[Relevant documents: First Joint Report of the Health and Social Care and Housing, Communities and Local Government Committees, Long term funding of adult social care, HC 768; Eighth Report of the Communities and Local Government Committee, Session 2016-17, Adult social care: a pre-Budget report HC 47; and Ninth Report of the Communities and Local Government Committee, Session 2016-17, Adult social care, HC 1103.]
I beg to move,
That this House
notes that eight years of Government cuts to council budges have resulted in a social care funding crisis;
further notes that 1.4 million older people have unmet social care needs;
notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis;
recognises with concern the increasing funding gap for social care;
further recognises that proposals from the Government to invest £240 million will not close that gap;
and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.
In October 2016, the Prime Minister told this House that her Government would provide a long-term sustainable system for social care that gives people reassurance. Then the Conservative manifesto said:
“Where others have failed to lead, we will act.”
But the Government have failed utterly to act and people in need of care have paid the price of that inaction. It is approaching a year since the Government promised they would deliver a Green Paper, yet it is still nowhere to be seen months after the planned publication date originally scheduled for summer. Since then, we have seen a further £1 billion cut from social care because of the cuts the Government have made to the budgets of the councils that deliver it, with disastrous consequences for the social care system.
The Prime Minister has not heeded her own warnings about failing to act. During last year’s election campaign, she said that
“the social care system will collapse unless we do something about it. We could try and pretend the problem isn’t there and hope it will go away, but it won’t. It will grow each year.”
That is exactly what has happened. The problem has not gone away and it has grown in the past year.
Does my hon. Friend agree that in addition to the immediate injection of £2.5 billion funding for social care, with 20% of the poorest local authority areas losing nearly £280 million in the past year compared with 20% of the most affluent local authorities gaining £55 million, we also need to address the issue in relation to the deprivation grant funding allocation?
Following on from that point, one issue I have raised on a number of occasions in this House is the lack of local authority funding for social workers. We end up with a situation where people cannot be released from hospital—we used to call it bed-blocking. Does my hon. Friend agree that this is causing major problems both for local authorities and the patients concerned?
Indeed. My hon. Friend makes a really good point. I noticed that the number of delayed transfers of care due to care packages has started to rise, even though it is not fully winter—[Interruption.] Yes, they have, over the last couple of months. The Care Quality Commission has said that in some parts of the country the social care system has now reached the tipping point that they warned of two years ago.
The response from the Secretary of State was to announce that £240 million would be given to councils to deliver packages of home care to people this winter. That is nowhere near what is needed. The social care funding gap is already over £1 billion this year and, as my hon. Friend Debbie Abrahams said, it will reach £2.5 billion by 2020 unless the Government intervene.
By my calculations, the Government’s offer will provide only three months’ worth of care packages for 70,000 people, so when the Secretary of State gets to his feet, will he tell us what will happen to people who need publicly funded home care when the money runs out? What plans do the Government have to provide care beyond the winter?
For some people, it is not possible to wait for money to be available. A third of people who are diagnosed with motor neurone disease will die within one year and over half will die within two years. A delay of a matter of weeks can alter someone’s pathway towards death. Does my hon. Friend agree that there is no time to delay?
I very much agree. In recent months, I have met carers of people with MND and one becomes aware of how much time presses on them.
Our motion deals with social care funding, but this debate is really about people, such as the people my hon. Friend just referred to. It is about how society treats older and younger adults, how we should enable them to live independently and with dignity, and how this Government are badly letting them down. I will look today at the damage caused by Government inaction—damage to vulnerable people who rely on social care to live with dignity, damage to the lives of unpaid family carers who have had to step in to care for their friends and relatives, and damage to 1.4 million hard-working care staff, many of whom are so badly paid and so overworked that they cannot deliver the care that people need.
I am not sure whether the hon. Lady knows that in Oxford this is now starting to affect the local NHS. The John Radcliffe Hospital had to suspend non-urgent operations on two separate occasions in March because 170 beds were being bed-blocked. Does she not agree that it is time to see the promised Green Paper on social care, before this winter?
Indeed. As I said, it is now coming up to a year since that was promised and it is about time that we started to see some plans. However, we have to bear in mind that a Green Paper is only the first stage of change—and a very early stage at that, really.
I want to pay tribute to the care staff I just mentioned. There has been a lot of talk recently about low-paid staff and how they will fare in terms of migration policies. Being low-paid does not mean that caring roles are low-skilled. Caring staff are highly skilled. They are a credit to this country, and without their dedication the problems facing social care would be immeasurably worse. Unfortunately, their efforts cannot paper over the cracks that have emerged because of this Government’s hammer blows to council budgets. I will come on to talk about the impacts that social care cuts have on people.
The hon. Lady talked about the Green Paper and how we will fund this in the long term. Obviously, we all have to contribute to that. I was interested that in the last debate she said her party was looking at such things as a wealth tax. I wonder whether she has developed her thoughts on how we should pay for this and whether it will be considering a wealth tax.
We have indeed been doing more work on this, but we laid out in our manifesto—the hon. Gentleman’s party did not—what our future plans for social care funding were. We said what the three options for funding social care were and that it would either be one of those three options, or perhaps a combination of all three—I think that the party that is being left behind here is his.
The impact of social care cuts means that less care is now available for older and younger adults like. Four hundred thousand fewer older people got publicly funded care in 2015 than in 2010, and 1.4 million older people now have unmet social care needs. Put simply, that is over 1 million people who are not getting help with washing, dressing, going to the toilet, making meals or taking medication.
The hon. Lady mentions the plans in the Labour party’s manifesto, but since then the Health Committee and the Communities and Local Government Committee have produced a joint report on the future funding of adult social care that unanimously recommends adoption of the German-style social insurance system. Will Labour consider those recommendations? Is she minded to support that cross-party recommendation?
The hon. Gentleman asked me the same question six months ago, on our last Opposition day debate on this subject, and I will give him the answer I gave him then: he should really be trying to influence his own party. I thank those Committees for the work they did, as the Prime Minister did today. Labour has got as far as producing a White Paper—not a Green Paper. We have a 2010 White Paper, and I have a copy with me. I recommend that Conservative Members who keep asking about this look at the extensive proposals in that White Paper, which followed a Green Paper and an extensive consultation. The party being left behind is the Conservative party.
It is really up to the Secretary of State, whose party has not produced any proposals, to answer that. On the point about cross-party working, it is the Conservative party that has no proposals. The only proposals it has come out with are the damaging ones that have now been abandoned.
My hon. Friend is doing a very good job of reminding the Government that they are the ones in power and the ones with the decision-making powers. If they support the Select Committees’ report, they should bring forward their Green Paper and adopt them all in full. They have the opportunity to do that.
I want to ask my hon. Friend about unmet need and the growing gap between social care funding and continuing healthcare funding. I am increasingly seeing severely disabled individuals in my constituency with very high levels of need being bounced from pillar to post between continuing healthcare funding and social care funding, neither of which is meeting their needs. What does she suggest the Government do to bridge that gap?
I suggest that the Government start with the cash injection that our social care system needs. The Labour party promised a £1 billion injection upfront to ease us out of the crisis and £8 billion across this Parliament. I suggest that that would be a starting point and that the Conservative party then tell us how it will fund social care in future.
No, I will not give way; we have very limited time.
As my hon. Friend Melanie Onn just said, the effects of reduced access to care are very keenly felt, especially by older people, but I want to highlight what happens to young adults with learning disabilities and autism when there is too little funding to support them in the community. A recent BBC “File on 4” programme on transforming care highlighted the impact on young people with autism or a learning disability of being kept in assessment and treatment units for long periods.
The nature of these settings is chilling. A young woman with autism and extreme anxiety called Bethany, aged 17, is being kept in seclusion in St Andrew’s Hospital, Northamptonshire, in a cell-like room and fed through a hatch in a metal door, at which even her father must kneel to speak with her when he visits. She is being detained and held in seclusion despite an assessment that the current hospital setting cannot meet her needs and a recommendation that she be moved to a community residential setting with high support. As “File on 4” pointed out, however, moving a young person such as Bethany to a community setting would involve her local council paying £100,00 to £200,000 a year from the adult social care budget, instead of leaving the NHS to pay what is a much higher bill—in this case, £676,000 a year, or £13,000 a week.
The lack of funding is clearly a factor here. Bethany’s dad was told by the Walsall Council officer responsible for her placement that her care had already cost the council £1.2 million. To be frank, he said, “Walsall could do with a breather.”Bethany is being treated shamefully. It is hard to imagine someone making a similar comment about the cost of treatment for a young person with cancer.
Bethany’s case highlights a growing problem which is part of the crisis in adult social care. Underfunding social care places people with a learning disability or autism at risk of being left for long periods in institutional care settings. Now that I have raised this case, the Secretary of State must look at the state of funding, which leads to perverse incentives for private hospitals like St Andrew’s to charge the NHS for keeping vulnerable young people with autism or learning disabilities in expensive and unsuitable placements because the local council does not have the resources to fund a community placement.
The journalist Ian Birrell recently wrote about Bethany’s being kept in those appalling conditions, in seclusion in a tiny cell. He asked, “Have we moved far from Bedlam?” The answer is, I am afraid, that we have not. The transforming care programme is making hardly any progress. The most recent data, published in May this year, show that 2,400 people—people like Bethany, with a learning disability or autism—are still in in-patient units, and that is an increase from an earlier figure. Many people in such units are subject to over-medication, inappropriate restraint and seclusion. They can be far from home, and they can be kept there for a very long time. The average stay is more than five years.
As the National Audit Office found, such placements are extremely expensive. In 2012-13, the NHS spent £557 million on people with a learning disability in mental health hospitals. Will the Secretary of State tell us why the Government are still funding the institutionalisation of so many people with learning disabilities, or autism, at great cost, seven years after the scandal of Winterbourne View, after which they promised to cut those placements by half?
The very troubling case that the hon. Lady has described illustrates why we, as a House, must get this right. Does she accept that there has been political failure to resolve the issue of how we fund social care, and will she commit herself to taking a constructive, cross-party approach to getting it right?
The hon. Lady has asked me that question a number of times, and I always find it difficult to answer. She will know that my party really tried, but when we produced that White Paper in 2010—when we had a way forward and a set of funding proposals—all that we heard was “death tax”. In last year’s Budget, the Chancellor raised the issue of the “death tax” again: he said that it was not an option. I wonder how the hon. Lady thinks that Labour Members can talk to a party whose Chancellor has ruled out one of the options right at the start, before anyone sits down and discusses anything. I think that that is impossible. I valued the hon. Lady’s role as Chair of the Health Committee, of which I used to be a member. Perhaps she will write to the Chancellor, and ask him to stop doing that.
As the hon. Lady will know, this is a pattern that has pinged backwards and forwards with successive Administrations. I repeat that we must get it right. We cannot continue these cycles of political failure. We will only solve the problem—particularly in a hung Parliament—with a constructive, cross-party approach.
I am constantly astonished when Conservative Members talk about a cross-party approach. It is up to their party to come up with some proposals. When it has some proposals, there will be something to talk about. All that we have seen the Conservatives do is abandon all the proposals that they have previously had. We legislated, in the Care Act 2014, for a cap on care costs and a lifting of the ceiling—the asset threshold—but the Conservatives have abandoned that now. They had a set of policies at the time of the election last year, but they have abandoned that. The hon. Lady needs to speak to her own Secretary of State, and I hope that she can have a constructive conversation with the Chancellor as well.
I must press on, because we have very little time. The Government’s cuts have not just reduced access to care in the ways that I have outlined; they have reduced care quality. Cuts mean that there is less good-quality care, which causes great indignity to both older and younger adults. The Care Quality Commission tells us that one in five care services—about 4,000 facilities—requires improvement or is inadequate. In too many care facilities quality is hanging by a thread largely because of the goodwill and dedication of care staff, but there are times when even their efforts cannot prevent standards falling. In a recent case in Tameside a care home rated inadequate was eventually forced to close for financial reasons. Care home staff were not only not being paid themselves, but they had paid out £5,000 for the food for care home residents, and an agency was owed £37,000 to pay care staff. An earlier CQC report had noted that that care provider had been made bankrupt. During the time before this home was closed, care quality was scandalously low. In 2017 the CQC found that one resident had been left in bed for five months without a bath or shower. It beggars belief that the Government think that care home managers in such situations should be given responsibility in the process for assessing a cared-for person’s mental capacity under the proposed mental capacity legislation currently in the other place, but that is what the Bill currently says—even care home managers in that failing home would be given a part in the process of assessing mental capacity—and it seems that the Government will not shift from that. I join others in the other place and urge the Secretary of State to pause the passage of the Mental Capacity (Amendment) Bill and listen to the concerns being raised about his proposals, because that is not a role that should be dumped on care home managers in the way the Bill is trying to do.
The Kirklees Solidarity Economy Network in my constituency is working to establish a community-based care co-operative. The model it is developing seeks to demonstrate that a better way is possible by putting people before profit, valuing, rewarding and respecting careworkers, and ensuring that the people receiving care and the workers providing that care have a real say in how the service is run. Does my hon. Friend agree that we could all look to that model in the future?
I very much do and thank my hon. Friend for making that point. There is a great place for co-operatives and mutuals and other such organisations. Organisations like Shared Lives are producing outstanding care in some parts of the country, and we must look at all those models.
I want to talk about hard-pressed family carers, because the situation of less care and lower quality care means that family carers are under pressure as never before to step in and provide care. The strain of caring has seen almost three quarters of carers suffer mental ill health and nearly two thirds suffer physical health problems, according to Carers UK. But too few carers can access respite from caring; they are at breaking point.
Problems with poor care quality and a lack of support were highlighted earlier this year in a report by Age UK entitled, “Why call it care when nobody cares?” At the launch of that report, both I and the Care Minister heard from carers like Joyce. At 73, Joyce cares full-time for her husband David who has had a stroke and a massive brain haemorrhage. Joyce has to do everything for David to make sure he is
“clean and comfortable at all times”.
That involves regularly lifting him in and out of his bed or chair to wash him or take him to the toilet, throughout the day and night. She said:
“It is extremely hard to get good respite care where we live in Cheshire. Our local care home is no longer an option due to being cut as a provider by the local council. I had to fight tooth and nail for the care David currently gets in a day centre—but it just isn’t enough.
I don’t know how I’ll continue to cope without more support and regular respite breaks. Our care was cut in March, the third time that we have had respite care pulled. I am so angry and frustrated, I am so worried at what is facing us at the moment I hardly dare think about it.”
What carers like Joyce need is comprehensive support and carers breaks to allow them to look after themselves as well as the person they care for. What they have received from the Government is the damp squib of a “carers action plan” in place of a proper national strategy.
Labour has already pledged to deliver a national carers strategy as we did with our second national strategy in 2009. That national carers strategy pledged £150 million of funding for respite care breaks for carers. That funding has now disappeared into a black hole in the better care fund, leaving carers like Joyce to fight “tooth and nail” to get any respite at all.
I must make progress.
For care staff, the combination of cuts to social care funding and increasing demand for care has created the perfect storm of pressures, affecting the quality of care. Care staff themselves are reporting seeing a major decline in standards of care over the past couple of years.
Kim, one member of care staff, told her trade union, Unison, that she
“found it increasingly difficult to provide a good standard of care because of staff shortages and the greater need of clients. Often visits to clients have to be rushed, making medication mistakes by staff more commonplace and no social time for clients.”
Another care home staff member from Lancashire said that
“a lot of the time it feels like we are operating a ‘people warehouse’
and just offering the basics of feeding and personal care.”
I find those comments deeply troubling. They show the direct human impact that the underfunding of social care is having. Staff are rushing from one appointment to another, with no time to talk. They are being seen as
“heartless robots as opposed to a lifeline service”.
That is how one care home staff member described her job. Care staff are some of the most dedicated and highly skilled workers in this country, but these pressures, added to their pitifully low pay and their poor terms and conditions, are driving people from a sector where they have never been needed as much as they are now.
The care sector is teetering on the edge of a cliff. Without an urgent response from the Government, it could topple altogether. Ministers in this place talk glibly about making hard choices, but the truth is that this Government have chosen to pursue austerity on the backs of older people and vulnerable adults, who rely on social care. If austerity is now over, as the Prime Minister has claimed, the Government must put in the funding that social care needs to bring it back from the brink.
At last year’s election, Labour outlined a plan to invest an additional £8 billion in the social care system. We want to lift the quality of care and to lift access to care and support for carers before moving on to build our new national care service, as outlined in our White Paper. The Prime Minister said last year that the Government would act. They must now commit to a sustainable long-term funding plan. I urge hon. Members to vote for our motion tonight, to ensure that the Government honour the Prime Minister’s promise, because the people who need care, their family carers, and the care staff who care for them deserve better than this.
Each and every one of us in this House recognises and values those who care, from care workers to nurses to the millions of unpaid carers who look after loved ones. I think the whole House can unite behind the statement that how we care for the most vulnerable is a mark of our civility as a society. Across our country, in our NHS and in our care homes, so many people dedicate their lives to caring for others. I want to address the pressures we face in our social care system in the short term, as well as the long-term reforms we must take to ensure that our social care system is sustainable and fit for the future.
Right at the start, I want to address the individual case of Bethany, which Barbara Keeley rightly raised. On seeing the reports of the case in the media, I immediately asked for an investigation inside the Department, along with NHS England and the Care Quality Commission. This is clearly a distressing case—it was initially brought to my attention by Ian Birrell—and we will get to the bottom of it. More broadly, the number of in-patients is now down to 2,375, a fall of 17% from March 2015, including 600 who had previously been in hospital for five years or more. So there has been some progress, but there is clearly more to do and the hon. Lady was right to raise the issue.
I gave the House a statistic of 2,600. Bethany’s dad, who is campaigning on her behalf, wants to see her in a proper community placement, but there are thousands of Bethanys. This is a serious matter. We had a debate here on transforming care a few months ago, but very little has happened since.
As I said, progress has been made. There has been a reduction of 17% in the number of in-patients—down from 2,875 in March 2015 to 2,375 on the latest figures—but I would fully acknowledge that there is more to do and I am determined to see that happen.
Our population is ageing. More people are living longer and, as a society, we must address the challenge that that creates for social care. To put that into context, over the next 25 years, the number of people aged 75 and over is set to double and the number of people aged 85 will rise by more still. Of course, this is good news. It is down in part to the hard work of our NHS. Cancer survival rates are at a record high and strokes are down by a third, but with such successes come new challenges. For instance, we are seeing a rise in dementia and in age-related conditions, with 70% of people in residential care homes now suffering with dementia.
Will the Secretary of State agree to support a dedicated dementia fund, as proposed by the Alzheimer’s Society, to recognise the inequity given the additional care costs that such people would be paying?
I have seen that proposal from the Alzheimer’s Society and we are looking at it now. At the same time, we are working on both the Green Paper for the future of social care, which will come before the end of the year, and the long-term plan for the future of the NHS. The interaction between the two is important.
Does the Secretary of State accept that there is actually a lot of support on the Government Benches, the Opposition Benches and, indeed, across the country for the Joint Select Committee’s proposals. The concept is that, if everyone who can afford it pays something, that means that no one has to lose everything, and that is not only worth while, but urgent.
I will come on to the proposed funding reforms. My hon. Friend is right that there is support for reform across the House, but there is support for different types of reform in different parts of the House. I respect the shadow Opposition spokeswoman, but it would help if she could bring more clarity to the Opposition’s position, updating the proposal that they put forward in 2010, which I will come on to in some detail. That will help if they want to genuinely contribute to this debate.
Of course, social care is not only a challenge of old age. The number of people of working age with care needs is also growing. Many of us in this House will know the pain and difficulty of helping a loved one who needs constant care or faces dementia. Such pressures bring long-term challenges, and we must ensure that both the NHS and our social care system can respond to the challenges we face.
There is an acute nursing shortage in this country. According to the CQC, nursing homes may need to re-register as residential homes, possibly due to the difficulty in recruiting enough nurses, which would have disastrous consequences for some of the country’s most vulnerable old people. With the looming prospect that Brexit will further restrict our ability to recruit nurses from Europe with the necessary skills and talent, does the Secretary of State agree that he needs to do everything he can to ensure that the nursing home sector does not collapse?
There are more nurses on our wards than in 2010, but it is important that we have more in the future, and a whole run of work is going on to ensure that we can get more nurses right across the NHS and the social care system, including community nurses. As we put £20 billion extra into the NHS, we are going to need more nurses as a result. The nursing associate route is now available in social care, and there is a policy programme to try to ensure that we answer the exact question that the hon. Lady rightly identifies.
In the light of what my right hon. Friend just said about the long-term nature of the challenges, may I put to him the question that the Chair of the Health and Social Care Committee put to the Opposition spokeswoman? Does my right hon. Friend agree that the only way to get a decent long-term solution for all the people who will need social care is by doing so on a cross-party basis with a wide degree of consensus?
I pay tribute to my right hon. Friend’s work in this area. He is incredibly thoughtful and has been prepared to ask some of the difficult questions and give his answers to them. I agree that this is something that we should take forward on a cross-party basis wherever possible. I will come on to the long-term funding in a moment, but I just want to address directly the question of short-term funding.
I query the Labour party’s motion because 80% of local authority funding was reliant on the central Government grant in 2010, and that is no longer the case. Looking only at the central Government grant is an inaccurate way of assessing the question. For instance, we introduced the social care precept directly to address some of these costs. It would be far better if this debate took place in the context of the available budget for social care, which is increasing by 8% in real terms over the four years from 2015-16 to 2019-20. The debate should be based on facts rather than partial facts, and that is how I will seek to proceed.
Quality is important, too, and 83% of adult social care settings are now rated good or outstanding by the CQC. The figure has risen from 79% in just the last year, and it is the highest since measurement started in 2014, but I want to see it rise further still.
The links between the social care system and the NHS are important, too. No one should stay in hospital longer than necessary.
My right hon. Friend is right to highlight the link between healthcare and social care. If we are to care properly for people with the long-term conditions he has outlined, we need to have a more joined-up and integrated system. It is hard to deliver that when we have a taxpayer-funded NHS and a social care system in which many people now have to pay for their own care. In looking for a cross-party solution, which he is open to, will he consider that we may need to look at a taxpayer-funded solution for funding social care so that we can deliver the transformative integrated care we want for older people?
Part of the social care system is, of course, tax funded, but I also value the contributions that people make to social care. They are an important part of keeping the system strong. We dismiss those contributions at our peril, but I agree with my hon. Friend that we need to make sure we get more funding and better integration between the healthcare and social care systems. We can do that with different funding sources, as long as we have better organisation on the ground.
We must make sure we have the appropriate amount of care available so that people can leave hospital at the right time; people should not have to stay in hospital longer than necessary, as it reduces their dignity and quality of life and leads to poorer health outcomes, as well as putting unnecessary pressure on the NHS.
Since February 2017, more than 1,900 beds have been freed up in hospitals by reducing NHS and social care delays, yet we know that the winter months bring increasing pressure on adult social care services, which can have a knock-on impact on hospitals. On top of the rising social care budget, we are providing an additional £240 million for adult social care capacity this winter, which will help councils to get patients home quicker and free up hospital beds for more urgent and acute cases.
Today I have published the allocation for every local authority in England, and the Barnett formula will apply to allocations in Scotland, Wales and Northern Ireland. Individual allocations include, for example, £1.3 million in Salford and £1.5 million in Leicester.
My constituents and my local council are thankful for the funding increase of £870,356, which will help the adult social care situation in Solihull. We have a lot of people over the age of 65, including 40% of the Silhill ward alone.
I am grateful for my hon. Friend’s work in making the case for more support for adult social care in Solihull, and to support the NHS in Solihull through that. I hope the funding we have announced today will help in Solihull, and the people of Solihull should know they have an excellent champion who has helped them to get that funding.
That is an interesting proposal, and I have seen others similar to it. We are looking at the link with housing as part of the Green Paper, and I have been discussing that with the Department concerned. The point the hon. Lady raises is important. I note that £731,800 has been allocated today to improved adult social care in York, to take the pressure off the NHS in York this winter. I hope that she will acknowledge that fact.
In Scotland, like in England, Wales and Northern Ireland, we have seen unbearable cuts to councils, which have made the problems of funding social care get worse. Does the Secretary of State agree that the Tories and the Scottish National party have to get a grip of the situation and give the councils more resources? They have given out figures for the Barnett formula. What is Scotland actually getting?
Through the Barnett formula, we have made available funding for Scotland today, which in England we are spending on adult social care. I very much hope the SNP Government in Holyrood will make sure they do the right thing by this funding and ensure that it goes to helping people get out of hospital when they medically can leave hospital but need care once they get out. I think we are agreed between us that the SNP Government in Holyrood should spend this money wisely.
I am keen to learn how much extra my constituency is getting, given that the Secretary of State is doing a roll call of all that. I also wish to ask him about the comments he made about the streams of funding for social care and healthcare. Is he proposing that funding would be ring-fenced? There is a concern that when we try to integrate the two, urgent healthcare will always come before social care.
That need not necessarily be the case. It was slightly disappointing that the hon. Lady, who is normally a great champion of cross-party working, did not welcome the £780,000 extra for Grimsby, but you can’t win them all. The people of Grimsby need to know that we are there to support them and to support their local NHS.
I will now turn to the long-term funding pressures. The lifetime care costs of a 65-year-old today are about £45,000 on average, but those total average costs that people face are not distributed evenly. Some people face no care costs at all, whereas the care costs for someone with dementia who lives into their 90s can run into hundreds of thousands of pounds. As a society, that is the challenge we face, yet right now there is no way to predict or insure this potential financial burden. We are committed to ensuring that everyone has access to the care and support they need. However, as has always been the case, that must be based on the principle of shared responsibility. With sensible planning, people should not have to fear the risk of losing everything. The adult social care Green Paper, which will be published later this year, will bring forward a range of ideas to address the long-term challenge. We want to learn from what has been proven to work, with one example being the auto-enrolment pension reforms, which have been taken forward on a cross-party basis over a decade. The rate of opting out has been remarkably low, and this has put in place the foundations for the strengthening of our pensions system over time. The Green Paper will propose a range of options and ideas, learning from both the UK and from around the world.
The Secretary of State has said that he wants this debate to be based on fact, not partial fact, so may I have his assurance that research behind the Green Paper has taken full account of overseas options, which provide insurance models and choice, taking us well beyond these simplistic more tax solutions to address this complex problem?
Yes; I enjoyed reading that report on my summer holidays and thought the research that underpinned it was very interesting. Of course, the taxpayer does contribute to the system, but we cannot rely only on the taxpayer to support the growing cost. Some people propose the answer that the taxpayer should simply fund everything, but I do not think that that is a valid solution.
Alongside the reforms to the funding, we need to transform our care system, so we will look into how the Government can support innovation and encourage new models of care provision. That will include looking at the role of housing and how we can replicate the very best models that combine a home with quality of care. For instance, I love the examples of combing care provision for the young and the old. I pay tribute to the doctors behind the “Old People’s Home for 4 Year Olds” project, which is good viewing on Channel 4. We also need to better support people through well-designed aids and adaptations, and we must ensure better support for carers, too.
The Secretary of State is making some good points, but may I press him on the point made by my hon. Friend Andrew Lewer about the social-insurance recommendation in the Select Committee report? The Opposition shadow Minister refused to confirm whether she would consider the findings in that report; will the Secretary of State agree at least to consider the proposals and recommendations that were delivered on a unanimous cross-party basis?
Yes, absolutely. I am considering them. In fact, I shall go further and say that I am attracted to the insurance and contribution model. There are many different potential details in how such a model can be delivered, but I am very much taking that Select Committee report into consideration as we draft the Green Paper.
Alongside ensuring that the funding is in place, we need to make sure that we support carers. In June, we published the carers action plan, a two-year package of support for carers to ensure that they are properly recognised, helped and valued in a way that supports their health and wellbeing. The Green Paper will go further and propose how society can strengthen support for carers as a vital part of a sustainable health and social care system.
The guiding principles behind the Green Paper will be sevenfold: first, improving the quality and safety of care; secondly, integrated care, with the NHS and social care systems operating as one; thirdly, giving the highest possible control to those receiving support; fourthly, better practical support for families and carers; fifthly, a sustainable funding model supported by a diverse, vibrant and stable market; sixthly, greater security for those born with care needs or who develop those needs in later life; and seventhly, a valued NHS and social care workforce. Those will be the principles behind the Green Paper, and I hope that we can build cross-party support for it.
As a society, we need to rise to the unprecedented social care challenge that our generation faces. For the sake of future generations, we must act now to build a better and more sustainable social care system, in the short term and the long term, that ensures that people are properly valued: a system both for those in need of care and for their carers, a system that supports carers—not only those who work in care homes but those who care for loved ones at home—and with the goal of building a sustainable health and social care system of which we can all be proud.
Order. I wish to manage expectations in this debate. By my calculation, I estimate that when we come to Back Benchers, there will probably be less than half an hour, so I will have to impose an immediate four-minute limit. Colleagues would be very popular if they kept to less than that, because others would be able to get in. Of course, that does not apply to the Scottish National party spokesperson, whom I am about to call. If colleagues want others to get in, I urge them to take even less than four minutes.
Here we are discussing this issue again when we discussed it just before the summer recess. That shows not only its importance but the fact that we are not making progress. We were promised the Green Paper last year. Then it was late last year, then early this year, then autumn 2018. I gently point out that it is now autumn 2018.
The five year forward view talked about managing demand in the NHS if there was an absolute game-changer of an increase in public health to try to reduce the demand at the front door of the NHS, an increase in funding and provision of social care to stop funding haemorrhaging out the back door of the NHS. Unfortunately, what we have seen over the past five years is ongoing cuts to social care. I am sure that the £240 million for the winter from the Secretary of State is very welcome, but it is not nearly enough, and we will just keep on having this debate unless we can move forward and have a serious debate around the Green Paper.
As was mentioned earlier, Age UK estimates that more than 1.2 million people are not getting the care that they require. Need has increased by almost 50% since 2010, and yet there has been a decrease of 26% in England of local authority funded places. One third of people needing care are totally dependent on their family. It is estimated that 6.8 million—that is one in 10 of the UK population—are involved in caring for a loved one, either full-time, part-time, or topping up care. Age UK also estimates that one third—700,000 people—receive no care whatever.
Despite an almost 9% cut in their budget, the Scottish Government spend £163 per head more on health than the UK Government—the Minister might actually want to listen to that, having made snide remarks about the Scottish Government—and £157 per head more on social care. Scotland is the only country in the UK that provides free personal care, and we have sustained that since 2002. That has led to less than one third of the increase in A&E attendances and emergency admissions in Scotland over the past five years compared with England. The system is really expensive and it is challenging, but it reduces delayed discharges and it reduces emergency admissions, and the estimate is that it is still cost-effective. I suggest that the Government might want to look at that in the Green Paper.
In my constituency, the Barchester Alexandra Court Care Home has closed, with 53 residents losing their places. That was because Glasgow City Council’s funding has been cut by 10%, yet the discretionary spend for Scottish companies has been cut by only 5%. Surely that is a disproportionate cut in social care in Scotland. Although the objectives are laudable, we have seen continued pressure on social care in Scotland as in the rest of the UK.
There is no question but that there is pressure. There is no question but that all the systems face the pressures of increased demand, workforce and money, but if the hon. Gentleman would like us to match funding down here, then we will remove £881 million from our health budget and, obviously, that £157 a head from our care budget. We spend more per head of population in Scotland—considerably more. [Interruption.] That is one of the mantras that is always heard down here, but may I point out that, for a Barnett consequential of 9.3%, the Scottish Government have to manage one third of the UK landmass—that is roads, rail, GP practices, hospitals and schools.
No, I am sorry, I will not give way. Members want to make speeches, but if they intervene on me, there will not be any.
In Scotland, we have been working for the past five years on integrating health and social care. I can say that it is an awful lot harder than the job that we did of integrating primary and secondary care, simply because one side is tax-funded and the other involves multiple private companies and is means-tested. We are already working on that. Our integrated joint boards manage one half of our health budget along with local authority funding. It is about shifting money from hospital into primary care, mental health, community care and social care.
There are three particular groups who need social care. The frail elderly mentioned by the Secretary of State, the number of whom will escalate massively in the coming 20 years, need support and comfort, and most of them would like to be at home. The home care hours in Scotland have doubled over the past seven years, which allows people with more complex needs to be cared for at home, so as not to end up in a care home or to land acutely in hospital.
As was mentioned by Mrs Moon, who is no longer in her place, end of life is a critical issue; it is a point at which time is of the essence. Since 2015, all Scottish local authorities have provided free personal care to people defined as having a terminal condition—facing the end of life—even when they are under 65. The Government should look into such a measure, as it provides dignity.
Working age disability accounts for a huge chunk of social care funding. These people want to be mobile and to be allowed to participate in society, and it is important that that is what they do—that they are not just stuck away somewhere, as might have been the case many years ago. From April, under Frank’s law, which was named after the footballer Frank Kopel, under-65s with degenerative conditions, not just disability, will be able to receive free personal care. That includes people with early dementia and multiple sclerosis. We ask that the DWP does not then rob these families of that money by cutting other disability allowances.
I mentioned the workforce, which is an enormous challenge in the health service and one with which every local authority, integrated joint board, company and care home is struggling. Despite the workforce in Scotland increasing by 11% over the last three years, it is becoming harder to recruit. Brexit only makes that harder because a significant proportion of social care staff are from Europe.
We need to make social care a career—to be decent to carers by paying them the real living wage, not the pretendy one, and by paying them for all the hours they work, even at night. It is important to treat people with dignity if we want them to treat our loved ones with dignity. Carers should have job satisfaction from having time to care. Having 15 minutes to flit in and out does not provide job satisfaction, and it does not provide satisfaction or continuity for the patient or the carer. There needs to be a career structure. Caring should be looked upon like nursing, with training, investment and a way of staying in that career. It should not just be some job that people do until they get a job on the checkout at Tesco because that pays better.
We have talked about being able to discuss the Green Paper, but unfortunately there is no sign of it. It is meant to offer an opportunity to rethink care. The Nuffield Trust suggests looking at the Japanese system or the German system, which has already been mentioned. It is noticeable that levers have been built into the Japanese system so that demand can be controlled, and that means that eligibility may well change. On the plus side, the system is Japan is a holistic one and it looks at the global wellbeing of the older population—so if we do look at these other systems, we should look at them in their entirety.
The German system is based on social insurance. Well, does that not ring a bell? We used to have national health insurance, but then the “health” was dropped. Maybe we should think about whether national insurance should really stop when people retire. Perhaps we might set a level above anyone who is living only on the state pension, because there are pensioners who are very well off and who suddenly stop paying national insurance exactly at the point when their health, care and social needs start to increase. We need to look at all these options, but it is crucial that there are no sudden changes—that we do not have a WASPI situation, whereby the goalposts suddenly move with only a couple of years’ notice, and that we do not have a measure like the one in the Conservative manifesto last year that was then labelled the dementia tax.
We need to discuss this issue as adults, to look around the world and to look at the demands ahead. Older people and people with disability across the UK need to be able to live a life of decent quality, with dignity.
There are just 15,000 centenarians in the UK today, but the population aged 90 and over is growing rapidly. One in six people alive today—more than 10 million—will reach triple figures and get a letter from Her Majesty the Queen. Social care is at the heart of a system that must ensure that everyone can live a long and fulfilling life, and that is both an opportunity and a challenge. I welcome the Government’s action in this area, which is reflected by the Care Quality Commission’s conclusion in its annual state of care report that 82% of adult social care services are good or outstanding.
I commend the hard work of carers, professionals and management who work tirelessly every day to make sure that our loved ones receive the best possible care. That is certainly the case in my region. Across Hampshire, 26 of 28 care homes provided by Hampshire County Council are rated good or outstanding by the CQC. That includes, in my constituency, Malmesbury Lawn care home in Leigh Park. But we need to continue this success, and funding is an important aspect of that. I welcome the fact that the Government have given local authorities an extra £2 billion over the next three years to meet these challenges. I also welcome today’s announcement by the Secretary of State of the extra £240 million to help adult social care get through this winter. Hampshire will receive over £4.7 million, and that is extremely welcome.
However, it is clear that money is not the only issue that needs to be debated and is not the only solution to the challenge of a growing and ageing population. Only by embracing technology, as the fourth industrial revolution accelerates, can we keep more people out of care homes and in their own homes. Some local authorities are already moving forward at pace with ambitious plans to make sure that new technology plays a role in revolutionising social care. In my own region, Hampshire County Council has been at the forefront of the new wave of assistive care technology. That includes alarms worn by patients that can detect falls and epileptic fits, and even have GPS capability in case a dementia sufferer wanders from their care home. Around the county, 8,600 people benefit from supported by assistive technology.
The roll-out of such technology has saved the council about £7 million in domiciliary care and care home costs, so there is a financial benefit to it. Hampshire has also become the first authority to work with Amazon in trialling a new customised version of its Echo device to support people to live independently in their own homes, which should be one of the goals of the social care system. I commend the council’s Liz Fairhurst, the cabinet lead for this area. It is right that she has been shortlisted for the Local Government Association’s councillor achievement awards for this year. She has been a fantastic leader of adult social care services across Hampshire, and other county councils are following its lead.
The use of technology in adult social care is exciting and necessary. However, as I said in my Centre for Policy Studies paper published in May this year, we can make full use of all these technologies only if we end the culture of fax machines, pagers and paper in the NHS. Just as the NHS must go fully digital over the next 10 years, care homes, the care sector and local authorities must also be digital-first. That is the key to making sure that we can make the most of technology to help alleviate the challenges of adult social care in the years ahead. As the baby boomer generation ages, we have a new generation of tech-savvy pensioners who will be going through our care system for the first time. They will be a generation comfortable with new technology and willing to embrace digital care.
I understand that the pressures on the care system are not just financial, and that technology is not a silver bullet, but by deploying technology we can unlock savings, alleviate funding pressures, keep more residents in their homes, and deliver a better service. I hope that these aspirations will be reflected in the Secretary of State’s Green Paper when it comes out in the weeks ahead.
This year is the 70th anniversary of the NHS. It is also the 70th anniversary of our social care system—but that has received far too little attention to date. It is not getting any of the national celebrations—the birthday cakes and cards—and certainly none of the £20 billion birthday present that the NHS received from the Prime Minister.
Yet social care is more important than ever before. A quarter of older people now need help with daily living—getting up, washed, dressed and fed. More adults with physical and learning disabilities need substantial packages of support. There are 1 million paid care workers and 6.5 million unpaid carers. Yet despite the fact that this touches so many people’s lives and that there is an increasing demand, we have no sense from the Government of the reality of the situation. There has been a 10% cut in real terms in social care spending, with 400,000 fewer people getting any kind of help and support. A third of carers have to give up their job or reduce their hours to look after their loved ones, and a quarter of the paid care workforce leaves every single year. There is nothing from Government Front Benchers—no sense of the urgency of the challenge we are facing.
We cannot solve this problem without substantial extra funding. The Health Foundation says that we need £6 billion just to maintain the current inadequate system. It is not good enough.
Over the last 20 years, we have had 12 Green and White Papers and five independent commissions, but we have not solved this problem, and we need to understand why. Most people think that they are not going to end up needing this support. When they end up needing it, they do not realise that many of them will have to pay. They think the current system is unfair, but when radical proposals have been put forward for how to fund the system, they believe that those are unfair too.
This issue has been a political football. Labour was accused of imposing a death tax, and the Tories were accused of imposing a dementia tax—but it is not the politicians who suffer; it is the people who use the services and their carers. We cannot go on like this any longer.
I believe that one of the reasons this issue has not been solved is that much of it is about low-paid women who work in people’s homes and care homes invisibly. Caring is not valued, and we have to change that.
My hon. Friend is making an excellent speech and is an expert in this area. She is right; the language we have heard today is all about the challenges and the costs. This is an infrastructure issue, and it needs to be treated as such. Because women lead this workforce, it is not considered an infrastructure issue, and if we did that and changed the language around this, we would have a completely different debate. Does she agree?
I absolutely agree. If a third of parents had to give up work or reduce their hours because they could not get childcare, it would be a national scandal. We need to make social care as much a part of our economic infrastructure as childcare, and we have to wake up to that.
The reality is that we face a choice: either we leave individuals to pay for care, through no fault of their own, with only the wealthy able to afford to put aside extra money—the idea that a “care ISA” will solve the huge challenge of social care is, quite frankly, ridiculous—or we pool the costs and share the risks for a fairer and more equitable and efficient system. My view is that we have to look at the contribution of wealthier older people, not just the working-age population who are already struggling with so much of the cost of daily living.
Alongside extra money, we need real reform. We have to change and improve the way we offer care and support, to give people more choice, say and control and to ensure that care is personalised and flexible around the needs of individuals and families, not just one size fits all. We have to shift the focus towards prevention and early intervention and promoting genuine wellbeing. We have to put people who use care and have lived experience at the heart of the system, in terms of both policy and delivery. That is what has to be in the Green Paper. I cannot believe we are still without it. The Government need to get a move on and take action.
It is a pleasure to follow Liz Kendall.
Two years ago, Greater Manchester became the first region in the country to have devolved control over its health and social care services, with a significant budget of £6 billion. My constituency sits in the Stockport Council area, which is one of the 10 local authorities in the combined local authority. Greater Manchester is home to almost 3 million people, with a thriving economy bigger than that of Northern Ireland or Wales, yet life expectancy ranks among the lowest in the country, and figures vary significantly across the 10 boroughs of the region. There are differences even at ward level. For instance, in Bramhall South and Woodford in my constituency, men and women live 12.4 years longer than someone living only 5 miles across the borough in Brinnington and Central.
The rising number of older people across the country means that there will be a greater need for health and social care support in both the short and long term, and we have to approach this in different ways. In his speech last week, Mayor of Greater Manchester, Andy Burnham, indicated that a unique opportunity for the region is
“to integrate health with everything—early years, education, community safety, housing and employment.”
Successive Governments have long argued for that, and only recently are this Government the ones that are tackling it.
To provide effective support and truly implement integrated services, we must enable care to move out of hospitals and into communities, closer to where patients want to be—in their own home. The hospital transfer pathway, more colloquially named the red bag initiative, is already proving to be an effective tool in that regard, and care homes in my constituency have been chosen to pilot its effectiveness. The red bag holds standardised information about a patient’s general health and existing medical conditions. Most importantly, it clearly identifies the patient as a care home resident. This means it is possible for the patient to be discharged sooner; the care home is able to support the resident, and the knock-on effect is to ease the pressure on hospital services and to free up beds.
At this point, may I welcome the £1.28 million that will be given to Stockport Council in social care winter funding? Since the devolution settlement two years ago, Stockport has striven to create a more person-centred health and social care system. An extra £41 million is being spent on GP practices by 2021 to make it easier to see medical professionals at convenient times.
Nationally, GPs spend at least a fifth of their time on non-medical issues. In Greater Manchester, we have identified the need to address health through other means—specifically, social prescribing. It is a relatively new innovation in the health service. It is a means of enabling GPs and other frontline staff to refer people to services in their community, instead of offering only medicalised solutions. These services range from gardening to walking or arts and leisure. As a direct result of social prescribing, evidence suggests that there have been 28% fewer GP consultations and 24% fewer A&E attendances. Research also indicates that 90% of health problems are affected by the patient’s wellbeing. Social prescribing has been described as “absolutely fabulous” by one patient, who has said that
“my whole perspective of life has been changed!”
Through Stockport Together’s programme, the borough has developed a collective local approach to improving health and care outcomes aligned with the overall Greater Manchester strategy. I appreciate that there is no one-size-fits-all approach to addressing social care, but by partnership working and working together, we can address this issue and deliver the social care that people want and deserve.
Nothing brings home the reality of the problems we face in social care like the experience of our constituents. A month ago, I was contacted by the son of a constituent. His mother, who has Alzheimer’s, had a care package in place that was working well and she was being kept at home. However, she also has heart problems and, sadly, she was admitted to hospital, via A&E, some weeks ago in July. He told me that she is now well enough to leave hospital, but her care package cannot be reinstated. She certainly could not go home without support, and he was becoming increasingly frustrated at the lack of a care plan. He feared that the longer she stayed in hospital, the worse her overall health would become. He found that totally unacceptable, and I have to say I did too, and I immediately took up her case with the local authority. Officers looked into this case and found that, yes, despite the best efforts of the social work team, it had not been possible to find a provider to fulfil my constituent’s needs. Other people are also waiting for a care package, as providers cannot be found quickly. Like her son, I find this an appalling situation.
I tell this real-life story not to tug at the heartstrings, but because it reveals a few of the problems we have with the current social care system. My constituent has high needs due to her physical and psychological conditions. She was fortunate—pre-hospital admission—to have an established care package that worked for her and helped her to live independently. We know that there are many people across England who have unmet needs. They are unmet because the funding is not there to give them the help they need and that local authorities would wish to give them. This cannot be right.
The case reveals very clearly another problem in our social care system—the fragility of the home care market in many parts of the country. What a state we are in when we cannot find people willing to provide help to those who need it; when providers are unable to run a business employing people who will do that job; and when the price local authorities are able to pay is set at too low a level to provide any service at all. I want to make it clear that I want to see our social care services directly provided by local authorities to restore such control.
The case also reveals another problem with our social care system, that of not treating our social care workforce with dignity, respect and, yes, providing them with decent pay and conditions. These staff look after the most intimate needs of our most vulnerable people, and the least we can do is give them a level of pay that recognises the skills they need. To do that, we need a plan for social care. We need more money to provide the care that people need to remain independent and to help people at an earlier stage. We know that earlier intervention works and reduces pressure on the NHS.
As we approach the Budget, I call on the Minister to ensure that local authorities have the funds they need to provide that care. An extra £240 million will not put things right—and yes, I know how much it is in Gateshead; I have looked it up. It is just another piece of string trying to hold together our pressurised social care system. I also call on the Minister to talk to local authorities and our trade unions about establishing a pay system that recognises the importance of working in social care and the skills involved. In short, we need a thoroughly thought-out and resourced national workforce strategy for social care.
Owing to time constraints, I cannot talk about residential care, but we need to resolve the sleeping situation. I am aware that there is an appeal, but those staff deserve to be considered and paid properly.
It is a great pleasure to follow Liz Twist, who made a very good speech. It is a shame that we have such a short time to debate this, because it is one of the key issues of our lifetimes and will impact all of us in many different ways—it is impacting my life. I am absolutely blessed with the most wonderful in-laws, and I am saying that not just because I am having dinner with my wife in an hour, but because, frankly, they are absolutely golden people. We are dealing with issues of social care as a family, often from far away. The challenges, which are multifarious, varied and deep, affect every part of our life in ways that cannot be understood until one is in that situation.
We are part of the sandwich generation, and my town is at the frontline in that respect. We have an ageing population. I was told by a member of my staff that we have an older population than Eastbourne—I am not sure what that is supposed to imply, but we do. According to Solihull Council, by 2036 one in four of our population will be over 65 and fully 5% will be over 85.
Time and again I encounter on the doorstep what Age UK has dubbed the “silent crisis”—people quietly trying to look after elderly loved ones behind closed doors. They often do so just out of pure love and decency, and often they have care issues themselves. My experience, from knocking on some 30,000 doors across my constituency and from my family, has driven home how essential it is that Members on both sides of the House, despite dogma and party politicking, try to come to a long-term solution. We have to work together to find the bold solutions needed to put social care on a stable, sustainable footing. That is why I welcome the report from both Select Committees. Many of its recommendations make a lot of sense. It is essential that we accept that this problem cannot be met with a patch-and-mend approach, yet providers and local authorities need support to ensure that the level and quality of social care provision match the need in the short and medium term. However, unless these measures are accompanied by a serious root-and-branch strategic review of how we fund and deliver social care services—one that recognises that many of the problems currently facing the sector are not down merely to insufficient funds —they will provide, at best, only a temporary reprieve.
That is the challenge we all face. We will have to debate this for many years to come, but we have to get there. We owe it to our kids; we owe it to our parents.
I want to make a brief contribution, picking up on the excellent contribution by my hon. Friend Liz Kendall. The Minister said earlier that he sent money out to various local authorities, which is welcome, but frankly it is a sticking plaster. It would have been great if he had come and said, “I have heard the outrage and frustration across the country about the number of people who have to stay in hospital because there is no social care for them, people who have inadequate care and people who cannot get the care their deserve, and I am bringing a Green Paper to Parliament today. I will ensure that it is looked at and dealt with as a matter of urgency, and then I will bring a White Paper. We will actually grasp the nettle and sort this out.” Julian Knight, unless I misheard him, rightly agreed. Unless we get a hold of this issue, this debate will happen again in six months, a year, two years and three years.
The Secretary of State challenged my hon. Friend Barbara Keeley on parties working together. If he has read our manifesto, he will have seen that, before it says how we are going to spend the money, it says that we commit to working on a cross-party basis to sort this out—it says it in the manifesto. But people have to mean what they say. It is no good all of us in the Chamber saying that we agree if, the first time a shadow spokesperson or a Minister gets up and says something, people decry it. That will not work and we will, in the end, let the people of this country down.
That is what I wanted to say, Madam Deputy Speaker. People are raging about this; Parliament should be raging. The Secretary of State and Ministers—they are Ministers of the Crown—have it within their power to get it sorted. That is what this debate and this Parliament is saying to the ministerial team today: let’s get this sorted. The people out there deserve it.
To try to get as many people in I am imposing a three-minute time limit. If people can take less than that, that will obviously help.
In light of that, Madam Deputy Speaker, I will be as quick as I can. I will make two quick points.
One point that has to be made—I am sorry—is that in every debate on this issue, those on the Labour Front Bench bang on about cuts to local authority spending in the 2010 Parliament, which we accept, and which have been followed up, since 2015, with higher spending. But what did the Labour manifesto promise in 2010? This is absolutely critical. It promised to:
“protect frontline spending on childcare, schools, the NHS and policing”.
It did not protect local government spending. It went on to say:
“We will drive forward our programme to strip out all waste…We recognise that investing more in priority areas will mean cutting back in others.”
Labour would have cut local government spending, the same as we did. And what did it say about how it would pay for its reforms to social care? It said that they would be paid for
“through savings and efficiencies in the health budget and in local government.”
There is no parallel universe in which where would have been billions more to spend on local government under Labour.
On a far more positive and constructive note, I have one key point on long-term spending that I would like to make to my hon. Friend the Minister. I agree with my hon. Friend Kevin Hollinrake, who has made the point many times about the German system. He has said that we should have more of an insurance-based system for those in the working population. The key issue relates to those who are retired and have assets. My request would simply be for there to be a choice. For example, there should be a choice between relying on your assets if you wish to take that risk, or paying some kind of lump sum or similar insurance fee, which could even be taken from your estate, so that you would be covered. You either share the risk or take the risk. I think that that is a very fair principle. I am not going to say any more than that or take any interventions, because of the time and because I know that others wish to speak. We need to have choice in the system for those with assets.
I thank the shadow Secretary of State for mentioning my constituent Joyce, who has literally become the face of hundreds of thousands, 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?”.
Why are people like Joyce being so badly let down? In my opinion, the answer ultimately lies in the marketisation of adult social care. It has been characterised by stealth over four decades, initially as a limited initiative to improve choice and create a competitive mixed economy, and then to the virtual elimination of public sector provision. There has been growing tension between the need for private companies to sustain a profitable business and the needs of vulnerable people for care and support. Local authorities have had an almost impossible task with ever-stretched budgets and they have been reduced to the role of commissioning authorities. What does this result in? Money matters; people’s care does not.
Due to a lack of access to the care system for members of the public, people who pay for their own care, often at very high prices through their homes, their life savings and their pensions, subsidise both state-funded residents and the state. Despite that, the care market in England is highly unstable because of the significant cuts to local government budgets and the growing role of private companies operating business chains based on high risk financial models. We have already seen failures of care homes in my constituency. No serious thought has been given to how to deal with this prospect and the policies that have been introduced are too insubstantial to make any real difference.
I also wish to touch on the sleep-in crisis, on which I, like many others, campaigned for justice. In July 2018, the Court of Appeal delivered a ruling that was a hammer blow for thousands of careworkers who work sleep-in shifts. The Court denied these workers the hourly minimum pay that is the very least that they deserve. In the aftermath of that ruling, Unison—and I—made a commitment to those careworkers and everyone affected that we would keep fighting for what is right. Everyone who understands the work of careworkers knows that sleep-in shifts are working time, so they must be paid that way. If someone is not allowed to leave their place of work, are obliged to be away from their home and family, and are up and down all night caring for those in real need, they are at work and should be paid for it.
The problems in social care are clear, and Labour Members believe that now is the time for action rather than further reviews and more consultations. We will build the national care service that this country deserves: a needs-based compassionate service that provides dignity in later life and promotes independent living for working-age adults with disabilities; that is based on people and not profit; and that, like the NHS, is seen as a wealth creator and not a burden.
A former US President once said that there are no easy solutions, but there are simple solutions. What we need to solve this problem is a simple, scalable and sustainable solution.
Ideally, when people look for a solution, they try not to invent a new one but to find one that somebody has already used for that problem. That is exactly what the Joint Select Committee inquiry did. It looked at the German system. We looked at it twice, in our earlier report and in the joint report between the Health and Social Care Committee and the Housing, Communities and Local Government Committee. We looked at it cross-party and unanimously came to the conclusion that this was the right solution for us. It is a social insurance, not a tax.
Dr Whitford mentioned that national insurance would be a suitable vehicle. National insurance went the same way as every other hypothecated tax—it was spread around general taxation. That is not the right way; it must be separated from Government.
This solution is simple and scalable. It is not easy, but it is simple and cross-party, and I very much hope that both the Opposition and the Government will support it.
I pay tribute to the work not just of the social care workers in my constituency, but of the ambulance service, with whom I recently spent a day on a shift. Over about 10 hours, we saw a mere four jobs, thanks to the geography of Lincolnshire. Three of the four jobs dealt with the consequences of people needing a different social care package from that which the current system is able to provide them with. We need to see the White Paper, but when we look at the reform of the current system, we need to work with the ambulance service, the police and crucially to bear in mind that this is not simply a problem of ageing. One of the three jobs I mentioned that were about social care support involved a mental health issue. In the current set-up, we are not dealing with the respite care and social care needs of people with mental health problems as well as we are dealing with physical problems. I appeal to the Minister to pay tribute in her closing remarks to those workers—I am sure that she will—and to look at this system in the round.
I will be very quick, given that the Front Benchers are waiting to speak. This is a key debate for Torbay, and I particularly highlight the experience IN Torbay of integrated health and social care. Pooling budgets between the council and the local NHS is making a difference. It is a model that needs to be looked at and adopted across the country. Hopefully, given that this is such an issue for my constituency, I will have more than 30 seconds to contribute to a future debate, but at least we have had some time for this issue today.
I begin by thanking hon. and right hon. Members for their contributions from across the House. It is the convention to mention Members by their contributions. I apologise that, because of the time restrictions that have been put in place, that is not possible.
I pay tribute to all who work in our social care services, whether they work in the NHS or our councils or are paid or unpaid carers. We have been here before. I have a sense of déjà vu. It was in April that we called for immediate action from the Government to address the crisis in social care, yet here we are, months later, and no progress has been made. Since then, we have had a new Health Secretary and a new Communities Secretary, but still no new ideas and still no Green Paper. There is only so much longer this sector can wait.
Given the lack of support from the Government, and in the face of year-on-year cuts, local government has been forced to step up. With the Cabinet too busy squabbling among themselves and in the absence of any Government action, the Local Government Association has published its Green Paper on social care. It is worth the Government considering some of the responses that the consultation received. According to the District Councils’ Network, the
“adult social care crisis is the single largest problem facing local government services and their financial sustainability”.
Absolutely. I am always happy to visit my hon. Friend’s city of Bristol and to see the great work it is doing in very difficult circumstances—Labour local government leading the way and making a difference where it matters.
The LGA estimates that adult social care services face a £3.5 billion funding gap by 2025—just to maintain existing standards of care—but councils in England receive 1.8 million new requests for adult social care a year, the equivalent of almost 5,000 extra cases a day. It is a national scandal. The Government should feel ashamed that 1.4 million older people are now not getting the necessary help to carry out essential tasks, such as washing themselves and dressing. That is 20% more people without care than only two years ago. One of the people experiencing adult social care said of their provision:
“I haven’t washed for over two months. My bedroom floor has only been vacuumed once in three years. My sheets have not been changed in about six months and my pajamas haven’t been changed this year. My care workers don’t have time for cleaning, washing or changing me”.
Those words were taken from a report by the Care and Support Alliance into the state of care in the UK, and it makes for heartbreaking reading, but we have yet to see a Minister even acknowledge that a crisis in local government funding even exists. “We introduced the social care levy”, said the Secretary of State. No, they enabled councils to raise more council tax in a limited way, but a 1% increase in his council’s council tax raises a very different amount from a 1% increase in my area. That only widens the inequalities and the unfairness.
The Secretary of State’s big announcement at the Conservative party conference of an extra £240 million of emergency funding for adult social care should not be celebrated; it should be a source of shame. The Conservative leader of West Sussex Council summed up the response to the announcement:
“I am not skipping round—I am really cross about it. It’s half a crumb. It’s not even a crumb.”
Earlier this year, the former Secretary of State for Health made a candid admission to the British Association of Social Workers, when he accepted his share of responsibility for the lack of progress since the Tories entered government in 2010. The crisis is a result of this Government’s policies. Our Prime Minister has given up and our councils are at breaking point, but the Government remain committed to their programme of cuts, taking £1.3 billion extra funding out of local government next year. Let that sink in for a moment. It is now being reported that nearly 50% of council heads are seriously worried about impending bankruptcy in their councils, which should send shivers down the spines of members of the Government. One of the chief executives surveyed by the Local Government Chronicle said:
“The next three years are secure if we can manage the demand in adults and children’s services...a complete lack of policy means that even with a well-run council and relatively strong local economy we are likely to start to significantly struggle in 2021/22.”
That is the reality, and that is why I commend our motion to the House.
In the very limited time that is left to me, I will begin by thanking all the Members who have contributed to the debate. Unfortunately, I shall not have time to name them all, but I want to address some of the points that they have made. I want to reaffirm our commitment to the social care system and to ensuring that it is fit to face the challenges of the future. I also want to look ahead to the Green Paper. Most of all, however, and most importantly, I want to pay tribute to the amazing hard work and dedication of the people—both those in the social care workforce and informal carers—who play such a vital role.
A number of Members, including the hon. Members for Leicester West (Liz Kendall) and for Gedling (Vernon Coaker), made points with which I agreed about the importance of cross-party working and not using this issue as a party-political football, but I disagreed with the claim made by them and others that we are complacent. We are absolutely not complacent. We absolutely recognise the need to act. It is because of the Government’s prudent actions that overall funding for social care in 2019 will be 8% higher in real terms than it was in 2015. But we also know that there are short-term pressures on local government in particular. That is why we have given councils access to up to £9.64 billion more dedicated funding for social care over the three years up to 2019-20.
Today the Secretary of State reiterated his recent announcement that the Government would provide £240 million for additional adult social care capacity this year, but that is far from our only contribution to the sector. Since 2017-18, we have been able to allow councils to raise their council tax by up to 3% per year, specifically to help them to respond to the pressures facing adult social care. Those additional resources will help councils to commission care services that are sustainable and diverse, and offer sufficient high-quality care. We have seen a real difference in services across the country. We have also discussed winter resilience and allocated £145 million to NHS trusts to upgrade wards and procure beds.
As we have made clear today, the funds that we have already put into the system have stabilised the market and enabled councils to respond to the short-term pressures they are facing, but we are aware of the future challenges faced by the care system, and our Green Paper will also present proposals designed to make our social care system much more sustainable in the long term.
The motion refers to cuts amounting to £1.3 billion. That is wrong. It is entirely misleading to refer only to the revenue support grant when councils have access to council tax, business rate retention, the social care precept, and other funding to deliver their local services. It is right that more of our money that is spent locally is raised locally. In 2010, councils were 80% dependent on Government grants; by 2020, they will be largely funded by council tax and other local revenues. We have been backing councils in England with £200 billion for the delivery of local services in their communities between 2015 and 2020. This year’s settlement includes a £1.3 billion increase in the money available to councils over the next two years, which means that they will have more money to enable them to deliver for their local communities.
The motion claims that 1.4 million older people have unmet needs. By passing the Care Act 2014, the Government established a national threshold that defines the care needs that local authorities must meet—and they can exceed it if they wish. That eliminates the postcode lottery of eligibility across England.
The Secretary of State has announced that the workforce is one of his top three priorities, and he is keen for us to find ways to support staff better and make it easier for them to work in the NHS and social care. To improve engagement, we have launched an online platform, “Talk Health and Care”, to give support workers an opportunity to interact with the Government. We are also launching a recruitment campaign this autumn to raise the image and profile of the care sector. We continue to work with our delivery partner, Skills for Care, to provide a range of resources to attract, train and retain the brightest staff.
The Government are absolutely committed to a social care system that delivers high-quality care for all, and we hope that the Green Paper on care and support that we will publish later in the year will be a catalyst for debate.
claimed to move the closure (
Question put forthwith, That the Question be now put.
Question agreed to.
Question put and agreed to.
That this House
notes that eight years of Government cuts to council budgets have resulted in a social care funding crisis;
further notes that 1.4 million older people have unmet social care needs;
notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis;
recognises with concern the increasing funding gap for social care;
further recognises that proposals from the Government to invest £240 million will not close that gap;
and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.
On a point of order, Madam Deputy Speaker. Yet again the Government sit on their hands and refuse to vote on a key social care motion. We have heard in this debate some moving cases of people whose lives are being damaged by the crisis in social care, but no solutions from the new Secretary of State for Health and Social Care. We do not need more warm words; which we have just heard from the Care Minister and other Ministers. We need action to close the funding gap. If the Government disagree with our motion, they should have the guts to vote on it, and shame on them for not doing so.
The hon. Lady has put her point of view on the record. As I am sure she knows, there have been undertakings by the Government that in response to situations like this there will be a report back to the House at a future date, and I am sure those on the Treasury Bench will have heard the points made.