I beg to move,
That this House
notes that Government cuts to council budgets have resulted in a social care funding crisis;
further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care;
is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care;
and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.
It has been six months since the House called on the Government to commit the extra funding needed to ease the crisis affecting social care—six months of missed opportunities for the Government to bring more stability to our fragile social care system; six months in which the situation has deteriorated further. The care of older people and of younger people with disabilities seems sometimes to be an afterthought for this Government. The Secretary of State finally made a speech about social care in March, having had the words “social care” added to his title two months previously. Indeed, he told a conference of social workers:
“We need to do better on social care”.
This Government have had eight years to do better on social care.
The simple fact is that since 2010, things have got manifestly worse. I told the House in October that the care system, in the words of the Care Quality Commission, remains at a “tipping point”. Eight years of cuts to council budgets has meant that over £6 billion has been lost from social care budgets since 2010. The diminishing care fees that councils are able to pay in the light of those cuts have further destabilised the care sector, which is already described by the Association of Directors of Adult Social Services as “perilously fragile”.
ADASS reported last year that two thirds of councils had seen care providers close in their areas and that more than 50 councils had contracts with care providers handed back to them. A major chain of care homes, Four Seasons, recently ran into financial trouble, bringing with it the threat of care home closures and uncertainty for thousands of vulnerable elderly people. A few days ago, Allied Healthcare, one of the country’s biggest providers of home care, announced that it would be seeking a financial rescue plan from its creditors. Allied Healthcare has contracts with 150 councils and it cares for over 13,000 older and vulnerable people, so the Minister needs to be able to tell the House how local authorities will be able to discharge their statutory duty to deliver care if Allied Healthcare collapses.
On local authorities, my hon. Friend will know as well as I do that because of the cuts to local authority budgets, there is on the one hand, bed blocking in hospitals, because they do not have enough social workers to prepare a care package, and on the other hand, when people can go into care, care is so expensive that they cannot afford it. Councils are under pressure to try to make up the shortfall, which they cannot do.
Indeed they cannot, and given the fragility in some of these private care providers, I wonder what on earth councils are supposed to be able to do.
Does the shadow Minister agree that Allied Healthcare looks like the tip of the iceberg? So many care providers are contemplating getting out of the publicly provided social care market or have already done so, so we run the real risk of drifting towards a situation in which people with money can get good care privately but those who do not have the money could be left without it.
That is almost the situation we are in at the moment. It is worth thinking about why we seem to have this issue with Allied Healthcare, given that the problem has occurred in the last few days. It was reported that Allied Healthcare’s cash-flow problems had been triggered by increases in the national minimum wage for care staff and by an £11 million bill for back pay owed to sleep-in care staff. However, Allied Healthcare is not the only provider that is facing a large back-pay bill for care workers on shift. Learning disability social care providers have warned that they will have to withdraw services or close altogether to pay the bill for back pay, placing the care of even more people in jeopardy and putting care staff jobs at risk.
This trend of closures and contract cancellations is set to continue. A recent report into residential care by the Competition and Markets Authority painted a bleak picture of the current care home market.
I recently met Lifeways Group, which looks after thousands of people with learning disabilities and has many hundreds of staff who do sleep-in shifts. It pays above the national living wage and is a good employer, but it cannot afford the back-pay claims if they are found against it. Should the Government not provide the funding to support these organisations?
It is reported, in fact, that the total back-pay bill across the social care providers that provide sleep-in cover will be something like £400 million, so it is not surprising that a care provider such as Lifeways would say that. The Government have to come up with answers for this, because there has been a dragging of heels, the guidance has been very confusing, and it is a serious matter. I understand that the Government have completed two reports, but they have not been made public. Hon. Members and I would certainly welcome having those reports placed in the Library so that we can get that information.
We have seen warnings from the Competition and Markets Authority that care homes would find themselves having to close or move away from local authority-funded care because the funding is now only just covering day-to-day running costs. It is quite clear from all this that there is a growing funding gap in social care that must be filled. Clearly there is a growing funding gap in social care that must be filled. The Local Government Association has said that our social care system needs an immediate injection of £1.3 billion to fill that gap, and this is projected to rise to £2.5 million by 2020, according to the King’s Fund.
In our last Opposition day debate on social care, in October, the strain social care was under—from the weight of growing demand, reducing supply and the lack of funds from Government—was plain to see, but since then the system has cracked still further under the pressure of Government funding cuts.
When elderly people fall, they often have a stay in hospital, putting additional pressures on the NHS, and when they are ready to be discharged, hospitals sometimes cannot discharge them, because local social care provision is not available. Two thirds of admissions to hospitals for falls could have been averted by early intervention in the home. Does my hon. Friend agree that we need more money for our adult social services?
I do absolutely—and that is the point I was making. It was only when the number of delayed transfers of care hit a record high that the Government started to pay much attention to this issue. The other worry is that, as the British Red Cross has reported, in attempting to reduce the number of delayed transfers of care, hospitals often discharge people before they are ready. One can see a vicious cycle of admission and readmission.
As I was saying, the system is beginning to crack. Hard-pressed councils and their associations are pleading for more funding to deal with the ever-increasing demand for social care. In December, the former president of ADASS, Margaret Willcox, said:
“The crisis facing us is so acute that we fear social care could pass the point of no return in 2018 while we wait for decisions to be made.”
The National Audit Office has warned that councils could face insolvency after using their reserves just to meet those increasing costs of social care. As well as Northamptonshire County Council being technically insolvent, we recently learned that Worcestershire County Council has a massive budgetary disparity. A report from the Chartered Institute of Public Finance and Accountancy has warned the council that it faces a £26 million hole in its finances this year and that that would rise to £60 million in 2020, owing mainly to an increase in demand. The council chief executive, Paul Robinson, has said that
“there comes a point where cost-cutting can’t go any further – there has to be a solution, and I think it has to be a national solution.”
“you can’t keep dipping into your savings;
sooner or later the money will run out.”
Let us think about what these cuts to social care mean for the quality of care that people receive. In the recent words of the Secretary of State himself, there is unacceptable variation in the quality of services. One in five care facilities receive the lowest quality rating from the Care Quality Commission, and Labour’s own research has revealed that over 3,000 care facilities that already have the lowest quality rating continue to receive the lowest rating even after being re-inspected. Cuts mean providers have less money to pay staff or to invest in training or building renovations, which can obviously lead to their getting trapped in a cycle of poor-quality care provision, and that poor-quality care has a serious impact on the lives of people who need care.
I am grateful to my hon. Friend for pointing out the very high percentage of care homes being found to be inadequate or requiring improvements—the figure is over 40% in my local authority. Does she agree that in many cases this is about care not being safe in those care settings? The real worry is not just that the settings are a bit grotty but that the care is unsafe.
Yes, indeed. My hon. Friend takes ahead a bit in what I was going to say, but I know she has been involved with Age UK in understanding the state of care in her own local area, and I applaud her for that. Cuts have resulted in poor-quality care provision, and that is having a serious impact on the lives of people who need care. It means people not being washed or going hours without receiving a meal or being given a drink; it means people being left without help to go to the toilet; and in some cases, as she just said, it means people not being given crucial medication.
Care quality has become so bad that Age UK’s recent report was entitled, “Why call it care when nobody cares?” Many Members went to the launch of the report and listened to the older carers who were there. The anger of those older carers who spoke at or attended the event was palpable. Some told me that they and their families were often at breaking point, that they felt betrayed by a system of care that left them with little or no affordable support, and that they faced rising care costs which they described as crippling, although the care for which they paid was often not good enough.
I know that the Minister was present at that event. She may have talked to one carer there, Elaine from Northamptonshire, whose council is battling insolvency. Elaine gave up her job to care and has cared full-time for her husband ever since, but rather than giving her any extra help, the council recently tried to increase the weekly cost of care support at home from £88 to £178 per week. That was another battle for a carer to fight to obtain the care support that she needed at a price that she and her husband could afford.
Labour Members recognise that unpaid family carers need more support. We understand how much families are doing to look after their family members, and how hard that is for many carers. The Government have not even developed an updated national strategy for carers, having scrapped the planned strategy back in October. Since then, they have even failed to publish the action plan that was promised for January. What does that say about their attitude to carers?
The motion states that
“there is an unacceptable variation in the quality and availability of social care”.
Where in the country does the hon. Lady think it is really good at the moment?
It tends to be outstanding in the independent sector. Charities in particular can be outstanding, although they are not always so.
The care sector’s funding crisis also has an impact on the growing number of people who need care but are given none at all. More than 1.2 million people are now living with unmet care needs, many of them isolated and lonely, and that number rises to 1.5 million with the addition of people who need assistance with taking medication. Unmet needs can lead to people being forced to wear incontinence pads overnight because there is no one to help them to get to the toilet, which takes away their dignity. The number of older people living with unmet care needs will inevitably rise without an injection of new funding, because of the growing demand for care in our ageing population.
It is clear that the social care system needs sustainable funding from central Government, but the Government’s response to the crisis so far has been to push the funding problem on to hard-pressed councils and council tax payers through the social care levy. The only increase in Government funding has been the paltry £150 million extra for social care in the local government finance settlement. That is nowhere near enough to avert the crisis that the Government have created in social care. Moreover, it was not the new money that councils desperately needed. The Government admitted that the increase would be funded through an expected underspend in existing departmental budgets.
It is clear that local authorities are now facing some of their greatest challenges just to make ends meet. I want to highlight the heroic efforts of Labour councils to protect adult social care in the face of swingeing budget cuts from the Government.
My hon. Friend has referred to Labour councils. In each of the last two years my local authority, Bolton Council, has had to increase its council tax rates by 3% and 2% respectively in order to fund social care, and it will have to increase them next year as well. It has had a shortfall of £6 million, and has been able to cover it only by increasing council tax, which is really not acceptable.
Indeed. As I have said, the Government have pushed the problem on to councils, which have been forced to use their reserves, and pushed the council on to council tax payers who have had to pay the levy.
I was talking about the heroic efforts of some councils. Despite budget cuts which are now running at between 40% and 50%, my local authority, Salford City Council, and neighbouring Manchester City Council have acted to ensure that care providers with which they contract will pay care staff a real living wage, and I know that Labour councils in Lambeth, Southwark and many other London boroughs have committed themselves to paying their care staff the London living wage.
As my hon. Friend is mentioning many councils, may I draw her attention to the work of Bristol City Council under Councillor Helen Holland? It is leading an important Proud to Care campaign to encourage more care workers back into sector, particularly at a time of increasing demand and labour shortages. Will she join me in commending Bristol City Council’s work in this area?
I will indeed, because given the cuts that many councils have been facing—I am sure Bristol is the same—these efforts to protect care services are really excellent.
I was talking about those London boroughs that have committed to pay care staff the London living wage which, at £10.20 an hour, is way above the Government’s so-called living wage of £7.83—a commitment that is no small undertaking. That is a further example of the good that Labour-run councils are doing for the most vulnerable people in their communities. We on this side of the House—this ties in very much with the point that my hon. Friend has just made—see the need for social care to be valued as a career. At last year’s general election, Labour pledged to implement the real living wage for all care staff and to ensure that care staff were paid for travel time, that 15-minute care visits were scrapped and that zero-hours contracts were ended for care staff. Those are important steps, but we know that we have to go much further if we are to improve care quality.
It is clear from the reports of the Care Quality Commission that staffing levels are still a major issue in those care services rated as inadequate or requiring improvement. Much of the care workforce is underpaid, undervalued and overworked, which leads to high turnover and vacancy rates in the sector among care staff and, more importantly, the registered managers who are responsible for overseeing care quality. Improving pay for care staff will help with that, but we also need to commit to improving care staffing levels to reduce the workload pressure and offer better training and career paths.
The National Audit Office has criticised the Government for failing to have an up-to-date workforce strategy for the care sector and for their lack of oversight of workforce planning in local areas. Indeed, the Government have no major workforce strategy for social care. It was the Labour Government who produced the last strategy, in 2009. The head of the National Audit Office has said:
“Social care cannot continue as a Cinderella service—without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.”
Skills for Care has a budget of only £21 million for care staff training, whereas Health Education England has a budget of £4.7 billion. That disparity in budgets between health and social care says it all about the Government’s lack of priority for improving the quality of social care.
At the 2017 election, Labour pledged an extra £8 billion for social care across this Parliament, with an extra £1 billion to ease the crisis in social care this year. That aimed to relieve the pressure on the social care system. It would have been enough to begin paying care staff the real living wage and would have sought to offer more publicly funded care packages for people with different levels of need. Today’s debate is not primarily about the long-term funding of social care, but Labour has made it clear that maintaining the current funding system is not an option in the long term. Recently polling by the Alzheimer’s Society has shown that paying for social care is a growing public concern and that there is overwhelming public support for a cap on care costs. The next Labour Government will implement a lower cap on care costs than the cap set under the Care Act 2014. We will also raise the asset threshold to a higher level than under the current system.
I think there must be an echo, because the hon. Lady asked me exactly the same question in the last debate, six months ago. I said to her previously that there are a range of options that we could use to raise the money, including wealth taxes, an employer care contribution and a social care levy. However, it really is a bit rich of Government Members to raise that question when they have no idea whatsoever how they would take forward any social care developments. Furthermore, there was absolutely nothing in the Conservative party’s election campaign last year about the funding for anything. We had a costing document. We had a costed manifesto. I can stand here and say that we had the funding to put £8 billion extra into social care in this Parliament, including £1 billion this year. The Conservative party said nothing whatsoever about that.
No, I need to move on. The Deputy Speaker has asked me not to take too long, and not take too many interventions. I have been very generous up to this point.
We believe that the time to act on this care crisis is now, but instead of taking the bold steps needed to fix the crisis, this Government are promising a Green Paper. Since the royal commission first reported on the long-term funding for the care of older people in 1999, we have seen 12 consultations and four independent reviews, so I really question why the Government are undertaking yet another consultation and producing yet another Green Paper. It is clear that they have become increasingly fond of consultations, reviews and Green Papers. In fact, they have launched more than 1,600 consultations since 2015, and more than 500 of them have not yet been completed. Sadly, I have to say that that includes the carers strategy. The Government spent £1 million on the Dilnot review, only to delay the introduction of its recommended care cap before shelving it indefinitely. The Government are wasting time and public money on consultations, and even more on adopting then shelving long-term funding solutions for social care.
The time to act is now. I urge the Government to give our social care system the funding it so badly needs, both this year and in the longer term, and I urge hon. Members to support our motion tonight. We must give councils the proper funding to deliver the high-quality care that people across this country need in order to live with dignity. That is nothing less than they deserve.
I thank Barbara Keeley for introducing the debate. We want this to be the best country in the world in which to grow old and in which people can face their third age knowing that they will be supported to live healthy, independent lives for longer and for as long as possible, with a choice of good-quality, affordable care that is there, should they need it. Today’s debate is a welcome opportunity to cover the action that this Government have taken to improve social care, highlighting a few examples where real progress has been made, as well as discussing our longer-term plans for the Green Paper, which will be published later this summer.
Most of all, however, I want to do something that the hon. Lady forgot to do, which is pay tribute to the extraordinary people—both the social care workforce and the informal carers—who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country.
The Minister has just said that I did not pay tribute to informal carers. That is just not true. Everybody who knows me knows that I have never stopped paying tribute to informal carers, and I did so in my speech today. Please will the Minister not attribute comments to me that I did not make?
What I actually said was that the hon. Lady forgot to pay tribute to the social care workforce, who play such a vital part in our health and social care system. At the heart of their endeavours is the commitment to do all they can to support individuals and families throughout the country to live healthier lives with comfort, dignity and respect. However, it is absolutely right to begin by acknowledging that this sector has been through some really difficult times.
The hon. Lady is right to pay tribute to informal carers, and indeed to paid carers, but does she not feel uncomfortable with the fact that she and all her colleagues on the Conservative side legislated with us to introduce a cap, committed in 2015 to implement the cap, then abandoned it, thus abandoning the very informal carers she says she cares so much about?
We have not abandoned the cap. The Prime Minister said very clearly that we would continue to consult on the cap, and that will come forward as part of our plans for the Green Paper later in the year. We in this Chamber often hear about Labour’s recession and how it led to some hard decisions about public spending in order to get the country back on track, but we often forget—
Let me make a little progress, then I will happily take the hon. Lady’s intervention.
We often forget that we inherited not only difficult spending choices but a social care system that was on its knees because successive Governments—not just Labour—had failed to act. Labour acknowledged the problem in its 1997 manifesto, promising to find a solution. However, 13 years later, after one royal commission, two Green Papers and the 2007 spending review pledging to address the situation, Labour left office without delivering it. Worse than that, by the time Labour left office, despite the booming economy, council tax had doubled and every year 45,000 older people were forced to sell their home to pay for residential care costs.
Let us get back to the present day, because that is what we are debating. Disabled people of working age make up more than half of adult social care users. Given that the UN condemned the Government’s breaches of the convention on the rights of persons with disabilities, particularly article 19 on independent living, what does the Minister estimate to be the impact on independent living for disabled people of the cuts to social care?
If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—
If the hon. Lady would give me the courtesy of allowing me to finish my comments, I will explain why in a moment.
Debbie Abrahams wondered why we were going back to the past and looking at Labour’s record, but Labour is asking people up and down the country to vote for them in the local elections, so they will rightly look at Labour’s record and at how it dealt with the social care crisis when it was in government. After 13 years of inactivity and bluster, people need to be able to make a choice based on historically accurate facts.
The hon. Lady had plenty of time to make her comments, so I will make a little progress.
When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.
I will be coming on to the cap later.
To give the Labour party its due, it recognised that we had difficult decisions to make. Had Labour stayed in government, it planned £52 billion-worth of cuts to local government budgets by 2015. However—enough of the history lessons—I intend to make progress and answer many of the shadow Minister’s questions.
If hon. Members will bear with me, I will now make some progress.
The tough spending choices that we have made have paid dividends, meaning that we have turned a corner in recent years. That is why local government will be able to increase spending on adult social care in real terms in each of the next three years. Our population is growing, ageing and diversifying. At the same time, the money, means and methods that we deploy to serve their long-term health and care needs are under increasing pressure to deliver, and we need to address those issues now.
There is recognition across the House that even if we had an infinite amount of money to fix the problem, the system would need reform. We are taking steps to make the system more effective and to ensure that it better serves the needs of vulnerable people and society in general. That is why this summer’s Green Paper will complement those measures and ensure that our social care system is placed on a sustainable footing and will serve this nation for generations to come.
The Secretary of State recently outlined the seven key principles guiding our thinking on social care as we approach the Green Paper: quality, whole-person integrated care; control; workforce; supporting families and carers; a sustainable funding model for social care; and security for all. As I have said, this is not just about older people. The Green Paper will cover a range of issues that are common to all adults with care and support needs, but we are committed ensuring that any issues relating to social care that are specific to adults of working age are identified and given the right focus. Work on that is being led jointly by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government.
I will reflect on some of the Green Paper’s themes, but first I will highlight a couple of areas where real progress has been made. I have said that we know there is growing pressure on local authorities’ finances, but it simply is not true that this Government are failing to deal with or acknowledge the crisis.
The Minister talks about trying to use finances appropriately. My local council has had a 54% cut to the funding that it receives from central Government, which is why it has a shortfall in funding for social care.
The Government have been able to find money to cut corporation tax, capital gains tax and inheritance tax, as well as £1 billion for the Democratic Unionist party. Are they really saying this is all about austerity and choices? Is it not really that the Government have different priorities from the Opposition?
I can honestly say with my hand on my heart that the Labour party does not have a monopoly on care or kindness.
I mentioned earlier that local authorities will receive a real-terms, above-inflation increase in their funding profile. We have announced significant dedicated funding for social care. The Opposition regularly seem to forget that we allocated an additional £2 billion to social care only a year ago, with a further £150 million this year. That means councils have access to £9.4 billion of dedicated funding.
Kirklees Council has had its funding cut by central Government by nearly £200 million. This year, it has raised its council tax by 5.9% to help pay for services. The three percentage points for social care come to £4.8 million, but there is a shortfall of £12 million a year. Can the Minister tell councillors where the rest of the money for social care should come from?
I will make a bit of progress.
The shadow Minister asked about Allied Healthcare. She is right to raise that, and I am grateful that she has done so. As she said, Allied Healthcare announced last Thursday that it is proposing a company voluntary arrangement to its creditors. I want to talk about that specifically because people across the country will be concerned. I spoke to the chief executive officer last Thursday to emphasise the importance of continuity of care for everyone receiving its services, both in adult social care and primary care, and the company has made it clear that those who receive services from Allied Healthcare will continue to receive the same level of care and that their care plans will not change.
I am glad the Minister has responded in that way, but I asked her how she would ensure that 150 councils can fulfil their statutory duty to provide care if that company goes bust. We need to know a bit more than that she has had verbal reassurance. Of course the chief executive, in his current position, will try to give her verbal reassurance but, under the CVA, the creditors have to be satisfied within four weeks. What is going to happen if this company goes bust? Is it going to be another Southern Cross?
I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are currently working up contingency plans to ensure individuals’ care and support needs continue to be met.
While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.
My local East Sussex County Council is a rural authority, so for decades it has had 49% less funding per head of population, yet it has had the same pressures as the areas of Opposition Members. By working together with health services, my council has reduced delayed discharges by 38%. Will the Minister welcome the hard work of East Sussex County Council?
I do welcome it. I recognise the very hard work of local councils which have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.
We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.
Following on from the point about the big variations in how much per head councils get, may I point out that some time ago West Berkshire and Wokingham were cut back because they were very efficient and doing a good job? Will the Minister make sure that in the new formula good conduct is taken into account and does not lead to penalties?
The Minister is just proving that she was not listening to what I was saying. What I said was that the British Red Cross has said that it had found innumerable cases where discharges have happened so quickly that people were discharged without the right amount of care, and that can just lead to a cycle of readmission. A constituent told me that, in the case of Salford Royal, which is an excellent hospital, she felt she had been “thrown out of hospital.” That is what she told me.
I very much thank the hon. Lady for that clarification.
Our funding increases have gone into initiatives such as the better care fund, which provides a mechanism for local authorities and clinical commissioning groups to pool budgets for the purposes of integrated care.
I hope my hon. Friend will not mind, but I want to make a little progress. The fund has helped to join up health and care services so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible.
Another area where we have made significant progress is quality and safeguarding. The Care Act 2014 placed adult safeguarding on a statutory footing for the first time and established a national threshold that defines the care needs that local authorities must meet. This eliminates the postcode lottery of eligibility across England. Last year, local authorities in England advised more than 500,000 people how to access services to meet their care needs—this includes services provided by leisure, housing, transport and care providers, as well as voluntary groups.
Everyone is entitled to, and deserves, quality care, and we are working to improve the terms and conditions for people accessing care, to ensure that their rights are protected.
On the sleep-in allowance, is it reasonable to expect providers to fund these back-pay claims, given that at the time the liability was incurred commissioners and providers entered contracts on the basis of what the Government said was right in terms of the minimum wage? When the Government change the position, surely it is not fair on organisations, private or third sector, retrospectively to expect them to pay.
I understand and share the right hon. Gentleman’s concerns on sleep-ins, and will be addressing this a little later in my comments.
We have established adult safeguarding boards to help to protect vulnerable adults in our society from abuse or exploitation. They can also act as an important source of advice and assistance for those using the adult safeguarding system. This Government also introduced the toughest system of care home inspection in the world. Eighty-one per cent. of adult social care providers are good or outstanding according to the CQC, which is a testament to the many hard-working and committed professionals working in care, to whom we owe a huge debt of gratitude. The CQC regime is already having a positive impact and 82% of providers who are rated as inadequate go on to improve.
Regardless of that, there is too much variation in the quality of care. Neighbouring local authorities can have radically different success rates on care quality and we are taking steps to address that. We are working with the adult social care sector to implement Quality Matters, a shared commitment to take action to achieve high-quality adult social care for service users, families, carers and everyone working in the sector.
We welcome the Competition and Market Authority’s recent market study on care homes. It makes difficult reading, but we have welcomed it and as part of developing the Green Paper the Government are carefully looking at all the issues identified. What is more, we have published a package of measures to improve consumer protections in the social care sector after the CMA raised concerns about unfair consumer practices in homes, including the charging of unfair fees to residents and the lack of contractual and pricing transparency.
Those measures, which include working alongside industry to develop model contracts and supporting the Care Quality Commission to better hold providers to account, aim to put the power back into the hands of residents and their families. We are clear, however, that if improvements are not seen we will look to change the law to strengthen protections so that people can be treated with the dignity and respect they deserve.
That leads me to the third aspect on which I want to focus. Ultimately, the social care workforce is the backbone of the care sector. We know that there are challenges and that is why we need to ensure that they are supported to deliver the best-quality care now and in the future. Part of that endeavour involves respecting not only the compassion and dedication of care workers but the vast range of skills they have. Alongside social workers, occupational therapists and nurses, we have many care workers who could benefit or be inspired by new career progression ladders. We need to ensure that we have enough people within all those skilled roles to support individuals and families in living their best possible lives. That means ensuring that new routes into social care professions have as much variety and value as those developed by the NHS. Apprenticeships are part of that story. I am proud that in 2016-17 more than 90,000 social care apprentices began their training. That is up more than 40,000 compared with in 2010.
Of course, pay remains a constant and often emotive issue. Care workers deserve a wage that reflects the true value of their work. The national living wage is, in part, a reaction to that and the average salary for a care worker in the independent sector has gone up by 4%, with those full-time staff on the minimum wage seeing a pay rise of up to £2,000 since 2015. We are not complacent about the economic pressures faced by many in the system, but that is a good place to start.
A couple of hon. Members have spoken about sleep-ins and they are absolutely right to raise that. The Government are committed to creating an economy that works for everyone, ensuring that workers are paid fairly according to the law, including through the national minimum wage, but we recognise the pressure that has been placed on the sleep-in sector by historic liabilities for back pay. We are carefully exploring options to minimise any impact on the sector caused by this and have been engaging with the European Commission to ensure that any response would be legal. The Government will continue to work with representatives of the social care sector to strengthen the evidence base, building on the work we began over the summer. I will, of course, keep the House informed when we have made progress.
There are thousands of care workers in England, and we need many more, but it is true that we already have hundreds of thousands of carers out there—the unpaid hidden army of family, friends and community volunteers without whom the system would simply grind to a halt. We know that about 60% of us are likely to become carers at some stage in our lives. As it is today, one in eight of the adult population is a carer. That is why carers will be a fundamental part of the Green Paper. A sustainable settlement for social care will simply not be possible without focusing on the support we provide to them. Ahead of the Green Paper’s publication, we will shortly publish an action plan on carers, setting out a cross-Government programme of targeted work to support carers over the next couple of years.
Another principle that the Secretary of State has spoken about in the context of the Green Paper is control. We know that the greater control people have over their care, the better the outcomes. The only people who have a specific right to have a personal health budget are adults in receipt of NHS continuing healthcare or children receiving continuing care, which is why earlier this month we launched a consultation on extending the right to personal health budgets and integrated personal budgets to achieve better outcomes for those with the greatest ongoing social care needs as well as health needs. Those are some of the principles that are guiding the Green Paper. The goal is that, whatever a person’s age, they can be confident in our care and support system, not just for their own health and care needs but for those of the people close to them.
The 2015 Tory manifesto was very clear on the commitment and the assurances about the cap. The 2017 manifesto abandoned that. I think the Minister said earlier that that is still part of the Government’s considerations. Will she clarify from the Dispatch Box today what we are to expect in the Green Paper with regard to the cap?
The Prime Minister said last year in the general election that we would be consulting on the cap in due course and that will be part of the Green Paper. Building a sustainable care and support system will require some big decisions, but getting this right promises a better system in which everyone can have confidence, where people understand their responsibilities, can prepare for their future and know that the care that they receive will be to a high standard and help them to maintain their independence and well-being. The paper will set out options to put the social care system on a more secure footing and address issues to improve the quality of care and reduce the variation in practice.
Order. Before I call the Scottish National party spokesperson, I should inform colleagues that we have about 17 people who wish to participate in this debate. I do not want to impose a time limit, which means that I require some discipline. I suggest that if hon. and right hon. Members could confine their speeches to about seven minutes, we might not have to impose a time limit.
It seems no time since we were discussing this topic in the autumn. There are three groups of people who require social care. The first and the one commonly thought about are the frail elderly. There is expected to be a rise of 25% in those aged 85 and above between 2015 and 2025. By 2030, that proportion will have gone up 63%. Therefore, this requires us to make urgent preparations. Elderly people requiring social care need support and comfort.
The next group comprises those who are facing the end of life. They want dignity and, if possible, to be at home. If their family is looking after them, they want their family to have respite. The third group, as has already been mentioned in the debate, are younger people with disability. For them, it is the quality of their whole life, their mobility and their ability to participate in society. This last group is expected to rise by 9.2% between 2010 and 2020.
The five year forward view for the NHS and the amount of money requested was based on a game-changing approach to public health and a strong increase in social care funding. In actual fact, the opposite has happened and social care has lost almost £5 billion. Age UK says that 1.2 million elderly people have a social care need that is not being met—up 48% since 2010. In England, there has been a 26% drop in local authority-funded patients getting social care—that is 400,000 people —despite an increase in the ageing population.
One third of the elderly population are looked after by their family. Those carers have been paid tributes here, but they need a bit more than tributes; they need support and, in particular, they need respite, because many of them are literally working all the hours of the week. There will be 2 million carers who are themselves over 65. At the moment, carers’ allowance is only £60 a week; it is not even the same as the jobseeker’s allowance. In Scotland, this is one of the benefits that we now have control over, and it is rising to meet the level of the jobseeker’s allowance. That is little enough tribute to these people who, frankly, are saving the state millions.
Some 700,000 people were identified by Age UK as getting no help whatsoever. The Green Paper is looking at options in the long term, but the problem is that social care needs funding now, and it is estimated that the gap will be £2 billion by 2020. The social care precept has been identified, allowing local authorities to raise council tax by 2% to 3% over the next few years. That will bring in £1.8 billion, but it will be the richer areas that will be able to raise more money.
The better care fund has been put forward for the integration of health and social care, which we should all welcome. It is estimated to raise £1.5 billion by 2019-20. The problem is that some of it—£800 million—has been raided from the new homes bonus, and when we are not here talking about social care, people are at the Dispatch Box talking about the lack of housing and the lack of affordable housing. The problem is that if we do not get away from silo thinking, we will never reach a point of health in all policies.
At the same time, the local authority funding grant will be cut by £6.1 billion by 2019-20, so we are talking about giving with one hand and taking away with the other. As has been touched on, the cuts to local authority funding of social care are causing providers to close. In the first half of 2016, one third of local authorities had at least one home care provider—and half had a care home or nursing home—that closed due to becoming bankrupt. Anyone who has had a relative supported by these services will know how traumatic it is, particularly if it is a residential care home, for someone who may have lived somewhere for years suddenly to be moved to a strange place.
Perhaps some consideration should be given in the Green Paper to combining health and social care, and to looking at some of the different approaches in order to consider whether it is actually safer to provide social care publicly. In Scotland, we have been increasing the funding into the community in primary care, which will rise to 11% of the health budget, and in mental health, community care and social care. The aim is to rebalance the budget over the coming years to 2021 until half the health budget is going to the community. We have been funding integration joint boards since 2014, and the care, design and planning is by health and social care partnerships. This is already joining up health and social care, so that we do not have the situation that I experienced when I worked in a hospital, with the social care side and the health side bickering over where Mrs Jones would be best served. With integration, we should just be able to work out what is best for Mrs Jones.
From what the hon. Lady is saying, I get the impression that she rather agrees with me that the Government will never come up with a solution by focusing in their Green Paper on one part of one part of the problem—in other words, older adult social care. We need to look at the whole system across the NHS and social care.
I utterly agree. Obviously, we recognise the change in title of the Secretary of State. I am sure that many of us across the House hope that that would mean a move towards a more joined-up approach to health and social care. The pressure on the NHS is absolutely exacerbated by problems in social care.
There is an inconsistency between funding through continuing healthcare as part of NHS provision and the funding that is available to support people through social care. Does the hon. Lady intend to suggest that that discrepancy should in some way be rectified so that there is not a difference between the routes through which someone comes into the care system?
Many relatives and patients complain about the fact that, depending on which illness people have towards the end of their life, they will either be supported in an NHS or hospice system or they will pay for it in the social care system. A fragmentation has resulted from the Health and Social Care Act 2012 and the change in structure. Someone’s treatment may be delivered under NHS England as a specialist service for so many days, but then they go back to the clinical commissioning group and the ongoing care is suddenly not there. It is all very disjointed. In actual fact, we require an entire approach that joins up health and social care for the entire patient pathway. We should not expect patients to navigate from one pothole to the next.
We have exactly the same challenges with an ageing population. Indeed, the Scottish population is older and ageing more quickly than the English population. In all these debates, I always say that we must not look on this as a catastrophe. Having spent over 30 years of my life trying to get people to live longer, I ask Members to remember the alternative—living shorter. However, without public health changes and a game-changing approach, we are not ageing well; and we need to age well. But that will take a long time to turn around. We need to look after the people who require care right now.
Having failures in social care traps people in hospital. In Scotland, although we have a long way to go as well, delayed discharges from hospital have dropped in every year since 2014, when the integration started. Between 2010 and 2017, the average hours delivered through home care have doubled from six to 12 per week. In future, a quarter of us will die in a care home, so what kind of quality of care do we want to have, and what kinds of palliative care skills would we like our nursing homes and care homes to have? We need to create links between the hospice movement and care homes so that those skills and that supportive approach are shared.
The hon. Lady’s dedication and work in the NHS knows no bounds. One of the things that no one has touched on is the absolutely vital importance of aids and adaptations that allow people to go home and have social care, or even have their family provide care. Often one of the major problems with delayed discharge is the lack of access to those adaptations—the commodes, the hoists, the hospital beds and the walk-in showers that people need in their home. Does she recognise that that is one of things that nobody is talking about that we must get right, and that money must be put in to make it possible?
I thank the hon. Lady for her intervention. In my years of working particularly as a breast cancer surgeon, where I was involved in the palliative care of my own patients, we often met that as a barrier. We started to have the fast response teams who could get hold of hospital beds and commodes and get the changes done, particularly for somebody who actually might not have very long to live.
Since 2015, those who are defined by their medical care team as being in the terminal phase of an illness, whether it is cancer, motor neurone disease or another condition, have not been charged for personal care or nursing care at home. This means that they are not delayed by means-testing, which is another thing that can end up keeping a terminal patient stuck in hospital for weeks and weeks that frankly they just cannot spare.
Younger people with disability have been mentioned. In England, approximately half of local authority spend, and in Scotland approximately 40%, is for the working-age disabled. However, Scope, a charity involved with those with disability, says that two thirds of those who applied to local authorities for care were offered no help and were simply signposted to other charities. The 83% who were given some care felt that they did not get enough hours for it to support them sufficiently.
When we discussed social care in October, I mentioned that in Scotland we were hoping to pass Frank’s law, which is in honour of Frank Kopel—a footballer who played for Man Utd and Dundee Utd and who, possibly related to heading the ball, developed dementia at a very young age. I am glad to report that this law has now been passed. Starting from April next year, those under 65 with degenerative, chronic and eventually terminal illnesses will also be able to have personal care, and this will simply be needs-based, as it is for those over 65. I pay tribute to his widow, Amanda, who fought for a very long time to raise the issue of people who are being excluded from care based on precisely when their date of birth is. However, the Scottish Government are trying to clarify with the Department for Work and Pensions whether providing this additional free personal care to someone under 65 will not result in cuts to their disability benefits, because to give with one hand and have it taken away with the other would be tragic.
The UK Government’s Green Paper provides a chance to step back and rethink care. Obviously, the aim is to achieve sustainable care—as I say, perhaps to look at more radical considerations such as combining it with health and not having it as an utterly separate system.
On those who are younger with disability, the Minister talked about a parallel workstream for the under-65s. What are the terms of reference for that? What can people with disability expect?
After the complete shambles of the 2017 manifesto, it is crucial that there are no sudden changes or things that catch people out, with no notice to prepare for what they might have to pay for care. This is something that will affect people in the future. We have all debated the WASPI women in this place. Let us not create a new tragedy of people who are trapped by some sudden change in how social care works.
As the Minister said, the workforce are absolutely key to the care service. This is a service that is utterly delivered by people. It is not high-technology or machines, and by and large, it is not hospitals. In Scotland, the homecare workforce has risen by 11% over the last three years, but all care providers are reporting that they are struggling to recruit, and all of them see that Brexit will make that much worse, because colleagues who have come from Europe, and particularly eastern Europe, make up a significant proportion of our social care workforce.
We need to value carers. They have often been treated far too much as a cheap workforce, and that says to people, “This is not a profession or a job to stay in long term. This is until you get something better.”
There are of course also carers who are not employed. I came across kinship carers in Hartlepool. Does the hon. Lady agree that kinship carers, and in particular those who receive no benefits, should also feature in this debate?
I thank the hon. Gentleman for his intervention. There are all sorts of aspects to the provision of care, for whichever age group or needs, and the Green Paper will fail if it does not result in us stepping back and taking a wider view.
It is important to pay the real living wage, which the Scottish Government already support and fund, and not the national living wage. All hours should be paid—that commitment is being consulted on in Scotland at the moment—and that should include travel as well as overnight care.
For local authorities that have social care within their service, this is the biggest driver of the gender pay gap. Men who empty the bins are paid considerably more than the women who are caring for our grandparents. We should think of job satisfaction and give them the time to care, not 15 minutes. We should think of continuity for both the patient and the carer, but particularly we need to think of the career structure and the training. Caring needs to be a profession, and a profession that is respected.
It is always a pleasure to follow Dr Whitford. I think the Opposition are quite right to want to debate this issue, and I also think strongly that the long-term solution to the problem of funding care—particularly for the frail elderly—will require cross-party agreement, so I hope that the debate can take place in a relatively non-partisan way.
I agree with Barbara Keeley that radical change is needed, but I gently put it to her and her colleagues that in this long-term and complex area, indignation is not enough. Simply saying, “We must spend more money,” at the same as saying, “But we must restrict the amount of money we take from other people,” which I understood to be the import of part of her speech, does not cut it.
I will certainly give way to the right hon. Gentleman in a moment, because I am about to mention him, but I am conscious of time.
There needs to be radical change, and the Green Paper needs to be radical and brave, because although in this debate, as in the wider debate on this issue, a lot of people talk about the fact that we live in an ageing society, we have not remotely adjusted as a society to what that means yet. Our population is projected to grow by around 10 million over the next 40 years. Almost all that growth comes from older people, and particularly those in the oldest age group. There are 5.3 million people over 75 in Britain today. That number will double to more than 10 million in 40 years. This is not just a looming problem; it is a problem today. There is a short-term and a long-term problem to solve. Frankly, in the spirit of non-partisanship, no party has an record unblemished by using social care as a political football. Phrases such as “death tax” or “dementia tax” make good copy and can affect the outcome of elections, but they do not help rational debate or, more importantly, help us improve the lot of the increasing millions of older people.
I think that the phrase “death tax” dates back to the previous Labour Government’s attempt to solve the problem in 2008, and I am sure that the hon. Lady used the phrase “dementia tax” during the last general election campaign. I hope that she will reciprocate my attempt to be non-partisan—so far it does not feel like it.
In the short term, the challenge for the Government is one of capacity and quality of care. Both problems will become more difficult in the long term. There is a range of things that we must do as a society before people need social care. For example, we need to keep people active for longer, we need to keep them in the workforce for longer, because that is good for their health, and we need to make changes to the planning system so that we can keep them in appropriate housing of their own for longer. In the end, however, the nub of the issue will be funding.
I want to address a point raised by the hon. Member for Central Ayrshire about joining the whole thing up with health funding. I agree with the broad thrust of the 10 principles proposed by Norman Lamb, Liz Kendall and my hon. Friend Nick Boles yesterday, particularly the idea of hypothecation, whose time is coming, but I think there is a problem with the idea of simply integrating all health funding and all social care funding.
It is a no-brainer that, organisationally, social care and healthcare need to be much better integrated, so that the individual is not trying to negotiate a very complex system, as the hon. Member for Central Ayrshire said. If we simply roll all the funding together into one pot, however—a sort of national health and social care fund—there are two serious dangers. The first is that social care takes over from mental health as the Cinderella of the health system, never quite at the top of the priority list when money is allocated. The second is that nobody feels that their contribution is related to their personal needs. The effect is that some of the sources of funding that could be made available—I agree with all those who say we need more funding—such as the £1.7 trillion of equity in residential property, of which more than two thirds is held by the over-65s, would be in danger of being permanently excluded, which I think would be a great mistake.
The right hon. Gentleman is making a thoughtful and reasonable contribution. He suggests that if there was a completely combined united funding stream for health and social care, social care would be relegated and disadvantaged. Of course, social care already loses out here and now—under Labour, the coalition and the Conservatives—compared with NHS funding. He complained about people just using indignation, and he made the case for cross-party working. Does he share my frustration that those of us who have tried to make the case for working together are constantly rebuffed by the Government? Will he join us in pressing the Prime Minister actually to engage in this, so that we can make it a reality?
I agree with the right hon. Gentleman that cross-party working is necessary. I gently point out that when I was a member of the Government, I met him and the hon. Member for Leicester West in a cross-party group to discuss precisely this—I was responsible for this policy area at the time—because I wanted to work with them. I thought that was the only way forward when I was in government, and I still do.
There is not time today to go into detailed funding proposals, but I think we have to accept that in the long term the funding of social care will need to be not only more generous than it has been in recent years, but fair, and seen to be fair, to every generation. I make the point, which is not often made in this context, that intergenerational fairness means being fair to older people as well as younger people. The view has taken hold in some circles that being over 60 means being over-privileged. I strongly challenge that view. The current generation of 50 and 60-somethings is the first in which people are often simultaneously trying to help their children with housing and their parents with care needs. This is not special pleading for a particular cohort. It is important to remember the obvious but salient point that young people themselves will grow old. Setting one generation against another is not only a bad basis for policy making but very short-sighted for the individuals most affected. Instead, we need to find a solution that will provide stability for decades to come.
I suspect that Members on both sides of the House would be united by the proposition that, however much better we get at using technology and housing design to keep people in their own homes for longer, the sheer growth in the number of people needing some kind of care will mean that we need to find more money. Precisely because that will be a problem for decades, not just for the rest of this Parliament, it is vital that the solution has cross-party support. Social care is a challenge for all parties.
The fundamental issue of whether social care should be a national or local service is often ignored. I am struck that 44% of Kent County Council’s budget goes on adult social care. That number will only rise. I am also struck that, in contrast with almost every other area of policy that involves local government, when I talk to local councillors about this issue they say, “Maybe this should be dealt with at a national rather than a local level.” They almost do not want it to be their responsibility any more. That is practically unique. I hope that Ministers will address that.
I urge Ministers to include staffing needs, the importance of which has been mentioned by Members on both sides of the House, in the Green Paper. Given what the wider situation will be post Brexit, we need to find ways of using technology, being much better at training care workers from the British population, and raising the status of care work. Labour Members mentioned that, and I agree. Looking at care purely as a business sector, it seems to me a classic case of somewhere that both technology and the human touch are vital. That combination is vital to providing high-quality care. To put it starkly, a robot may be able to do the lifting part of the work, but it cannot provide the equally necessary words of encouragement and comfort. I think social care will be an employment growth sector in the decades ahead.
Getting social care right is clearly one of this Government’s biggest challenges, as it will be for every Government for many decades to come. Over the next couple of years, we will have the chance to reset the debate so that it becomes calmer and more realistic. I know that my right hon. Friend the Secretary of State and the Minister for Care, my hon. Friend Caroline Dinenage, want to provide that calm and realism, and I hope that those of us contributing to this debate from the outside will live up to that, too. I very much look forward to the publication of the Green Paper.
There are few career commitments more commendable than dedicating time to the care of others, especially our elderly and vulnerable relatives. I am disappointed that the Care Minister is no longer in her place. I was shocked by some of her comments. She accused my hon. Friend Barbara Keeley of not mentioning or thanking social care workers. I listened very carefully to my hon. Friend’s speech, and it was imbued throughout with a passionate defence of the people who work in the care sector—their terms, their conditions, their pay and their commitment. I would like the message to go back to the Minister that I thought what she said was very unfair. All of us on both sides of the House know that people in our social care workforce deserve a huge amount of respect and gratitude for the hard work and long hours they put in to deliver the best care to our elderly parents and grandparents.
There is no doubt that social care has been in crisis for a number of years. Time and again, commitments have been reneged on and the issue has been kicked into the long grass. Government cuts have put pressure on the ability of local councils to deliver key services. Redcar and Cleveland has lost £90 million since 2010 and has had to cut £5 million from social care over the past three years. There is no way that that will not have an impact.
Warrington Borough Council faces funding pressures of more than £3.3 million to meet its adult social care needs in 2018-19. Does my hon. Friend agree that it is up to the Government to support councils in their efforts to provide quality social care to their communities, not to pass the buck—
Order. I need to correct that. When I say “order”, it means you should stop. I am not trying to cause any problems. We must have short interventions. If not, I will have to put a time limit on speeches. Intervene, by all means, but interventions must be short.
My hon. Friend Faisal Rashid is spot on. It was telling that Damian Green made the point that local councils have reached the point where they do not want to deliver social care anymore. We know perfectly well what the reason is. If they had the funding, I am sure they would be delighted to deliver social care, but we know what impact the cuts have had.
Ministers have focused on squeezing more out of local taxpayers, which provides only a drop in the ocean compared with the extra funding that is needed to close the gap.
My hon. Friend will be aware that increases in the precept have regional variations, so 2% in Redcar is very different from 2% in Stoke-on-Trent. That then causes greater regional imbalances.
My hon. Friend is absolutely right. This is a regressive form of taxation. Every time the precept or local council tax is raised, people pay twice: they see less of a service, but they are still paying through their income tax and through council tax.
I want to talk about the people who are the backbone of our care system: those who work in the care sector. In my local authority area, just over 170 social care staff are employed to support about 5,750 people. That is an average of 33 to 34 cases per member of staff, with all the challenges and safeguarding issues that come with that. The more experienced staff often deal with many more cases than that. As people live longer, with multiple and increasingly complex health conditions, the time and effort required from staff becomes greater. Currently, about 22% of residents in Redcar and Cleveland are over the age of 65. That is expected to increase to 27% by 2030. There are also many working-age disabled or vulnerable adults who have long-term care needs.
The needs of the individuals who need care vary hugely, from those who are frail and need physical support to those with learning disabilities or mental health problems. Mental health poses a particularly difficult challenge, with one in 14 people over the age of 65 developing symptoms of dementia in their lifetime. The care demands required of staff to support these people are ever more complex.
I praise Redcar and Cleveland Borough Council for being the first council in the north-east to adopt Unison’s ethical care charter, which promotes staff training and pay and quality care. It has also been adopted in Hartlepool. Will my hon. Friend join me in supporting the further ambition to establish local care academies to guarantee that such training and care packages are written into employment contracts?
To follow up on the issue of training, it is important that people who are going into people’s homes to care for them or who care for people in a home setting have all the training they require to perform the duties that are expected of them. Too often, they are not given the training they need and are expected to do far more than they are qualified to do.
I believe there is a voluntary time limit of seven minutes. We are in danger of spoiling that. If we do, I will have to bring in a time limit of about 5 minutes. I do not want to do that, so I need Members to help me ensure that everybody gets an equal amount of time.
My hon. Friend Melanie Onn is absolutely right and I welcome all the interventions, but I should probably now crack on with my speech. She is spot on in saying that there is a critical need for training in the workforce and that not enough has been invested in it.
My hon. Friend Mike Hill mentioned Unison, which has done fantastic work in the sector. Its biennial survey with Community Care magazine last year revealed a worrying picture of care workers having a lack of time to spend with residents. Nearly half the respondents to the survey said that the volume of cases they were responsible for left them feeling “over the limit” and more than half blamed staff shortages for their heavy workload.
As well as providing direct care, practitioners often have a responsibility to support the army of family carers who themselves are working to look after relatives at home. The shadow care system, as it is known, is running alongside the care system, keeping the whole thing going through the love and good will of unpaid family support and kinship carers, as has been discussed. For example, the Junction Foundation in my constituency, which I am proud to support as my charity of the year, does a lot of work with young carers who bear the pressures of looking after relatives while their peers are enjoying growing up. In Redcar and Cleveland, we have a fantastic organisation called Carers Together, which provides support and tailored services to people in care roles. It is aware of around 7,000 carers in the borough, but the 2011 census suggests that the number could be much higher.
I want to say a bit more about the workforce. As my hon. Friend the Member for Worsley and Eccles South said, they are underpaid, undervalued and overworked. The National Audit Office report from February was damning in its assessment that the Department of Health and Social Care
“is not doing enough to support a sustainable social care workforce.”
Data from the Skills for Care charity suggests that there is currently a turnover rate of 32% for the role of care worker in adult residential care in England, but that rises to a shocking 44.3% for care workers in adult domiciliary care. It is completely understandable that people working in this tough environment decide to leave the care profession when the pressure becomes too great. If people are to see social care as a viable career, they need to feel valued, and too often that is not the case.
With demand for social care increasing as our population ages, the workload will only get larger for the staff who remain. As the National Audit Office report also suggests, the Government are simply not providing the leadership that is needed. Local councils and care partnerships that are commissioning care are not being given the confidence of a national strategy designed to support the workforce and recruit new carers. A national strategy, for example, could see health and social care brought more closely together. The silo mentality between the NHS and social care has meant that the two services have passed patients to and fro, duplicating resources and missing the opportunities to work together to deliver better outcomes.
It is welcome that the Government have endorsed more partnership working, and these relationships are already getting results. In Redcar and Cleveland, our current partnership, which is led by the health and wellbeing board, has been given a rating of excellent by the National Audit Office. Our better care fund shared budget with the local clinical commissioning group is already leading to some positive outcomes, with a reduction in the number of non-elective admissions to hospital. This joined-up working is also leading to the establishment of an intermediate care centre in Eston in my constituency, which will help elderly patients to avoid long hospital stays and receive recovery support closer to home. It is a great initiative, with the local council and the NHS working more closely together. These initiatives show the huge possibilities from integrating health and social care, but on their own, they barely scratch the surface in dealing with the crisis facing services.
Social care is in desperate need of an urgent cash boost to address the funding gap, to ensure that social care services are properly staffed, and to ensure that the workforce get the pay and development support that they deserve for the work they do. The social care levy and grants in the autumn 2017 Budget have staved off collapse, but the disastrous bankruptcy of Northamptonshire County Council shows what happens when the pressure from cuts becomes too great to manage.
In the longer term, the system needs reform and these decisions cannot be kicked into the long grass any more. It is time for a care system fit for the 21st century, which puts social care on an equal footing with the NHS, and does not leave elderly people and their families worrying about needing to sell their home to pay the care bill.
It is a pleasure to follow Anna Turley and to take part in this very important debate. For me, this is the biggest service delivery challenge that we face as a nation. The UK has an ageing population and a finite amount of money, regardless of what Members on some Benches in this place say. We have to focus on delivering outcomes for people. Sometimes that gets lost when we are chasing our tail and focusing on dealing with conditions, rather than with prevention. We face a challenging environment in terms of service delivery. That is why I would support a royal commission on social care, and I agree with and echo the sentiments of my right hon. Friend Damian Green on that.
In Cornwall, the challenges are compounded, and let me explain why. The last census showed that 22% of people in Cornwall were over 65, and this will increase as more and more young people leave the county to seek work or a career. I believe that the next census will show that the problem has been compounded even further. As for the rural sparsity of Cornwall, we have 550,000 people in this county of ours across almost 150 miles of coastline. Traditionally, we have had a low-wage economy and a much less competitive marketplace, particularly in care. This highlights the rural productivity lag and the economic challenges facing the day-to-day delivery of care in our area. It is the perfect storm.
A typical day for a carer in Cornwall might involve long journey times to make care visits, difficulties parking and meeting care time targets and delivering complex care in pressured timeframes, and when people step in to cover sickness or pick up a complicated care package because someone is away, it can be particularly difficult. It is easy to see why people might choose to work in a supermarket or another career, rather than work in the care sector, but there might be light at the end of the tunnel. Recent changes implemented by the Royal Cornwall Hospital, which now agrees care packages when people arrive at hospital, have improved the system, increased bed capacity and helped people return to their own beds—in my view, a person’s own bed is the best bed for them. The £12 million the Government recently provided to Cornwall Council, for which I thank them, has also helped.
Technology, which has been alluded to, has a huge part to play in delivering care in rural communities. There are big opportunities here. The roll-out of 4G, 5G and broadband will make rural communities much better connected, while the GovTech initiative, which the Government recently announced, is looking at health provision. We have a chance utilising technology to take a much more community-focused approach to care. The Post Office has a part to play as well. I recently attended a dinner hosted by the Post Office, and what it does in terms of care in the community should be welcomed.
I am vice-chairman of the Parliamentary Internet, Communications and Technology Forum, and I had a very interesting discussion with somebody recently about a social care app they were developing to provide a care service that works in much the same way as Uber, by linking purchasers and care providers, and which could cut out some of the top slicing by private providers and local authorities and put that money directly into the pockets of carers, who, instead of surviving on the national living wage, could see a significant uplift in income.
It is vital that we retain good people in the profession and boost morale. If we can create a better and more effective system in our rural areas, that is what we should do. So I say to the Government: be bold, go for the technology and see what we can do. The provision of social care needs to be much more socially inclusive and decentralised. We need to empower individuals—both carers and their loved ones—and create a balance that puts rural communities on a level playing field with urban communities. This matters to people in North Cornwall and so it matters to me. I want to make sure we get it right.
It is a pleasure to speak once again in a debate on this important subject. I applaud my hon. Friend Barbara Keeley, the Labour Front-Bench spokesperson, who has made this speech before and been resolute in standing up for the care industry, and I support the Labour motion, which is very good. Dr Whitford, who spoke for the Scottish National party, also made some very important points.
I support what the royal commission on long-term care for the elderly said 19 years ago: long-term care should be free at the point of need and paid for out of general taxation. I want to go beyond what Labour is saying at the moment, however, which I applaud and support, and look to a world with free long-term care and a care service run on exactly the same basis as the national health service. We were moving in that direction just before we lost office in 2010. The then Secretary of State for Health suggested a national care service like the national health service. I intervened on him and said, “Yes, and paid for out of general taxation and free at the point of need”, but we did not get it. We did not get the support all those years ago, despite the support of many Members for the royal commission report, strong support in the country and a trade union-led campaign calling for free long-term care. It was all to no avail and so the issue has rumbled on ever since. The issue did not go away, however, and I raised it myself in the Chamber several times over those years.
Eventually the Dilnot commission was set up, and in its 2012 report it recommended a compromise. Sir Andrew Dilnot, whom I know well, is a superb man, and he did a brilliant job. He came up with a compromise that he thought might be worn by the Treasury, proposing that self-funding should be capped at £35,000 for a lifetime. The Government dragged their feet and resisted, but eventually, after wriggling a lot, they agreed to a lifetime cap of £72,000—twice the amount that Sir Andrew had suggested. Even then, however, that was deferred until 2020, and now it seems to have been deferred indefinitely. We are well away from where we should be. Scotland, of course, has had free care, and I applaud Scotland for that. I do not know why we should not follow suit.
If self-funding affected only the wealthy, it would not be such a worry, but it actually affects millions of working-class families. The first generation who became owner-occupiers have been particularly badly hit. Successive Governments have wrung their hands about the difficulties experienced by young people in achieving owner-occupation, while at the same time cutting off one of the only possible routes to owner-occupation for many: the cascading of family equity down the generations, whereby the capital in Granny’s home passes down to grandchildren when she ends her days.
I hold resolutely to the view that long-term care should be free to all, and funded from progressive taxation at the point of need. I am not too concerned about how that taxation is raised—it could be national insurance, income tax or a hypothecated tax—but the money should come from general taxation.
The hon. Gentleman is making a valid point about the funding of care, but I should be interested to know whether he considers the use of technology, which I mentioned and which was mentioned by a couple of my colleagues, is an option that might enable us to do things slightly better.
Does the hon. Gentleman agree that, given that some funding decisions and challenges are very difficult, and given the amount of money that is needed, we should adopt a cross-party approach, looking at all the options, building consensus, explaining the position to the public and ensuring that this arrangement is delivered?
In fact, the royal commission did cover funding. Over the last 20 years and more, I have spoken to many audiences, and have asked them, “What would you prefer—to have your house taken away from you, or Granny’s house taken away, or to pay slightly more tax?” The unanimous view was in favour of a slightly increased level of taxation to pay for long-term care. Everyone is going to get old. I am easily the oldest person in the Chamber. I am not planning to go into long-term care any time soon, but on the other hand I am closer to it than the other Members who are present. However, I will not speak about myself.
There is another factor in all this. In my constituency, there were three local authority care homes where the residents were happy, the staff were wonderful, and the healthcare professionals treasured them. All those homes were closed, and the land was sold off. Now we see the private care sector in constant difficulty. Given the collapse of Southern Cross and the ongoing threats to the future of many more homes, I believe that at some point the state will have to step in to ensure that care continues to be provided. Indeed, the Minister conceded that point: she said that we would have to step in and solve the problem. Why not set up a national care service now, and start to bring care homes back into the public sector as we did in 1948? I am not old enough to remember Nye Bevan’s speech in the House in which he proposed the establishment of the national health service, but I was inspired by him when I was at school, and my policies developed as a result.
Another scandal has been reported recently, namely the practice of effectively using self-funders to subsidise publicly funded residential care. Contracts with cash-strapped councils are squeezed, and charges for self-funders are increased to compensate. In one case, the charge for a care home resident who had been state-funded and then became self-funding was multiplied by several times. Most worryingly, there have been reports of inadequate care in homes across the country, which was mentioned by my hon. Friend the Member for Worsley and Eccles South. When care is provided by homes in the private sector that are squeezed for funding and have to make profits, it is inevitable that care standards will eventually be cut. It is clear that long-term care should not be in the profit-driven private sector, but should be a true public service, in the public sector. I commend today’s motion and all that has been said by many hon. Members on both sides of the House, but we have to move towards a national care service, based on exactly the same principles as the national health service.
I would like to praise our social care workforce and those who provide care voluntarily. The Government are not in denial about the issues that we face. That is why the Green Paper is being worked on and will be with us within months.
In spite of the huge challenges in this area, the Select Committee on Health learned only yesterday that there were 1,700 fewer delayed transfers of care this February compared with the previous February. That is a small bit of progress in the right direction. In evidence to our sustainability and transformation inquiry, the Committee learned about some of the other good things happening around the country, including the passport scheme for care home staff in Wakefield, which allows them to transfer easily around the sector with their qualifications and experience properly registered and recorded. That will lead to an extra 750 jobs in that area by 2025.
In addition, we learned that in the 12 months to quarter 2 in 2017-18, compared with the 12 months to quarter 2 in 2015-16, emergency admissions in enhanced healthcare homes fell by 1.4%, compared with care homes in the rest of England that were not in that scheme, where they rose by 6.7%. We learned that in Buckinghamshire, through joint working between the NHS and local councils responsible for social care, there was a 57% reduction in falls leading to harm. The last example is from Tameside and Glossop, where, we were told, nurse-led telemedicine to care homes reduced hospital admissions from 122 to 75 and resulted in 75 earlier discharges. Those are examples of good practice around the country, but as ever with health and social care the question is how we can mainstream them all over the country.
In my remaining few minutes, I want to discuss what we do about the situation. Germany has introduced a proper nationalised social care insurance scheme, whereby people pay contributions, with adjustments made every few years. It has been in place since 1995 and has settled down. It is not contentious, but has broad agreement, and Japan has a similar scheme. They have been doing it for 23 years, and for me that points to the direction that we need go in.
I think Germany absolutely has something to teach us, and it has a private insurance scheme on top of that as well.
We need to see weekend discharges in hospitals, on Fridays, Saturdays and Sundays, with local authorities and social care being available over the weekend, so that we do not get a bulge on Monday morning, causing our hospitals huge problems. We need proper pay for care home staff. They have a choice, but there is no choice for us as a country about whether we look after our frail elderly people and those who need social care. We have to do it, but people do not have to choose social care as a profession. Therefore, we need some proper labour market analysis and parity between similar jobs in the NHS and social care. The lowest-paid workers in the NHS have just had a 29% pay rise. If we are to have true parity, we need to treat the social care workforce as well as we treat the NHS workforce. Independent living schemes, which my own local authority of Central Bedfordshire is pioneering, are showing the way, and the Housing, Communities and Local Government Committee was impressed when it went to see Priory View in Dunstable. I gather that in East Sussex there is data to show that this type of extra care scheme—
Does my hon. Friend think that there is also a role for the greater use of co-operatives such as the CareShare organisation, which matches those in need of care with care givers so that they can swap time with each other?
That is an excellent scheme. Returning to East Sussex, I understand that data suggests that its extra care scheme is now saving about £1,000 per resident. We have seen examples from overseas—Germany and Japan in particular—and we have a Government who are committed to finding a solution. I eagerly look forward to seeing those solutions in the Green Paper and to our implementing them quickly.
It is a pleasure to follow Andrew Selous, who is very knowledgeable on these issues. In October last year, we sat in the Chamber and conducted an Opposition day debate on this crucial issue of social care. Today, six months later, we are doing exactly the same thing, not because there has been any major policy change or even any significant ideas from the Government, but because, six months on from the Government being told that there was a social care crisis, they have taken no concrete action to solve it. In fact, rather than tackle it head on, all they have done is shift the responsibility further on to hard-pressed councils and devolved the funding burden and pain on to individual taxpayers in my constituency and throughout England.
Social care faces a deficit of £2.5 billion by the end of the decade. That is not a Labour party figure, and it is not fake news; it is from the reputable King’s Fund. Cuts of £6.3 billion have been made to adult social care since 2010. As a result, there has been a 26% fall in the number of people accessing care, meaning that 400,000 fewer people are able to get the support they need and deserve.
My constituency of Weaver Vale is served by two councils: Halton, and Cheshire West and Chester. Both have fought a valiant battle against Tory austerity, doing all they can to protect the most vulnerable, but things are now at crisis point. Figures show that since 2011-12, external funding for Cheshire West and Chester Council and Houlton Council has been cut by 38.1% and 43.7% respectively. That situation is unsustainable. The care sector says so, the charities that support our vulnerable people say so, and even the Tory-led Local Government Association says so, yet still the Government do not listen. If they do not listen to the experts, or even to their own Tory councillors, perhaps they will listen to those at the sharp end on the frontline of social care: our staff. On Saturday, I spoke to Paula, who represents thousands of local government workers in Unison in my constituency. She had a message for the Secretary of State:
“Do the right thing. Invest in our valuable public services. Invest in our amazing workers”.
This touches on some of the points made by Conservative Members. I agree with some of my hon. Friends who have said decent, quality social care costs money and that we need to put our money where our mouth is. We need to have an honest conversation about this. Let us finally take the bull by the horns and establish a national health and social care service. The Government must listen to public sector workers like Paula, and the millions of people like her, as well as to unions such as Unison. Only then will our communities and our councils have the funding that meets their needs, and which is stable and fair. Only then will we begin to tackle the crisis in social care.
It is a pleasure to follow Mike Amesbury. I start by declaring an interest as my husband is the non-executive director of a social enterprise in the area of social care. I join my colleagues and others across the House in welcoming this debate, and I am pleased to have the opportunity to speak about this hugely important issue. I am a great believer in localism. I was a borough councillor for several years before entering this place. As a member of the Housing, Communities and Local Government Committee, I have worked with colleagues to examine the issue and to question Ministers on the provision of social care across the country, and I am pleased that the Committee published a report on adult social care last year.
The health and social care devolution settlement to my region of Greater Manchester provides us with an opportunity to tackle health issues from the ground up, and I commend the Government for the considered approach that they have taken since the proposal’s inception several years ago. Greater Manchester is home to almost 3 million people across 10 local authorities. However, according to the Office for National Statistics, life expectancy in Greater Manchester is among the lowest in the country, so the challenges that we face are significant. If things continue as they are, we will be facing an unsustainable £2 billion shortfall in health funding by 2021.
Greater Manchester faces a number of issues, one of which is dementia. Members will know from the experiences of the constituents they meet in their surgeries, or perhaps through their own personal experience, that dementia causes immense suffering to individuals and their families. Dementia is now a leading cause of death in the UK, and it is estimated that there could be nearly 35,000 people living with dementia in Greater Manchester by 2021, a third of whom will have symptoms so severe that they will require 24-hour care. Dementia care is estimated to cost around £375 million a year in Greater Manchester alone.
Similarly, strokes are the fourth biggest killer in the UK and a leading cause of disability. More than 100,000 strokes happen in the UK each year, with someone suffering from one every five minutes. In Greater Manchester, there are 6,000 a year. However, swift, specialist treatment can make a huge difference. My constituency has the No. 1 rated stroke unit in the country. Stepping Hill hospital’s stroke centre has high-tech scanners to detect blood clots in the brain and uses emergency clot-busting drugs to break them down. It also provides stroke patients with a full rehabilitation programme and a high-tech sensory garden in which they can recover.
Hospitals are an important part of our healthcare provision. However, if we were to start again, given the sort of patient environment we have today, perhaps we would not design a system like that developed in 1948, which focused on acute hospitals. We would create a system much more focused on health and tackling long-term conditions such as dementia, heart disease and diabetes, all of which account for 70% of the NHS’s total spend. As a result, much more needs be done in the community. A key aim of combining the health and social care budgets is to reflect that trend. Care needs to be moved out of hospitals into the community.
To provide effective support, integrated services are vital. A key Government aim from the outset has been to enable care to move out of hospitals and into the community, closer to where patients want to be—in their own home. An example of that strategy in practice is the “Stockport Together” programme, through which five health and care organisations have come together to integrate health and social care services across the borough. Stockport is proud of the fact that we are one of the healthiest places to live in the north-west, but the rising number of older people in Stockport means that there will be a greater need for health and social care support both in the short and long terms. Currently, one in five people in Stockport are over 65.
NHS and social care organisations in Stockport, led by the local clinical commissioning group, have come together to tackle fragmented care by joining up services for older people in supported living schemes and care homes. I appreciate that there is no one-size-fits-all approach to addressing social care—what works for Stockport might not work for areas such as Salford, Sale or Stretford—so this is not about reducing the amount of money spent on care, as Members sometimes assert; it is about investing it in a smart way to ensure that we can meet the increased care needs that we face. The “Stockport Together” programme has demonstrated that, by joining up the arms of local government and health providers, we can reduce the number of ambulance call outs to falls and reduce the number of people in hospital who could be treated at home.
The Greater Manchester combined authority has £6 billion of devolved funding at its disposal, and I hope part of that will be channelled into primary care to facilitate early assessments and to support patients newly diagnosed with dementia. Doing so would have a positive knock-on effect. By focusing on community care we can reduce the level of emergency admissions and care home placements, and relieve the pressure on our local hospitals.
The integration of health and social care in Greater Manchester is a significant milestone in tackling the challenges I have outlined, and I look forward to the publication of the Government’s Green Paper on this hugely important subject.
I will make three brief points. The cuts we have seen to social care because of the huge reductions in local council funding are not just morally questionable but economically illiterate. Hundreds of thousands fewer people are now getting publicly funded social care, which is there to help frail, vulnerable people just to get out of bed and dressed, fed and washed—things we all take for granted. Those who still get publicly funded support are seeing it reduced, with shorter visits than they desperately need. The result is that we are seeing increasing numbers of elderly people going into hospital and getting stuck when they do not need to be there, which is terrible for them and costs the taxpayer far more.
As the shadow Care Minister said, this has a huge impact on unpaid family carers. One in four unpaid carers has not had a single day off caring for five years. Not a single day in five years! Think of the strain that puts on their physical and mental health. One in three unpaid family carers in work has had to give up their job or reduce their hours, so their income goes down, they end up claiming more in benefits and their employer loses their skills. There would be an outcry if that happened in any other area of the workforce.
I am afraid that the Government still do not get it. They are still failing to look properly at the NHS and social care together. It is astonishing that we have a separate Green Paper on social care, and doubly astonishing that the Green Paper focuses only on older people and not the hundreds of thousands of disabled people. We have to look at them together, and I urge the Minister to think again about the Government’s approach.
That leads me to my third point, which is about the solution. We need an urgent and immediate injection of cash into social care and the NHS. We simply cannot put the services, patients, carers and families through this all again next winter. We also need a bold 10-year strategy for investment and reform.
The NHS and social care will always be political issues, and rightly so—they are things we deeply care about—but we need a cross-party approach on future funding, especially of social care, not just because any party that comes up with a bold proposal risks being obliterated by its political opponents, but because we desperately need a system that will last for the long term, not for the politicians but for the people who use and work in those services.
I urge the Government to heed the calls from more than 100 MPs on both sides of the House for a short parliamentary commission on a long-term strategy, which would report within a year. I also hope the Government will consider the 10 principles of long-term funding for the NHS and social care put forward by myself, Norman Lamb and Nick Boles. We agree that the NHS must remain a universal tax-funded service, available free at the point of delivery, based on need, not ability to pay. We agree that spending on the NHS and social care must increase by substantially more than inflation over the next 20 years because of our ageing population, new treatments and technologies, and the need to achieve genuine equality of access to treatment for people with mental ill health. We believe that people are more likely to be willing to pay more for the NHS and social care if they can be certain that additional resources are dedicated to that end and cannot be diverted into other Government programmes—in other words, there should be hypo- thecation. We believe that increases in funding must be progressive and fair between the generations, with higher earners, the self-employed and better-off pensioners making a fair contribution to future funding. We also believe that every five years there should be an independent assessment, carried out by the Office for Budget Responsibility or a separate health-focused body, to look at the resources needed to run the NHS and social care in future, which Parliament will then debate and decide on.
These are tough issues, no one is denying it, but we have to join up the services, and we need in this year, the 70th anniversary of the NHS, to get a future funding settlement. If we were creating the NHS today, it would be a national health and care service. It must be fair, it must be progressive and it must last for future generations. I urge the Government to act.
It is a great pleasure to follow Liz Kendall, who made a typically passionate speech, and I echo what she said about the need for a cross-party approach. When she mentioned that anyone talking about social care almost has to do it out of election time because otherwise they can end up being torpedoed by their opponents, I was reminded of one particularly vile leaflet issued in the Cheltenham constituency during the 2017 election, which stated, “First dementia will take your mind. Then the Prime Minister will take your house.” That sort of politics is pretty low and does a disservice. So I firmly believe that we need cross-party working on these very long-term issues.
Building a social care system for the mid-21st century–it is incredible to be talking about the upcoming mid- 21st century; this feels very old in that respect—is one of the most important tasks facing this Government and any subsequent Government. Many Members have mentioned the fact that our population is ageing, and indeed it is. The number of people aged 75 and over is expected to increase by 70% between 2015 and 2035, and the figure for older people as a share of the population is expected to rise from 28% in 1971 to more than 36% in 2037, when I reach retirement age. Not only are people living longer, but there will be fewer working-age citizens to support them through the taxation system. That is particularly acute in my constituency. In the Silhill ward, from which the constituency takes its name, 40% of people are over 65, and I regularly come into contact with people who are dealing silently with huge care issues. Solihull rests and survives on a sea of volunteers and those who are willing to give of their time in order to help people in this vulnerable situation.
I welcome the Government’s decision to invest an extra £2 billion in our social care sector over the next few years. That is a first step, but this is not a problem that can be fixed just by spending money. We need not only to explore why some councils are perfectly able to provide quality care on their current budget whereas others are not, but to futureproof our social care system against demographic trends that will place huge strains on it.
I wish to focus on the two structural reforms that Ministers should consider as they draw up their Green Paper, the first of which is providing more support for the co-operative movement in this sector. There has not been a great deal of debate on that, although I mentioned it to my hon. Friend Andrew Selous. I am thinking of examples such as CareShare, which helps to match those in need of care with care givers and which fosters that peer-group support—it is a social care platform owned by its members. There are working international examples of that in areas that do not have an NHS, such as Spain, Italy and Latin America, which also have strong family networks and strong family connections. The social care co-operatives have proved very popular and could augment rather than replace state and other systems. It is about a network, effectively, moving us forward, because the state alone cannot solve or resolve this.
On the subject of creating variety in the sector, I would also like to see support for the growth of mass market social care insurance. That could be provided by both the state and, to a degree, private suppliers. The state approach should follow a National Employment Savings Trust model for funding and for distributing that funding to the carers. That is a solid example that we can follow, and we need to look closely at the examples we have seen in Germany and Japan. That can help people to prepare for their old age while they are still able to set appropriate funds aside and make meaningful decisions about their future care.
Ministers are rightly trying to ensure that individual service users are at the heart of the reforms as we go forward. Making patients equal partners in the care process and instituting principles such as “No decision about me without me” are all about empowering people and delivering higher quality, greater transparency and more accountability as a result. Supporting a wider variety of providers and care methods is the next step in that process. That is the lesson of the free schools movement, where the Government recognised that supporting a wide range of schools was essential in giving parents and pupils meaningful choices about their education. Ministers must ensure not only that the new social care system properly supports the work of excellent third sector providers such as Mencap, but that it uses tax breaks and other incentives to help to foster alternatives such as the patient-led co-operatives I talked about earlier.
We also need to restore the market for long-term care insurance products to fund social care. That used to exist to some degree, but it was never able to achieve substantial economies of scale. Since the disintegration of independent financial advice, it has basically also disintegrated. That must change, for two reasons. First, people need a realistic idea of how much they will need to set aside to fund the level and style of social care that they want, and a properly functioning market with a wide variety of products is by far the most successful way of achieving that. Without it, that essential planning will be the preserve of the well-informed few.
At present, too many people put off thinking about social care until they have no other choice. I had this happen in my own family. At a moment of crisis, they are suddenly in need of extra support, but leaving all the decisions to this late stage hugely reduces a patient’s scope to make decisions about their care and choose a model that works for them. I believe, having echoed the point made by the hon. Member for Leicester West about the need to work across parties and not torpedoing ideas, that we need an honest conversation in this country about when we need care, and to plan it, rather than reaching those crisis points.
I want to touch on some of the social care workforce issues. Social care is what we rely on when we need help—whether that is residential care when we need to go into a home, or care in our own home. We rely on social careworkers, residential careworkers, and home careworkers and support workers if we need help at home. These are staff who deal with our most personal needs at a time when we might be at our most vulnerable, yet we fail to value adequately the work that they do and the care and sensitivity with which, on the whole, they deliver it. I know how vital that support is and how well and compassionately it can be delivered when it is at its best, as we briefly had that support for both of my parents recently.
These are staff who are often under pressure to meet impossible visit schedules, who are on the frontline of looking after our families and neighbours, and who are on the lowest pay grades, too. They are predominantly female. As has been mentioned, Unison, the trade union that represents many of these staff, conducted a survey of the staff in social care with Community Care magazine. It showed a picture of staff feeling stressed, working more hours than they are paid for each day, and staff shortages that put pressure on others. It gets more basic than that: many staff are not even being paid the national minimum wage let alone the national living wage; domiciliary care staff are not being paid for the time that it takes to travel between visits; and staff on zero-hour contracts—UNISON estimates that there are about 300,000 of them—are facing uncertain and often disrupted hours.
UNISON has been pushing an ethical care charter for home careworkers and a residential care charter, too—here I should mention the “sleep-in” staff who are not being paid the national minimum wage. I am sorry that the Minister is not in her place at present, because when she touched on this matter in her remarks, she appeared to suggest that the Government are looking at legal ways not to pay sleep-in payments at the national minimum wage rate. Perhaps she, or one of the other Ministers, could correct me if I misheard that point. These staff deserve, and are entitled, to be paid for the work that they do.
It is no wonder that staff turnover is huge in the sector, varying from 31.8% in the residential sector to 44.3% in domiciliary care. These are not just trade union figures. Yesterday, the Health and Social Care Committee and the Housing, Communities and Local Government Committee, which are working together on adult social care, heard from the chief executive of Care England, the providers’ body, who also highlighted the huge problem of turnover in staff. This is not good for employers and it is certainly not good for the people for whom these careworkers work.
This is no way to provide care for the most vulnerable people in our communities—they deserve the most compassionate care that meets their needs—or to treat the staff who provide that care. This is not just about the staff. They are under such pressure because, year after year, this Government have cut funding to local councils, which provide the care, at the same time as those councils face a huge rise in demand. We know that the care market itself is fragile and failing.
Our social care system is not working as it should do. If we are to make it work, we must ensure that funding is provided now and that the care staff are treated properly. We must give social care equity with NHS services. Our older people, and those who care for them, deserve nothing less.
It is a great pleasure indeed to speak in this debate and to follow Liz Twist, and all the other contributions that have been made. In the brief time that I have, I wish to start by speaking about my own experience and why I am so passionate about this subject. I am one of the one in six people to whom the Minister referred when she talked about carers. I am a carer for my elderly mother who has dementia, so many of these problems touch me and my family quite personally. I totally recognise the situation that we face up and down the country. In the case of my own mother, she is receiving excellent care in Cumbria. I am delighted to pay tribute to the carers in Cumbria who are doing a fantastic job looking after her in a very challenging situation.
Closer to home, in Redditch, I recognise the importance of getting care right in my constituency. I have taken a close personal interest in the care that is available in my own home town. I have seen some amazing examples of care—whether it is at the Dorothy Terry House, Stonebridge or Brambles. In all those places, I have seen staff go above and beyond to care for elderly people at a very difficult and challenging time in their lives. That is really important and it is something that the Government are getting behind.
We have heard much criticism of the Government from Opposition Members. It is very difficult to take that on board when we all know how difficult the situation was when we first came into office. To put the matter into perspective: I had a meeting with Worcestershire County Council just this week, and I discovered that the care of some people in Worcestershire costs £38,000 a year. I am sure that every Member will recognise that that is a lot of money. We all want to provide the best care for our constituents. That is what we all came into politics for. I resent the accusation that we do not care and that we do not want to get that right. We passionately want to get that right. We know that our constituents deserve it; people in Redditch deserve it and demand it. It touches all our hearts when we see people being failed by the system.
At the same time, we need to have a realistic debate about where the £38,000 comes from. We sometimes hear from the Opposition that, in the words of Mike Amesbury, it is wrong to ask hard-pressed local council tax payers to pay. Well, if money is to be found, the only place that it is going to come from is tax payers—the tax payers in the hon. Gentleman’s constituency, and up and down the country—and we are all mindful of that. The economic argument therefore has to be at the heart of what we are doing.
The Minister for Care has just returned to her place. I commend her for showing real leadership on this issue. Like Barbara Keeley, who has just left her place, I am a member of the all-party parliamentary group on carers, and I attended the meeting, as did the Minister. We all heard the stories from the carers, which were similar to the stories that we hear from our families and constituents. This Government and the Minister have shown considerable commitment, and real care and compassion towards getting this right. I also commend Carers UK, which is behind the excellent APPG, for its work; it really celebrates unsung heroes in our communities.
The Minister is going above and beyond to put into practice a system that can be long-term, sustainable and, most importantly, funded. She is aware that there has to be money going into the system. Money has to come from somewhere, and the only place it can come from is taxes. It is therefore important that we get behind the leadership of the Health and Social Care Secretary, who has shown a dedication to bring together the health and social care sectors. That is the only way that we will solve the problem.
As my hon. Friend Julian Knight said, there has to be cross-party consensus on this matter. We cannot descend to the pitiful levels seen in the general election when the Conservative party tried to have a grown-up conversation about one of the most difficult issues in our society—dementia. [Interruption.] Whatever Opposition Members are saying from a sedentary position, they know that the debate then really frightened and upset some of the most vulnerable people in our communities. [Interruption.] I am sorry, but I am going to focus on the experience in my constituency.
The Government are putting a lot of money into public services, which help people every single day of their lives. I have seen evidence of that in my constituency, where £29 million is on its way to the Alexandra Hospital and the Worcestershire Royal Hospital that serve my constituents in Redditch. Joining up hospital care will of course help with some of the issues around delayed transfers of care. It will also aid the elderly and frail unit to help people who are most in need of both health and social care.
I recommend that the Government take forward the consultation as soon as possible. Today’s debate has been excellent.
It is great to follow Rachel Maclean, although I do not believe in most of the things she said. I am grateful to the Leader of the Opposition for once again giving Members the opportunity to raise the important issue of social care funding on the Floor of the House. I thank my hon. Friend Barbara Keeley for leading this important debate.
Time and again, we hear from care providers, service users and charities that the social care system is at tipping point, that it is in crisis, that urgent Government action is needed, and that without that help the entire system will collapse, yet the Government continue to bury their head in the sand on this issue. It is clear that the social care system is still in crisis and the Government are still failing to act. Damian Green said that we should make this non-political. Well, the Conservative record on social care is utterly appalling. It is a record of savage cuts, U-turns and passing the buck that cannot be ignored. Since 2010, we have witnessed a fall in the quality of care, as well as cuts to the number of services that are offered and the number of people they are offered to. The Conservatives are spending less money on social care now than Labour was when we left office in 2010, despite demand having increased significantly. As it stands, only 2% of social care services are rated as “outstanding”, and according to the CQC, 41% of services that have been rated as “requiring improvement” in the past have failed to improve or have even deteriorated.
Even worse, though, is the Conservatives’ record on action on these issues. There has been a policy vacuum from the Government since the U-turn on the disastrous dementia tax, and they have since missed the opportunities to address the crisis. They failed at the autumn Budget, and they failed again with the one-off £150 million local government financial settlement, which fell well short of what is needed to rescue the sector. They have abandoned plans for a cap on care costs and a plan to introduce an asset floor of £118,000. These are cold, hard facts that cannot be ignored any longer. The social care system is at tipping point. This is about ensuring that the most vulnerable adults in our society receive the care they need, when they need it.
Since 2010, councils have shouldered the largest burden of spending cuts. Years of underfunding mean that our councils can no longer put enough money into care to meet the needs of an ageing population. As a result, cuts to adult social care during that time have now reached over £6 billion, and now less than one in 12 directors of adult social care are fully confident that their local authority will be able to meet its statutory duties in 2017-18. As I said in an intervention, Warrington Borough Council is facing funding pressures of over £3 million in meeting adult social care needs in 2018-19.
Social care infrastructure is at the heart of our society. Many of us here today will rely on the social care system for ourselves or for our loved ones at some point in our lives. Indeed, some of us here today, and many of the constituents we represent, will already have experience with this broken system, and it will be clear to every single one of them that social care is in crisis. The situation is simply not sustainable. This is one of the most pressing issues of our time, and it cannot continue to be ignored. The Government must get to grips with this crisis now, before it is too late.
It is a great pleasure to follow the detailed analysis of my hon. Friend Faisal Rashid. As a Yorkshire MP, it is always good to follow a Member from the other side of the Pennines—it is early season yet, Mr Deputy Speaker, but particularly when Yorkshire is at the top of the county championship and Lancashire is at the bottom.
I want to take up two points directly from the seven principles that the Secretary of State outlined when he talked about the Green Paper in March. One of them is about a valued workforce, which many hon. Members have spoken about, and the other is about a sustainable funding mechanism for the future.
Every morning in the villages and towns of Airedale and Wharfedale—some of which I am lucky to represent—very early, before the commuters have got up and even thought of going into the great cities of Bradford and Leeds, another workforce have just finished their night shift and are getting the first buses and trains into those cities, where they live. They have the characteristics of the social care workforce, who number about 1.4 million in our country. They are a massive workforce. About 80% are women and 80%—the overwhelming majority—are British, with 11% coming from outside the European economic area and about 5% from within it. There is a massive turnover in the social care workforce, as Unison has illustrated, with more than one in three care workers in care homes leaving their job in the course of the year. It is higher in domiciliary care.
Members on both sides of the House have talked about valuing these workers more. They are undervalued, underpaid and in many cases undertrained. Damian Green and particularly my hon. Friend Liz Kendall talked about building a consensus, so that in the future we value more this extremely important workforce, which looks after the most vulnerable people in our society at the time they need it most.
I have a couple of suggestions for the Government. It was good to hear from my hon. Friend Barbara Keeley that a Labour Government would abolish 15-minute care—the idea that social care workers have to provide for the most intimate needs in 15 minutes, tick a few boxes and then rush off to the next appointment. It makes me proud to be a Labour MP that we are committed to ending that sort of thing and to paying people properly.
There are things the Government could do, and some are little things. I notice that there is an advisory council on the Green Paper. The great and the good are on that advisory council, but it would be good to have a figure from the workforce on it. I remember the Prime Minister speaking on the steps of Downing Street about involving the workforce more. Unison is a union you can do business with, and it would be good to have an additional person from the unions on that council. The Library’s list does not indicate that there is any such person on it at the moment.
If there ever was an industry crying out for a sectoral council, with the Government, the trade unions and the industry, to improve skills and the quality of the workforce, it surely is the care industry. Those are just a couple of ideas.
My hon. Friend the Member for Leicester West spoke passionately about the need to get consensus on a long-term funding model that all parties can agree on. I would stop talking about a “dementia tax”, and the bargain would be that the Conservatives would not talk about a “death tax”. We have used both those terms in the last 10 years, and I agree that they have not particularly enhanced our politics.
The letter from Members of all parties suggested raising and hypothecating national insurance. I would like to keep on the table the idea of an increase in inheritance tax, which the now Mayor of Manchester mentioned in the latter days of the Labour Government. Only 4% of people currently pay inheritance tax. It raises £5 billion. It is a potential way of achieving intergenerational fairness. A national insurance rise at the moment would hit many workers whose real incomes have been cut in recent years, so we should consider the option of raising inheritance tax. I think that many people in our society who are lucky enough to own their own home would accept that bargain—a guarantee that they could pass on the bulk of their estate to members of their family or to any good causes they wanted to support, in return for which I think they would be prepared to pay an additional inheritance tax.
Dr Whitford reminded us that one in four of us will end our days in a care home, but of course we do not know which of us that will be. We have to face up to the fact that, under the current system, those of us who are lucky enough to own our own home would lose most of it, if we are in a care home for a prolonged period. I see that as a life tax, rather than a death tax.
The hon. Gentleman talks about one in four of us ending up in a care home, but we do not know which of us that will be. Does that lead him to conclude that we should pool the risk through social insurance, as they have done very successfully in Germany, having moved in 1995 from a local authority-funded scheme to a social insurance scheme, which also has great community benefits?
I certainly agree that we have to pool risk, but it has to involve everyone in society, from the poor to the rich, so that whatever our circumstances we get the care we need in those days.
We heard a lot from Scott Mann and other hon. Members about the potential of technology. That is a worthwhile point to make. Age UK has provided all hon. Members with the number of elderly people in our constituencies who need care. For example, in Keighley there are 3,500 long-term disabled people and 16,000 people with long-term illnesses. One way of helping them is through telemedicine from Airedale General Hospital. Even when the “beast from the east” was raging at its worst, people in Keighley, Airedale and the dales, even in remote areas, could still have tests and get treatment via broadband. That kept them out of hospital, even in the depths of winter.
This has been a great debate and I look forward to the Green Paper—may it come sooner, rather than later.
It is a great pleasure, as a Manchester MP, to follow a Yorkshire Member from the other side of the Pennines, my hon. Friend John Grogan. I am pleased to have an opportunity to contribute to the debate and want to make a few points that have not come up very much in the debate and that particularly affect my constituents in Trafford.
We have a relatively elderly population in Trafford, compared with Greater Manchester as a whole, which creates a higher level of need in the borough. We also suffer from a high level of delayed transfers of care— in February we had 737 days of delays in the system because of a lack of places in nursing homes, residential care homes or domiciliary care. We also have a disproportionate number of self-funders, which makes it more difficult for the local authority to shape the market. It also means that many self-funders have no connection with the social worker, so they do not necessarily get good advocacy to ensure that their care needs are met.
In Stretford and Urmston we have relatively few large chains supplying residential or domiciliary care; the market is characterised by small businesses, often long-established and family-owned. Those businesses struggle with a lack of reserves, and they are often in buildings that they have occupied for decades and that were not purpose built as care homes. They are now unable to raise the funds to enable them to upgrade their facilities to meet modern standards, not least because of the relative inadequacy of funding from the local authority. Only the other day another small local business decided that it will have to close its doors. As we heard from my hon. Friend Barbara Keeley, that is a cause of great anxiety and stress for residents and their families.
Many hon. Members have talked about the pressures on the workforce. That is a particular problem in Trafford, where there are many job alternatives—people can work in the Trafford Centre or in MediaCity, or they can travel into Manchester to work in the many businesses in the city centre. I am sorry to say that I think that position will become worse as a result of Brexit, because we rely heavily on European Union nationals to serve our care sector.
One thing that I think the Government could helpfully do is talk of care jobs as skilled jobs. They might be low-paid jobs and they might have relatively low qualification entry requirements, but they are skilled jobs. If we have to replace workers from the European Union with more workers from our domestic workforce, we will need to make social care jobs seem attractive to them with good pay and conditions, training and career paths, and by talking up the quality and importance of those jobs.
I am sorry to say that the pressures on Trafford put us in a very bad position. According to Independent Age, we have the seventh worst CQC inspection record in the country. The CQC has found that 43% of residential care homes and 45% of domiciliary care providers in Trafford are either inadequate or require improvement.
I turn to what I hope will be in the Green Paper. Let me say first how concerned I am that the CQC system, although it provides assessments, seems to lack real bite when it comes to bringing about improvements. It seems that providers are given poor assessments and have six months to try to raise their standards, during which time the local authority has some conversations with them but there is a lack of sustained external attention and pressure to ensure that they actually improve, and that by the time the CQC comes back they have not much improved. When a care home or care setting receives a poor assessment, the local authority rightly is no longer prepared to place residents there, which of course means that its income drops further, making it even harder to improve. I would be grateful if Ministers, in preparing the Green Paper, paid particular attention to how we can make that CQC process work better so that it drives improvement rather than simply providing a picture of what is going wrong.
We have talked about family carers. I absolutely recognise and applaud the work they do. Age UK recently held a focus group in my constituency with family carers, who said they felt it was difficult to find co-ordinated information and support. Very few people plan or choose to be a family carer, and it is incumbent on us to think about ways we can get much better co-ordinated information to them about the support that is available and how they source it. We must also recognise that family care is not always appropriate. Some family members will not be able to provide family care—someone’s needs may be too high or the family member may have other commitments. In some cases, the person who requires care will not want a family member to provide intimate care to them.
I want to draw Ministers’ attention to a second phenomenon in my constituency that is putting further pressure on the system. The south Asian community in particular has relied heavily on family care, but traditional family patterns in that community are breaking down. We must look to the point in 10, 15 or 20 years’ time when we have raised the education and aspirations of women in those communities and they are no longer prepared to stay at home and care for auntie and granny, as previous generations have. We desperately need attention to be paid to building up the provision of culturally appropriate care.
Integration has been much talked about. We are finally making progress with the health and social care partnership in Greater Manchester. I welcome that, because we have talked about integration in Trafford without many visible results for many years. Members touched on working-age adults, for whom integration with just health is missing the point. Many of them are not unhealthy, but they do need integration with employment, education, transport, housing and so on. I hope the Green Paper picks up on that point.
Let me join other hon. Members in talking about funding. We need much greater clarity about what is means-tested and what is universal. We need to think that through in a strategic and rational way. We have all said that it is not right simply to expect those who need care to bear the whole cost of it. We must begin to set up a system that properly enables us to pool and share cost and risk. I am with my hon. Friend Liz Kendall in thinking that that requires us to use a range of measures through progressive taxation. I am also with my hon. Friend John Grogan in saying that that means that inheritance tax, and taxes on assets, have to be part of the mix. That is necessary to ensure intergenerational fairness and fairness between my constituents in the north of England, where house prices are relatively lower and all someone’s assets will be used up paying for care, and those in London and the south-east with much more valuable properties, who may be left with more assets after they pay for their care.
Finally, I say to Rachel Maclean, who sadly is not in the Chamber, that council tax can be only a very small part of the answer, because it produces a very uneven pattern of funding given the very different council tax bases in constituencies around the country.
I would be grateful if the Green Paper picked up, in addition to all the other points that have been made this afternoon, on the specific points I have made. It would make a big difference to people in my constituency who need care today, to their families and to all of us in the future if, finally, this matter was properly and strategically addressed.
It is an honour to follow my hon. Friend Kate Green.
Four weeks ago today, one of my constituents from the village of Hough attended Parliament to speak at Age UK’s parliamentary reception. We meet some people in life whom we will never forget. Joyce Yoxall is one of those people. Those who came to the event will remember her harrowing account of life as an unpaid carer. I was as moved then as I was when I first visited Joyce at her home to discuss the problems she is having with our social care system. Joyce’s husband David suffered a stroke in 2014. Since then, she has been forced to stop the care that David should be entitled to because of its high cost and poor quality. She talked about crippling care costs and how she felt she had been “let down”. I had to fight back the tears as she spoke about being mentally and physically exhausted, and how she dare not think of the year ahead.
Joyce has literally become the face of hundreds of thousands of people—and maybe more—who are in a similar situation by featuring on the front cover of Age UK’s aptly named report, “Why call it care when nobody cares?” The report is the result of 127 interviews regarding the quality of social care that people have experienced. I encourage anybody who has not read the report to do so.
The reason I started by talking about Joyce and David is that I want to remind everybody of the heartbreaking human reality behind the statistics I will refer to later. Let us start by reminding ourselves why those like Joyce might feel let down. As has been mentioned, a growing and ageing population is placing ever more demand on the social care sector, but that should not come as a surprise to anybody who has been living in the real world for at least some of the time in the past few decades.
Almost eight years ago, the Dilnot commission was set up by David Cameron’s coalition Government, tasked with making recommendations for changes to the funding of care. It published its recommendations in 2011, including a more generous means-testing threshold and a cap on care costs. That sounded promising, but after another general election the Government announced that the measures would be delayed until April 2020 and, at around the same time, closed the independent living fund. Then the Government promised to publish a Green Paper in the summer of 2017, but along came yet another general election, during which the current Prime Minister threatened to introduce a dementia tax.
Since then, we have had an autumn Budget in which the Chancellor failed even to mention social care, let alone provide adequate funding. We have seen the Department for Health and Social Care’s single departmental plan, which failed to mention the social care workforce. More recently, we had the spring statement, and still there is no lifeline for those with care needs or their families or carers.
We know that at some point, hopefully before the summer recess, the Government will publish their Green Paper on social care for older people, but we do not yet know when any proposals will be implemented after the consultation. To make matters worse, the Green Paper will not cover care for younger adults, which accounts for almost half of all council spending on adult social care.
There has been one missed opportunity after another—delay, delay, delay. Meanwhile, local councils, which are responsible for delivering social care, are seeing their budgets slashed, and one care home after another is placed into special measures or forced to close. What is the result? Research published recently by BMJ Open links cuts to adult social care and health spending to nearly 120,000 excess deaths in England since 2010.
The Care Act 2014 has been about as useful as a chocolate fireguard against a backdrop of inadequate funding and insufficient resources. The legislation has done nothing to protect the 1.2 million older people whose care needs are not being met. Our system clearly places more emphasis on councils setting balanced budgets to an ever-reducing bottom line than it does on making sure that all its residents care needs are met.
Cuts have consequences: I refer to my constituent’s words—that she
“dare not think of the year ahead.”
I do not blame my constituents for having little faith. The past eight years have been nothing but empty promises and never-ending cuts. Fully integrated health and social care would be a good start, but that does not go nearly far enough. We need a whole new approach to disability and ageing based on a commitment to the social model of disability that permeates every aspect of Government.
For example, our social care system needs to be aligned with an appropriate welfare policy and housing strategy, so that we remove as many barriers to disabled people as possible. Access to services should be on the basis of need and not affordability. I wholeheartedly agree that pumping more money into a broken system is no long-term solution.
I have waited a long time to speak and I am going to carry on.
We need to stop viewing social care as a cost or a burden and instead as a wealth creator. Penny-pinching has proved to be a false economy when it comes to social care. It undermines the ability to take preventive action that not only is morally and ethically the right thing to do, but saves money in the long run by reducing the demand on our NHS. We also need to stop neglecting our 1.5 million workers in social care and build a more highly skilled and better-paid workforce. Finally, we need to address the failings of privatised adult social care, as outlined in the 2016 report by the Centre for Health and the Public Interest. Without any real debate, market values have penetrated areas where they do not belong and social care is perhaps the worst example of this. We cannot keep burying our heads in the sand and letting the crisis escalate.
There is no excuse for the Government’s inaction. The CQC warned us last year that social care was reaching a “tipping point”. This was after the Prime Minister had herself acknowledged that our system is broken. This cruel, callous Conservative Government have turned their back on older people and disabled people up and down this country. They have also repeatedly let down the social care workforce and the invisible army of unpaid carers.
We need a Government who put people before profits. Until then, I fear that we will be left with the same fragmented, failing system that is letting our constituents down daily.
Thank you for keeping the best until last, Mr Speaker. It is a great honour to speak in this very important debate.
The care home market, both for residential and nursing care, is dominated by the private sector, which holds 86% of all places. It is divided between lucrative self-pay homes and those with local government-funded residents, which are really struggling to cover the growing costs of caring for a population that is living longer, with more complex health needs. Many councils are struggling just to meet their statutory duties on a reduced budget. The Government’s decision to push a crisis of their own making on to local government is helping nobody. Central Government funding is totally inadequate. That is why, despite the new funding that has been made available for adult social care, there will still be a funding gap of £2.2 billion by 2020. I hope that this is addressed in the delayed Green Paper.
The Government must accept that their over-reliance on the private sector is not solving the problems in the social care sector and all too often is making them worse. In the last few days, Allied Healthcare has issued warnings and is now searching for a rescue plan. The company cited a rise in the cost of nurses and doctors as a result of tighter immigration rules and a shortage of trainees—problems that were created wholly by Government policy. Across the sector, providers and councils are reporting difficulties in recruiting from overseas because of the hostile environment created by our Prime Minister.
One of the nine priorities in the Government’s “Shared delivery plan: 2015 to 2020” is to
“make sure the health and care system workforce has the right skills and the right number of staff in the most appropriate settings to provide consistently safe and high-quality care.”
A report by the National Audit Office published in February shows the extent to which the Government have failed on this. The high turnover rates and difficulty recruiting that the NAO reports can be traced back to central Government underfunding. A cash-starved state is forced to tender contracts for services that private companies can only deliver by paying low wages, cutting corners or exploiting their workforce with zero- hours contracts and unpaid travel time. The Green Paper is an opportunity for the Government to go back to the drawing board on social care funding. Councils need a sustainable settlement, and we need to see adult social care given parity with the health service. Surely this joined-up thinking was why the Department of Health was renamed the Department of Health and Social Care.
We have had a very wide-ranging debate with 16 Back-Bench contributions. I pay tribute to my hon. Friends the Members for Redcar (Anna Turley), for Luton North (Kelvin Hopkins), for Weaver Vale (Mike Amesbury), for Leicester West (Liz Kendall), for Blaydon (Liz Twist), for Warrington South (Faisal Rashid), for Keighley (John Grogan), for Stretford and Urmston (Kate Green), for Crewe and Nantwich (Laura Smith) and for Bedford (Mohammad Yasin) for their passionate, powerful and well-informed contributions. I also thank Damian Green, and the hon. Members for North Cornwall (Scott Mann), for South West Bedfordshire (Andrew Selous), for Cheadle (Mary Robinson), for Solihull (Julian Knight) and for Redditch (Rachel Maclean) for their contributions. We might not always see eye to eye, but there is consensus that we have to fix the problem in adult social care, although how we go about that will always be up for debate.
Is the hon. Gentleman aware of the very constructive cross-party, collegiate visit of the Communities and Local Government Committee to Germany, where we looked at its social insurance scheme, which could provide the perfect, sustainable and scalable solution to the adult social care conundrum?
The Government need to decide their position, but there are examples across the world of how adult social care can be funded. We need to make sure we get a system that works for England.
I also pay tribute to the workforce and carers. They do not just need platitudes from us in the House; they need the Government and politicians on their side.
This is the second time we have had to call an Opposition day debate on this issue, following the Government’s lack of action on social care. In our debate last October, there was broad agreement across the House, as there has been more or less today, that reform of social care was a priority, but here we are, six months later, and little has changed. Last month, we heard the Secretary of State for Health and Social Care tell the British Association of Social Workers that he accepted his share of responsibility for the lack of progress since the Conservatives entered government in 2010.
The social care Green Paper, due this summer, has faced substantial delays. We need a commitment from the Government that it will not be delayed any further. There is only so much longer that the sector can wait. Let us remember that in January there was hope that the Government would place an extra focus on social care after the Department of Health was rebranded, but then, shortly afterwards, in what sounded like a tribute act to the Prime Minister, the Secretary of State for Housing, Communities and Local Government told a packed LGA conference—I was there—that
“nothing has changed, nothing has changed”.
Confusion still reigns, and it is true: nothing has changed. This confusion means that 1.2 million people are being denied the support they need.
Let us look at what the cuts mean. According to its director of adult care, social care provision in Northamptonshire County Council—a Conservative council —is
“on the verge of being unsafe” as a result of the cuts. That council has effectively been the first in England to declare insolvency. According to the director, the additional funds in the local government finance settlement will have “little impact” on the county’s problems, and I fear that that is right; but the Minister will be aware of the widespread fear that what has happened in Northamptonshire could happen again elsewhere. Mark McLaughlin, who was appointed from the Department for Environment, Food and Rural Affairs in December to oversee Northamptonshire’s finances, has warned that all top-tier local authorities will soon face similar issues. Then, only last week, we heard that Worcestershire County Council, the Conservative-run local authority in the constituency of the Secretary of State for Housing, Communities and Local Government, had buried a report expressing urgent concern after rising costs, including the cost of adult social care, had forced the council to use more than half its reserves in the past five years. The Chartered Institute of Public Finance and Accountancy expects the growth in demand to result in a budget deficit of £60.1 million by 2020-21.
Worcestershire County Council covers the whole of my constituency, and I am aware of the concerns that the hon. Gentleman has raised. I want to respond to them, because I too have been worried about the position, as many other people naturally are. I met the chief executive and the leader of the council to address this very issue, and I can assure the hon. Gentleman that they have a sustainable plan to deal with it. However, I will of course keep it under review, and I thank the hon. Gentleman for raising it.
“there comes a point where cost-cutting can’t go any further—there has to be a solution”.
He is right too, but we have yet to hear a Minister even acknowledge that this crisis in social care funding in local government is as serious as it is—and it is a crisis that has its roots in Downing Street. Let us be clear: austerity and cuts in local government budgets have been a political choice by this Government since 2010.
It gets worse. Behind every statistic that I can quote are real people working in the service, real people receiving services, real people requiring services, and families worried about how to support their loved ones. Funding cuts, poor pay, recruitment problems and a lack of support for the sector have hit the quality and availability of adult social care support. In the past year, one in five local authorities have seen more of their care homes rated “inadequate” or “requires improvement”. In some areas, as many as one in two care homes are now rated inadequate.
For some of the most vulnerable, even gaining access to any form of support is difficult. Vulnerable older people with conditions such as dementia and motor neurone disease are being denied support because there is a postcode lottery for treatment. According to Which?, where people live can make them 25 times more likely to receive social care support. South Reading paid care costs for 8.7 patients per 50,000 people, while Salford funded 220.3 per 50,000. In Stockport, people are nearly seven times less likely to receive the funding than those just a few miles away in Salford, and patients in Richmond are more than three times more likely to receive it than those in Ealing.
Ministers cannot hide the terms of a social care levy behind flexibilities on council tax. They know, as we know, that in the areas with the greatest need, a small increase in council tax will never make up the shortfall in funding caused by cuts in grants from central Government, which have been slashed by an average of 50% since 2010. That has exacerbated inequality, as poorer areas, which often have many needs, have struggled to raise the funding that they so desperately need. I will use a local example for the Minister. Tameside, one of two local authorities that cover my constituency, will face a £33 million funding gap in adult social care in the next three years, yet a 1% increase on council tax raises just over £700,000—never, ever enough to plug that gap.
The news that Allied Healthcare, one of the biggest providers of home care, has fallen into financial difficulty shows the impact that is being felt in the sector. The fact that 150 councils rely on Allied Healthcare should send shivers down the spines of Ministers. We got no real answers or any assurances from the Government that they were taking these developments seriously or putting in place emergency contingency measures to ensure that we do not see a repeat of the Carillion collapse.
There are four reasons that people now give for their dissatisfaction with social care: staff shortages, long waiting times, a lack of funding, and Government reforms. That is coming not just from the Opposition; the same concerns that we have raised today are being raised in living rooms and care homes across England. The Government have a duty to respond, and I commend our motion to the House.
I should open with a thank you to those Members who have made some very thoughtful contributions to today’s debate. We recognise the challenge we face, and Dr Whitford put it most strongly when she said that it is the result of something very positive: that we are all living longer. That requires some serious strategic thought about how we fund social care. It is in that spirit that we are rising to the challenge.
Both Opposition Front Benchers, the hon. Members for Worsley and Eccles South (Barbara Keeley) and for Denton and Reddish (Andrew Gwynne), expressed their dissatisfaction with the speed with which we are pursuing these reforms, but it is important that we get it right and that we take people with us. With that in mind, we have put together an advisory group to work with on the reforms. The whole sector is co-operating with us and actively contributing to the debate, because it more than anyone recognises the need to fix this and get the solutions right. I make no apologies for the fact that we are where we are now, but we are well down the track with the process. In the spirit of cross-party consensus that I have heard a lot about this afternoon, I will not get into some of the partisan points that have been made, but I want to set the context of where we are with the debate. When we introduce the Green Paper, I hope it will be received in the spirit of the comments that we have heard from most hon. Members today.
The Minister who opened the debate was unable to respond to my question, so I will repeat it to this Minister. What assessment have the Government made of the impact of social care cuts on the ability of disabled people to live independently, and will she apologise to those disabled people for what the UN has described as this Government’s “grave and systematic violations” against disabled people?
To be frank with the hon. Lady, one of our priorities is to make sure that disabled people can live independently for longer. That is very much a central part of our approach and we are making more money available for it. [Interruption.] She can sit and smile, but that informs our approach.
I should also like to associate myself with the comments made by a large number of colleagues in paying tribute to the hard-working, committed people who make up our social care workforce and to the informal carers who play such a vital part in our health and social care system. Central to the points made by the hon. Members for Stretford and Urmston (Kate Green) and for Keighley (John Grogan) is that we all collectively need to send a clear message that the work that those people do is valued. We are working with Skills for Care to put more value on this as a profession. People who work in the care sector do so because they are personally motivated and money actually matters less to them. We ought to give them a clear message that we really appreciate all the efforts that they make.
Many Members have raised the issue of funding cuts to council budgets. That subject obviously informed the comments from the hon. Member for Denton and Reddish just now. I will not run away from the fact that there have been challenges for councils in recent times— [Interruption.] Opposition Members mention cuts, but the bottom line is that we can only spend what we collect from taxpayers. That is the reality of the situation. I will be first in the queue to pay tribute to those councils that have stepped up to the challenge, coped well with the reductions and worked hard to become efficient. They have shown real innovation in rising to the challenge.
I fully appreciate the Minister’s point that we can only spend the money that we raise from taxes, but this is a question of priorities. Why did she vote for a £5 billion cut to the bank levy in the Budget? Is that not the wrong priority?
I think the hon. Gentleman will find that we actually have a very progressive tax paying system none the less.
I want to celebrate those areas that have continued to deliver their social care responsibilities in challenging circumstances. We have heard a lot about what has gone wrong, but let us just remember this statistic: 81% of people in care homes are in homes that have been rated good or outstanding. I think that is an achievement, and something to be celebrated. I also want to compliment those councils that have really stepped up to the plate to deliver an improved performance on delayed transfers of care. Stoke and Trafford in particular have cut their delayed discharges by more than half. This comes down to leadership and determination. Where councils show real leadership, it will deliver improvements and change—[Interruption.] I have just named those councils: Stoke and Trafford.
The Minister is right to say that we are making progress on delayed transfers of care, but the figures have been very high. It really comes down to the fact that we just do not have enough well-funded places to enable people to be discharged from hospital quickly and get into the care in the community that we all want them to have.
I do not disagree with that point. That is why we need to embark on a process of reform and really get it right. We are embarking on the process on that basis.
A number of Members, including Liz Twist, mentioned sleep-ins, and I just want to restate what was said, because it seems to have been misunderstood. We fully recognise the pressure on the sector resulting from the ruling on sleep-ins and the fact that the historical liabilities could be a problem. We are working closely with providers, in liaison with the European Commission, to come up with a solution. Hon. Members will understand that the matter is too commercially sensitive for me to say any more than that—[Interruption.] We are working with providers and meeting them on a regular basis.
I understand what the Minister has just said about sleep-ins and that she is working with providers. We all understand the pressure on those providers, but I asked earlier, are we looking at a way to reward the staff properly for the work they do during sleep-ins, or are we trying to avoid the question?
The ruling from HMRC is clear that those on sleep-in shifts are still entitled to the minimum wage, so we are working out a solution to those historical liabilities. We are clear that we expect all employers to abide by the national minimum wage legislation, and I hope that that gives the hon. Lady some clarity on that point.
We can expect the Green Paper to be brought forward, but I also want to address what Members have said about the variation in quality and availability of provision. As has been said, local councils are responsible for responding to that, and the CQC has rated 81% of care services as good, but it is important that we work with those that are performing less well to achieve significant improvements so that everyone is entitled to the best possible care.
I was pleased to hear the contribution of my right hon. Friend Damian Green. His philosophical approach perhaps reflects the amount of time that he has spent thinking about this topic. I associate myself with the comment made by him and several Members across the House about the fact that no one has an unblemished record when it comes to debates about social care. If we are genuinely to come up with a long-term solution, we need a spirit of consensus in order to take people with us, and people on both side of the House need to remember that.
In conclusion, we have had a full debate and it will not be the last time that we debate this subject. We are now quite a way down the track when it comes to working up real proposals to bring genuine reforms of the social care system to equip ourselves for a world where life expectancy ends not at 70, but at 100. That will require significant change. We are stepping up to the challenge and will bring forward proposals in due course.
Question put and agreed to.
That this House
notes that Government cuts to council budgets have resulted in a social care funding crisis;
further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care;
is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care;
and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.
On a point of order, Mr Speaker. The motion that has just been unanimously agreed calls on the Government
“to meet the funding gap for social care”— widely said to be £1.3 billion—
“this year and for the rest of this Parliament.”
Given that Ministers have agreed to the motion, can you advise when we might expect an announcement from the Government on this important agreement on social care funding?
The most pertinent response that I can offer to the hon. Lady—I understand her perfectly legitimate point of order—is as follows. On
“Where a motion tabled by an opposition party has been approved by the House, the relevant Minister will respond to the resolution of the House by making a statement no more than 12 weeks after the debate.”
That is the position as things stand. The hon. Lady has registered her point with considerable force, it is on the record, and I do not dispute the fact of what she said about the motion being carried unanimously.