It is a pleasure to see the Minister here for this debate as well as you, Mr Robertson. I thank the Speaker for this opportunity to discuss the present and future state of the adult social care sector. This area of local government covers a vital service for the most vulnerable people in the country, with the elderly, the disabled and those with mental health difficulties being among its most prominent users. In the past four years, its future has become more of a concern.
We are weeks away from a general election and the Government are anxious that their fiscal plans are seen to be successful. Central to those plans is the fact that cuts to public services are unavoidable and necessary and that they must continue for the next four years. Before we blindly accept that doctrine, the debate gives me an opportunity to spell out briefly the extent of the damage those cuts are having on the lives of hundreds of thousands of vulnerable people who use the adult care service.
The Government have ring-fenced the health and education budgets, so, with those two huge Departments free from cuts, money has to be found from other Departments. In local government, adult social care services is the next largest budget. The Government have claimed to understand the sensitivity of that work, but nevertheless the 40% cuts in local government spending have made it impossible for the service to escape unscathed.
Age UK, the leading charity in this sphere, states that the sector has lost more than £1 billion since 2010—and that is at a time when, because of demographic changes, with people living longer, the services requires more money, not less. It is good that people are living longer, but when they eventually ask for help, because they are older, their needs are more complex and expensive.
Does the hon. Gentleman accept that cutting that spending is a false economy? If quality care is not provided at the right time—in particular in the home environment—more expensive care will often need to be provided later in hospitals and other care support centres.
The hon. Gentleman is quite right. I will touch on the sheer lack of connected thinking in the Treasury—I do not think that the Department of Health has much to do with that.
The National Audit Office, which is usually pragmatic and non-political and accepted as objective, pointed out in its review of the service that total spending on adult social care—covering the whole gamut of, I suppose, 18 to death—fell 8% in real terms between 2010-11 and 2012-13. Older adults experienced the greatest spending reduction at 12% in real terms. Interestingly, the NAO stated:
“Rising needs, reducing local authority spending, and reductions in benefits may be putting unsustainable pressure on informal carers and acute health services.”
Chillingly, it went on to say:
“National and local government do not know whether the care and health systems can continue to absorb these cumulative pressures, and how long they can carry on doing so.”
That is from its review last year, yet the cuts have continued.
To substantiate the point that my hon. Friend has just made, I can tell him that about a fortnight before Christmas we met local GPs who were voicing concerns about bed blocking in particular, caused by cuts in local government expenditure for social care. That is reminiscent of what happened under the previous Conservative Government.
The other affected area is meals on wheels. When a visitor goes to an old person’s house, they see what condition they are in and often they are able to help but get only 15 minutes to do so.
My hon. Friend is quite right. When I was a trade union official, I looked after what were termed home helps and I always appreciated that point—as I did as a councillor, just like him. They were invaluable people who went into old people’s homes, met them and formed relationships, and if they were handled and trained properly, they would report back on any change in condition they saw. That was often valuable for the old people.
If the Minister read the excellent newspaper The Independent this morning, he will no doubt have seen the article reporting the comments of the chief executive of Age UK, Caroline Abrahams. The article states:
“Care of the elderly is in a state of ‘calamitous, quite rapid decline’…with…thousands fewer people receiving care than five years ago.”
She spelled out the fact that the number of people receiving home care has fallen by a third since 2010.
Places in day centres, where lonely, vulnerable adults could find warmth and companionship and escape cold, empty homes are down 66%. Incredibly, in the area that my hon. Friend just mentioned—equipment and adaptations such as rails and stair lifts—40% fewer people now receive help. I say that is incredible because everyone accepts that such adaptations and aids help old people stay in their homes. Often, they save their lives, but they are certainly a method of preventing them going prematurely into residential homes or hospital beds, yet the money has been cut and 40% fewer are being helped.
The article continues:
“Ms Abrahams said that hundreds of thousands of older people were being left ‘high and dry’.”
It goes on:
“‘The lucky ones have sufficient funds to buy in some support, or can rely on the good will of family, neighbours and friends. But there are many who are left to struggle on entirely alone,’ she said.”
I remind the House that that is the chief executive of Age UK, the leading charity for old people.
The Care and Support Alliance pointed out that population changes mean that more people need care, but, as we know, fewer people receive it. There have been further cuts to adult social care budgets in recent years, and a 26% reduction in the number of older people receiving state-funded services, despite the Personal
Social Services Research Unit having predicted that demand would increase by 17% between 2000 and 2020.
The picture is the same among working-age disabled people, 90,000 of whom lost access to state support for their care needs between 2008 and 2013. The alliance says that there is a “chronic underfunding” of care. With local authorities having had to find significant savings owing to reductions in Government grants, there have been further cuts to social care budgets in recent years. The Association of Directors of Adult Social Services and the Local Government Association estimate that about £3.53 billion has been taken from adult social care budgets during the past four years. In the last year alone, 40% of the total savings made by local authorities were achieved through reducing adult social care services. That is quite an alarming figure, but perhaps understandable. That has resulted in a tightening of eligibility for care at local level and of the size of care packages for those who remain eligible. When discussing the Barker commission’s recommendations for more funds and the options that had been set out, the CSA commented:
“What is no longer an option is to continue the current chronic underfunding of care.”
I hope that in the short time available to me, I have allowed the voice of representatives to be heard and put on the record—not partisan politicians but those working in the service full-time, who know the people, the finances and the difficulties. What it all adds up to something that has been known in this place for some considerable time—the service is underfunded, at a time when it is recognised that there are additional pressures and that there is a need for more money, not less. We all know that. It has been known in this building for at least 10 years, covering two Governments. People told us until they were blue in the face that more money was needed, because there were more older people who were living longer and had greater needs. Yet because of elections, I presume, everybody dodges the column and no one has made the difficult decision about how we put money into the service. There should have been a public debate along those lines, to show people the quiet neglect of vulnerable people that is happening every day, in almost every street in our communities.
The situation is a little worse than that. We are really going back to about 30 years ago, when local authorities were forced into doing deals with the private sector for old people’s care homes. Recently, we have witnessed some of those care homes going bankrupt, which means closure and a lack of places for people.
It is clear that my hon. Friend has read my speech; I was just coming on to the privatisation of adult care services.
I hope that I have highlighted in my remarks the important role of local authorities in the sector. As an ex-councillor, I instinctively have much sympathy with the difficulty they face in having to take some very difficult decisions about priorities in the face of the Government onslaught on their budgets. Leeds, my home authority, has faced a tremendous task in running a city when it has had to find £250 million in cuts during the period of the first spending review. Having achieved that, it is now dismayed to hear the Chancellor threaten—indeed, promise—further cuts until 2018, if he gets back in office. In fact, Leeds has been told that it will face a budget cut of £46 million in 2015-16. Other councils face similar problems, and I simply do not know how the Chancellor feels he can order those huge cuts and still have our major cities being run and our elderly and disadvantaged being properly cared for.
I was alarmed when I was informed that a dementia residential and daycare home in my constituency, The Green, was being closed, and that many hundreds of home care workers were also losing their jobs. When I looked into things, I discovered that, chiefly as a measure to keep the city intact financially, the council had had to act in line with other big cities and had taken two unfortunate steps.
The first, which has been mentioned in passing, was to raise the criteria level at which help should be given. This meant that new applicants would have to meet higher eligibility thresholds than before. Parkinson’s UK and the National Autistic Society are two organisations that have pointed out how the new criteria put their members at a disadvantage when it comes to receiving help. The Government have legislated on that point in the Care Act 2014, and although that meets the Government objective of ending postcode unfairness, it also legitimises local authorities, or rather strengthens them, when they have to turn people down because they have needs that are lower than the criteria require. Those organisations have given evidence on how the quality of life of individuals with either Parkinson’s or autism has been diminished. I hope that the Government’s decisions will be reviewed in happier times.
What is more difficult to review is the point that my hon. Friend Mr Cunningham touched upon—the decision to outsource adult care services. That has been done to help meet the shortfall in Government grant. Perhaps I am paranoiac—I probably am, because I think paranoia keeps us safe—but I wonder whether that is what the Government intended. Many people have been outraged by the Government’s propensity to privatise much of the NHS, but thanks to the love that the British public quite rightly have for that unique and wonderful organisation, the Government have backed off from adopting a full-frontal approach and are now taking a more subtle, if not devious, approach.
So quiet has the handing over of care homes and home care staff been that it has rarely been picked up by the general public, except by the clients of those homes and the ex-local government staff themselves. There is a growing awareness of 10-minute visits and the failure to provide elderly people with the same carer; providing the same carer is an important part of home care, so that people can build a relationship with them and trust can develop. The former staff are aware of the loss of local government wages, the use of zero-hours contracts and the loss of payment for travelling time, which accounts for those 10-minute visits.
I will just depart from my script to say that that situation is not surprising. If a council outsources contracts and there is a duty to save money, given that those contracts primarily involve labour, the only way in which money can be saved is to hand them over to a private company. That company would have no compunction in offering lower wages, no travelling time, worse holidays and worse sickness schemes. That is what has happened in the majority of cases.
Does the hon. Gentleman accept that, in many cases, the private sector businesses are effectively offering wages that are below the national minimum wage, as a result of the commissioning process? In some cases, they are being given only enough money to offer no more than £12.50 or £13 an hour, which cannot cover all the costs of travel, transport, uniforms and training. That means that the private sector businesses are often almost being forced out of business.
I totally agree with that. Now that the local authorities have pocketed the money, it is clear that they are pressing down on the private firms, and we are a step away from the disaster of the private firms just going, “There—that’s it.” What happens when we have closed all our residential homes? There is a real problem building up.
I am sad that financial pressures have forced councils to do that. The care of the vulnerable elderly is a service that, just like hospitals, should remain in the public sector. The various scandals in care services have underlined the temptation—indeed, often the necessity—of people in business to do more than cut corners when looking after people who are helpless. I am less than convinced that the Care Quality Commission, with its proposed risk-based regulation, is any better than its predecessor, which turned out to be disastrous.
In Leeds, thanks to the protests by staff and unions, the public unhappiness over the closures and the sagacity of the council leader, Councillor Keith Wakefield, the decision on care is under review. I understand the pressures that the council faces, but I hope that it makes the right decision.
I will end my remarks by asking the Minister three questions, which, if past debates in this place are anything to go, I will not receive answers to; I am referring not to this Minister but to his disreputable colleagues. I know that this Minister is a man of honour.
First, is any discussion taking place about putting adult social care, which is closely affected by and connected to hospital care, inside the ring fence? Secondly, are councils under any instruction about privatising or outsourcing adult services? Thirdly, is any Government legislation preventing councils, in commissioning work, from inserting provisions stating that wage and working conditions should be at a specific level?
I know I am crowding the Minister’s time, but I shall take just half a minute more. I was once in a group of people in sheltered housing discussing some problems, and I met an old lady of 90. She said, “I’m 90 and I haven’t had bath for two years.” I started back. She said, “No, I do my best to wash myself standing up, but every time the door opened and the home care worker came in to bath me, I was getting a stranger. I may be 90, but I have my self-respect and my dignity, and I want to keep it.” That is happening to too many of our older people. They are vulnerable, they are being treated badly and they are neglected. It is about time that not the Minister, but the Chancellor, woke up to this.
I thank Mr Mudie for raising the important issue of the reorganisation of care pathways in Leeds. I prepared a speech dealing with the reorganisation of health and care and their integration in the town, but I only have nine minutes left and I need to deal with the questions raised by the hon. Gentleman. Perhaps I can write to him with the detail of some important reforms going on in the city.
First, I want to take on the hon. Gentleman’s questions. I reassure him that the reforms in the city are absolutely not the result of any diktat by Ministers. They are in fact being led by hard-working and pioneering health, NHS and social care leaders in Leeds, to whom I pay tribute. My right hon. Friend the Minister of State, who is responsible for care, has publicly commended the work that they are doing locally. They are doing pioneering work in the important mission of integration.
In much the same way that NHS England is autonomous and responsible for delivering health services locally, local authorities are responsible for providing social care services for their communities. As autonomous public bodies, they are best placed to decide the needs of local people. I support the work done insofar as it encourages people locally to contribute to that democratic process.
The hon. Gentleman made some important points. First, he asked whether the proposed closure is due to cuts in Government funding. The answer is no. Public finances are in a precarious position. This year the deficit is still, despite the best efforts of this Government, projected to be over £100 billion. I remind him that when we came to office, debt interest alone was running at £70 billion a year. In Labour’s last year, one in every four pounds spent by the Government was borrowed. We had to get that under control.
It is true that priorities have to be set across the local authority system, but the vast majority of local authorities have prioritised social care. Indeed, in Leeds, work has been done to allocate priorities appropriately. The evidence is encouraging. Despite difficult public spending constraints, spending in Leeds on adult social care is up 3% in cash terms. Importantly, satisfaction with levels of care and support is up 10.8%. I do not recognise the picture of catastrophic collapse that the hon. Gentleman painted.
Secondly, the hon. Gentleman asked whether the Government are doing enough on accident and emergency and about the extent to which that is being driven by the problem in social care. The truth is that we ring-fenced a grant for £25 million to help councils with hard-pressed hospitals. An ageing population—there are 1 million more pensioners this year—is driving increased pressure on A and E. We have set up the Better Care Fund, which I will say a little bit about later.
I cannot let the allegation about privatisation go without a response. Labour’s scaremongering about privatisation has been discredited as a myth by just about every health commentator, including the King’s Fund. Our Health and Social Care Act 2012 made it illegal for any Government to drive the private sector into the NHS, as happened under the Labour Government. It was Labour, actually, that was prepared to pay private sector providers 11% more than NHS providers, and under this Government, led by my right hon. Friend the Secretary of State for Health, that has been made illegal. Under Labour, independent provision comprised 5% of the NHS, but under this Government it is now 6%, which is not an increase of the order that the hon. Gentleman described. Spending on private providers for general and acute secondary care increased by twice as much under Labour as it has under the coalition.
The health service has always been a mixture of private, public and voluntary providers. It ill behoves the Opposition, just before the election, to scaremonger on privatisation. That does not support patients and it is not what the people who work in the health service want to see.
In the few minutes I have left, I want to say something about the reforms to adult social care and the integration of care, and about the work that Leeds has been doing. I know how difficult it can be for elderly patients when health and care services are reformed and changed. That is why it is important that it is done locally, with consultation and led by local professionals.
This morning, I spoke to the interim director of adult social services for Leeds, who assured me that no decision has been made on these proposals. They are still being consulted on and they are part of the council’s wider six-year programme to move more services into the community. I understand that there is plenty of alternative capacity in the area: 123 independent sector care homes in the Leeds area alone would be able to accommodate anybody moving. Furthermore, he tells me that the council has successfully closed a number of its care homes, so, if a decision is made to close other care homes, it will use that previous experience to handle those closures sensitively and appropriately.
I want to say something about the context of and pressure on social care and how it is changing. Above all, I emphasise the importance of all services, not just social care, adapting and working together to meet the needs of an elderly population in the 21st century. We are living longer, healthier lives and that is something to be celebrated. The fact that many of us can look forward to reaching 85 and over and many of us—perhaps not me, but perhaps the hon. Gentleman—will live to be 100 is a fantastic achievement. However, it puts pressure on the system. Historically, health and care costs have risen by about 4% every year in real terms. The number of people living with three or more long-term conditions is set to increase from 1.9 million in 2008 to 2.9 million in 2018. One of my former ministerial colleagues, my right hon. Friend Paul Burstow,has talked about how care homes need to be made
“fit for the rock and roll generation”.
That is why we have been pushing the integration of health and care and the changes set out in the Care Act 2014.
It would be remiss of me not to admit that in recent decades we have allowed ourselves to tolerate a care system that too often steps in too late and picks up when there is a crisis, rather than acting to prevent one; a system in which there are still too many barriers stopping people getting the integrated care they need; and a society, for which we all take responsibility, that, despite the best efforts of those working in the care sector—professional and voluntary—increasingly has tolerated too much loneliness and isolation.
The case for reform and integration of the care system is not just serious, it is overwhelming. That is why this Government have put such emphasis on integration. People worry that care services will not help them regain their independence and maintain a decent quality of life. It is in all our interests to integrate health and care better. That is why we created the Better Care Fund, the biggest ever financial incentive for the integration of health and social care, providing £5.4 billion of investment in better integrated care from
I pay tribute to the leaders in social care and health in Leeds, because they are doing great work as a pathfinder area and the Government have supported them. It is a Labour-run council, but it is doing good work in the integration process. I understand that Leeds is opening 37 open access neighbourhood networks. Those schemes are helping around 22,000 older people every year with a range of activities; they have prevented 1,400 older people from going into hospital; and they have supported over 600 older people when discharged from hospital.
Time is against me. I want to close by highlighting the fact that these are not easy issues. The integration of
NHS and care services is a challenge across the country, in my constituency as well as the hon. Gentleman’s. The Government have inherited a legacy of neglect in recent decades: I do not just blame the Opposition. We have not integrated properly and we have allowed this problem to go on too long. I believe this Government have attempted to tackle the deficit responsibly. Of course, we all have to tighten our belts.
We have ring-fenced health expenditure. In an integrated system, putting more money into health and driving integration means that there is more money indirectly for social care. The statistics in Leeds simply do not represent this catastrophic picture of privatisation, which has been discredited, or of crisis in the system. I do not pretend for a minute that everything is perfect, but I do believe that we, working with local authorities, are putting the right solution in place for the longer term.
Question put and agreed to