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My Lords, I thank my noble friend Lord Smith for securing this debate. I confess that I am not one of the usual suspects taking part in this annual event, nor am I an expert in local government funding, and I would not dream of engaging on the detailed consideration cited by many other noble Lords who have expertise. However, I have some expertise in what cuts or inadequacies in local government funding mean to consumers, especially to caring families and to the voluntary sector. It is on this that we should focus in the difficulties that we are facing, and in each case it is evident to anyone engaged in these sectors that not supporting caring families and not supporting the voluntary sector result not in the savings that we all know have to be made but, rather, in increased expenditure. We have already heard from my noble friend about the numbers of people staying in hospital because local services were not available to enable them to be discharged.
I want to illustrate this with an example. Mandy is a woman in her 60s caring for her severely physically and mentally disabled son, who is 32—she has been caring for him since he was born—and her mother, who had a stroke three years ago. Mandy’s husband left her some years ago and she is the sole carer. She dearly loves both George, her son, and Vera, her mother, and happily accepts her role as carer, even though it is very stressful. What has enabled her to cope and to manage to keep going is that George goes into residential care one weekend a month and her mother attends a day centre run by the Stroke Association twice a week. She was told in November that George will now be eligible for respite care only for two weekends a year instead of every month, and the day centre has no funding beyond the end of March this year.
Mandy herself is a diabetic. The stress associated with losing most of the very minimal support that she has been enjoying, if that is the word, means that her blood sugar levels have gone up to a dangerous level and it looks as though she herself will have to be admitted to hospital. If this happens, both Vera and George will need residential care. So the withdrawal of a small amount of care will result in more expenditure for the state.
This is the reality of what cuts to local authority budgets mean: cuts to direct services to families and to the voluntary sector. Many of the services provided by the charitable sector are in the area of preventive work, and we have heard from many noble Lords how important that is in stopping situations developing or getting worse—the day centre for the stroke patient, the drop-in centre for someone with mental illness and family support for those coping with addiction. Many local authorities hardly engage in this work at all nowadays, since eligibility criteria have become so much stricter, so they have to rely on charities. Of course the charitable sector must play its part and take its share of financial cuts, but it would be not only unjust but counterproductive to make it take more than its fair share. Where a local authority has control of only 5% of its budget, the rest being set out in statute, and that 5% is whence comes the funding for the charitable sector, the budget may be drastically cut simply because it can be when other budgets cannot. We see this happening everywhere. Will the Minister tell the House what guidance is being given to local authorities in this regard because so many initiatives that make up the so-called big society are dependent on precisely this funding, which is now at risk?
I also want to say a word about morale. The services which support families are dependent on the dedication and commitment of hundreds of thousands of local authority and voluntary sector workers. Since the rewards and conditions are not great, their job satisfaction is an important factor in keeping them dedicated and committed. This is hard when you are constantly being told that your working conditions are only going to get harder as yet more resources are cut, and that the public sector must bear the brunt of future cuts, as we have just heard from the Chancellor. In addition, if your morale and the morale of your service are low, you are inevitably less inclined to embrace change and new ways of working, which are essential when making the best of scarce resources. You are inclined to retreat into your silo for safety. Nowhere is this more important than when considering integrated services across health and social care and the voluntary sector, which are so essential from the point of view of the patient, the user and the carer. Again it is counterproductive not to invest in staff support of all kinds to ensure that these dedicated people, on whom many rely, do not become entrenched in the so-called silo mentality.
Labour’s Total Place programme was a fine example of the benefits of integrated care. This Government’s Whole Place scheme is more limited in scope, but the potential is there. Pilot projects focused on health and social care and families with complex needs in high-cost areas show how services can be combined and transformed to produce significant savings and improve outcomes. For example, Greater Manchester estimates from pilot work that it could achieve £270 million net savings over five years, while Essex forecasts that savings of £414 million could be made over six years. Does the Minister agree that if we want to break down the barriers to integrated working, the morale of workers is of the utmost significance? Will she tell the House how the Government intend to maintain it in the face of constant threats to the public and voluntary sector as a result of pressure on the budgets of local authorities?