me to make a declaration today, and it was a nice try, but we did not hear a word from Ministers about their plans during Health questions yesterday. I will, however, make what I think is an important point to the hon. Lady and to any other Member who raises the same issue. Labour would not have put our councils in this position to start with. If the hon. Lady looks back at our spending plans, or looks at the analysis by the Institute for Fiscal Studies relating to the different parties, she will find that our plans meant that we did not have to make the cuts that her party has made. This Government’s cuts will take £5 billion out of social care. I will send her the link to the IFS analysis if she wants to read it.
My hon. Friend is making a powerful case. The scale of the crisis in some areas is very serious, and it will become even worse following the increase in the minimum wage. Although that increase is welcome, if the local authorities do not have the budgets to cover it, the crisis will be exacerbated.
Is my hon. Friend aware that many providers in both the private and the charitable sectors are returning council contracts? They are saying, “We can no longer make this pay; in fact, we will go bankrupt if we carry on servicing the council.” That is adding to the current problems.
My hon. Friend has made a key point. I have already mentioned the fragility of the care market. We shall not be able to explore that fully during my speech, but it is a serious factor. If we do not get the funding right, more and more care providers will simply walk away. At the Unison meeting, members of a Leicestershire rehabilitation team spoke of the problems that they experience when care providers walk away from a contract. When the staff are not there any more, they have to plug the gaps.
The Communities and Local Government Committee is conducting an inquiry into the funding of social care. We have learned that not only are care providers handing contracts back, but councils are terminating contracts because of the inadequacy of the care that is provided. Ultimately, that means that individuals do not receive the care that they should be receiving. Their appointments are cancelled, or there are flying visits from under-trained care workers who are paid less than the minimum wage.
My hon. Friend is right, and I shall come to that point shortly.
Carers UK reports that insufficient support from health and social care services is leaving the carers who are doing all that extra work
“isolated, burnt-out and unable to look after their own health.”
The Richmond Group of Charities published the story of Susan. She cares for her husband Bruce, who has been diagnosed with both Parkinson’s and dementia. The struggle that Susan underwent to find quality care is one about which I have been hearing from carers for some time. She was provided with respite care from a care home which was of such low quality that her husband was unrecognisable when she returned for him.
“He hadn’t been shaved, he couldn’t walk, and his eyes were crusted…with blepharitis.”
When Susan managed to get home care for her husband, it was also poor quality. She said:
“They didn’t know what they were doing. It seemed like they’d never cared before. They turned up at five o’clock in the afternoon to put my husband to bed. Or they turned up at ten, once I’d already helped him to bed. Absolutely awful.”
It is also telling how carers like Susan feel when dealing with the challenges of negotiating complex and fragmented care systems. She “felt small” and she said:
“You go in there, and you’ve got no idea about anything, about care. It’s like going in on the first day at school.”
Susan is not a rare case of a carer battling to get respite care or home care of an acceptable quality. Carers UK tell us that three out of 10 carers in its survey have experienced a change in the amount of care and support services that they receive. Six out of 10 of those carers experiencing a change said the amount of care and support received had been reduced.
The hon. Lady argues for bringing forward funding, and I agree. Does she agree, however, that that is not enough in itself and that all of us on both sides of the House must confront the chronic underfunding of the health and care system, and we need to find ways to raise significantly more resources to ensure we have a modern and efficient health and care system?
I agree, and our motion talks about the need for
“a longer-term settlement to ensure that the social care system is sustainable going forward”.
We absolutely do need that.
On quality of care, I was talking about Susan finding a care home and it giving inadequate care. There are too many such care homes. In its 2016 “State of Care” report, the Care Quality Commission said that when it makes a return visit to a service originally rated as “inadequate”, one quarter of those services were not able to improve their ratings. Susan found poor quality home care, and last week the ombudsman reported that the number of complaints about homecare is rising and that the number of complaints upheld by the ombudsman is also rising.
I agree with Norman Lamb on the need for cross-party working to achieve sustainable funding for both health and social care. As the hon. Lady will know, I have set out my concerns about the underfunding of social care in a letter to the Chancellor. Does she agree that it is not just about funding, however, but also about how we support and train our social care staff? Would she like to see further progress made on the recommendations of Camilla Cavendish about how we train and support our care staff to help to retain them as well as recruit them?
I agree, and that is why I started my speech by saying we should value the job our care staff do and we should train them properly; it should be a proper job with a proper career path. The care staff I met today were reduced to worrying about what they were being paid, however, simply because they were paid less than the minimum wage.
This is what six years of funding cuts to social care actually mean for people who need care and their carers: unmet needs for care; patients stuck in hospital, increasingly because they have to wait for a care home or a nursing home place; poor quality care in care homes, with one quarter of “inadequate” services unable to improve; poor quality home care, with more complaints being upheld by the ombudsman; more unpaid family carers having to step in to care; more unpaid family carers having to provide increased levels of care; and, without the right support, those family carers becoming isolated, burnt-out and unable to look after their own health. That is a disturbing deterioration in the state of social care. I want the Secretary of State to tell us whether he recognises the scale and seriousness of the issues I have outlined.
As chair of the all-party group on Parkinson’s—and motor neurone disease—I have had repeated complaints about the 15-minute calls that local authorities are being forced to introduce because of cuts in their social care allowance. They mean that people are neglected: carers literally run in, and, if the person cannot communicate or has poor mobility, the quality of their care is appalling.
It is indeed. There are many examples of that, and we have debated them here many times. The funding crisis is at the base of all this.
I repeat what I said at the start of my speech: social care is in crisis due to a lack of funding. It is notable how many leading doctors, health experts and organisations involved with the NHS are now expressing their concerns and fears about social care and the lack of funding for it. Here are some of those people: Simon Stevens, chief executive of NHS England; Miss Clare Marx, president of the Royal College of Surgeons of England; Professor Dame Sue Bailey, chairwoman of the Academy of Medical Royal Colleges; Dr Suzy Lishman, president of the Royal College of Pathologists; Professor Carrie MacEwen, president of the Royal College of Ophthalmologists; Professor Neena Modi, president of the Royal College of Paediatrics and Child Health; Professor David Oliver, president of the British Geriatrics Society; Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists; Professor Sir Simon Wessely, president of the Royal College of Psychiatrists; Dr Anna Batchelor, dean of the Faculty of Intensive Care Medicine; Dr Liam Brennan, president of the Royal College of Anaesthetists; and Professor Jane Dacre, president of the Royal College of Physicians. All those people have expressed their fears and concerns about social care and the lack of funding for it.
I should like to add to that list some of the organisations working in the NHS and social care that are now expressing their serious concerns about the funding of social care. They include: the King’s Fund, the Nuffield Trust, the Health Foundation, the Local Government Association, the Association of Directors of Adult Social Services, the County Councils Network, the BMA, Care England, Unison, Age UK, the Alzheimer’s Society, the British Red Cross, Carers UK, Independent Age, United for all Ages, the Learning Disability Coalition, the Motor Neurone Disease Association, and the Care and Support Alliance. Those people and those organisations share a belief that the Government must act now on social care funding, and I urge hon. Members on both sides of the House to support our motion and vote to save social care tonight.
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“welcomes the Government’s Spending Review settlement for health and social care, which ensures that the amount of money available to local authorities for adult social care services will rise significantly across the Parliament, and ensures that up to £3.5 billion more will be available by 2020;
commends the work and dedication of those in the social care sector;
and further welcomes the introduction by the Government of the social care precept which allows local authorities greater autonomy in making decisions about how they best meet their local communities’
needs for social care.”.
I too want to start by paying tribute all those working in the social care system; there are few jobs that are more important to our society. They work with some of the oldest and most vulnerable people in our society, many of whom have dementia. That is a growing population, with the number of over 90-year-olds having increased by more than a quarter. Life expectancy is up by a whole year since Labour left office. While I would like to claim credit for every Government achievement, that is a demographic change and no thanks to this Government. It also places huge pressure on the system. Every older person is a dad, a mum, a grandparent or a neighbour, and Members on both sides of the House, whatever our disagreements, want them to be treated with the utmost standards of dignity and respect.
There are none so noble as those who care, and they include the Castle Vale carer I met who buys Easter eggs out of her own pocket to give out in her own time to those she cares for. Does the Secretary of State understand the despair being felt by carers who are told that they have only 15 minutes per visit, the despair being felt by those being cared for because they no longer have the contact they once had, or the despair being felt by the family and friends of those who built this country and who now deserve better in the twilight of their years?
I absolutely agree with the hon. Gentleman. It is the hallmark of a civilised society that we treat all older citizens with dignity and respect. I totally disapprove of 15-minute visits. I find it impossible to understand how anyone could really look after someone’s needs in a 15-minute visit. I hope that, like us, he is proud of the introduction of the national living wage, which is helping the people who do this very important work. It will help 900,000 people working in the social care system by paying all over-25s a minimum hourly rate of £7.20 from this April.
The Secretary of State will know that Ministers have acknowledged that illegal non-payment of the national minimum wage is rife in the care sector. Does he agree that Her Majesty’s Revenue and Customs should publish the results of the investigations it launched two years ago into the six big providers? Where employers are found to be non-compliant in relation to an individual care worker, does he agree that HMRC should carry out a full investigation into that employer to see how widespread that non-compliance is?
We are absolutely determined to clamp down on employers who do not pay the national living wage. If the hon. Gentleman or any other hon. Member has any evidence at all of that happening, they should let HMRC know. HMRC has a policy of naming and shaming employers who do not do the right thing and rightly so.
It is welcome that the minimum wage will increase and that money will hopefully reach the workers we are discussing. Will the Secretary of State acknowledge, however, that the consequence of the increase is that the precept that local authorities charge residents for social care will be eaten up by the wage increase—even in local authorities such as the London Borough of Redbridge, of which I am still an elected member? What will he do to alleviate the very real financial burden on my local authority and others to ensure that everyone gets the quality of care they need?
The Secretary of State is being generous in giving way. He started his peroration by talking about the importance of care for the elderly and he is absolutely right about that. Does he agree that we are also talking about caring for people with learning and physical disabilities? The care debate is often entirely about the elderly, but it is much wider than that.
I will give way shortly, but I want to finish my point about the critical role played by care staff. In total, 1.5 million people work in the social care sector, and I want to mention one group in particular: the 90,000 who come from the EU. They do a brilliant job and we value their contribution to the sector.
If the House will forgive me, I want to share one story from early in my time as Health Secretary about an absolutely brilliant manager, who is Polish, of a dementia care home in Swiss Cottage. The people at the home had advanced dementia and many were unable to talk or move, so the atmosphere in the home was challenging to say the least. I asked the lady how she motivated her staff every day, and she said, “If I can get a resident to smile, they won’t remember it the next day, but I do, and I go home with a smile on my face.” The care that was being provided was, to be frank, completely remarkable. This is a moment for all of us to reaffirm what the Prime Minister said today at Prime Minister’s questions: we want these people to remain and we are confident and optimistic that we will be able to get them to remain.
I totally share the sentiment that EU workers are welcome in our country and that we must guarantee their future as soon as possible.
Does the Secretary of State ever feel that he is confronted by a pretty fundamental choice? He can either preside over a system that deteriorates with an increasing number of failures of care, which I know he cares passionately about, or he can be the politician in Government who confronts that, who works with other parties and who comes up with a sustainable long-term solution. It is one or the other. I urge him to take the latter course.
I absolutely want to be someone in this role who confronts poor care and does everything possible to fight for the highest standards. That is exactly why I am doing this job. Poor care comes in different forms and, yes, funding is an issue. As the health and social care system goes through perhaps its most financially challenging period since the founding of the NHS, I particularly want to ensure that we protect the high standards that the right hon. Gentleman cares about.
I heard the Secretary of State’s earlier words about EU carers. I am sure that they were genuine, but words are not good enough for them. The longer the Government leave them in limbo, the greater the risk is that they will leave. Our national health service and our care system could not cope with losing all those staff, so what more is he doing? Is he petitioning the Prime Minister for a decision now that will give them leave to stay and properly respects their contribution to our society?
With respect to the right hon. Gentleman, with whom I have enjoyed many debates in this House, neither he nor I wanted the Brexit vote to happen, but now that it has, we have to cope with a very changed world. The Prime Minister said that she is confident of getting an early agreement. I hope that what we are saying in this House this afternoon will resonate with people and make them understand just how valued they are.
I want to conclude the section about the role of social care staff.
Whatever disagreements we have in this afternoon’s debate, I want the message to go out loud and clear to all social care staff that Members from all parts of the House recognise the work that they do, and that they value it and support them to do that work better. That is part of the definition of a civilised society.
On the point about the need for a long-term sustainable health and social care system, is it not the case that the Secretary of State is driving through work in devolution deals and sustainability and transformation plans, which aim to achieve exactly that—bringing together health and social care to create a much more sustainable system?
My hon. Friend is absolutely right. Although this afternoon’s debate is about the social care system, the sustainability and transformation plans are a critical part of the long-term solution for financial efficiency and for improving the quality of care.
I congratulate Barbara Keeley on introducing this debate, which is the first Opposition day debate that she has led. I also pay tribute to the fact that she has had a long-standing interest in these issues. She has asked me questions about the social care system on many occasions. She was particularly right to focus on the impact on the NHS, which is real, and on the impact on family carers, which is also real. She talked about Susan and about the impact on people who are finding that they are giving more hours of care than they were planning or are sometimes even able to give. That is something of which we must all be aware. She asked me to answer a direct question: do I recognise the scale and seriousness of the issues faced by the social care system? The answer is, yes, I do. I want to try to address, as comprehensively as I can, some of the substantive issues faced in the social care system.
Let me start by saying that, although today’s debate and the majority of the hon. Lady’s comments were around funding, the issue is not only about funding. Toby Perkins mentioned that social care is not just about older people. In 2011, we had the shock of what was uncovered at Winterbourne View by a BBC “Panorama” programme. We have had a number of examples of horrific abuse at care homes. The Ash Court Care Home case in Kentish Town was one that came to light in 2012. The abuse there was filmed by a relative on a hidden camera. Those issues were primarily not about funding, but about cruelty—a strong word—that we have tolerated in our system. We have had some very significant policy responses since then, which are making a real difference. The first is that this Government, under the coalition, introduced the toughest system of care home inspection in the world.
We often talk in this House about the work of the chief inspector of hospitals, but I wish to pay tribute today to the work done by the chief inspector of adult social care, Andrea Sutcliffe, and her team. She has completed the inspection of nearly 90% of care homes and domiciliary care services. It is encouraging that, despite the pressures that we have been talking about this afternoon, 72% of the places that she inspected were good or outstanding. More importantly, the 28% that are not are the 28% that we know about and are therefore able to do something about.
I take issue with the way the shadow Health Minister presented her findings. She said that a quarter of the inadequate places were unable to improve following re-inspection. However, the reality is that more than three quarters of places that got an inadequate inspection did improve, which is a huge step forward from where we were a few years ago when we did not know where those places were and when there was no change happening at all.
The Secretary of State is right to highlight the need to improve standards and the need for a rigorous inspection regime, but—taking on board what his former ministerial colleague, Norman Lamb, said—does he accept that even if every single care home in the country reached the appropriate standard, there would still be a care crisis? There is not sufficient funding in the system to make it work. Will he agree to work with all parties to do what we should have done many years ago—before the general election in 2010, as he will recall—and get a grip on the issue and, as a country and as a House, try to sort it out?
I am more than happy to work with people of all parties to come to a sensible consensus. The one thing that unites all the major parties is a commitment to the NHS and social care system. With respect to the other issues, it is not just about rooting out poor care. It is also about something that the hon. Member for Worsley and Eccles South mentioned earlier—giving a career structure to people who work in the care system and giving them recognition. That is why in April last year we introduced the care certificate, which is based on achieving 15 standards. It is a voluntary system, but the CQC inspects against it, so there is a strong incentive for care providers to get their staff enrolled for the care certificate. I pay tribute to the work done by Camilla Cavendish, who did a lot of thinking and had a long-standing interest in this issue in her time as a journalist and at No. 10, and on whose proposals we are basing our work in this area.
I am grateful that my right hon. Friend has mentioned the CQC and also touched on wages. When I met the south-east director of the CQC, it was clear that there is an issue of staff not being paid properly and then moving around the care home sector for a small amount of extra money, which is vital to them. Does my right hon. Friend agree that the living wage will stop that occurring and result in more people staying in jobs for longer?
That is a very important point. We have heard suggestions that the Government have been about words, not action, but the national living wage will do an enormous amount to help keep people in jobs for longer and help them to start to think about their jobs as a career, with potential progression into other parts of the health and care system, such as nursing. I commend my hon. Friend for the work that he does on this in Sussex.
The Secretary of State said that the issues in social care were not only about funding, but it seems that funding is the only issue that he does not want to talk about. The Communities and Local Government Committee is taking evidence on social care. We have had evidence from local councils, including Conservative councils, council directors, unions, care providers in the private sector, care receivers, carers, academics and research institutions, all of whom say that there is a funding crisis in social care. Does the Secretary of State think he might just be wrong in being the only person to deny that such a funding crisis exists?
With great respect to the hon. Gentleman, I was coming on to talk about funding. I just wanted to make the point that the issue is not just about funding.
I respectfully disagree with some of the suggestions made by the shadow Health Minister in her comments earlier that this is essentially about party political choices, for the simple reason that at the last election, Labour promised less for social care and would have spent less than we are spending. I gently remind Opposition Members that Ed Balls as shadow Chancellor was absolutely explicit in 2015. He said that he would not reverse funding cuts to local government—indeed, he would have made further cuts. Under this Government, those cuts have started to be reversed. Spending on adult social care increased—[Interruption.] These are the facts. Spending on adult social care increased by around £600 million in the first year of the Parliament and is set to increase further because of the spending review, which will mean that up to an additional £3.5 billion can be spent during this Parliament.
I am afraid the Secretary of State is living in cloud cuckoo land. My council has to make £55 million of cuts on top of the £100 million it has already made. There is a funding crisis, and we will not solve it unless he admits there is a crisis. He cannot continue to be in denial, and we cannot have a Prime Minister who constantly says that the NHS and social care have the funding they need. We need cross-party agreement on this long-term issue, but, first, he has to acknowledge that there is a problem.
I have great respect for the hon. Lady, but Leicester Council actually increased its adult social care budget by 7%. Overall, there was an increase in the adult social care budget last year, and that was made possible by the new social care precept, which is being used by 144 out of 152 councils. That will raise £382 million this year and up to £2 billion a year by 2019-20.
My council has had to cut other vital local services to fulfil its statutory obligations. The social care precept will not even pay for the increase in the minimum wage—the council is going to have to move money from elsewhere. The Secretary of State is living in denial. You cannot solve a problem unless you admit there is one. People are willing to work across the House to deliver a long-term solution, but he has to admit that there is a problem.
With the greatest respect, I do not know whether the hon. Lady heard what I said just a few moments ago, but I answered very directly what the shadow Health Minister said. Do I recognise the scale and seriousness of the issues? Yes, I do, and I am coming on to explain what I think the solutions are. The point I am making is, yes, the budget—the amount spent on social care—was cut in the last Parliament, as a result of the very difficult economic situation we faced after the financial crisis in 2008, but it is starting to go up again in this Parliament. We need to look at what we can do to try to turn that into a sustainable improvement in the care received by all of our constituents.
A crucial point was missing from the shadow Health Minister’s opening speech. There was a suggestion that the issues in social care are essentially caused entirely by decisions made by central Government. We need to salute the efforts made by councils of all colours to deal with the pressures in social care, because those are very tough. Middlesbrough Council, for example, increased its social care budget by 11%—it is the most improved council in England. My own council, Surrey, which is in an affluent area, but which has a large number of elderly people to look after, has battled enormous odds to expand provision.
However, the fact is that there is enormous variation in the way local authorities have responded to these challenges. If we look at the impact on the NHS, and at the delayed transfers of care that are attributable to social care, we can see that the best councils, such as Peterborough, Rutland, Newcastle and Torbay, have virtually no delays in hospital discharges attributable to social care. That can be compared with Birmingham, Manchester, Reading and Southampton where there are between 14 and 21 days of delayed transfers attributable to social care per 10,000 of population every working day. That is a difference of 20 times between the best and the worst councils, and we cannot say that there is a 20-times difference in funding between the best and the worst councils.
Members have alluded to the fact that local authority budgets are under the hammer at the moment. More importantly—I have raised this with the Secretary of State before—one of the big problems is having the social workers to get people a care package when they leave hospital to go home, and that creates bed blocking, so we are in a vicious circle. The last Labour Government looked at an offer from the then Conservative Opposition to get together and have a properly funded national care service. Why have we not looked at that?
The hon. Gentleman is absolutely right to say that the presence of social workers in hospitals is vital in discharging people, but I think he will be quite shocked to know that 50% of all the delayed transfers of care in the entire NHS happen in just 20 local authority areas. There are many places that are doing these things well, even in the current challenging financial circumstances, but there are others that, frankly, could do a lot better.
Overall, what we see is a picture where the best councils have expanded funding and provision. For example, last year, Windsor and Maidenhead increased its spend by 6.4%, and the number of people accessing long-term care is up by 8%. That was a Conservative council, but the Labour council in Doncaster also chose to increase its social care budget by 10%—nearly £8 million—and it is looking after nearly 7% more people.
This is not just about funding; it is also about the speed of health and social care integration and about local leadership. Where such leadership exists, important changes are happening even now. For example, in Cheshire East, dedicated workers are supporting people with early-stage dementia, saving more than £4,000 a year per client in social care costs while improving the service for patients. Milton Keynes is another good example: its innovative pilots have cut delayed days attributable to social care by nearly three quarters.
Others, regrettably, have chosen to cut funding and provision. There are many reasons for that, but the one thing that is difficult to explain to the public is why, at times of such challenge, local authority reserves have increased by nearly £10 billion since 2010. The hon. Member for Worsley and Eccles South made a fair point when she said that there has never been greater financial or operational pressure on all councils. Like the NHS, there is huge pressure, but unlike the NHS, it has not been possible to protect their budget since 2010.
What is the way forward in this very difficult situation? I think that it is a combination of the right financial decisions locally and recognition by local authorities and the NHS that they are part of the same team. That is why, as has been said, the sustainability and transformation plan process is so important.
It is easy to knock a process whereby local areas come together to have yet more meetings, which we are pretty good at doing in the NHS and social care system, and it is also easy to characterise those meetings as secret, but the fact is that people do not want to publish their plans until they are ready, and they will all be published by the end of this year. Many Members on both sides of the House criticised the Health and Social Care Act 2012 because they felt that it did not do enough to promote integrated care, but now we have a process to do that. That is massively important for the social care system, as this is the first time that local authorities are properly involved in NHS planning. Indeed, four of the STPs—namely those for Greater Manchester, Norfolk and Waveney, Nottinghamshire, and Birmingham and Solihull—are headed by local authority leads. On Monday, the head of operations at NHS England told me that there was not one STP meeting that he had been to where a local council was not represented. At the moment, it is a planning process and it needs to be delivered, but planning needs to happen collaboratively. It is a significant change for the NHS and social care system, but it is finally happening.
So why is it that Stoke-on-Trent City Council tells me that no council officers or councillors have been involved in the Staffordshire STP? Given that it covers the whole of Staffordshire, the more deprived areas of Stoke-on-Trent and north Staffordshire will, in effect, subsidise south Staffordshire, because it has greater debts. Why cannot MPs have input into the plan? It is absolutely disgraceful.
Everyone will have input into the plan, but the hon. Gentleman might want to ask his council why it is complaining about pressures on the social care system when it has refused to use the social care precept and raise extra money, which could be desperately used for social care. That would make a real difference to his constituents.
Where councils and local NHS organisations are working together, we are seeing some real financial savings that are having a big impact. For example, Northumberland has saved £5 million through integrated services with Northumbria NHS Trust, and there has been a 12% reduction in demand for residential care as a result. In Oxfordshire, where the local authorities, clinical commissioning groups and trusts are all working together, discharge delays are down 40% in six months, and those due to social care have more than halved.
We are having an interesting tour of various councils around the country. I referred earlier to the fact that people have been let down after the 2015 Conservative manifesto, which promised them that they would be secure in their own homes. The proposal to that effect in the Care Act 2014 was postponed because so many councils put pressure on the Government to delay. The Public Accounts Committee has been told that the proposal will be introduced in April 2020. What work is happening in the Department to ensure that that proposal will come forward so that people will be secure in their own homes?
We are doing work, and I would simply say that we have also delivered on that promise because we have introduced the deferred payment scheme, which means that no one will need to sell their home because of social care costs.
I will wind up now, because I know that many hon. Members want to speak. When we have local authorities and the NHS working together, what is our objective from that process? We want a seamless transition for patients between the health and social care system. We want shared electronic health records so that patients are not asked the same questions time after time. We want a single assessment system so that people are not assessed twice by different organisations trying to get different results. We want to see the pooling of budgets, we want to get rid of delayed transfers of care, and we want multidisciplinary teams. Most importantly, we want there to be a single plan for every vulnerable person, to which everyone who is involved in their care adheres. Those are the objectives.
In the face of enormous pressure, the best solution for local authorities and local NHS organisations that are finding things challenging right now is not to slow down those vital changes, but to accelerate the pace of change, so that we eliminate waste and improve patient care at the same time. Councils that do so will have the full support of the Government. I urge the House to support the Government’s amendment.
Before I call the next speaker, I will have to impose a seven-minute limit. I have to warn Members that the more interventions that are taken, the more that limit will have to come down.
I congratulate my hon. Friend Barbara Keeley—my good friend—on an excellent speech. She has no equal in this House as a champion for older people and their carers. Her speech, unlike the speech by the Secretary of State, was firmly rooted in the real world.
This is the century of the ageing society. Caring for people as they live longer lives is the greatest public policy challenge of our times, but for years Parliament has shown itself to be unequal to that challenge. I want to speak today to tell the story of the efforts to reform social care over the last decade, because I want the facts to be on the record, so that people can understand what happened and vow to do better. The story explains the mess we are in today. To be honest, it is quite a shocking story of partisan point-scoring and, worse, political cowardice, which have seriously failed millions of older and disabled people.
The story started nine years ago at the spending review in 2007. I was Chief Secretary to the Treasury at the time, and at the insistence of the Treasury I gave the Department of Health the condition on its spending review settlement that it would conduct a root and branch review of the funding of social care. There was a recognition, even in the Treasury, that if we allowed the situation to continue, it could, in the end, damage the national health service. Quite clearly, the funding was not sustainable, and if social care was left to collapse, it would drag down the NHS with it.
The urgency of such action had been recognised almost a decade earlier, in 1999, when a report by a royal commission on the matter recommended free personal care, paid for by general taxation. It did so for the reason that if we pay for free preventive care in people’s homes, those people do not end up in hospital and costing us all more. Nothing was done, and by 2007 the need for reform was urgent. So between 2007 and 2009, a huge amount of detailed modelling work was done and options were looked at.
When I arrived in the post of Health Secretary in 2009, the work had come to a head. The analysis supported a clear conclusion that radical reform, rather than patching up, was needed. Department of Health officials supported the Treasury analysis that there would be risks to the NHS if social care was allowed to decline. A Green Paper was published in July 2009, and the idea of a national care service was first put forward. The thinking was that only by bringing the systems together, with a system of clear national entitlement, would we be able properly to move towards integration. The maintenance of two entirely differently funded systems—one free at the point of use and the other means-tested and charged for—would mean that they would never be able to speak the same language and there would always be barriers to integration.
I was ready to grasp the nettle, because it was clear to me that the NHS was facing a decade of lower funding from 2010 and 2020, and that one of the ways it could cope with that was with the efficiencies we could unlock through properly and fully integrating health and social care and by moving from a hospital-based medical model to a person-centred social model of care starting in the home.
This is where things went wrong. Picking up that I was ready to up the momentum for reform, the then shadow Health Secretary, Andrew Lansley, approached me in Portcullis House just before Christmas 2009 and asked me for cross-party talks. I thought about it, but I agreed. I thought, as my hon. Friend John Woodcock has suggested, that we should take the issue out of party politics, which would be better for everybody. We had a couple of meetings, in which we went round the issues. I favoured the more ambitious, comprehensive reform of paying for social care on the NHS principle—that everybody contributes, but everybody is covered for their care needs and has peace of mind in later life. Andrew Lansley wanted a more voluntary system, in which the insurance market would come up with solutions. That was where we left it.
Then a bombshell was dropped in February 2010: the poster saying, “Now Gordon wants £20,000 when you die.” I very vividly remember the day when it landed. I was told that Andy Coulson had put pressure on Andrew Lansley to do it, and that he did not really want to, but felt he could not say no. I do not know whether that is true, but I know that the Conservatives, who asked me for cross-party talks, betrayed the confidence that I gave, and they have never seen fit to apologise for that. The point is not about the personal political damage that that did, but about the chilling effect the poster had on the social care debate. It instantly killed any talk of radical reform, and it actually had a deadening effect for the rest of the following Parliament—the last Parliament—during which no real progress was made.
That brings me to what happened after the election, when, as shadow Health Secretary, I challenged the Government from the Opposition Front Bench about the poster that they had put out during the election saying that they would cut the deficit, not the NHS. I made the point that if they did so, they would in effect cut social care: if they prioritised NHS spending within the reduced envelope, that would have devastating consequences for social care and would in the end come back to affect the NHS.
From the Dispatch Box at every Prime Minister’s Question Time, the then Prime Minister used to quote me as claiming that it would be irresponsible to give the NHS real-terms increases, but he never commented on the second part of what I had said, which was that it was irresponsible to do so if we were cutting social care. I did say that, and it was irresponsible to social care in the way they did to pay for their commitment to the NHS. Social care was cut by 9% during the last Parliament, with 400,000 vulnerable people losing support in their homes. Those people ended up in A&E or trapped in hospital beds, piling pressure on the hospital system.
I pay tribute to the right hon. Gentleman—this may be my last chance to do so—for the work he has done as a Member and wish him well in his future career if he is successful in his election. Does he agree that the chilling effect of the outcome of those conversations before the election and perhaps the betrayal of his confidence, as he puts it, is that there could no longer be a rational conversation about properly funding the health and care system through any form of taxation? That is the problem that has emerged, and perhaps the best way to fix it is through general taxation.
I am very grateful to the hon. Gentleman for his intervention and the spirit in which he made it. He is absolutely right: that set everything back and meant that there was no possibility of a cross-party approach. There will have to be such an approach if we are to fix social care and, indeed, to give the NHS what it needs, because they will both need more funding during this Parliament. That is the real shame. I did not make my point about Andrew Lansley for political reasons; I just want people to understand what happened, so that the current generations of politicians might do something different.
The answers we have since had from the Government are wholly inadequate. We have heard today that the precept does not raise enough money, particularly for poorer councils. It is no answer; in fact, it just cynically devolves the responsibility for the whole issue to local government, even though councils did not create the problem. I still favour an all-in system. I will say it: I favour a system in which we ask older people to pay a set contribution, so that they have peace of mind in later life, with all their care costs covered.
I am listening very carefully to the right hon. Gentleman. In the spirit of wanting to rise above party politics, will he agree that it was totally wrong of him to suggest at any stage in the last Parliament that the Government wanted to privatise the NHS, when we have never had the intention to do so? It was wholly irresponsible to scare the public about that.
In a week when Virgin Care is taking on a huge community care contract, I do not think the Secretary of State should be making that point—particularly the Secretary of State who privatised ambulance services in Greater Manchester. I honestly do not think we need to go there.
The point that I am making is about funding social care. The Conservatives claimed that we were introducing a new inheritance tax. Do people not understand that just 3.4% of estates in this country attract inheritance tax? Why is that? Because the vast majority of estates are whittled down by the costs of care—tens of thousands of pounds, or hundreds of thousands of pounds for some people. That is not fair and it is not sustainable. We must be able to do better.
I feel so strongly about this because I saw my grandmother go through the care system in England 20 years ago and, frankly, it was nowhere near good enough. I arrived here saying that I would do something about it. I tried to do something about it, but we have not got anywhere near a solution to the scale of the challenge. People will need to put party politics aside and find common ground. The point scoring and failure to grasp big issues have led to a situation where people have low regard for this place.
We are left with a malnourished, privatised care system in England that is sinking lower as we speak. A culture of slap-dash 15-minute visits is entrenched, in which staff do not get properly treated, trained or respected. Standards in care homes have slipped even further, and stories of neglect and abuse abound—we hear them all the time. Countless vulnerable people and their families still have to pay these cruel dementia taxes, which have risen under this Government, losing everything they have worked for and going into later life with everything on the roulette table: home, pension, savings—the lot. That is not the care system we should have in 2016 in this country. At what point are we going to say, “Enough is enough,” and actually do something about it?
I cannot promise anything as dramatic as what we have just heard from Andy Burnham, who speaks with great authority and knowledge. I follow three fascinating speeches. He was correct that no one knows more about care and older people than Barbara Keeley, who speaks for the Opposition. She always speaks in her quiet but incredibly knowledgeable way and puts a strong case. My right hon. Friend the Secretary of State set out the challenge that he faced on coming to office and in dealing with many of the issues outlined by the right hon. Member for Leigh.
The narrow nature of an Opposition day debate does not allow us to go into all the issues that have been raised between the three of them, but the truth is that we will need to do something different in due course to deal with adult social care. These issues have not been tackled as well as they could have been in the past. Everyone has had a go, but everyone draws back at a certain stage. The ageing population means that we cannot continue to do that.
There are two straws in the wind that the House should be conscious of. The first is the integration processes that I was asked to start delivering when I came to office. There was a determination from the former Chancellor and the Secretary of State to make sure that integration actually happened, to deal with the issues that have been outlined today. There is a determination right the way through the process to deliver that at last, instead of just talking about it—we have passed that stage.
The second is devolution in areas such as Greater Manchester, which will give the right hon. Member for Leigh the perfect opportunity to put into practice exactly what he has been talking about, along with the skilled and experienced director, Jon Rouse, who has moved from the Department of Health. No one knows more about it than he does. That provides the perfect opportunity to deliver on what the right hon. Gentleman has been saying.
I should declare an interest not only as a former Minister, but as the co-chair of the all-party parliamentary group on carers. In the few brief minutes allotted to me, I want to take the opportunity to thank carers for what they do and speak about how this issue impacts on them. It is obvious that the difficulties of provision elsewhere impact very much on the 6 million carers in the United Kingdom, who provide largely unpaid services to care for their loved ones and who do an exceptional job.
I am very pleased to have kicked off a review of the carer’s strategy, which is working its way through the system. The Under-Secretary of State for Health, my hon. Friend David Mowat, will deliver that review in due course, and I am very interested to hear what will be said.
To give some background on finances for a moment, the financial situation is very difficult. I want to support my right hon. Friend the Secretary of State in the Lobby tonight because I know how hard he tried in the financial settlement of 2015 and the extent to which he succeeded. I will mention two things. First, he got an increased amount into social care. Secondly, in recognising that more money was needed and introducing the social precept, the former Chancellor, my right hon. Friend Mr Osborne, crossed quite an important barrier. No longer would the Government’s position be that there was enough money in the system; allowing local authorities to raise more money was a recognition that more money was indeed necessary. The nature of the settlement means that the early years are difficult, but more money will be going in in due course. The situation is exceptionally difficult. No former Minister or Member of Parliament would say that things are not incredibly stretched—they are—but I know how hard my right hon. Friend the Secretary of State fought to get that money coming through.
The key point my right hon. Friend the Secretary of State made, which is desperately relevant, is this business of variation in practice. I was constantly concerned about how it could be that, at a time when it has never been easier to transfer knowledge from one area to another, two neighbouring areas could have radically different processes that meant one area had more difficulties than the other and the best practice in one area delivered better results. Until there is the sense that best practice can be followed everywhere, we will not get the changes we need—my right hon. Friend highlighted some of those. We see the same thing in terms of delivery of the Care Act 2014 and in relation to work on the better care fund.
As for areas where things will continue to improve, I am very pleased that my right hon. Friend said what he did about Andrea Sutcliffe and the Care Quality Commission in relation to care homes. It is very important that the work continues to identify bad practice and to deal with what I call a tolerance of standards of care in some places that would not be accepted in acute hospitals but are sort of tolerated in care and in mental health. It is very important to address that, so that there is no longer such a difference.
I want to put on the record some areas of concern. Yes, things are increasingly stretched. I want to raise the employment issues there are for carers. We have spent a lot of time and effort on looking at childcare and the ability of people to cope with their childcare responsibilities. We now need to look at those caring for people who may be older, and who are older themselves. I hope that an important part of the review that is coming forward will look at what employers can do to make things easier for carers.
I want to emphasise the dark corners that exist. There have been complaints to the ombudsman because people are afraid of making complaints about the care of their family members due to the fear of reprisals. That simply should not happen, and it is right that we are alert to it. I thank groups such as Your Voice Matters for their work; Jenny Moore from that group came to me with her concerns. Sometimes pressure groups can be an irritant—they are the stone in the shoe that makes the difference. I make a plea to them and others to work together to bring their concerns forward. People should not feel that they face reprisals for raising complaints. That is extremely important.
Just before my right hon. Friend wraps up, I want to put on the record my thanks to him for his outstanding work in my Department, both in mental health and in social care, and for his real commitment to the voluntary organisations and the patients and service users in those areas.
I am extremely grateful to my right hon. Friend and to other colleagues. I loved and enjoyed the job. There is much more good work still to be done. I saw good examples everywhere. The concern we all share is how to make the examples of the best the quality of everywhere. There is no reason why that should not be the case.
In the extra minute I now have—I thank my right hon. Friend for his kindness there—I will look ahead. The things that will continue to make a difference include, first, more co-ordinated working and, secondly, new technology. We must look at how technology can be used, including remote monitoring and different ways of providing care, both in homes and for care workers. Increasingly, technology will make a difference.
Thirdly, on environments for living, there will be more retirement communities, more people will live together, and there will be a greater consideration of independence and self-care. I should always mention the work of Men in Sheds to combat loneliness and isolation, as they need more recognition.
Is there a need for more money? I encourage my right hon. Friend to continue what he started with the settlement process, for which he fought very hard. The whole Department needs to be behind the Secretary of State as he continues to make the arguments, because life for some is just too stretched. A combination of the right quality of care and the right amount of money will make a considerable difference.
I am afraid it was the same old story from the Secretary of State: no response to the funding crisis. It is a national crisis and a national disgrace that social care is not being funded properly.
The social care system should of course become more efficient, but much work by local authorities and local health providers to make it more efficient and bring about improvements has already taken place. The simple fact, however, is that there is just not enough money. My local authority, Halton Borough Council, works closely with local NHS providers, but it has suffered a 50% cut in its budget, so how can it be expected to sustain and grow support for adult social care?
In the time I have, I want to quote parts the Care Quality Commission “State of Care” report of
“despite increasingly challenging circumstances, much good care is being delivered”.
We know that, but it goes on to say:
“However, the sustainability of this position is in doubt…The financial challenges in the NHS have been extensively documented…there has been evidence of a deterioration in quality…and some providers…are struggling to improve their rating beyond ‘requires improvement’.”
By the end of 2015-16, NHS providers had overspent their budgets by £2.4 billion. Local authorities were reported to have overspent by £168 million. Delivering high quality care while achieving good financial management is therefore more important and more challenging than ever before.
The fragility of the adult social care market and the pressure on primary care services are now beginning to impact both on the people who rely on these services and on the performance of secondary care. The evidence suggests we may be approaching a tipping point. Profit margins are reducing because of pressures on fees and cost pressures that include the national living wage. Some providers are already starting to hand back home care contracts as undeliverable. Local authorities predict more of that to come.
The Treasury allowed local authorities to raise an additional 2% above the existing threshold, but this amounts to only £790,000 in 2016 for Halton Borough Council. That is well short of meeting the increased cost of adult social care. In addition to the costs, the council is facing its sixth year of austerity measures and has to find a further £30.3 million by 2020. Adult social care has delivered £17.4 million in savings from 2011 to 2017, but this level of savings is no longer sustainable given the pressures on the service. That pressure is compounded by increasing demand and financial constraints from health services, which can have a direct impact on social care services. Halton has to find an additional £2.9 million, while the additional precept it has received amounts to only £790,000. The council tells me that the adult social care and funding reform allocations in the Care Act 2014, which moved into the settlement funding assessment, are insufficient to meet the requirements of part 1 of the Act.
The national living wage is the greatest financial pressure at present facing adult social care, and the Government are not funding it. The ageing population of Halton is increasing, and that is part of a general change in demographics. The number of residents aged 65-plus will increase by 43% by 2037. Care providers, on the other hand, are exerting pressure on the council for increases in rates over and above inflation. The expectation appears to be that local authorities should fully fund the additional costs. I pay tribute to our care workers, who work under great pressure with a greater workload and fewer staff. Things do go wrong from time to time and they have to be addressed, but the care workers do a fine job. I was struck by the findings in the Unison “Care in Crisis” report. In answer to the question, “Have budget cuts affected your work or workplace?”, 70% said there was a greater workload and over 60% said there were fewer staff.
I have been in touch with my local hospitals, too. Warrington and Halton Hospitals NHS Foundation Trust says it is currently engaged in the challenge of trying to achieve the 4-hour A&E target, as well as an improvement programme. As part of that, an independent audit was recently carried out under the emergency care improvement programme. On the Warrington site, it reviewed 241 patients across 15 in-patient wards where the length of stay was longer than six days.
The feedback received was that 58%, or 140, of the 241 patients reviewed were deemed medically fit—in other words, did not require a bed in an acute hospital. Of these, 91 required the intervention of an agency external to the hospital, such as local authority, social care or community care providers. The top three delays identified were: waiting for external agency assessments; waiting for a community hospital placement or other bedded intermediate care; and waiting for the start of social domiciliary care packages. The hospital of course acknowledges the difficulties that local authorities and commissioning bodies face around social care.
On the subject of Warrington hospital, the Minister will be interested to know that I asked the chief executive of Halton CCG whether, as part of the STP programme, consideration had been given to reducing the opening hours of Warrington A&E, but he refused to answer the question and gives no reason for that. I hope that the Minister will look into the matter and ensure that I get the information I should be entitled to.
The Government cannot go on ignoring the fact that there is not enough money. We heard the Secretary of State again today ignore this fact. He spent most of his speech not talking about the crucial point, which is funding, and that is clearly the feedback from all parts of the service. The CQC says that the system is fragile and at a tipping point. This is not Labour MPs or Labour councils; this is the CQC. I ask the Minister to tell the Secretary of State that he and the Chancellor need to come forward with a proper plan for funding social care. If they do not, the crisis will continue and deepen, and the Government will be responsible.
Order. The limit on Back-Bench speeches has now to be reduced, with immediate effect, to six minutes.
A while ago, I spent a week in intensive care—not, I assure you, as a patient—and I remember well how the unit was unable to admit a seriously sick patient because there were no beds free, and there were no beds free in the intensive care unit because there were none free in the hospital. The ward sister told me that that was because patients, particularly elderly patients, could not be discharged because there were no care home places for them. She described that as bed blocking. That is a familiar story, particularly to hon. Members in the Chamber, but I should tell the House that that was 20 years ago. Delayed transfers of care, as we now call them, are nothing new.
The fact that this is nothing new is a reminder that the problem will not be easily solved; there are no easy answers, but that is not to say that we should not try. In fact, I believe that we should and must try. We must address the problem of delayed transfers of care, not only because NHS hospitals need to use their beds for acutely sick people who need acute hospital care, but because hospital is a very bad place for patients to be, particularly older patients, if they are ready to go home. It is absolutely the worst place for older patients, when they could be at home regaining their mobility, as opposed to losing it stuck in a hospital bed. A few weeks confined to a bed in an acute hospital can mean that an older person never walks again, even though they went in perfectly able to walk and live independently. I say that from the experience of my own grandmother.
I appreciate the efforts being made across the system to solve this problem. I know that hospitals and the social care system across the country are working together to speed up discharges; to put in place packages of care; to identify who needs single-handed versus double-handed care; and to try to make best use of limited resources. I know that that work is being done in Kent in my constituency. A few months ago, I convened a meeting between East Kent NHS hospital and Kent County Council specifically to talk about what they were doing to reduce the number of delayed transfers of care. I should give Kent some credit, as this year the number has fallen significantly: it approximately halved between last June and this June, so it really is possible to make progress, even in a tight financial situation.
At the regional level, the STPs, the devolution deals in places such as Greater Manchester, emerging accountable care organisations and vanguards such as Encompass in east Kent are really working on how to bring health and social care together and how to improve the situation with delayed transfers of care. They must prioritise this and they have to go beyond questions of whose budget the money comes from, whose money it is, whose problem it is and whose patient it is. Instead, they need to look at the problem as a whole and take account of the patient as an individual. They should simply look at what care the patient needs, not whether it is part of one system or another. I would like to thank all those working on this across the country for their efforts. They are working not just to free up much needed beds, but for the sake of individual patients who need better care outside hospital.
That brings me to the question of money. As a society, we face the challenge of people living longer, needing more care and rightly expecting better care. Thanks to the work of the CQC inspecting care homes and care providers, we are seeing some transparency in the quality of care, and we are identifying where there is poor care. Thankfully, the vast majority—70% or so—of care providers are either good or outstanding, but a significant minority is not good enough. It is good to see, though, that the majority of those are, in turn, improving.
I welcome the improvements to care, driven in part by the CQC and greater transparency, but we cannot get away from the need for more money in the system. We all know that the Government have recognised that. Despite the large deficit and debt left by the Labour party in 2010, the Government have even so committed to funding the NHS through the five year forward view and to increasing funding to social care. Social care funding is rising in real terms. I enormously welcome the social care precept—the extra 2% that Kent and other councils are levying to increase the funding for social care. I have not heard a single person in my area complain about that levy, that increase in the amount of council tax that has to be paid, which I think shows widespread support for funding more care.
It is good to spend money where we can on social care as well maintain the commitment to funding the NHS, but there is a case for work to be done so that we know what any extra money spent on social care will achieve. To what extent might it achieve savings for the NHS? When I asked the experts questions in this area, I encountered a lot of vagueness about what could be achieved for the NHS by increased spending on social care.
Finally, I emphasise the importance of having a system that truly joins up health and social care, so that each pound is spent most effectively across both those areas and so that each person gets the right care for them. It should not depend on whether they are in the NHS or social services spheres; it should be the right care for every individual person.
They say that growing up is optional, but growing old is inevitable. Our social care system is on its knees and, regardless of what has been said today, lack of funding is the cause.
I invite you to picture this, Mr Speaker. You are sitting in your living room, unable to read or watch the TV as your sight is failing; you are unable to stand or go to the bathroom because your mobility has failed; and you are unable to delve into your deepest, happiest memories because your cognition has failed. This is the reality for millions and millions of people in this country. This is what they live with, day in, day out. They may be lucky to have family members who can help, or they may be reliant on the kindness of strangers to help them with basic everyday things such as washing, going to the bathroom, eating—things that you and I, Mr Speaker, may take for granted in our younger years.
Many councils, including Wandsworth Council, have removed vast amounts of money from their adult social care budgets. The most vulnerable in our society need safety, not insecurity. We need to ensure that robust systems are in place to provide the care for people, many of whom might have fought so that we can have the liberty that we enjoy today. We do not need an unretainable workforce or the reduction of funds year on year.
The vast cuts and insecurities do not merely amount to cancelling a bus to the seaside for a day, or cancelling over-80s bingo; real, core care treatments are being cut. They are being cut to the bone. This is happening to many people who have given the country so much in their lifetimes. They have paid their taxes, they have worked hard and they have raised their children, yet all that the Government can do at the moment is leave them high and dry. I say that that is not good enough: they deserve more.
What about the personal carers who leave their jobs because they do not want to leave their families to the will of local provision? There are 19,000 people caring for family members in Wandsworth alone, and they have to choose between heating and eating every winter just to make ends meet. We are failing those people.
The people who work in our care system dedicate their lives to working in social care, and they work very hard. I want to put on record my personal thanks and admiration for the work that they do day in, day out. It is not easy for them to leave their own families and work so selflessly and for such long hours to help others. They do so in the hope that they can provide even just a small amount of support and can put a smile on someone’s face, as the Secretary of State said earlier. He has now left the Chamber, so he will not hear my peroration. Anyway, it is great to be able to make someone smile, just for a day.
The current provision in Wandsworth, however, is the “most economically advantageous”, which is a euphemism for “cheapest”. Our country deserves better. It may be said that we are providing high quality cheap care, but in many cases we are not, certainly in Wandsworth. Both the Secretary of State and Helen Whately spoke about CQC inspections and high ratings. That is great, but Wandsworth council is having to contract out to agencies whose CQC ratings describe them as “requiring improvement”. Let me ask Members this, if they will look up from their phones for a moment. Would that be good enough for their families? Would it be good enough for my family? I think not. I think that all the families in the United Kingdom deserve care from people who do not “require improvement” but are delivering the best possible care, because they deserve nothing less.
In Tooting, I have heard reports of patients sitting in their homes waiting for the knock on the door from a carer who has not shown up. Day after day, I hear of family members having to hide in their cars just to prove to the council that the carers are not showing up, because the carers are saying, “Unfortunately, your dad has dementia. He did not remember that we came.” That is not good enough. It is not good enough for our families. This is a cross-party issue. I implore the Government: please listen to what I am saying, and do the right thing.
I spent 11 years working in the NHS, in A & E, on the front line. Our staff at St George’s hospital in Tooting worked incredibly hard, but NHS staff throughout the UK also work hard. Day after day, I saw families in crisis. They brought their elderly family members to the door, crying, saying, “I cannot cope: I do not know what to do any more.” Such people are treated by our wonderful NHS staff, but, as we have already heard, that causes bed-blocking, because there is no adequate social care provision that would allow them to leave hospital.
The Government are allowing contracts to be awarded to companies that do not pay the living wage. It is fantastic that the living wage is going to go up, but how are staff to be retained and provide the high quality care that they so wish to deliver if there is not the budget to pay for it?
As I said earlier, I spent 11 years on the NHS front line. Now I am in the House of Commons, and I am flying the flag for every single carer, every single NHS worker and every single patient. I am flying the flag for every single person in the United Kingdom who deserves better for their loved ones: for your parents, for my parents, for absolutely everyone. Not investing in social care leads to avoidable mistakes. Not investing in social care leads to more pressures on our already pressurised NHS. Not investing in social care costs lives and dignity.
How much more time do the Government need to recognise that not addressing the current funding crisis in social care is severely affecting lives and crippling our public services? Respectfully, I call on them to wake up and do the right thing.
I shall not be supporting the motion. While I agree that there are pressures on social care, the answer is not just financial. As many Members have pointed out, notably my hon. Friend Dr Wollaston, we need to change the system and combine health and social care.
I have worked in the NHS for more than 20 years, and I still work as a nurse. I have always found it odd that health and social care are delivered separately, funded separately, and seen as separate entities. When I trained over 20 years ago, we were taught to treat people as a whole, not to treat them in terms of their social care needs or their health needs. I have spent most of my time working as a nurse in a hospital, and it is very different there. If someone needs personal care—if they need washing or feeding—we just get on and do it because we are looking after that patient as a whole. When patients are discharged home, they get their healthcare needs and medication delivered by the NHS, but if they need feeding, washing or dressing, they have to wait sometimes for many hours for someone else to provide that separately. I find that increasingly difficult to see.
Healthcare and personal care in hospitals is delivered by trained nurses and healthcare assistants who have had much training and are very well respected and valued. Personal care, however, is often delivered by people who are paid less than the living wage and who very often have had little or no training. Is it any wonder that this goes wrong, and that people are readmitted into hospital after ending up at home with healthcare problems? It is no wonder at all that we are facing this issue, and that is because the system is not working, not necessarily because there is not enough finance.
We need to appreciate the skill involved in social—or what I call personal—care. Washing someone is not just washing someone; if a person’s health needs are being looked after properly by a highly trained nurse who washes them, they will be checking whether they have eaten and taken their medication, and whether they are a little more confused today, and if so, why? Is a urinary tract infection brewing? Are their opiates too much? Are they hypoxic or constipated? There might be a whole host of reasons, and that nurse gets on top of those things and keeps that person well. Without that knowledge and skill, delivering social care on the cheap is never going to work.
We have seen hard evidence of this today from a pan-European study that says that the risk of a patient dying in hospital increases by a fifth for every nurse replaced by a healthcare assistant. I am sure if that study were extended to social care and into the community, those figures would be even worse. There has been an historical undervaluing of social care, which has been the Cinderella service in the care sector. I believe we should stop referring to healthcare and social care and just call it care.
The answer is not just to throw more money at the problem. I agree that money is needed, but the answer is to combine both things: health and social care need to be jointly commissioned, jointly paid for and jointly delivered. Currently, social care does not work for patients. They often have multiple visits—four or five visits in a day by four or five different people, with one person who can give them their medication but is not allowed to wash them, and the next person who has to say, even if they need medication, “Sorry that’s not my job. You’ll have to wait for your next visit.”
We heard from a previous Labour Secretary of State, Andy Burnham, that attempts have been made to join health and social care together, but these have not made progress. I congratulate the Government on bringing forward sustainability and transformation plans and the better care fund in an attempt to make that difficult transition to merging health and social care. We are hearing about the progress that is being made, and the Secretary of State said that in places where this is starting to work admissions are dropping by 40%, which is welcome.
I passionately believe health and social care need to be combined. That will improve outcomes and reduce spending and admissions, but most of all it will improve patient care. The only way forward now is to be bold and brave, and when we have groups such as the King’s Fund with its Time to Think Differently programme recommending this as a new model of care, we have to move swiftly.
I cannot support this motion. While I believe that social care is under huge pressure, finance is not the only answer; we need a combined service, and we need to free up healthcare professionals to look after their patients holistically and free up bodies such as the CCG to commission services jointly. I support the Government’s efforts in trying to do that.
I really welcome the opportunity to have this debate today, and we have heard some excellent speeches. I want to pay particular tribute to my right hon. Friend Andy Burnham, who made a powerful speech. I pay tribute to the work he has done and to his passion and commitment to bringing health and social care together. He deserves credit for that and I wish him all the best as he takes that fight beyond this place. I think he will do great things with it.
My local authority, Calderdale Council, has already written to the Chancellor and the Secretary of State for Health to outline its concerns about the crippling underfunding of social care. Following a motion passed at full council, council leader Tim Swift has called on the Government to bring forward the better care fund, to develop a workforce strategy and to accelerate progress towards establishing a single pooled budget for health and social care in all areas by 2020. The King’s Fund report has recently acknowledged that local authorities are having to make incredibly difficult decisions about where to make service reductions, with no room to make further savings. The report goes on to state that without further funding, most councils will soon be unable to meet even their basic statutory duties.
At a time when we are having yet another rethink about how we organise and structure NHS services with the sustainability and transformation plans, the NHS Confederation, which brings together all the different organisations that make up the NHS, has said in its representation to the Treasury that if the Government continue to fail to provide the right conditions to transform the service into one that is sustainable for the future, a tough challenge will become an impossible one. It cites the decisions to cut spending on public health through the local authority grant and to delay much needed social care funding until later in the Parliament as examples, saying that while there is no doubt that these decisions have made short-term savings for the Treasury, there are strong indications that this will come at the expense of significant long-term costs and could hinder the transformation that we all want to see. Rob Webster, the chief executive officer of South West Yorkshire Partnership NHS Foundation Trust and the lead on the West Yorkshire and Harrogate sustainability and transformation plan, made this clear when he said:
“We must invest in social care and public health. Our STP shows quite clearly that modern health and care services focus on the whole person—and that means their mental, physical and social care needs. If we do not invest in social care and prevention, we may not have a sustainable NHS at all.”
I recently spent time with the Yorkshire Ambulance Service in my constituency, and I was particularly interested in how the paramedics would be affected by the proposed downgrade of services at Huddersfield royal infirmary. It was clear to me just how many ambulance call-outs, and consequent hospital stays, could have been avoided if appropriate mental health provision and social care had been in place. We visited an older gentleman who had initially simply become dehydrated. He had grown increasingly confused and, in his confusion, he had stopped taking his medication. His neighbours called an ambulance when they realised that he had become quite unwell as a result. According to the paramedics, that was not unusual and they would expect to see a number of similar calls over the course of a 12-hour shift. He was a proud man and was clearly distressed to think he had caused a fuss. That ambulance call-out and hospital stay could have been avoided had social care been in place, empowering him to live well in his own home and saving the NHS the cost of more serious interventions later on. That experience reinforces the case made by the NHS Confederation to the Government that without the appropriately funded delivery of mental health support and social care services, attempts to transform the NHS into a more sustainable model are doomed to fail.
Another issue that I want to touch on is respite care. My constituent, Mrs Burrows, came to see me in tears last week. Her elderly mother has Alzheimer’s and a variety of related health complications. Following an assessment, Mrs Burrows was allocated eight weeks of respite care a year for her mum. Despite this allocation, she has to work with social services to find an appropriate establishment that is able to care for her mother. She also has to make the arrangements, but she struggles to find a place for her mother in residential care because temporary beds are just not available. Part of the problem is that she is able to book respite care only a week in advance, which means that she cannot plan ahead. She finds it difficult to book holidays or confirm her attendance at family events such as weddings. Mrs Burrows was particularly distressed because her daughter required urgent medical treatment and she desperately needed to find respite care for her mother so that she could look after her grandchildren while her daughter had the treatment. However, there were just no beds available.
I want to take this opportunity to commend the Alzheimer’s Society for the work it has done with its Dementia Friends programme, which, as of 1 pm today, has trained 1,752,419 friends, all of whom now have an enhanced awareness of what it takes to support someone to live well with dementia. It is a massive achievement, and I am proud to be one of those dementia friends. Worryingly, however, research undertaken by the Alzheimer’s Society found that 38% of homecare workers do not receive any dementia training and that 71% do not receive dementia training that is accredited—despite the commitments made in the Prime Minister’s challenge on dementia. Some 850,000 people are living with dementia in the UK and an estimated 400,000 of those are in receipt of some form of home care. The scale of the challenge is huge, but if we do not start working on finding the answers to both the availability and the quality of social care now, imagine the crisis we will be facing in five, 10 or 20 years’ time.
Without an injection of investment into social care, we will have no chance of balancing the demands on the NHS. Good, proactive social care would require investment but it is not just the right thing to do; it would ultimately be cost-effective and prevent more costly and avoidable interventions later on.
It is a pleasure to follow Holly Lynch, who articulately outlined some of the human challenges facing some of her constituents due to problems in the social care system. We have heard many contributions from right hon. and hon. Members today, many of whom drew upon their own front-line experience of working in the health and care system and of the difficulty in getting the right care that people up and down the country are facing.
We must remember that we are debating issues that affect real people and real people’s lives, which we sometimes forget in the heat of political debate. We need to remember that social care and good social services are about providing basic dignity in the care of older people and disabled people with things such as dressing, eating and washing. No Member should forget the importance of personalised care that provides dignity. We need a system that is not only more integrated and joined up, but better funded than the current system, which is not adequately financed to meet the needs of the people it looks after.
I want to talk briefly about welcome initiatives such as vanguards, the better care fund and the STPs, which are moves in the right direction. I also want to discuss the future. Andy Burnham was right when he highlighted some of the missed opportunities over the past two or three decades to grip the issues of improving social care and properly funding a sustainable health and care service. Before I do all that, it is worth pointing out some of the fundamental challenges facing the health and care system today.
However one dresses up the figures, there is an undoubted trend towards increasing delays in transfers of care. That is the truth that the figures show us. Of course, there are areas of good and bad practice, but the national trend in delayed transfers of care shows increasing pressure on the system. Budget reductions in the social care sector are real and amount to about £4 billion over the past decade. It is welcome that more money is coming into the system through the local precept, but that barely touches the sides when we consider the challenge of also meeting the increased demands of paying the national living wage. The NLW is a welcome initiative that will raise the living standards and quality of life of many care workers by properly rewarding them for their work—or make a much better contribution towards doing so—but the change is nevertheless putting budgetary pressure on local authorities, which manifests itself in difficult decisions about how care is provided and rationed on the frontline.
One of the big trends of the past decade has been that many local authorities have tightened the eligibility assessment for social care. It is effectively now the case that someone has to be in severe need to receive social care, so we must recognise that the tightened criteria mean that those who receive social care are no longer those in moderate need. That is symptomatic of some of the budgetary pressures that the system faces.
The welcome initiatives—the vanguards, the better care fund and the STPs—are all about the better joining up of what health and social care do together, but we must remember that STPs have perhaps come about in spite of the Health and Social Care Act 2012 rather than because of it. Prior to the 2012 Act, we had strategic health authorities, which helped to co-ordinate care at a regional level. Those were abolished and disappeared. STPs are now a welcome return to the recognition that we need a degree of regional co-ordination of our health and social care system in order to deliver the right care. That co-ordination must be across primary care, secondary care and social care. Housing providers are equally important, because many delayed discharges from hospital are due to the lack of appropriate housing for people with mental health conditions and dementia who do not have the right houses or the right circumstances at home. That is an important part of delivering those local plans to make sure that the system works better for people.
The elephant in the room is of course funding. Yes, we need to transform services, and more money is needed to do that. There are transformation budgets available through STPs to support clinical commissioning groups in delivering improvements in the NHS, but that will barely touch the sides and will not make enough of a difference. The great tragedy is that if we really want to drive integration, we must put the money into the same place. We must properly fund the integration and joining up of care. The loss of opportunity before the 2010 election was highlighted by the right hon. Member for Leigh. I urge the Government to look again at having cross-party talks to consider a sustainable future for the health and care system in which we all believe.
I think we all agree that the way in which a society looks after its vulnerable and elderly is a mark of its humanity. By that measure, our Government are failing. Social care services are facing financial crisis under the Tories, with social care funding slashed by £4.6 billion over the course of the last Parliament. We know that demand for care is rising, yet fewer people are receiving services. Between 2001 and 2015, the number of people aged over 85 increased by more than 38%, and the number of people with limiting long-term illnesses increased by 1.4 million, which means that the challenges are great. Despite rising demand, fewer people are receiving support. Research by the King’s Fund and the Nuffield Trust shows that 25% fewer older people are receiving social care support today, compared with just five years ago. Research by the London School of Economics shows that 500,000 people who would have had access to social care in 2009 are no longer entitled to it.
Funding for social care remains insufficient and that only increases the cost to our national health service, as many Members have observed, The Government have announced increased funding from 2017-18 for the NHS better care fund, which aims to integrate health and social care and allow councils to raise council tax by up to 2% to fund adult social care from April. However, there is a shortfall of £1.1 billion simply to maintain care levels at the 2014-15 level. According to the King’s Fund, £5.5 billion has been taken out of social care budgets in the past six years. The most recent budget survey by the Association of Directors of Adult Social Services in England highlights that an extra £1.1 billion investment is needed simply to maintain care provision at the same level as last year.
Research from the Nuffield Trust, the Health Foundation and the King’s Fund demonstrates that, even if every council were to utilise the precept, the estimated funding gap, taking into account the impact of the living wage, will be between £2.8 billion and £3.5 billion in 2019-20.
ADASS states that the social care precept this year raises less than two thirds of the calculated costs of the new national living wage. This significant and sustained underfunding is resulting in a loss of independence and quality of life for older and disabled people, and reductions in carer support, undermining the positive changes for carers introduced in the Care Act 2014.
In the past six months, 62% of councils have had residential and nursing home closures and 57% have had care providers hand back contracts. The closure of services and the handing back of contracts have affected more than 10,000 people using council-funded care.
There is significant regional variation, too. ADASS has already reported the inequality in funding for local authorities collecting the 2% precept, stating that it raises
“much more in some areas than others and raises least in areas with the greatest need for social care.”
Although the Government have said that the additional funding from the better care fund will be used to top up funding for local authorities that will raise less from the precept, that extra funding will not be released until 2017-18 when it will deliver only £105 million.
I wish to talk very briefly about the impact on the national health service. Before doing so, let me say that, despite the Secretary of State’s warm words around STPs and local decision-making, he is doing nothing to allay the fears of patients, carers and NHS staff in Wirral about the risks that are posed to services at Arrowe Park hospital in my constituency.
We know that good social care is far less costly than a hospital stay. The crisis in social care means that patients are forced to stay in hospital for weeks or sometimes months longer than they need to because they cannot get the care they need in the community. The social care crisis is affecting our NHS. The Care Quality Commission said recently that the level of cuts to social care is forcing hospitals to admit more patients as emergencies, who they are then unable to discharge because the social care that they need is not available for them at home. The number of patients unable to leave hospital because of the unavailability of social care has risen 70% since 2012. The CQC’s most recent annual report shows that the number of hospital bed days lost through patients being unable to leave because of social care not being available has increased 70% since April 2012.
Delays in securing these vital social care services and the desire to free hospital beds can put extra pressure on families at the point of discharge. Evidence shows that of carers who have recent experience of hospital discharge, a quarter report that they were not consulted about the process. Almost six in 10 carers said that they did not feel that they had a choice about providing care to the person following their discharge from hospital. In other words, families feel that there are no alternatives available.
If a carer is unprepared or simply unable to care for their loved one when they are discharged and no support is put in place, families can find it difficult to cope. This not only has a huge impact on the individual needing care, but can cause significant cost to the NHS, as re-admission is more likely. It is important that in debates such as this, we remember those people who do not have family to help them. The implications for them are far worse. It is vital that we address the failings in our social care system. The Government must find the money needed to fund it properly.
Finally, I want to say a few words about the impact on carers. I have a high number of carers in my constituency who play a vital role in providing care, but it is unfair to expect them increasingly to prop up a social care system in crisis. With that in mind, I urge the Government to do all they can, to take note of the concerns expressed in today’s debate, and to find the funding both to address the current crisis and to put in place a long-term settlement to ensure that care is there for those who need it, whether they are elderly or vulnerable in any other respect.
The motion that we are debating is wide ranging because when we talk about social care, we are talking about the needs of older people, the disabled and their carers. In my constituency, we have one of the fastest-growing ageing populations in the country, so I understand only too well the pressures placed on my hospital, Addenbrooke’s, when elderly patients cannot be discharged.
My county council, NHS trusts and CCG are well aware of these challenges and are working well together as a team to see what transformation is possible to break the cycle, just as the Secretary of State recommended. However, I know that although they are determined and very capable, they are not miracle workers. As local authority budgets are reduced and we are rightly asking for better value for taxpayer money, it is inevitable that the pace of change will be different and variable across the country, and my worry is that the standard of care may suffer while that transformation occurs.
I believe that our care providers have the potential to transform. The question is whether they can do so swiftly enough and whether they can do it without a short, fast boost of additional funding to release them from the unrelenting pressure so they can find the head room to manage and make change.
Many of the issues that we face in the care sector apply equally to the disabled and to the elderly. Supporting the vulnerable is a moral and political priority, so for those who cannot help themselves, including the 1.5 million people living with a disability in the UK, we must help our care providers adapt. I shall focus on the disabled, as we have heard a lot about the elderly today.
Our growing and ageing population means that the current terms for the delivery of these vital services are no longer sustainable. Many providers have nowhere left to turn and are withdrawing from services that help those most in need. I have visited such a provider in my constituency, Voyage Care, which delivers 24-hour support to adults with significant disabilities. The care staff are the most humbling and dedicated human beings I have ever met. I am so proud to have them looking after my constituents, but they cannot continue to deliver a service on local authority rates that are frozen year after year. Fortunately, this year I have managed to help them secure a very small uplift, just enough to keep their heads above water, but throw in rural geography, a higher national minimum wage, changes to payments for sleep-in shifts, and a likely reduction in the number of keen eastern European carers coming here, and we start to run out of options.
The Government’s transforming care programme sets out a clear vision for ensuring people with learning disabilities receive the right level of high quality care in their local communities to support them in living as independently as possible. We have some great tools at our disposal to facilitate pathways into independence and employment, such as Access to Work, so let’s get smart about this. By supporting this community transition, we generate not only life chances but economic activity. Some 45% of young disabled people want their social care support to help them find and stay in work, but their care package does not include such support.
The debate must also draw attention to supporting our carers. I immediately thought of Alan, one of my constituents, who looks after his mum, Marion, who has very progressed Alzheimer’s, in one of my villages. He has dedicated his adult life to looking after her, but he needs a break, too. I know he has just about managed, but that is at huge personal and financial sacrifice. The value of the care that carers such as Alan provide is about £132 billion—almost equivalent to the UK’s total health care annual spend—so this little debate, Alan, is for you and your mum, Marion.
In financial terms, the Government have rightly allocated money via the better care fund, but we really cannot wait until the end of the Parliament—we need to do all we can to bring that money forward now. The precept is not enough; even if every council out there had taken up that offer, it would have generated £380 million, not the £1 billion shortfall. So we need to bring that better care funding forward, and it will provide an immediate uplift to councils so that they can pay care workers an appropriate wage. However, we should also be looking closely at how care is given, based on time spent, not tasks—and that means proper time, because I want to see an end to these 15-minute slots. Our country is more civilised than that, and cutting corners now means more costs later.
It is not enough for the Opposition to simply demand more money. The complexity of these issues and the current economic climate mean it is simply not good enough to make such demands without offering solutions. To transform the social care landscape, we need to be as brave as those care providers we are asking to work in a new way. As Andy Burnham so eloquently put it, we need to work together to come up with new ideas. So let’s get smart. We need to fund areas based on their proportion of older and disabled residents, not on deprivation, as the funding model currently does. We need to ensure—legislating if necessary—that councils, the NHS and CCGs pool their money and resources. The key to unlocking a new model of social care, as we have heard loud and clear today, is to make a team effort. Those in my area are working in partnership, but the Government need to set up a health and social care commission to pull these work streams together. Health and social care are entwined, but, currently, the decision-making and budget priorities are not.
The Care Quality Commission said the system has reached a “tipping point”, with providers starting to hand contracts back. I have seen it in my own county—it is true. So let us work together as a team and come up with a brand-new plan for social care in the 21st century.
I want to pay tribute to the careworkers across the country who will be spending today and every day looking after vulnerable adults in their homes and in residential settings. The work they do is hard—often impossibly hard in the current context. On too many occasions, they are paid very little, and they are often provided with little training to equip them for their work.
I am a member of the Communities and Local Government Committee, which is undertaking an inquiry on adult social care. The Committee is yet to report, but, for my part, I think that much of the evidence we have seen and heard to date is damning. The proportion of GDP we spend on social care is falling at a time when need and demand are rising and will continue to rise. That is being felt in a system that is barely able to cope.
The Committee has heard evidence from local authorities that are having care contracts handed back by providers that cannot make them work, with careworkers facing impossible case loads. We have seen evidence of negligent providers, with owners paying themselves six-figure salaries while failing to provide even the most basic standards of care.
Last month, I attended the launch of the CQC’s “State of Care” report. David Behan, the chief executive of the CQC, spoke about how he and his team had agonised over whether to use the phrase “tipping point” in relation to social care, but, in the end, they decided that it was an accurate description for the state of the care sector. While there is much good practice and high quality care, structural problems in the sector and with the resourcing of care are leading to more and more care being provided on a basis that is simply not sustainable. As that happens, the scope for error and neglect, and for vulnerable people to be let down, is growing.
The Government’s approach to funding social care simply is not working. While take-up of the 2% social care council tax precept is high, many local authorities have told the Committee that the funds raised simply do not cover the shortfall left by the cuts to their budget in preceding years—still less the cost of the national living wage, and still less the increase in demand. The back-loading of the better care fund to the later years of the current Parliament is not working. I asked a local government Minister earlier this year whether he thought that that back-loading created a risk that smaller care home providers would exit the sector in the short term, leading to a loss of capacity at a time when demand is growing. He assured me that that would not be the case, but we are now seeing evidence that that is exactly what is happening. Often, local authority funding does not cover the full cost of providing care, and there is no slack in the system to provide for the investment needed to improve facilities and performance where necessary, so many providers are simply moving out of the market.
I recently visited a care home in my constituency that is provided by a small charity and is rated good by the CQC. The manager told me that, time and again, what the local authority agrees to pay does not meet the full cost of the care provided by the care home, and that it regularly subsidises residents from its reserves. That situation is completely untenable in the long term. I am very concerned that, by the time the increase in the better care fund is available in 2019-20, many small providers will have found the financial strain too much to bear, and that there will be a significant drop in capacity at the precise time when we will need capacity to meet growing need.
The quality of our care sector matters so much, because the way in which we look after our most vulnerable residents is a mark of our civilisation, and because the need to care for frail and elderly relatives is an issue for every single family in the country at some time in their lives.
Our social care system is not delivering the quality of care or the dignity and compassion that our vulnerable residents need. Neither is it delivering sufficient support for our unpaid carers, whether that is due to a lack of respite provision or to the difficulties that too many carers face in obtaining the assessment of their own needs, which is their statutory right. The underfunding of adult social care is, in turn, having an enormous impact on our NHS through avoidable hospital admissions and delayed discharge, and there is also the mental health impact of loneliness and isolation.
The Government must act now to address the state of our care system. We need more funding for social care—that cannot be denied—and I call on the Government urgently to bring forward the increase in the better care fund. We need a commitment to training for care staff and to fair terms and conditions, and I call on the Government to adopt the Unison ethical care charter as the standard for care across the country, because we know that better paid, better qualified and fairly treated carers also provide better standards of care. We need a fully integrated system that recognises the benefits and savings that can come from ensuring that vulnerable adults are well cared for and supported to live independently and remain active for longer. We also need support for unpaid carers, who save the taxpayer billions of pounds by providing care that would otherwise need to be provided by the state. Cuts in respite care, a lack of mental health support and inadequate carers’ assessments are a false economy, and the Government need to support carers to do their vital work without being pushed to breaking point.
I hope that the Minister will respond to the debate by confirming emergency measures to address the crisis and a wholesale review of the care sector so that it can be established on a fit-for-purpose, sustainable footing for the future. I also hope that the Chancellor will use the autumn statement to introduce proposals for the sustainable funding of social care, to relieve the burden on our NHS and, most importantly, to enable all of our vulnerable adults to live well supported, with dignity, for the whole of their lives.
My constituency has one of the highest rates of over-65-year-olds. They comprise 28% of my constituents, compared with the national average of just 17%. Indeed, the town of Bexhill has more 85-year-olds per head of population than any other part of the UK. Given those statistics, adult social care is a key driver in the success of our local public services. Not only is it directly relevant to the wellbeing of many of my elderly constituents, but it determines the ability of all my constituents to gain rapid access to their hospital and GP. It also determines the amount of money that is diverted away from other local public services, such as education and transport.
I want to touch on two issues where there is more to do to improve social care. First, of 35 care homes in my constituency that have been rated by the CQC, none has been rated outstanding and only six have been rated good. The remainder require improvement or are inadequate, and they have six months to turn performance around or they may be closed. If our local schools were failing in the same way, there would be outrage. That our often vulnerable residents, who are often without a voice, are being subject to that standard is a national disgrace that I do not believe should be tolerated, and I welcome the Government’s tougher approach to the inspection regime.
Having met the CQC to get behind the reason for the failure of those inspections, I believe that much of it is down to the design of care home buildings, many of which, because of their age, cannot easily be adapted from traditional residential homes for the elderly into modern care facilities. More people can use technology to enable them to stay in their own homes, so care homes tend to have a higher proportion of patients who have complex health needs.
Many homes are failing CQC inspections because they cannot demonstrate that they can evacuate residents in an emergency, and they do not have the right spatial design to keep residents active and engaged. The state of our care homes means that not only do residents not have the best wellbeing, but when individuals have to stay in hospital, authorities may be unable to discharge them back to care homes because no places are available if those homes are failing the inspection regime and are thus out of bounds. That leads to bed shortages in hospitals and to expensive longer stays.
There is an alternative. I recently attended the opening of a new state-of-the-art apartment block in Bexhill that offers shared ownership and rentals to the over-60s, some of whom are local authority-supported. Residents live independently and share in-house restaurants and amenities, which are also open to the public. For younger residents, it feels like any other smart apartment block with its mod cons. Crucially, however, the building offers facilities and care packages, so that as residents get older, they can access care but remain in their apartments. They can arrive at 60, and the design allows them to remain there for life. It is an excellent model for the future, but it was possible only because our county and district councils provided land and funding for our amazing housing association, AmicusHorizon, to build out.
Across our constituencies, land is being developed for housing. Every developer is required to provide infrastructure such as schools, GP surgeries and other public amenities. Care homes are private businesses, however, so there is no requirement to provide them. Since 50% of our care home patients are funded by the state, I suggest to Ministers that they fold in a requirement for developers to provide land or section 106 moneys to enable housing authorities and care companies to deliver the innovative new accommodation that will take people to their last days. Such accommodation should be part of the design as much as a school or a GP surgery is.
The second issue pertains to the joining up of our NHS and local authority social care providers. Much has been made of sustainability and transformation plans and of integrating adult social care and clinical care. I therefore congratulate East Sussex County Council and our NHS team in East Sussex, who have recognised that the £200 million of savings required from the STP and the delivery of a better care package can be better achieved if they join up and work together. Their “Better Together” project is designed, in their words, to
“spend £850m wisely, not saving £200m badly.”
To deliver that programme, our local team is implementing a single point for health professionals to access support, integrating social and community care under one management structure, offering frailty practitioner support for the over-75s for early intervention and putting prevention teams together for high-risk members of our community. The results thus far have being encouraging for adult social care: the number of clients going under early intervention watch has increased by 20%; early intervention has kept people out of hospital; 77% of clients have remained at home following early intervention; and there has been a notable reduction in the number of falls. I highlight those issues because they are key drivers for the improvement of social care.
The delivery by the Government of an extra £3.5 billion is welcome. However, it is crucial that we question the operating model in social care. To do so will not only make resources stretch further, but deliver the ideas and innovation that will improve the lives of those who rely on social care in their latter years.
Across the UK, local government funding has been reduced by 37% in real terms between 2010 and 2016, and the Local Government Association has estimated that councils’ overall funding gap will amount to £5.8 billion by the end of this parliamentary cycle. Those cuts to council services have severely taken their toll on the health and social care provision that millions of people rely on. That now presents an immediate risk to those patients and providers. Councils face a £1.9 billion funding gap in adult social care. We are at what the Care Quality Commission has said is “a tipping point”.
In my constituency of Heywood and Middleton, we have been hit hard. Rochdale Council has had to make huge Government cuts of £200 million in the past six years. Social care budgets face even more pressure in the next two years, as the council is forced to save a further £40 million. The social care precept of 2% on council tax this year will raise only about £1.4 million, which is a drop in the ocean of Rochdale’s total adult social care budget of £80 million.
Inevitably, there have been serious consequences as a result of this underfunding. Our hospitals and A&E departments report a 70% increase in bed-blocking. They identify the cause as the fact that social care is not available to allow patients to be discharged safely. The figure was 108,000 in April 2012, but it was a staggering 184,000 this July. Bed occupancy rates exceeded 91% during January to March 2016, which is the highest quarterly rate in the past six years.
These figures serve to emphasise that cuts to social care services have had an inevitable knock-on effect on the NHS, heightening the bed-blocking problem, as patients are forced to stay in hospital for longer because they are unable to get the support that they need at home. By properly funding adult social care, we could remove the burden from our hospitals, so that they could carry on the important acute work for which their services are intended.
I want to talk about home care providers and their staff. According to the local government ombudsman, they are “underfunded and over-stretched”. Sadly, there has been a rise in cases of neglect in patient care and a failure to deliver a decent and fair wage to carers. Some 63% of staff said they had less time to spend with the people they care for because of staff shortages, and nearly two thirds are doing their job alongside fewer staff than they were six years ago. The trade union Unison has said:
“Cuts have left a trail of destruction and this is affecting those in desperate need of care. Care workers do a vital job looking after the most vulnerable in society. But they’re not getting the support they need from their employers.”
I agree with Unison. Carers are an integral part of the healthcare system, and they must be valued and properly remunerated for the work they carry out, year in, year out.
I hope that now we have had a change of Prime Minister and Chancellor, we might have a change of mind and a change of heart on this issue. The autumn statement is the first opportunity to reassure the public that this will be a Government who not only work for everyone, but care for everyone. The importance of investment has been acknowledged on all sides of the debate. Stephen Dalton, chief executive of the NHS Confederation, has said:
“The critical and negative tipping point for the health and care system has been triggered by cuts to social care. It’s imperative the chancellor takes the opportunity, in the autumn statement, to prioritise investment in social care before the winter.”
This is issue needs to be addressed immediately. It cannot wait any longer.
Some people are of the view, locally, that the devolution deal in Greater Manchester might provide a solution to the underfunding of adult social care. My right hon. Friend Andy Burnham, who is now Labour’s Greater Manchester mayoral candidate, has long campaigned on the integration of health and social care, which he has talked about in this debate. If he is elected, that will give him an opportunity to put these plans into action. However, with devolution comes a £1.2 billion to £2 billion black hole in the finances. For healthcare to be properly devolved, it is vital that it is properly resourced and properly funded.
The Government must act to give health and social care services the investment and protection that they desperately need. In the long term, we must fully integrate health and social care, otherwise many of the most vulnerable and defenceless people will be left facing a prolonged winter of discontent and displacement.
It is a pleasure to follow the thoughtful and heartfelt comments of my hon. Friend Liz McInnes.
Today is Unison’s SOS—save our services—day of action, so I join it in calling on the Government to ensure that social care is properly funded, so that people in this country can be properly looked after.
In the past six years, the largest share of cuts has fallen on local government. Given that councils spend a third of their budget on social care, the Government will have known from the very start that social care would be one of the biggest casualties of their spending programme.
The budget of North East Lincolnshire Council has been cut by more than £70 million since 2010, with a further £7 million of cuts to be made by next year, causing spending on adult social care in my constituency to fall by 20% since 2010. People have been forced to live in completely unacceptable conditions, because there is not enough funding to provide adequate care.
I know of wheelchair-bound adults living in a care home in Great Grimsby who have been waiting for over two years for the button that automatically opens the door out of their flat to be fixed. At the moment, until a carer comes to visit, they are effectively trapped in their own home. That is an unacceptable position to leave people in, but it is just one example of the state of social care today.
The council has had to limit access to adaptations by increasing the thresholds for accessing them and capping spending. Disabled and elderly people are therefore often left in unsuitable housing. Understandably, that is also hugely frustrating for carers who are trying their best to look after people in inadequate conditions, while having continually to fight the council and care providers for the improvements they need.
A constituent who cares for his adult son was told by occupational health about six months ago that his home needed the back door widened and a ramp and lift installed. He feels as though he is being deliberately fobbed off, rather than getting the help he needs to look after his son properly. It is as uncomfortable for the son to live in those conditions as it is frustrating for the father to be unable to look after him properly.
Today, the Communities and Local Government Committee took evidence from family and friend carers who save the state so much money. One issue that was raised was the disconnect between the NHS and local authorities at the point of discharge from hospital. There were reports of families feeling abandoned when discharge occurs, with very limited support being accessible and no single point of contact or dedicated service to guide people through the options available to them and their families. That heightens the risk of readmission to hospital for many of those patients, costing the state even more money.
The carers spoke of the neglect of their own physical and mental health, with their overriding concern being for their loved ones. Respite that had previously been offered is ending. We heard the example today of two hours of respite being provided a week. That does not seem like an awful lot, but it was a lifeline to the women who came and gave evidence. That was provided by a local charity and funded by the local authority. It is now going to end because of cuts being made to and by the local authority.
We also heard about a looming crisis in intergenerational care, with a gap of hundreds of thousands of carers predicted over the next 10 years. The pressure on social care services provided by the state is only set to increase. As we heard at Prime Minister’s Question Time today from my hon. Friend Judith Cummins, there are also problems with dementia and Alzheimer’s services.
The social care precept is not the way to solve this problem. As we have heard, the areas with the highest demand for care are often those where the precept will raise the least. Furthermore, the Chair of the Health Committee, Dr Wollaston, claimed earlier this month that the additional funds raised through the precept have been “entirely swallowed up” in higher wages for carers. Although I am glad that carers are being paid more, albeit still not a proper living wage, councils are therefore unable to allocate any of the new funds to improving care.
When Mr Osborne announced the social care precept this time last year, he said:
“The truth we need to confront is that many local authorities will not be able to meet growing social care needs unless they have new sources of funding.”—[Official Report,
Vol. 602, c. 1363.]
Although the Government have accepted the need to better fund social care, they still need to find that new money if the growing demand for care is to be met. This is not only about supporting people who need that support in their old age or because of a disability; it affects us all. As the then Chancellor also said last year:
“The health service cannot function effectively without good social care.”—[Official Report,
Vol. 602, c. 1364.]
Failing to fund social care properly means that patients are forced to remain in hospital for weeks longer than they need to, blocking beds for new patients who need them and pushing up hospital waiting times. Meanwhile, every day the patient kept in hospital costs the NHS far more than caring for them in a suitable environment would.
I welcome the contributions made by Members on both sides of the House today. They have highlighted the scale of the crisis we face in adult social care. My right hon. Friend Andy Burnham set out passionately the long-standing need for integration. We had informative and knowledgeable contributions from my hon. Friends the Members for Halton (Derek Twigg), for Tooting (Dr Allin-Khan), for Halifax (Holly Lynch), for Wirral West (Margaret Greenwood), for Dulwich and West Norwood (Helen Hayes), for Heywood and Middleton (Liz McInnes) and for Great Grimsby (Melanie Onn). On the Government side, we also heard thoughtful contributions from Alistair Burt and the hon. Members for Central Suffolk and North Ipswich (Dr Poulter), for South Cambridgeshire (Heidi Allen) and for Bexhill and Battle (Huw Merriman).
It seems we all agree that there is a crisis. I believe that 2017 will be a make-or-break year for our social care system. That system is currently teetering on the edge of a precipice. More and more, we find that local authorities can no longer afford to fulfil their statutory obligations regarding the social care of elderly and disabled people. Social care providers are handing contracts back to councils because they are no longer financially viable. Beds in hospitals are occupied for weeks—sometimes even months—by people who are well enough to leave but cannot because there is no social care available for them once they do.
In a matter of months, within the still secret Staffordshire STP, the projected 2021 deficit for social care has jumped from just over £100 million to £256 million. With the NHS deficit, that makes more than half a billion pounds now, excluding anything from Stoke-on-Trent. Without further funding and investment, that gap is simply unbridgeable, so it is hardly surprising that in the past few days both the STP chair and its programme director have tendered their resignations.
I am glad my hon. Friend has had the chance to raise that very important point.
The crisis is affecting elderly people across the country, as we have heard eloquently expressed by my hon. Friend Barbara Keeley. More than a million elderly people in this country who need social care are getting no support. Half of older people who have difficulty bathing or getting dressed receive no support. One third of all older people who have difficulty going to the toilet on their own are receiving no support. An estimated 1.1 million are chronically lonely. Is it any wonder that almost 4 million older people in this country now say that television is their only source of company? That is happening on our watch, and we should all be both saddened and shamed by it.
The rise in demand for social care does not come as a surprise to any of us, however. We live in a society with an ageing population. We must concentrate on building a sustainable social care system to meet that rising demand. Members across the House know from their own constituencies, as I do from mine, that the spending cuts have already hit vulnerable people. One in 10 care homes has closed since 2010, and 400,000 fewer people accessed care in the last Parliament because of funding reductions. According to Learning Disability Voices, a shocking three quarters of all people who apply for social care support from their local council are now turned away.
For those who can access care, the bar for what can be described as care gets lower and lower. Staffing levels have been so severely reduced that workers have barely any time to actually look after people. As we have heard, some visits have been cut from 30 to 15 minutes. That is 15 minutes to make someone dinner, to bathe them, to give them medication, to change their sheets and to give them any other help they might need. It is barely time to take your coat off and say hello. In fact, 15 minutes is about the time we take in this place to divide. I hope Members will bear that in mind when they pass through the Lobby shortly.
The King’s Fund has described the care system as a
“threadbare local authority safety net.”
Although the majority of those receiving care are elderly people, roughly a third are younger people who have a physical disability, learning disability or mental health problem. These people are far less likely to have income to support them and far less likely to have children who can care for them as they get older. In fact, they are more likely to have elderly relatives who live in dread of what will happen when they are gone.
When disabled people are looked after in the community, with a local authority-provided care package, their needs are reduced by up to 50%. We often hear about needing to reduce the dependency culture, and the provision of social care, including day centres, does just that: it allows people with disabilities to live an independent and healthy life. Rather than allowing this sector to crumble, we should be looking at how to invest in it and expand it. It is said, and has been said here today, that the mark of a civilised society is how we treat the disabled, the elderly and the vulnerable. We are failing that test miserably.
Let us be clear about one thing: this crisis is not the fault of those working in the social care sector. In fact, they are among the most undervalued and underpaid workers in the country. Neither is this crisis the fault of local government. Nobody goes into local government and public service to cut care and support for the vulnerable. Local authorities are trying to plug the gap. In 2014 alone, councils diverted £900 million from other budgets to maintain the current level of social care, despite making efficiency savings. Local councils are on the frontline of government, providing the integral services that our communities rely on. It is simply impossible for them to plug the momentous funding gap in adult social care that they face. Let us make no mistake about the root of this crisis: it is the stark result of the austerity policies pursued by the previous Chancellor. It is his six years of brutal and devastating cuts to local government that have brought us here.
If we let our elderly and disabled people languish in loneliness and frustration in unhygienic and inadequate conditions, it will be a stain on our collective conscience. What kind of country would we be? When the new Prime Minister took up her position, she stood on the steps of No. 10 and said she wanted
“a country that works for everyone.”
Today, the Government have an opportunity to prove that the Prime Minister meant what she said. I would like the Minister to consider three questions when he responds to the debate. Will he confirm that the better care funding is not additional money, but has in fact been taken from the existing NHS budget? What assessment has he made of the effect of the living wage on care contracts, and does he have an estimate of how many contracts will be exited in the next 12 months by providers? Will he let me know what steps and checks he is making to ensure that local authorities are not commissioning 15-minute care visits, as recommended in their own guidelines? If the Minister cannot answer those questions today, I hope he will write to me in the coming weeks.
We are all hopeful that the autumn statement will bring forward urgent funding to stem an impending crisis in social care, but there must also be a strategy to put social care on a sustainable, long-term footing so that people can grow old in this country without fear, and disabled people can live with dignity and safety. The Government must recognise that by stripping local government of its funding to the point that even statutory requirements are difficult to meet, we will not benefit the economy or productivity of this country, or the wellbeing of our society. As the sixth-richest economy in the world, this country can, and must, provide this vital assistance to the most vulnerable people in society.
We have had a good debate, with a number of very good speeches from both sides of the House. I will try to respond to the points, or the themes of those points, that have been made.
First, I want to address the accusations, made by Labour Members, of criminal behaviour in relation to the minimum wage not being adhered to. If such evidence exists—I think the hon. Members for Sheffield Central (Paul Blomfield) and for Tooting (Dr Allin-Khan) raised this issue—please bring it to me. I will see that it goes to Her Majesty’s Revenue and Customs. Those involved will be named and shamed. Such behaviour is illegal and is not to be tolerated. I think the hon. Member for Tooting also said she had evidence that a care home or domiciliary supplier was forging attendance sheets. Again, if there is evidence of that I would like it to be brought forward. It should not just be bandied about here in a political way. We should investigate it and we will. If she brings that evidence to me, we will look at it.
One of the big themes in this debate, and one with which Members on both sides of the House can agree, is the importance of carers. Barbara Keeley spoke about that and, rightly, about the need for a better career structure and clearer training requirements, a point the Cavendish report also addressed. Some 1.5 million people work in domiciliary and care homes, but—this is a very difficult statistic—the annual turnover is about 25%. That is caused not just by poor pay—I am proud to be part of a Government who have increased the pay of many of these people—but by lack of career structure and, frankly, of regard, and we need to do more on that. She was right to raise it.
My right hon. Friend Alistair Burt made the important point that, as well as the 1.5 million paid carers, there are 1.1 million unpaid carers. In many ways, these are the unsung heroes of the entire system, and we can all agree we need to do better by them. When he was doing my job, he kicked off the carers’ strategy, which we will be coming forward with. It is a cross-Government initiative and will result in concrete actions to make the 1.1 million-strong unpaid carer cohort better off.
Several people talked about finances and money. Of course they are tight. The Secretary of State made it clear that in the last Parliament, in order to respond to the situation we inherited, there were cuts to local government funding. During the course of this Parliament, there will be a real increase in the rate of adult care funding, but that is not to say we do not understand that the system is under pressure. We understand that, as Simon Stevens said, if more money was available, it would be good if it went into the social care system.
Members on both sides of the House spoke about bed-blocking caused by a lack of money, and about delayed transfers of care, and it is true. Of course there is a correlation between the amount of money in the system and the number of delayed transfers of care, but one of the most extraordinary things about the numbers is that, between the best and worst 10% of local authorities, in terms of the number of DTOCs, the difference is a factor of 20 to 25. That is not just about budgets—budgets are not 20 to 25 times different; it is about leadership; about good people doing good work; about spreading best practice; about shared assessments, early discharge and discharge to assess; and about integration in the widest sense, as my right hon. Friend the Member for North East Bedfordshire said. Those councils, local authorities and health systems that have gone fastest and furthest with integration—the holy grail that Andy Burnham talked about—are those at the top end of the DTOC statistics. We should all think about that when we say, “We want more money.” We should all think about the reasons for that difference.
I would make another point about finance. An Opposition Member talked about the GDP equation getting worse in this Parliament. That is not true, but I would just make this point: in 2016, the OECD looked at the amount of money spent on adult social care right across the major economies of Europe, and we in the UK spend about 20% to 25% more than other major industrialised countries such as Germany and France. That is not to say that the system is not under pressure in our country—it clearly is—but the facts are that other countries do a better job in terms of long-term saving, social insurance and some of those types of things. We clearly have an issue with this. Let me repeat that Germany and France, which in the round spend more on the entire health system than we do—about 1% more as a proportion of GDP—spend 25% to 30% less on adult social care. It is critical to spend what we can spend better.
I hear what the Minister says, but it seems to me that, in common with the Secretary of State, he is avoiding the main issue. The main issue is the urgent financial crisis that councils are facing. They have not got enough money to care for the people who need care. Will the Minister answer a direct question? Has he or the Secretary of State made a submission to the Treasury for more funding for social care as part of the autumn statement—yes or no?
We are not having the autumn statement today, and we are not going to give a commentary on what will come out of the autumn statement. We—the Secretary of State and I—have accepted that the care system is under pressure. I was just making the point that other countries spend less, and that we need to spend every penny we can as effectively and as well as we can. During the course of this Parliament, moreover, there will be a real increase in the amount of spending on social care.
Let me make some progress, and I shall give way again later.
Another theme has been closure. Several Members have talked about contracts being handed back, and there is a bit of that going on in both domiciliary care and care homes. Let me put on record the fact that the number of bed places in care and nursing homes is broadly the same as it was five years ago. There has been no reduction. As for domiciliary care providers in the market, the number is now 47% higher than it was five years ago. There has been, rightly, a trend away from care homes to domiciliary care—and we should all welcome that, because people broadly want to spend more time in their own homes. I was asked a good question about the issue of 15 minutes of domiciliary care and what we are doing about the problem. When the CQC is doing its quality reviews, it has a specific question to ascertain whether 15 minutes is the norm, and if so, it would result in a poor quality assessment.
Members have raised broader issues of quality. Let me therefore say that 72% of care homes—a sector that is under a great deal of stress—are good or outstanding. This Government have been the first to do any kind of inspection to find that out. Of course some care homes are inadequate. As the Secretary of State said, inadequate care homes go into special measures and can be closed down after six months. That is the right thing to do, and we should be pleased and proud that that happens.
Also, users of care homes have been asked whether or not they are satisfied, and just under 70% said that they are either extremely satisfied or very satisfied with the level of care provided for them. Members of all parties should come together on this point and thank the people who work in these care homes for the dedicated care and the humanity that they provide.
The former Minister, my hon. Friend Dr Poulter, who is no longer in his place, talked interestingly about the vanguards, the STPs and what we are doing to bring in leading-edge better care models. A lot of work is being done on the STPs, and I heard a couple of Opposition Members say favourable things about their STPs.
Derek Twigg asked me a number of specific questions about his STP. I will probably not have time to answer in detail, but I can say this. His STP and my STP are the same, and it is being published today—[Interruption.] It is certainly not secret, and we should have some dialogue about it. The hon. Gentleman made the point that his council was under pressure, and councils are under pressure. I think we should join together to congratulate both Halton and Warrington Councils on being two of the best performing councils in the country on delayed transfers of care and on increasing their budget.
I finish by—
claimed to move the closure (
Question put forthwith, That the Question be now put.
Question agreed to.
Question put accordingly (
The House divided:
Ayes 200, Noes 279.
Question accordingly negatived.
Question put forthwith (
Question agreed to.
The Deputy Speaker declared the main Question, as amended, to be agreed to (
That this House welcomes the Government’s Spending Review settlement for health and social care, which ensures that the amount of money available to local authorities for adult social care services will rise significantly across the Parliament, and ensures that up to £3.5 billion more will be available by 2020; commends the work and dedication of those in the social care sector; and further welcomes the introduction by the Government of the social care precept which allows local authorities greater autonomy in making decisions about how they best meet their local communities’ needs for social care.