This oral statement is the Government’s response to the recent Opposition day debate on social care on Wednesday
An ageing society means that we need to reach a longer-term sustainable settlement for social care. That is why the Government have committed to publishing a Green Paper by summer 2018 setting out their proposals for reform. An inter-ministerial group is overseeing this work. This builds on the additional £2 billion over the next three years that we have already provided to meet social care needs.
In developing the Green Paper, it is right that we take the time needed to debate the many complex issues and listen to the perspectives of experts and care users, building consensus around reforms which can succeed. That is why we are starting a process of initial engagement over the coming months through which the Government will work with experts, stakeholders and users to shape the long-term reforms that will be proposed in the Green Paper. The Government have asked a range of independent experts in this area to provide their views, including the leads of the two most recent reviews on social care, Andrew Dilnot and Kate Barker. We are also engaging closely with key stakeholders, and with people who use services and their carers. The Government will host a number of roundtables to hear a range of perspectives from those representing different constituencies, including carers, service recipients, providers, health services, financial services providers, local government, and working-age adults.
Once the Green Paper is published, it will be subject to a full public consultation. The Government recognise that there is broad agreement across Parliament that reform of social care is a priority, and we look forward to working with parliamentarians to hear a range of views. We have already written to the chairs of relevant all-party parliamentary groups to invite them to meet us to discuss their priorities and perspectives on reform.
The Prime Minister has been clear that the consultation will include proposals to place a limit on the care costs that individuals face. To allow for fuller engagement and the development of the approach, and so that reforms to the care system and how it is paid for are considered in the round, we will not take forward the previous Government’s plans to implement a cap on care costs in 2020. Further details of the Government’s plans will be set out after we have consulted on the options. The Green Paper will focus primarily on reform of care for older people, but will consider elements of the adult care system that are common to all recipients of social care.
We are committed to ensuring that people with disabilities and complex conditions can live healthy, independent lives, and participate fully in society. Many of the issues and questions about the sustainability of the care system will be relevant to adults of all ages. To ensure that issues specific to working-age adults with care needs are considered in their own right, the Government have committed to taking forward a parallel programme of work on working-age social care, which is being led jointly by the Department of Health and the Department for Communities and Local Government. This work will be overseen by the inter-ministerial group to ensure close alignment with the Green Paper.
Of course, carers are vital partners in the health and social care system. It would not make any sense to pursue strategic issues related to carers in isolation from the wider work on the future of social care, so they will be a key part of the Green Paper. A sustainable settlement for social care will not be possible without focusing on how our society supports carers. I am committed to making sure that the issues raised with us through the call for evidence on carers in 2016 are central to any proposals for the wider social care system.
Alongside this, we must continue to work to improve the experience of carers today. The Government remain fully committed to supporting carers in providing care as they wish to, and in a way that supports their own health and wellbeing, and their employment and life chances. In the new year, ahead of the Green Paper’s publication, the Department of Health will publish an action plan for carers, setting out priorities for a cross-Government programme of work to support them over the next two years.
In the short and medium term, we are taking important steps to ensure we have a stable adult social care sector. We are promoting quality care across the system and supporting the wider networks and services that keep people living independently for longer. It is important to recognise that quality across the adult social care sector remains good overall: the October 2017 state of care report from the Care Quality Commission found that 80% of adult social care settings had been rated good or outstanding. However, it underlined that there are substantial variations in the quality of care depending on where people live. The Department of Health is working with the adult social care sector to implement Quality Matters, a shared commitment to taking action to achieve high-quality, person-centred adult social care. Through our programme of sector-led improvement, we are supporting councils to make savings and improve services by promoting good practice, including new approaches.
Looking beyond social care provision, it is important to highlight the broader support and services that help people to live independently for longer. Well-adapted, specialised housing is becoming increasingly important. The means-tested disabled facilities grant helps with meeting the cost of adapting a property to the needs of a person with a disability or support need. This year’s autumn Budget has provided an additional £42 million for the rest of the 2017-18 financial year, taking funding for this year to £473 million.
Getting social care right means a better system that everyone can have confidence in, in which all people understand their responsibilities, can prepare for the future, and know that the care they receive will be to a high standard and help them maintain their independence and wellbeing. This Government want to take the time to consult and build consensus on a long-term, sustainable settlement for the future, which includes looking at the quality of care being delivered, the funding of the system, and how it will be paid for in the round.
I thank the Minister for giving me advance sight of her statement, but it is a woefully inadequate response to the Opposition day debate we held in this place on Wednesday
That motion called on the Government to note
“the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home”, and we called on the Government not to proceed with their commitment to those proposals. The Minister has today finally confirmed what many of us on the Opposition Benches suspected: they will not be proceeding with their plans to cap care costs by 2020, as legislated for by the House. This a shameful waste of taxpayers’ money. Over £1 million in today’s money was spent on commissioning the Dilnot review, and it was a waste of parliamentary time enacting the cap. It is no good for her to say that the Government are consulting on the cap. They consulted on this during the general election, and their proposals were rejected by the electorate. Meanwhile, very many people are still faced with the catastrophic costs of paying for their care.
The motion also called on the Government
“to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care”.
During the debate, I talked about how Ministers had previously threatened councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care could not be met—fines for targets that half of social services directors believe to be unrealistic. Will the Minister confirm that the Government have listened to the will of the House and will stop these fines, which merely threaten to make the crisis in social care worse?
The motion also called on the Government
“to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.”—[Official Report,
Vol. 630, c. 312.]
At no point today has the Minister confirmed how the Government intend to enact the will of the House in meeting the funding gap—and of course, shamefully, there was no mention of social care in the recent Budget. Our social care system remains in a perilous state because of the cuts that this Government have chosen to make. The Care Quality Commission has told us that the social care system still remains at a “tipping point”. Will she now confirm that the Government will enact the will of the House and meet the funding gap?
The Minister in her statement addressed the Government’s decision to include the views of carers in the upcoming Green Paper and their failure to respond to the consultation of 6,500 other carers that has already taken place. As I mentioned in the debate, Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard. She told me:
“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”
Will the Minister give more details on the scope of the carers action plan and reassure those 6,500 carers that their time was not wasted?
The Government announced recently, and the Minister confirmed today, that working-age people with disabilities would be consulted as part of a “parallel” work-stream to the Government’s Green Paper consultation. Why a parallel work-stream? This is an extremely short-sighted approach to reforming social care, and far from one that looks at the system in the round. Will she give us more details about the parallel work-stream for working-age people with disabilities who have social care needs?
It is clear that only a Labour Government can deliver the much-needed reform to our social care system. Over the coming months, we will also consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as a new social care levy, an employer care contribution and wealth taxes. These experts will help clarify our options for funding our planned national care service, and our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs, as they do now or as they would have done under the Conservative party’s earlier dementia tax proposals.
The hon. Lady will not be surprised to hear that I did not agree with much of what she said, but I will address some of her points.
Fundamentally, we are setting out, as has long been established, how to get a longer-term, sustainable system for funding our social care. It is absolutely clear from our debates during the past year that, as far as the public are concerned, there is a real lack of understanding about how, at present, the cost of care has to be met by the person who requires it. That is what leads to catastrophic care costs, and the dementia tax that she keeps mentioning, and that is exactly what we are going to tackle by having a cap on the overall cost. In doing so, it is very important to take the public with us and to have a fully informed public debate. It does not matter how far we think we have had such a debate in this place when legislating in the past, because it is quite clear that the public do not understand this. [Interruption.] We are only going to get public consent for a long-term solution if we have a public debate that is handled with maturity, and so far we have not seen very much of that.
The hon. Lady raised the issue of carers, and she suggested that carers’ voices are not being heard in this debate. [Interruption.] I say to her that they very much are being heard. [Interruption.] She can sit there and chunter, or she can listen to the answer to the question. It is entirely up to her, but it is rather a waste of my time in coming to this place if I am just going to be talked over. [Interruption.]
Order. I say to the Government Whip that I think I can control the Chamber. I thank him for his help, but I have already told him once that he does not need to worry. [Interruption.] Order. The Whip is well aware that he is testing my patience. I do not need any help.
Carers’ voices very much are being heard, and there is no way we can actually tackle the broad picture of how we fund and manage social care need without properly considering the needs of carers. I am very grateful to the 6,500 people who responded to the call for evidence. We have listened to them, and we will consider what they have said in bringing forward the Green Paper. In the meantime, it is very important to pull together exactly what support there is at present and then respond to that, and we will publish our action plan in January.
On working-age adults, the hon. Lady is right to some extent in that there are some common issues in the adult social care system that affect both care for the elderly and care for working-age adults, and those common issues will be considered as part of the Green Paper process. At the same time, however, we are going through massive change in how we deal with people with disabilities. We have the very brave ambition of getting more and more people into work and we are on a journey of getting people with learning disabilities out of long-term residential care and into work in the community, and that brings a separate set of challenges. That work will go on in parallel, but the work on the Green Paper will look at the common issues as well as at the specific area of care for the elderly. I hope that gives her some reassurance. We cannot look at this in a silo—[Interruption.] She says this should all be looked at together, but care for the elderly and care for working-age adults face very distinct challenges, and I do not think we should diminish either constituency by grouping them all together.
On the funding gap, as the hon. Lady is well aware, we have made £9.25 billion available to local authorities to meet their needs over three years. The reality is that if we are to tackle social care in this country so that everyone gets the care they need as they come to the later part of their life, we need to build a longer-term, sustainable funding system. That is why we are taking forward this debate in the Green Paper, and I hope that everyone with an interest in this subject will get involved in that debate, because we can fix this problem in the long-term only if we can take the public with us.
The House of Lords Select Committee on the Long-term Sustainability of the NHS rapidly concluded that it would be impossible to carry out its task without investigating the interrelated nature of social care, and it changed its remit accordingly. The Committee changed the scope of its inquiry because it recognised that we will not see a long-term, sustainable solution unless we address both. I am afraid that a Green Paper that focuses entirely on social care will fail to rise to the challenge. Has the Minister read the Committee’s findings, and as she listens to those she consults at an early stage, will she be prepared if the advice from them is to consider health and social care together—that has been the advice of all the commissions that have looked at this—to go back to the drawing board and start again by looking at both health and social care?
To reassure my hon. Friend on the terms of reference for the Green Paper, let me say that part and parcel of getting a long-term, sustainable solution very much involves looking at care, and I pointed out in the statement that we need to look at holistic areas of policy to deliver it. Housing is one area, because if we get housing conditions right, we can obviously enable people to live for longer. The whole purpose of having a Green Paper and a debate is to make sure that we consider this issue not in a silo, but holistically, with a person-centred approach.
I thank the Minister for advance sight of the statement. I very much hope that we will not regularly have an Opposition day debate that is followed, months down the line, by the Government deciding to sneak in a statement on a Thursday morning, but this is perhaps a one-off.
If we are to have a consultation, we should start to look seriously at some of the challenges that we face with an ageing population. The Government currently have their head in the sand when it comes to who will actually look after these people when we restrict freedom of movement. The Government’s antics on social care have been far from the strength and stability that was talked about at the beginning the 2017 election campaign.
I very much welcome what has been said today about the cap, but I want to press the Minister about a point on which there is cross-party consensus in Scotland; in particular, it has the support of the Conservative party. In Scotland, the Scottish Government are extending free personal care to under-65s—under the so-called Frank’s law—on which her colleague Miles Briggs MSP has been working very hard. That will benefit about 9,000 people, but the UK Government have no intention of bringing in such a policy. Will she agree to meet me and colleagues from Scotland to look at this on a cross-party basis?
The whole purpose of a Green Paper is to allow us properly to debate and challenge all the options available. I am interested in what has happened in Scotland. The hon. Gentleman says that personal care is met by the Government there, but the lion’s share of costs for the elderly is of course the residential component, which is not met by them. We need to make sure that we are learning from the experience of everybody not only in these four nations, but across the world.
I appreciate the importance the Government attach to adult social care, but the title of this statement is “Social care” and, as the Minister knows, I have a strong interest in children’s social care. At a time when the number of children coming into care continues to rise, the thresholds for intervention are rising and preventive work is I fear going south, and the number of adoptions has also diminished, will she and the Government reassure me that they attach the same importance to dealing with the challenges faced by children’s social care services up and down the country at the current time?
I absolutely give my hon. Friend that assurance. If I may, I will suggest to my hon. Friends in the Department for Education that they respond to him on those points.
I think we are in danger of getting into a false debate. When I talk about social care, I do not talk about it to the exclusion of health but automatically include it. When people talk about the failure of the Chancellor to mention social care, the reality is that more money was made available to the NHS, which will benefit the social care system.
In the absence of any provision I may make—Dilnot might have encouraged me to make such provision—is it reasonable for me to expect my social care costs to be paid for by the state while my heirs inherit my substantial housing assets?
In a nutshell, my right hon. Friend has neatly summarised one of the debates we need to have in this area, which is how we can ensure that people obtain care when they need it and have it paid for, while at the same time achieving intergenerational fairness. I hope he engages fully in the debate on the Green Paper when it comes out. That is exactly that kind of thing we need to discuss to inform the public about the challenges and encourage everyone to think about how to plan for their long-term care needs.
As the hon. Lady knows, we have made an additional £9.25 billion available to local authorities, and they are now able to raise more through the social care precept. Some local authorities are very creative and imaginative in how they tackle that need, and we have increased the money available through the disabled facilities grant. That is taking a lot of demand out of the system, not least because it enables people to live independently at home without the need for care support, because of the extent to which it reduces falls. I encourage the hon. Lady to look not just at money, but at what else local authorities can do better.
I welcome the report and the focus on carers and the elderly—that is really important in Somerset. Let us not forget that four out of five social care institutions already offer good and outstanding service. As the Minister said, this is not just about funding; it is also about other measures that can be introduced to help. For example, hospitals such as Musgrove Park in my constituency link up with social care providers. It is doing a great job, and its end-of-life care has recently been rated outstanding.
I thank my hon. Friend for that point because although, quite rightly, we focus on the challenges and difficulties of this issue, a hell of a lot is going right. As she says, the Care Quality Commission found in its recent “State of Care” report that 80% of institutions were good or outstanding. That is a pretty good deal for a sector that is constantly and publicly criticised.
I welcome the Green Paper, and I hope that we can build cross-party consensus for the long term. However, any change will be years away from that Green Paper. The problems are here and now for local councils, and the Minister simply did not deal with them in her statement. The Local Government Association estimates for next year a funding gap of £2.6 billion on a cross-party basis. The Competition and Markets Authority states that care homes are failing because local authorities do not have the necessary resources to pay the fees. What will the Minister do about that? Where is the money to ensure that an inadequate social care system does not get even worse next year?
I welcome part of the hon. Gentleman’s comments. He is right: one reason we are at this stage is that the absence of long-term security means that some of these issues are crystallising rather more quickly than they ought to. We have made more money available to local authorities, but clearly they, more than any others, are desperate for a solution. It is incumbent on us all to hold a constructive discussion about the solutions to this issue. I am well aware of the challenges. The hon. Gentleman highlighted the CMA report, and it contains a lot that, frankly, did not surprise me. In the new year we will be bringing forward a response that deals with some of the issues raised.
I thank my hon. Friend for her statement, and I encourage her—as others have done—to engage with the whole House on an issue that so many Members care deeply about. As Mr Betts said, it is important to recognise the crises that exist now in certain areas of the country. We must engage for the long-term on a cross-party basis, but also on the crises now, including in my county of Staffordshire.
I do not disagree with much of what my hon. Friend says. Colleagues are talking about a crisis, but local authorities and the care sector have been put under a lot of pressure this year getting ready for winter, and they have stepped up to the plate. I pay tribute to everybody who works in that sector. They work incredibly hard and with real care. The work they do is not putting us in crisis but delivering great care outcomes for many people.
This is a shocking statement for thousands of families who live in this country with the misery of social care. The Minister referred to the previous Government, but the 2015 Conservative party manifesto was clear about what it was seeking to do, and about introducing a cap on care costs in 2016. A few weeks into office, the Government changed that, and moved the cap forward until 2020. I have written to the Minister about her exchanges in the House on
I think we made it clear in the recent general election that we will be revisiting this issue. The hon. Lady wants certainty about how we fund the care system in future, and on what obligations individuals and their families will or will not have. It is therefore important to have that full public debate, and work together to bring forward proposals that will put our long-term care system on a sustainable footing. In the absence of that we will not achieve any resolution, and that is contributing to misery for people who do not currently have a limit on their overall care costs. That is what we are trying to address through this process. [Interruption.] I hear noise from Labour Members about needing cross-party consensus, then I look at the behaviour of those on the Front Bench—lacking.
I welcome the Minister’s pledge to consult more widely about a long-term solution, given the pressures on Torbay with this issue. One problem is people’s complete lack of understanding about how the current system works with unlimited liability. If we just put in a blunt cap, that will mean little to someone who has worked for their whole life and bought a house in Torbay, yet quite a lot to someone who has a multi-million pound pile in the south-east. We must look carefully at how we do this on a long-term basis.
My hon. Friend encapsulates the problem in a nutshell. Many people do not understand that care must be paid for by the individual; nobody understands that they have to pay for it for as long as they have to pay for it. That is why we cannot simply implement the previous proposals because people do not understand them. If we are to expect people who are living longer to fund that care, we must take them with us. That is why we need a fully informed public debate, which is what the Green Paper is designed to achieve. I implore all hon. Members to engage with that and to help inform the public about exactly what our care system is now, and how it can be improved for their long-term security and that of the country.
After years of confusion for which the Government bear some responsibility, tens of thousands of carers engaged in sleep-ins will at last receive justice on the national minimum wage. However, the costs are formidable to the providers, and thousands—potentially tens of thousands—of individuals on individual care packages could face bankruptcy. Why was there no reference to that immediate and looming crisis, and when will the Government act to avoid what would be a catastrophe for the care sector?
I know that the hon. Gentleman cares deeply about this issue and he has rightly raised it with me before. I reassure him that the Government are now acting, and we are in close contact with providers to address those issues. It is important to ensure that employers uphold their obligations under minimum wage legislation, and we must not put at risk anybody who is dependent on long-term care—I am satisfied that no one is at risk. We are working in detail with providers to ensure that we get them through this.
West Sussex has some specific social care issues currently under investigation, and it would be inappropriate for the Minister to comment on those at present. However, I warmly welcome the expert panel. Will the Minister please ensure that it is fully acquainted with the lessons learned on financing from previous scandals, such as that at Orchid View in my constituency?
Absolutely. My hon. Friend mentions the expert panel, and it is important that we take the advice of those who have front-end experience of the sector. As he says, this is not just about money; it is about quality and getting the right blend of packages of support and help. We really need to think about achieving the best possible care for individuals, as well as how that care is paid for.
A recent Barnardo’s report showed that two thirds of child carers start caring in primary school, some as young as four, with long-term damage to their mental and emotional health. Will the Minister ensure that one of the Government’s primary responsibilities is to tackle the issue of child carers and take them out of a responsibility that we really should not be placing upon them?
I thank the hon. Lady for those comments. She highlights what is literally the Cinderella in this debate. It is appalling that so many children are acting as carers, stoically and fantastically but, as she says, to their long-term detriment. As a society, we would be failing if we did not do more to support them.
The fact that we need to tackle the challenge of social care has cross-party support and agreement. It was in the manifestos of both main parties. In fact, the Labour party’s manifesto said that it wanted to implement change through “consensus” and that the issue transcended party politics. Would the Minister welcome a cross-party approach, rather than political point scoring?
I am very keen to approach this matter through consensus. To be frank, I do not think that we can deliver change without consensus. We have written to all-party groups in the first instance to engage with them. Over the course of the next six months, I hope to engage in conversations and discussions with Members from all parts of the House.
Of course, there is a short-term series of pressures. The Minister has cited the CQC’s state of social care report, which talks about decreasing numbers of beds in nursing homes and contracts being handed back to local authorities because of the acute financial pressure. She has also recognised that there is a longer-term issue that all Members have alluded to—the need to set aside some of the yah-boo party politicking and find a cross-party way forward. Dr Wollaston, Norman Lamb and my hon. Friend Liz Kendall wrote to the Prime Minister saying, “Let’s have a convention across all the parties on social care reform.” Please will the Minister talk again to the Prime Minister? Let us do that, because it is the only way that we will really crack through this problem.
I welcome the spirit in which the hon. Gentleman makes his comments. It is fair to say that we are hearing exactly the same sort of plea from local authorities, which are at the front end of dealing with this problem. He is absolutely right that we need to separate the short-term pressures from the long term, and we ought to be able to have a more sensible conversation on the long-term pressures. Yes, let us save the politics for the short term and have consensus for the long term.
I appreciate the opportunity to speak, Mr Deputy Speaker, as I missed the beginning of the Minister’s statement—my apologies. I concur totally with what a number of colleagues have said about the issues in the here and now. At the minute, there are significant issues for a lot of councils and a lot of care homes that cannot wait for a few years. The here and now must therefore be the priority.
I have two points to make on that. The first is negative and I would like the Minister to take it back to the Chancellor. I call on the Government to make a public commitment to fund the back-pay bill for sleep-in carers. I do not know how many colleagues know about this issue, but if it is not sorted very soon, a number of very reputable charities and organisations are likely to go bust. On a positive note, I wonder whether the Minister has read the recent BMJ report that indicated how exercise can be a significant miracle cure for older people. May I meet the Minister to share the report with her?
I would be happy to meet the hon. Gentleman; I am always looking for solutions. He is absolutely right that if we can look after our own wellbeing—both physical and mental—more effectively, the need for care will diminish. That is another reason why we need to have this public debate. Like Jack Dromey, the hon. Gentleman has mentioned sleep-ins. It is a big issue, but we are working closely with the sector to make sure that we can address it.
I am currently caring for my 80-year-old mum who has dementia and lives on her own many hundreds of miles away from me. I pay tribute to the fantastic support she receives from the Cumbria services—it is excellent and it reassures me, when I am standing here, that she is being looked after.
My experience of door-knocking during the election demonstrated strongly that the public do not understand this issue. Dementia patients in particular are not able to understand how care can be funded. When I spoke to people from the Alzheimer’s Society in Redditch, they welcomed the focus in our manifesto on this difficult issue. Will the Minister also comment on the fact that countries across the world face a similar challenge? This is really not about who is in power or in government; it is a feature of ageing societies. That is why we must look at it in the round.
My hon. Friend is right. I mentioned that local authorities are very keen for us to find a solution to this problem, but it is the Alzheimer’s lobby that is keener than anyone. At the moment, one in 10 people faces long-term care bills. Therefore, if we are looking at an individual’s risk, making financial provision is not necessarily something that they will do, so we do need a solution. The one in 10 people who do face long-term care costs generally do face them as a consequence of dementia and the costs are very significant. That is exactly what we are trying to tackle by introducing a cap on the overall costs. That is why it is important that we all get involved and why the Alzheimer’s lobby is so keen that we establish cross-party consensus.
My hon. Friend raises an interesting point. The fact is that over the past 50 years, our lifestyles have changed significantly. Looking at my family, everybody lives within half a mile of each other, so as we get older it is very easy for the family to pick up caring responsibilities and share them about. I live 300 miles away from them. That is increasingly the pattern. Like her, when I knocked on doors during the election, I saw people in their late 80s whose families were living many miles away. That is something that we have failed to address over decades, and we need to address it now.
I am aware that there has been considerable press reporting on what is happening with Four Seasons. What I can say is that since Southern Cross, the CQC has been involved in market oversight and in stress testing exactly what is happening. We are satisfied that there is no risk to any of the people who currently experience care through Four Seasons. Beyond that, I cannot say very much because there are obviously commercial issues. However, the hon. Gentleman is right to raise the matter and I hope I can reassure him that the CQC is very close to what is happening there.