Local Government and Social Care Funding

Part of the debate – in the House of Commons at 3:48 pm on 24th April 2019.

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Photo of Marie Rimmer Marie Rimmer Labour, St Helens South and Whiston 3:48 pm, 24th April 2019

The focus of my speech will be the stark reality that adult social care faces today. I doubt anyone here—actually, I am absolutely sure that no one here—would argue that adult social care is not an incredibly important issue. Many of the most vulnerable people in our society rely on social care to provide them with dignity and a life that is not just a bare existence, but one worth living. Indeed, many of our vulnerable people look forward to their only visitor of the day being from the social care or health services.

It pains me to assert that social care in this country is failing, but up and down the United Kingdom, the actions of Conservative-led Governments since 2010—I will speak a little bit about that later—have left our social care provision tending to a state of disrepair. If action is not taken, that could lead to a collapse in social care provision. The Government must recognise that the demographics of our nation have changed and continue to change, and as we make advancements in medicine people in our nation are living longer.

The National Audit Office estimates that between 2010-11 and 2016-17 the number of people aged 65 and over in need of care increased by 14%. Indeed, that demographic shift can be seen in my constituency, where the percentage of over 65s will more than double in four years, between 2017 and 2021. That is in addition to the increase in the number of people with learning difficulties and dementia.

That pressure is being admirably handled by the men and women who work in our care industry. However, that workforce are low paid, with sick pay and pensions not even being universally delivered. Is it any wonder that the industry has a turnover rate of almost 34%? For those who stay in the workforce, there is a severe lack of training and development, in large part due to a frankly unacceptable lack of investment, which is laid bare when compared with the equivalent spending in the NHS. The lack of investment in and pay for our care professionals has left a chasm in social care staffing. The Care Quality Commission report, “The state of health care and adult social care in England”, highlights an adult social care vacancy rate of 15%. That means that 110,000 nurses, health professionals and social workers are not in place to do the severely needed work.

Unpaid carers provide an estimated £132 billion-worth of care each year. There has been a systemic unloading of responsibility by central Government on to local authorities. Legislation such as the Care Act 2014 has increased local authorities’ responsibilities in areas such as deprivation of liberty safeguards, the independent living fund and transformed care services, to name a few, without the funding necessary to deliver them.

The situation is further exacerbated by the continued delay of the Green Paper on the future of adult social care funding, following the proposals and recommendations of the Dilnot report. Until it is introduced, the future funding arrangements remain unclear. Despite that, my local care providers continue to deliver outstanding adult social care, with St Helens Cares receiving the Municipal Journal award, and Kershaw day centre winning the Dementia Care Matters award. Imagine what they could do if they actually received the funding they require. St Helens Cares truly integrates social care and health; it works with one pack of records and everything is integrated in one building. People remain at home and go to hospital only when they absolutely need to. It is a joy to see and we can prove—we have the evidence—that in just a few months that approach has reduced by 7.5% the number of people going into hospital.

My final point, which has been a common theme throughout my speech—indeed, it has been raised by many others—relates to funding. Since 2010 local authorities have experienced real-terms decreases in their core grant from central Government, which in turn has led to expenditure on adult social care falling by almost £1 billion between 2010-11 and 2016-17 and onwards. That has forced local authorities to choose between delivering either their social care responsibilities or their other commitments, as outlined by the “Long-term funding of adult social care” report.

I am sure that the Government will retort that they have made commitments to increase adult social care funding, such as the short-term funding measures of the additional £9.4 million between 2016 and 2020. However, as the Local Government Association told the report inquiry, those mechanisms have a number of limitations. They also fail to deal with the short-term issues facing adult social care, let alone the long-term issues.

The better care fund provided just over £13 million between 2011-12 and 2019-20. That is not to be sniffed at, but it is not enough to cover demand as a result of demographic shifts. To put it simply, the additional funding provided by the Government is like a sticking plaster on a gaping wound. It will not stop the bleeding and it will not help it to heal.

There has been a 1.4% decrease in nursing homes, and 32% of directors of adult social care saw homecare providers close or stop trading just six months before the “State Of Adult Social Care Services” report was published by the Care Quality Commission. The number of people receiving publicly funded care fell by 400,000 from 2009-10 to 2016-17. It is estimated that 1.2 million older people may now have unmet care needs—this has had a knock-on effect for the NHS, although in some places it has not been as hard as in others because, quite frankly, working together does work—leading to a delay in transfers of care out of hospitals and an increase in admissions as the lack of adequate care can lead to health complications. The issues facing adult social care are grave. There are solutions, however.

First, I call on the Government finally to face the facts and tackle the underlying issue of adult social care and make significant funding increases. As stated in the evidence given to the 2018 report, “Long-term Funding of Adult Social Care”:

“Before further reform of the system can be contemplated, the funding gap must be closed.”

We need to stop the uncaring austerity measures that have been forced on the country since 2010. And may I bring this to the attention of those who are not aware of it? There was a global financial crisis in 2008. It went right across the globe. It was not the Labour Government. In fact, Labour did get the economy going here before the Conservatives took office with the Liberals. So it was not Labour. In fact, that Labour Administration paid off more debt than any other previous Government on record—debt we inherited, Members might be surprised to hear, from the Conservatives.

St Helens does receive funding from the Government—short-term funding. We cannot refuse it. We want it and we need it. We have £8.3 million from the better care fund, but what is going to happen next year, in April 2020? Do we know that yet? Funding only goes up to April 2020. What will happen if £8.3 million is taken from St Helens? That is 17.5% of our total social care budget. Other councils will be suffering similar impacts, so what is going to happen to social care?

Secondly, let us follow the example of St. Helens Cares and others—Salford Together is superb. Such initiatives, however, need support. They involve, in large part, the integration of social care and health. That does help. It is certainly a much better experience for the recipients of the service, the members of the public. They do not want to go into hospital; they would much rather stay at home, with support. There are teams based in hospitals providing a single point of service, reducing pressure and providing an almost seamless transition from health care to social care. That truly is working together. We need more support to help us achieve that and sometimes that means a little bit more financial help.

The Government have renamed the Department of Health to the Department of Health and Social Care, but I fear this change in approach has been in name only. I call on the Government to link health and social care truly—not only by administration, but with regard to workers’ rights, training and financing—to deliver the social care that the people of this nation need and deserve. I call on the Minister to go back to the Department, to talk to the senior people above him and to get them to truly integrate and provide the necessary finances. There is no need for austerity—certainly not for social care.