I beg to move,
That this House
has considered social care funding.
I should like to introduce a discussion on the funding of social care and narrow that to adult social care and the specific areas covered in the admirable Library briefing around the Green Paper in its absence.
It is a relief to debate something that is not about Brexit, although there is probably some indirect connection. Attempts have been made to blame the delays on Brexit, but the Secretary of State was candid enough to acknowledge that deep-seated disagreements going back 20 years explain why we are at an impasse on the basic principles.
There are a couple of contradictions or paradoxes that we must try to unravel. We all say that the only way forward is to have an all-party consensus, but at the same time the issue is increasingly weaponised. We all say that this is an incredibly urgent problem, but it stays for longer and longer in the long grass. Until we get to the root of those problems, we are not going to make any headway.
Will the hon. Gentleman wait a moment? I will happily take interventions in a few minutes.
At the root of this—and trying to be generous to all parties—is a lot of public misunderstanding. This is a complex subject. To take just one point, half of the adult social care budget is not about old people; it is for younger adults. The public fundamentally misunderstand the nature of the means test—most people do not realise it exists until they encounter it. Consequently, people are frightened when they see proposals that are characterised on one side as a death tax and on the other as a dementia tax, apparently unaware that we have a death tax and a dementia tax now.
I cannot in my short contribution solve such a fundamentally difficult problem that has been going on so long, but we need to try to disentangle issues that are fundamentally different. My primary concern is social care—how we support people in the community so they can function with a proper life, preferably at home, outside of hospital.
A totally different set of problems—wealth, property and inheritance—leads to a lot of the emotional angst caused by what is sometimes called catastrophe risk: people landed with financial obligations as a result of having long-term personal care and the expense of £50,000 a year or whatever in a residential home. However, that is about wealth, distribution and assets. It has nothing to do with health and we have to try to separate the two.
I am grateful to the right hon. Gentleman for giving way. I am also grateful for the opportunity to discuss this matter on a cross-party basis. He mentioned a cross-party consensus earlier. Is he aware of last year’s joint report by the Health and Social Care Committee and the Communities and Local Government Committee on the future funding of social care? That report came to a cross-party consensus on how we can move forward, and one of the solutions was a social care premium.
Yes, there is a lot of joint thinking. We have the joint House of Commons Committees, and my hon. Friend Dr Wollaston, as Chair, was critically involved in that. There is also a very good piece of work by the House of Lords, and the considerable brains of Lord Lawson and Lord Darling contributed to a cross-party consensus. A lot of think-tanking is going on in the vacuum created by the Government’s non-publication. There is no shortage of ideas, but we need to be clear what the problem is—and it is a very serious one.
If the hon. Gentleman lets me go through this, I will take an intervention.
The first point is the rapid growth of demand as a result of an ageing population. We all know that. As far as we can establish, because of ageing and the onset of dementia in particular, we have a growth in demand of about 3.5% a year. That is considerably in excess of the growth of the economy and the resources to fund it. That is the fundamental problem at the heart of all this. We have 800,000 people with dementia at the moment, which goes up to 1 million in 2025, rising to 2 million in 2030. At the moment, there is no clear picture of how this demand is to be met.
My second point, related to that, is that we have a large and growing hidden cost that is not quantified—unpaid caring. If we take dementia alone—just one dimension of adult social care—we have 350,000 carers at the moment, of whom 110,000 have had to give up their job, which is a cost to them, the Exchequer and their employers.
I congratulate the right hon. Gentleman on securing this timely debate. He refers to costs. The costs to families and individuals hit with dementia are 15% higher than they are for any other illness. They are about £3.5 billion because people have had to give up their jobs for all sorts of reasons. I hope that further assists him and I hope he agrees that we have to think about it.
Yes, that is quite right. We tend to use dementia, particularly the work of the Alzheimer’s Society and others, to illustrate the problems here but they are not unique. Many people with arthritis, diabetes and serious stroke conditions face the same set of problems.
I am grateful to my right hon. Friend for giving way. He rightly points out the importance of unpaid carers. Any new consensus, which must come, should make clear provision to support those who do the caring— 12,000 unpaid carers in my constituency alone. If they were to cease caring—if we do not care for the carers—the social care burden on the taxpayer more generally becomes even more unmanageable.
A constituent of mine raised the case of her father who had been assessed by the health service as needing 24-hour, one-to-one support. That was withdrawn when he went into a care home, because the burden fell back on social care. There was then the problem of who was going to pay. He immediately had a series of falls and became more frail and more vulnerable, causing him and his family enormous stress. The right hon. Gentleman mentioned Labour’s proposal that we will support particularly those with dementia and their families in paying for social care costs. In the spirit of cross-party consensus, does he agree with that?
I will come to that point later and to the heart of what I understand to be the Labour proposal—on free personal care—in not too polemical a way. It presents opportunities but also serious problems.
We have the growth in demand, the hidden costs, and the burden on local authorities. It is easy to score political points, and I will put my hand up immediately: after the financial crisis I was part of the Government and we cut—in real terms—per capita spending in this area by about 11%. It did not start then. The number of people with so-called moderate needs who were excluded in the previous five years rose from 50% to 75%. It is an old problem as well as a new one, and we are all faced with the challenge of how to finance local authorities. If local authorities are underfunded, we all know the problem gets passed back to hospitals in delayed discharge.
There is the problem of the labour force. It is horrendous. Until I saw the figures, I had not realised just how bad it is. There is an annual turnover of 450,000 care workers for a mixture of reasons, a lot of it to do with pay and conditions. We currently have 100,000 vacancies, and there is the potential for stricter immigration controls, which would create even more vacancies and make them even more difficult to manage. The business model for the companies involved, partly in residential care but also in domiciliary care, is just not viable; as I understand it, four of the leading providers are now up for sale and one is in administration.
The problem, as we all recognise from our constituencies, is that there is a two-tier system: on the one hand, luxurious and comfortable homes for those who do not need to worry about money, but on the other crumbling homes with minimal standards, overseas workers on minimum pay, and a nasty smell of urine—we have all seen them. An intermediate level of care that is attractive and affordable is simply not available.
Those are the problems, as I think we all recognise, but the question is: what can be done? As has been mentioned, a wide variety of brains in and outside this place have been contributing and thinking about it; one of the unintended benefits of the Government’s delay has been that others have filled the vacuum with ideas. The most useful ideas that I encountered seemed to be from organisations such as the Health Foundation and the King’s Fund, which have no political axe to grind that I am aware of. They suggest that rather than trying to deal with all these complicated problems together, we should deal with them in sequence, starting with those that are more manageable. Essentially, they suggest that there are four stages to dealing with them, which I will briefly canter through.
First, we should identify what we need to do simply to stabilise the present position, unsatisfactory though it is, because there is a real danger of going even further backwards as a result of lack of resource. The King’s Fund identifies a need for an extra £1.5 billion by 2021 and £6 billion by 2030 simply to keep the system at its present level, unsatisfactory though it is. I hope we can all agree that that is the absolute minimum that we should aim for.
The second level up is improvement. As the King’s Fund identifies it, that means going back to the standards that prevailed in 2009-10, although they were unsatisfactory even then, and filling in some of the holes in availability of social care. It costs that at approximately £8 billion a year, rising to £10 billion after five years—a significant sum. My party, including colleagues present, has come with up with one suggestion: creating a ring-fenced fund based on a penny in every pound of income tax. That would raise £6.5 billion, which would get us most of the way there. I do not want to be doctrinaire about the best way of doing this, but I hope that there can be some understanding that that contribution, which is very limited in terms of public funding, could get us back to a more acceptable standard. People have different views about which taxes we should use and how we should ring-fence the money, but that seems to me to be the minimum level of ambition—and it could happen without legislation if the parties agreed that we should proceed in that way.
We then get on to the more difficult level, which relates to charging. One thing that has come through to me from reading the various think-tank reports is the growing interest in the idea of free personal care in the Scottish model. I confess that I have always been sceptical about it—I have the traditional economist’s scepticism of free things—but its proponents note two practical attractions that have nothing to do with ideology or party thinking: it aligns social care and healthcare, if we are going to integrate the two systems, and it brings in a lot of people who are currently excluded from social care provision, so that they are more likely to stay at home rather than going into hospital. It has potential benefits as well as costs.
I am an ex-nurse. Does the right hon. Gentleman agree that it is right to offset the costs of social care against what we would save the NHS? I regularly had eight patients, and probably three of them would be medically fit for discharge and did not want to sit in a bed, although they had to do so. When we consider the cost, we must also balance that issue.
That is the case, and I hope that when the Green Paper appears there will be a proper, objective look at free personal care. In the past this has been an ideological issue, but there is no reason why it should be. It is a practical proposition. As I understand it, the Scottish model has pluses and minuses—it is certainly very popular with the people who benefit from it, but there are much stricter tests for eligibility in terms of physical functioning—but at least let us consider it objectively. It is costly, however—about £8 billion a year over and above the other items I have mentioned.
This was a flagship policy of the coalition Government in which I served in the Scottish Parliament, and I am proud of that. One problem that we never got around—I think this also applies to rural English constituencies and Welsh constituencies—is the issue of sparsity and distance. How do we deliver this service when there are vast distances between the various old people involved? When there is a low population base, how do we find the number of carers that we desperately need to tend to those elderly people, who deserve dignity at that stage of their life? It grieves me to say this, but in north-west Sutherland in my constituency we have a distinct problem with finding those carers. People have come to see me in the last few weeks who have not had a carer for three, four or five days, which is terrible.
My hon. Friend is right to point out the practicalities of this issue. That links to one of the current difficulties with domiciliary care, which is that providers are often not compensated for travel. I imagine that in a remote constituency that would be accentuated many times.
Does my right hon. Friend accept that this could be done in a step- wise fashion? We could probably start immediately by introducing free personal social care for people at the end of their life, and we could then move forward to try to bring more people within that sphere. There is certainly a strong economic and moral case for introducing such care at the end of life.
That is a helpful and humane suggestion, and if we approach this whole question in terms of its practicality, rather than with abstract ideology, we might make some headway. What my hon. Friend suggests seems an eminently sensible way to start that process.
The last and most difficult issue is the one in which successive Governments have got hopelessly bogged down: the so-called catastrophe risk for the small number of people who are caught with prolonged expenses as a result of residential care. When I was in government the Dilnot report attempted to address that issue, but I think we have moved beyond that now. This is a classic problem of insurance, and it is now recognised in a way that it was not before—I think the current Prime Minister said this publicly—that the private insurance market cannot, and will not, deal with this problem. If there is to be insurance it must be social insurance, and large numbers of people will have to make a contribution to prevent the burden falling on a small number of unfortunates who contract long-term conditions, with all the costs involved.
That could be done in a variety of ways. One idea is a supplement to national insurance. Another idea from 10 years ago, which I had no problem with, is that if we are to solve the problem of people losing their inheritance, everyone who pays inheritance tax should pay a small supplement. That struck me as a good social insurance principle. Whether or not that formula was right, we have now got to a point of accepting that this is a social insurance problem, and there are different mechanisms for dealing with it. If we are reasonably grown up politically, we should find a way of closing that gap.
The right hon. Gentleman is making a fantastic speech on what we will all agree—Brexit aside—is the issue of the day. I visited Parkinson’s UK in East Kilbride, and Parkinson’s sufferers are particularly affected by social care catastrophe burdens because theirs is a degenerative condition that can start in their 50s, or even earlier, and go on for the rest of their lifespan. Does the right hon. Gentleman think the Government should look at conditions that particularly affect people and start by focusing on those as a priority, as Dr Wollaston, the Chair of the Health and Social Care Committee, said?
The hon. Lady is quite right. We are talking about a variety of conditions. I listed some, and Parkinson’s is clearly one. With Parkinson’s, it is difficult to separate the health and the social element, which is one of the problems with a lot of these conditions and why the current distinction is so arbitrary and unsatisfactory.
Perhaps I could finish with a quotation from Her Majesty’s the Queen, although it does not relate to her need for social care. Two and a half years ago she made a speech in which she said:
“My Ministers will work to improve social care and will bring forward proposals for consultation.”—[Official Report, House of Lords,
Vol. 783, c. 6.]
That was two and a half years ago, and the basic question is: where are they?
It is a pleasure to serve under your chairmanship, Sir Charles.
I think we all accept that there is an ever-increasing demand for social care. In fact, when I was looking at data for this speech, I found out that 5,000 people a day are trying to access social care, according to NHS Digital. However, we sometimes forget the human being behind the figures, and although I was not going to use this story in my speech, it has stayed with me, and I want to share it with Members.
A couple of weeks ago, I knocked on a family’s door. I was talking to the woman there, and she told me about her sister. She was really keen for me to read some research about why adults with learning difficulties die earlier than adults without, when there is no physical reason for that to happen. She told me that, despite being the younger sister, she had helped her older sister to learn how to speak and that, when she was younger, she had helped to look after her. She used to visit her, and they were very close, despite the fact that her sister had numerous learning difficulties.
Two years ago, however, the sister died, at the age of 51. The woman was clearly still very upset. She said her sister had died because there was no reason for her to get up any more. There was no reason for her to get out of bed; there was nothing for her to do. She said that her sister had been involved years ago in volunteer work placements, and that she would get really excited when she earned her money and was given a bit of a wage at the end of the day—she felt like she had a reason to get up. The woman told me there used to be activity co-ordinators in the care homes, who went in and did work and activities such as gardening and all sorts of other things. However, over the past few years, everything has gone. She said there was no reason for her sister to want to be alive, so she stayed in bed. Her condition degenerated, and she developed serious health conditions, which resulted in her passing away at only the age of 51.
We sometimes forget about those things. We talk about care, and we ask whether 15 minutes is enough to go and care for someone. It might be enough to stick a meal in the microwave, and it might be enough to give someone their medication, but is it enough to care? It feels like we have lost the caring from our caring system. We have lost the time to actually sit down and be with each other and to have that human contact and human care.
As automation increases, it feels like that human interaction could disappear even more. For example, there are fantastic new homes that are run by voice activation. People can tell them to open the curtains or the drawers. All these advances in technology are a reason to decrease the amount of human interaction, and I worry about that. I worry about where we are going as a society. We are replacing humans with automation, and we are replacing caring with just functioning. If feels like we have developed a system where people function but do not get cared for.
We need a fundamental rethink. The time for tinkering around the edges has definitely ended. I am obviously pleased with the Labour party’s proposals for free personal care. I hope we look at giving those free personal carers the time to care, and give the quality and status to carers, so that instead of their being dismissed as insignificant people on the minimum wage they are given that quality and status. We should view our carers in the same way as we view our nurses—as people giving a quality service and making a difference to our society.
It is time for us all to put the care back into caring, raise the status of the profession and give people the time they need, and I am very proud that that is exactly what the Labour party intends to do.
It is a pleasure to serve under your chairmanship, Sir Charles.
It is also a pleasure to participate in this debate, albeit briefly, and I pay tribute to Emma Hardy for her very well-founded comments and to Sir Vince Cable for securing this debate. It is indeed good to be talking about something other than Brexit.
This issue is the biggest piece of unfinished business not just of this Government or the coalition Government, but of the Governments of Gordon Brown and Tony Blair, because the concept of social care reform has been discussed in this place and more broadly in the country for many years. The right hon. Gentleman was right to recognise that many care providers face serious structural and numerical challenges in providing adequate numbers of people who want to work in the care sector. He was right to highlight the funding challenges that the care sector faces, which began about 15 years ago but have increased over the last few years. He was also right to highlight the fact that there is often a vocalised mantra of political consensus in this area but that when it comes to legislation or any sensible proposal being made there is a failure in practice to deliver that political consensus, so as to deliver reform to the people on the ground who actually need care.
The care sector faces short-term funding pressures. I know that the Government will want to address some of those challenges by putting extra money into the system and supporting local authorities in providing better care, because we know that we have put local authorities into a position whereby they, and indeed the care sector, have faced very straitened financial circumstances for many years.
At the same time as talking about extra funding, however, we should talk about what sort of care system we want to see, because far too often the debate boils down to the funding discussion, when the reality is that we should also talk about how we want to deliver care. We should understand and put right the commissioning of care services. It seems extraordinary to me, given that we often talk about the benefits for people with long-term medical conditions of better integrated health and social care, that we have two different commissioning systems: local authorities commission local care; and the NHS commissions the health service. In their interventions today, many contributors have made the point that we are dealing with the same people with the same problems, but they are being dealt with in a fractured manner by two systems.
We must fundamentally deal with that issue of how we commission services, and the only way we will deliver improved care—care that is centred on the whole person—and dispense with fractured care is by having one point of commissioning. Unless we have that, we will end up putting more money into a system that, yes, needs to continue doing what it is doing at the moment, but it will still be a system that fundamentally is not the right one to deliver the right care for the people whom we care about.
At the moment, social care often duplicates the functions of the NHS, even when we are dealing with the same person. It is very difficult for families to understand why, on the one side, someone has undergone a life-changing medical event such as a stroke or severe dementia, yet some of their care is delivered not by the NHS but by social care. So, yes, let us put more money into the system, but let us also consider how we can have a better commissioning system and unified commissioning for the benefit of patients.
It is a pleasure to serve under your chairmanship, Sir Charles. I will start by talking a little about my experience as a nurse on an in-patient cardiac ward and the number of times we saw delayed discharges. Delayed discharges happened when a patient was medically fit for discharge, had had all their assessments, had received physio and had seen the occupational therapist, and we knew what they needed, but because there was no social care provision, they could not go. Dr Andrews or Dr Kelly would tell them on a Friday afternoon that they could go home, and I used to think, “I’m going to be the one who tells them that they can’t.” Patients really hated that. There was also a cost to it; in cardiology—an acute setting—people would be waiting for a cardiac bed. We might have to choose to outlie that patient in a non-specialty area. We just did not have the beds. It was a constant juggling act.
I was really pleased to hear the announcement last week at the Labour party conference about the national care service; it will play a huge part in relieving the pressures on the NHS. Our NHS is in crisis; the Conservative party will say that it is not, but I still meet my friends for supper once a month, and it is. Part of that crisis is the fact that we have so many people sitting in beds, waiting for social care.
If people get decent social care in their homes when they are discharged, they will not bounce back into hospital so quickly, because there will be someone going into their home every day and keeping an eye on them. I know this from my experience with my mum. If someone is keeping an eye on them, they get to a doctor more quickly, and they are not as acutely ill when they are readmitted, as they very often ultimately are.
Elderly people face significant challenges these days in accessing a general practitioner. The GP service in Skellingthorpe, a village near me, is to be shut; it will be really hard for elderly people there to get to a GP, so they will just get more and more ill before they get to hospital.
Another important point is that when people need increased support, it should be provided by staff who are properly trained, paid and valued. Someone mentioned staff on low wages earlier. I will not utter the dreaded B-word, but when that happens, how will we provide social care, given that none of the staff we are talking about earn £30,000 a year? Labour has come up with a way. Last week, we said that people who earn over £80,000 will pay a little bit more in tax. Surely it is right that the wealthiest in society pay a little bit towards keeping the most vulnerable people safe; I know that does not go down too well with some people, but I think that that is only fair. It is also good to hear that undervalued carers who are struggling will get proper financial support in line with jobseeker’s allowance. We will introduce a cap on care costs for catastrophic illness.
I agree with everything said by my hon. Friend Emma Hardy. I have a little grandson—I say little; he is 13 —who has Down’s syndrome, and one of the worries of my life has been what will happen to him when we are gone. It is really important that people with learning difficulties are provided for. I completely agree with my right hon. Friend Sir Vince Cable; Joe used to go to all sorts of little clubs and things like that, and they have all gone. Things are really basic now. All that is viewed as a commodity. It is as though we do not care about people; it is all about how much things cost. I am sorry, I think my disgust for that view is probably apparent.
Providing social care for an increasing elderly population, as well as many others across our society, is one of the biggest challenges facing us. I am really pleased that my right hon. Friend the Member for Twickenham brought forward this debate. It is really important that we talk about the issue cross-party, because it is a problem that we all face, and we need to come up with answers.
I appreciate the opportunity to talk about something other than Brexit, and to talk constructively, to have a proper debate on the facts, to look at each other’s positions and, I hope, to try to find a middle way. I think it was Lord Tebbit who said that politics was about shooting the crocodile nearest the boat. This crocodile is about to swallow the whole boat. There are three big, ticking time- bombs, all connected to demographics: pensions, healthcare and social care. According to the Office for Budget Responsibility, our national debt is about 80% of GDP. By 2060, unless we look at this issue strategically and change our taxes dramatically, our debt-to-GDP ratio will be 280%. This is not something that we can just put a sticking plaster over and hope it will be okay.
I do not mean to be critical of the Opposition’s policies, but they are moving down the road of free personal care. The difficulty with that is the question of its affordability. We have to understand the sheer scale of the problem. Perhaps, once they do, they will still have the same perspective. Another point is that there is no such thing as “free”, of course. If something is free, it is funded by the taxpayer. Taxes would have to go up significantly to do what is being suggested. Sir Vince Cable talked about putting a penny on income tax, which will raise about £5.5 billion, but he acknowledges that the gap will already be about £8 billion in three or four years’ time. The scale of the problem is huge, and it will simply grow, so we need to look at the facts behind it.
The Health and Social Care Committee and the Communities and Local Government Committee held a constructive inquiry into all those issues and came up with a German-style social insurance premium. I felt that was the most sustainable, simple and scalable option that tackled the future as well as the past.
Germany introduced the system in 1995 and has already revised the level of contributions once. Since 2005, it has increased the percentage of total take from the premium by 56%, at a time when our resources have been decreasing. That shows that this can work on a cross-party basis. It is a simple system based on a percentage of somebody’s income. It is not actually put on national insurance, which I would not advocate, because we would go back, in a future Budget, to arguing about who could put the most on national insurance and who could spend the most on it.
It is an independent system in which people are categorised according to need, so it is possible to calculate exactly how much needs to be raised. In future, we can come to a cross-party agreement about by how much we need to increase the premium, because we will have to increase it. Everybody pays a small amount from their income—not just their salary, so it is for retired people as well. It is also mandatory, which tackles the insurance problem, because the insurance market will not work unless there is universal cover, and it is handled by not-for-profit insurance companies.
The key element in the system is that, when someone is categorised as needing care, they can pay for provision, ask their local authority or provider to give them care, or draw down the money and pay it to a relative or neighbour, so they get care from the people who care for them most and understand them best. That also helps to tackle the staffing element. If we have a system where everybody pays something, nobody has to give everything.
It is a pleasure to serve under your chairmanship, Sir Charles. Making sure that the sick and elderly are treated with care is the measure of any civilised society. I believe that we should not be judged by our personal wealth, but by our compassion for those in most need. Clearly, however, that ethos is not shared by our Government.
As we speak, 1.4 million older people are going without the care they need, which is totally unacceptable. We are faced with the huge challenge of meeting the increasingly complex care needs of an ageing population, yet as those needs have increased and intensified, state funding for those services has nosedived. Council budgets have been reduced by an average of nearly 50% since the Tories came to power. Those cuts have taken a staggering £7.7 billion out of social care funding since 2010.
In my constituency, Warrington Borough Council has had £137 million cut from its budget with another at least £22 million of savings to find by 2020. As a former new town, we are seeing a significant increase in our vulnerable older population—those who were drawn to Warrington for work and a better life in the 1970s and 1980s. Nationally, there are 8,000 fewer care home beds than in 2015, despite the kind of rising demand seen in my constituency. Reports indicate that, last year, almost 90 people a day died while waiting for care to be arranged for them at home. That is absolutely shameful. How can the Minister justify those figures?
The crisis in social care is felt by not just those in need of care, but their families and friends who must step in where the state has failed and where money is short. More than 5 million unpaid carers look after loved ones. Skills for Care has found an 8% vacancy rate in the social care sector, which is equal to 110,000 empty roles at any one time. Many who work in the social care sector are overworked and underpaid. Unison has documented at length the injustices faced by those who do such vital work: sleep-ins, impossible rotas, zero-hours contracts and unpaid travel time, to name just a few.
Make no mistake: this policy area is crippled by Government inaction and market failure, causing immense hardship and misery for those who need care and for those who provide it. It is high time our political leaders showed the courage necessary to rise to the challenge and fix this mess, ensured the safety and security of older generations and treated care workers with the respect they deserve. I am proud that my party has recently announced bold, radical plans to do just that.
Labour will introduce personal care free at the point of use in England funded through general taxation. Providing free personal care to older people will ensure that they will be able to live in their own homes for longer, providing them with dignity and the support to lead independent lives for as long as possible. I have seen at first hand from my mum, who passed away last year, how that is absolutely crucial.
I started the year encouraged by the 10-year plan and now by this weekend’s infrastructure investment. They are both welcome. Certainly, in Cornwall and on the Isles of Scilly, there is an ambition and enthusiasm for how they can use such opportunities to put right the challenges that we have. We all recognise, as has already been said this afternoon, that everything hinges on how we effectively and appropriately care for people in old age and people who need social care during their working lives.
The Minister might be interested to know something that I heard recently: care homes, including charitable care homes in Cornwall, have beds. Our urgent care centre closed its doors to new admissions not long ago because it had people in beds who needed to be elsewhere at a time when beds were available. However long we need to wait for the Green Paper—I really hope it comes soon because it is getting embarrassing now—I hope the Minister will ask searching questions of areas such as Cornwall, where beds are available in one place and individuals who should be in those beds. The system is under enormous pressure.
When it comes to the Green Paper—we have heard this already—there needs to be clarity and fairness. For example, why do we think that dementia is an issue for social care and not use NHS funds to properly care for people? As has already been said, it would lead to far better care and support for families and also reduce the burden in the cost of such care. Also, who pays? Why is it that someone who is funded by the state costs a certain amount of money, but if for some reason circumstances change and their family needs to fund their care, the cost of their care leaps by enormous amounts in just a weekend. Why, if it is state-funded, it is a matter of hundreds of pounds, but if it is privately funded, it is a matter of thousands for the same care?
Will the Minister look at some of the solutions that we are trying to bring forward in Cornwall? We have a health and care academy. There is an enthusiasm to train people in Cornwall to work in nursing and domiciliary care. Part of the challenge is that the cost of doing that, even using the apprenticeship levy, makes it not possible for everyone who wants to do it, but in Cornwall we need people to train locally so that they stay local.
Finally, I was on Scilly on Friday where urgent healthcare, GPs and social care have been brought together. A business case has been put to bring everything together in one place so that people do not need to leave the Isles of Scilly to get the care that can easily be provided at home. Again, it would reduce the cost and the pressure on the workforce, who at the moment are stretched all over the place. Will the Minister look at that plan to see how we can find some funding to make that integration become a reality on the Isles of Scilly?
It is a pleasure to serve under your chairmanship, Sir Charles. I congratulate my right hon. Friend Sir Vince Cable on securing this important debate. In the limited time that I have, I will concentrate on a couple of realities. Every colleague in the room knows that social care is on its knees and has been for a long time. I appreciated the intervention from Karen Lee, who said that she was a nurse before she became an MP. My partner is a community matron. She works out in the community with patients alongside social care, and she sees for herself how bad it is, as every Member here does. I have had numerous bits of casework dealing with the profound challenges in social care, so we know that it is on its knees.
Politically, because of cuts over a number of years to the money it receives from Government, East Sussex County Council has been cutting meals on wheels, rehabilitation houses and much more. I pay tribute to my colleague Councillor John Unger, who has been lobbying, harrying and fighting the county council to stop the cuts, but it has not made a lot of difference. Why not? Because it is on its knees. Social care is a massive issue, and all of us in the Chamber know that the only way to deal with it properly is to depoliticise it—I have a view on doing that with the NHS, but that is for another day. If we do not depoliticise social care, we will be in exactly the same position in five years’ time.
The real frustration and challenge is that, as MPs, we know how difficult it is out there for people in receipt of social care—or not, as the case may be. The same is true for those such as myself whose partners are nurses and others. Similarly, one of our colleagues is a doctor and would have seen things for himself. The challenge is that normal, ordinary people out there do not realise how bad it is until they need social care, and then—my God, it is a car crash. They come into my office and say, “Stephen, I cannot believe the service, or the lack of it, that my mum”—or dad, or grandad—“is receiving.” They are in bits, and until we can find a way to inform the rest of the public—85% to 90%, say; I do not know—just how awful things are, I believe we will just keep getting stuck.
There have been good ideas—we had good ideas in the Dilnot report and the coalition; Labour has come up with some good ideas, and free personal care in Scotland has real mileage—but the truth is that we will need to depoliticise social care. I therefore urge the House to recognise that, after this bloomin’ Brexit and the election, whatever the hell happens—I hope that I will be here to continue urging—we will have to depoliticise social care, otherwise it will never improve and our people will suffer.
Today, we are looking at a question that is certainly as vexing as that faced by Nye Bevan when he looked at how we would fund health. As has been said, the need for social care is increasing across our population—for older people, younger people, working people and retired people. It is a good thing that we live longer, but we have to recognise that that fundamentally changes how we as a society might address that need. The answer, in my view, is not simply to throw money at it. Money is clearly part of the solution, but this is a complex puzzle, and when we consider that our system has remained largely unchanged for 50 years, I think it is time for another Nye Bevan moment.
We therefore need to identify the true scope of the issue. There is much hidden need, particularly in isolated rural areas such as mine in Devon. What is the best way of delivering? I chair a national inquiry into rural health and care. It is taking two years to deliver, and it is clear that there are issues with different geographies that can be dealt with more efficiently and effectively with different methodologies. We need to look at how technology can be better used. We should look at how we might train and motivate people across both health and social care, and there has to be parity of esteem between the two.
We need to look also at how the community can be engaged. That is not, in this case, just about money. Sometimes, it is not about money but about a willingness to be part of that community. North Devon was cut off during the extreme winter two years ago, but people survived because they pulled together as a community. That is the sort of resilience that we have to build in.
We have to find something efficient and effective. We have to be honest about the cost. I agree that we need to help society to understand that, and we therefore need to understand what the right contribution is from the individual, family, community and taxpayer. We talk about integrating health and social care, but right now the challenge is that we have two systems that are funded in very different ways. The five reports that we have had so far have looked only at the social care problem, but it is naive to think that we can look at it in isolation. What we need now is a report on integrating both the provision and commissioning of health and care. That we have not done.
Dilnot looked at one side of the problem, and we have had other inquiries looking at integrating commissioning and provision, but that is not enough. It seems to me that we need to commission an integration report across health and social care. We need to deliver parity of esteem. We need to identify the barriers to integrating those systems, and remove them. Duplication of regulators and organisations does not work. What is the true cost? What is the best way to share that burden? How do we look at insurance, savings and taxation? But that will take time, and I support the view that in the short term we need to look at domiciliary care. I believe that we could integrate that into primary care and that it should be free, whether it is funded through tax, savings or some other mechanism.
I thank Sir Vince Cable for introducing this debate. I will be talking about children’s social care, with the forgiveness of his introduction on adult social care.
In Plymouth, our children’s social care system is on its knees, not just because of the cuts that my colleagues have spoken about; it is down to a very small number of exceptionally expensive young people who have needed social care. The exceptional costs are not unique to Plymouth, but in Plymouth we have had a number of them at the same time, resulting in severe budget pressures. One of those young people cost £50,000 a week in social care and required six-on-one care as ordered by the court. I stress that it is not that young person’s fault and no blame should be attached to them or their family, but that level of cost, for small councils with small budgets such as Plymouth’s, is exceptional.
I have met some of the Minister’s colleagues to talk about those exceptional costs and whether there is a possibility that, in those exceptional circumstances, the Government might look at applying the Bellwin scheme, which covers exceptional costs in the event of a natural disaster, to extend to something that is not normally acceptable within the budget. I think there is a possibility here, and I would be grateful if the Minister thought about whether there is a point where we can look at the exceptional care costs—of others as well, but especially of young people—and say, “Actually, it is unreasonable to take resources away from other children in that locality to apply to this.” I am grateful for the Ministers who have looked at this before. We do not yet have the answer, but I think there is a possibility of working around this.
Young people are not only, in many cases, receiving the care here, but giving social care. In my last minute, I will mention young carers, because in every single part of the country they are providing tens of thousands of hours of care to young people, to elder folks and to people with learning disabilities. Their role in the overall social care scheme needs to be understood, because they are not getting the support. In many cases, they are giving up time when they could be doing homework, socialising, learning or just being themselves to care in settings that they are not trained or equipped for.
I would like to see the Government encourage schools to start counting who in their school is a young carer. Many of the schools in Plymouth have started to do so and, my word, the results are scary—they show just how many of our young people are taking on exceptional burdens. There is a question about how we can provide additional, wrap-around support for those families and in particular for those young people who are doing something really exceptional in supporting and caring for their loved ones. That is an area that I would like to see included in the Green Paper, whenever it comes out, because in the case of exceptional care costs for young people, and of young carers themselves, there is much work to be done.
We hold this debate against the severe cuts we have seen in local authorities, with £7.7 billion taken out of the budget. Of course, we had the Dilnot report in 2011 and the promise of a social care Bill in 2012. In 2015, we had a manifesto promise; in 2017, we had the promise of a paper and then a disgraceful offer in the manifesto. In 2018, we were promised a Green Paper before the summer, before the autumn, by Christmas, in the new year and then “soon”, and then it was summer again in 2019, and of course this Green Paper has not seen the light of day. Meanwhile, 1.4 million people are not getting the care they need and 87 people each day die before they get the care they desperately need.
I want to tell the story of Mr Stewart, in my constituency. The love of his life, Nancy—they have been married for more than 60 years—was taken into hospital and then discharged to a care home. He wanted her home, and it was refused and refused, and then an inadequate trial was done without the right care support in place. He longed to have her back at home, but she was permanently moved to a care home outside Harrogate, which is over 20 miles away, and each visit costs £88. City of York Council will pay for him to visit his wife once a week, but he wants to spend his whole life with her. He pays for two additional visits despite not having the means, but the visits are all too short. He cannot afford to go every day; he cannot afford to live with her; and he cannot afford to have her cared for at home. The system is broken, and poor Mr Stewart has been broken by the system. Hope came last week when Labour announced that it will pay for the personal care that people need, which would enable Mr Stewart to live with his wife. It is right that we reform our care system and turn it into a therapeutic system as we do so.
I praise our diligent careworkers, but we must end the pressure placed on them by zero-hours contracts and short visits. They need time to care and to apply their expertise. Training should be put in their hands, so that they can be at the frontline of delivering care with confidence. I worked as a carer, so I know what it is like to work under that pressure. I then moved on to be a physiotherapist, and trying to discharge people into the system was massive challenge. We need to respect our careworkers and pay them well. No more talking; we will make it happen. It is the right thing to do. It is the Labour thing to do.
I begin by paying tribute to all the family carers and the care workforce, including those who looked after my mother-in-law Mary. It was only with their support that she was able to die where she wished: at home, surrounded by her loved ones. That support is not available to everybody, but it should be. For the want of good social care, far too many people unnecessarily end up in far more expensive hospital settings. We must act quickly, and I hope that the Minister will update us on when the Government will come forward with their consultative social care Green Paper, because it was promised two and a half years ago. Five publication deadlines have been missed, so when will we see that Green Paper?
I also hope that the Minister will confirm that she has looked at the Joint Select Committee inquiry by the Health and Social Care Committee and the Housing, Communities and Local Government Committee, because the proposals provide a blueprint for how to move things forward. It contains practical suggestions that have been road-tested for their acceptability through a citizens assembly. I hope that she will also confirm that the principles set out in the document will form part of the Green Paper.
I am afraid that I am going to disappoint my right hon. Friend Sir Vince Cable, who said that this debate provided an opportunity not to talk about Brexit, because Brexit poses a grave threat to a fragile sector. The Yellowhammer documents make it clear that smaller providers face going to the wall within two to three months and larger providers within four to six months. I hope that the Minister will be able to comment on what action will be taken to mitigate that.
The effects include not only the impact of an increase in inflation on a fragile sector, but the impact on the workforce. As the Minister knows, the vacancy rate is already at 8%, which amounts to around 110,000 positions across social care. Some 8% of the workforce come from our partner EU27 nations, and many workers are deciding that it is no longer economically viable for them to remain in the UK due to changes in the exchange rate. Several careworkers have told me in tears that they no longer feel welcome in this country, which is horrific and should make us all feel a sense of great shame, but that is the reality. People face racist remarks in our country today despite decades of service to the most vulnerable in society. We cannot afford to lose them. We need to set out what will happen to ensure that the people in this workforce, many of whom will not meet the income thresholds, will be able to come here, share their skills with us and be welcomed.
It is a pleasure to serve under your chairmanship, Sir Charles. I am grateful to Sir Vince Cable for securing what has been a well attended and thoughtful debate.
The Office for Budget Responsibility assessed the UK’s public finances as potentially £30 billion worse off each year in a no-deal Brexit scenario of medium disruptiveness. That sum is significant because it is more than the entire sum spent on adult social care, plus investment in NHS buildings and equipment, across the United Kingdom in 2017-18. Much of the responsibility for social care is, of course, devolved, with respect to Scotland. The Scottish National party Scottish Government are currently working with a range of partners to take forward a national programme to support local reform of adult social care support. Scotland continues to be the only country in the UK that delivers free personal care. That currently benefits more than 77,000 older and disabled people in Scotland.
In England since 2010 the number of people receiving publicly funded social care has decreased by 600,000, because of funding cuts. In 2019-20 the SNP Scottish Government are increasing their package of investment and social care support and integration to exceed £700 million, up from £550 million in the previous year. In England a boundary has always existed between the NHS and social care, contributing to fragmented and unco-ordinated care. In Scotland the SNP Scottish Government successfully integrated health and social care, which is the most significant change to health and social care since the creation of the NHS in 1948. Last month the First Minister announced that everyone diagnosed with cancer will have a dedicated support worker, provided through a new £18 million partnership fund.
Of course, the devolved Administrations do not operate in isolation. Policy decisions from Westminster continue to have an impact on social care. The independent expert advisory group in Scotland deems that changes set out in the UK Government’s immigration White Paper would reduce net migration to Scotland by between 30% and 50% in the coming two decades. That is extremely significant. It states that social care would be severely affected as fewer than 10% of those in caring personal service occupations in Scotland earn above £25,000, and almost no one earns over the £30,000 immigration threshold. Average earnings of adult social care workers are higher in Scotland than they are elsewhere in the UK, coming in at about £18,400 as opposed to £17,300. Yet people are thinking about a £30,000 immigration limit. Just let those figures sink in. Thanks to Scottish Government funding, staff can be paid at least the real living wage, but it is still nowhere near the immigration threshold. That is a serious worry in respect of future provision throughout the UK, not just Scotland.
The number of Scots over 80 with social care needs is set to increase by 68% by 2036. That is probably an even faster rate than the English figures that we have heard from some hon. Members. My hon. Friend Brendan O'Hara called for an independent evaluation of the impact of Brexit on the health and social care sector, through his private Member’s Bill, the European Union Withdrawal (Evaluation of Effects on Health and Social Care Sectors) Bill. The Bill was supported across the House and by 102 organisations, but I wonder whether the UK Government are listening.
“An already ‘fragile’
social care system is expected to be tipped over the edge by a no-deal, with providers starting to go bust by the new year”.
The report quoted the document as saying that “smaller providers” would be
“impacted within two-three months and large providers four-six months” after Brexit. The negative economic impact of a disorderly Brexit, including an increase in inflation and an economic recession, will augment the pressure on providers and will shift the burden of care work on to unpaid family carers, the majority of whom are women. I look forward to hearing the Minister address those points, particularly on the issue of migrant staff and the £30,000 immigration limit.
It is a pleasure to speak in a debate with you in the Chair, Sir Charles. I think that this is the first time I have done so. I join others in congratulating Sir Vince Cable on securing this important debate.
The number of Members contributing in this debate makes clear the appetite to speak on the matter, and it is a pity that more Government time—or even an Opposition day debate—has not been allocated. It is appropriate that on this International Day of Older Persons we have talked largely, though not entirely, about older people. That should remind us all that growing old with dignity is a fundamental right that we should all enjoy.
By my count we have heard 12 Back-Bench speeches and six interventions, and by the time we get to the Minister we will have heard three Front-Bench speakers. Many have rightly focused on the cuts to social care budgets and the harm caused to people who rely on and need social care. We have heard powerful examples of the impact of those cuts. That harm, however, is not inevitable. If social care is properly funded and delivered well, it can be life changing. My hon. Friend Emma Hardy gave an example of how life can be changed in the wrong way if social care is not available.
Social care can keep someone connected to their community rather than isolated and lonely. It can support people to live the lives they want to live, rather than just survive from day to day—sometimes not even that—when the care disappears. But that is not what our social care system looks like today. Over the past nine years nearly £8 billion has been taken out of local councils’ social care budgets as a result of cuts. Hon. Members have mentioned the swingeing cuts experienced by many local authorities. As a result, hundreds of thousands fewer people are receiving the care they need. That is the straightforward result of the cuts.
Age UK tells us that 1.4 million older people in this country are struggling with everyday activities. Whether that means getting washed or eating a meal, they are not getting the help they should be getting. Older people are being left trapped in bed all day and perhaps going unwashed all week because their children can visit them only on weekends. They are having only microwave meals, because that is all their neighbours or family friends have the time to buy in for them. That is not what this country’s older and disabled people deserve.
I am glad that many hon. Members have mentioned the immense pressure that the state of our care system puts on unpaid carers. Wherever the Government pull back from funding social care properly, the UK’s millions of unpaid carers have to step in. As we have heard, that includes young carers in the constituency of my hon. Friend Luke Pollard. It is very important to identify and support those young carers. I have tried three times to bring in legislation, including to identify young carers. The Minister’s predecessor did not support it, but we could still do it. I might give the Bill to my hon. Friend so that he can resurrect it.
It is a dire picture, including for young carers. Half of unpaid carers now spend 50 hours a week providing care, while 38% spend 100 hours of every week caring. One quarter of carers have not received any support, either for themselves or for the person they care for. Two thirds of carers say that they do not get as much social contact as they would like with other people. More than eight in 10 say that they cannot spend time doing things that they enjoy or value, and 40% of carers say that they have not had a day off for more than a year. In fact, a recent Carers UK report noted carers saying that if they had a respite care break, they would use it to visit their own GP for a medical appointment, which is very sad.
Even for the smaller number of people who manage to get a social care package, cuts mean that the care provided will not be of the quality expected. One in five social care services has been rated by the Care Quality Commission as either “inadequate” or “requires improvement”. The number of complaints to the local government ombudsman about social care provision has trebled since 2010, rising to more than 3,000, and two thirds of those complaints are upheld. There is very much wrong with our system. I find it deeply concerning that one in five care homes, housing as many as 9,000 older and disabled people, are now rated as being unsafe.
These are not services that any of us would like a family member to have to rely on. The situation can mean care homes that are so unclean that residents are at risk of infection, or residents being at risk of malnutrition because nobody is monitoring what they are eating. Care in one’s own home can mean visits by staff who have not been subject to basic checks or who have not completed any training. It can mean staff being so rushed that they do not have time to take off their coat while they are getting people up and dressed. The reality is that some care providers cannot provide high-quality services with the funding available; sadly, other providers choose to protect profit margins rather than the people who use their services.
That issue is clearest in the social care workforce. There are 1.4 million people—or there would be, if the vacancies were filled—working in social care. These people provide vital support day in, day out, but they simply do not get the respect they deserve for the work they do. More than a quarter of those care staff work for a minimum wage, and the same proportion of the workforce are on zero-hours contracts. It is no surprise therefore that there are 110,000 vacancies in the care sector. Those important issues have been touched on by many Members in this debate.
Rather than providing the empathetic care that they want to offer, care staff are often reduced to visits lasting 15 minutes or less. They must rush through their tasks with barely any time to talk to the person they are visiting. This deterioration in the quality of care is the result of nearly a decade of cuts, care staff stretched to breaking point and services that barely deserve to be called “care”. Hundreds of thousands of people have to go without basic support.
My hon. Friend is making an excellent speech and paints a picture of social care in this country. On 15-minute visits, does she agree that the issue is not just the time limit but the ever-changing individual presence? With vulnerable people, consistency of care and the ability to build up a relationship are equally important.
My hon. Friend is absolutely right. For people with dementia and learning disabilities, seeing a familiar face every day can be crucial.
We cannot allow this crisis to continue. We must see action to ensure that everyone is able to access the care that they need to live with dignity. That is why Labour has announced that we would introduce free personal care for all older people who need it and expand such provision to working-age adults as soon as possible. That would end the scandal of people having to sell their home to pay for basic care. We will fund social care in the only fair, sustainable and understandable way—through general taxation. That is how we fund our NHS and our schools, and it is how Labour will fund our national care service.
Before we can build this new system, we must also repair the damage caused by years of budget cuts. We will invest £8 billion in more care packages, in improved training and in better community support. The apprenticeship levy is not enough for training; skills for care should be better funded.
I do not have time.
A few months ago, we pledged £350 million a year for community resources, aimed specifically at helping to bring autistic people and those with learning disabilities out of in-patient units—over 2,000 of them—in which they are trapped. It is a scandal that we do not have the social care and community resources that are needed to prevent people being trapped in abusive care. Time and again, the reason given for people being in those units is that there is no resource in the community. My hon. Friend the Member for Plymouth, Sutton and Devonport has spoken about the burden that falls on social care authorities if they end up with a very expensive case. We have to get round that.
We can fix the crisis in social care only by properly funding the system, as the Labour plans will do. Two years after the Conservatives’ disastrous 2017 manifesto plans, which were later dropped, we are still waiting to hear what they will do. The Government’s promised Green Paper has been delayed and delayed, and now it looks to many—including many in this Chamber—as if it has been dropped altogether. Derek Thomas mentioned how embarrassing that was. It is not just embarrassing; people lose hope waiting for the care they need.
A cap on care costs, which would stop people facing catastrophic costs, and for which we legislated, was ditched by the Government in December 2017. I am sorry to say that instead the Government have provided only small, one-off cash injections—sticking plasters—rather than the long-term funding settlement that social care needs. Will the Minister tell us where the Government’s proposals on social care are? If the Government want to resolve the crisis that their funding cuts have created, as I hope they do, why have they constantly kicked social care funding reform into the long grass? It is time for a solution to the crisis that this Government have created. Labour Members have pledged a way to solve the crisis, which in itself gives hope to many people who need social care.
It is a great pleasure to serve under your stewardship in this important debate, Sir Charles, and I share the sentiment of many Members across the House in congratulating Sir Vince Cable on securing it. I also wish to highlight the incredibly constructive and collaborative nature of the way that he opened this debate. He was right to highlight from the outset that the only way to find a solution to this thorny issue, which is not unique to our country but a challenge faced by countries around the world, is by working in a co-operative, collaborative, and constructive way.
The right hon. Gentleman rightly pointed out that successive Governments have tried and failed to deal with this thorny issue, and despite everybody recognising the need for consensus, for too long it has been weaponised. We have heard expressions such as “dementia tax” or “death tax” used by all parties over the years. That has not been helpful, and it is one reason why different parties and Governments have placed this issue in the “too difficult” pile. He was also right to highlight the sense of urgency, because we no longer have the luxury of time to place the issue in that pile.
Over the past couple of years the Government have responded to huge short-term pressures, and funding for local government has gone up, as opposed to being cut, as outlined by Labour Members. However, we must set out our long-term plans, and consider how to solve the thorny issues of long-term funding for adult social care. At the moment, one in 10 people face what we might call catastrophic care costs in excess of £100,000, and potentially lose their home to pay for their long-term care.
I thank hon. Members across the House who have spoken with great passion and, in most cases, an enormous amount of collaboration and desire to work together to find solutions to these problems. I join them in recognising and paying tribute to the carers, nurses, social workers, and unpaid friends and families of those who require care. Every day, carers work tirelessly to ensure that people live dignified and fulfilling lives, regardless of how tough that challenge is. In doing this job and fulfilling this role, it has been my greatest privilege to meet those people on an almost daily basis and hear their stories. Emma Hardy said that carers must be accorded the status that they deserve, and given resources to drive the right amount of quality, and she was absolutely right. She was wrong, however, to say that we have lost caring from the caring system. People may be driven to that point in some respects, but they care and they do so in the most beautiful way.
May I associate myself with what Luke Pollard said about young carers who go home and look after parents who may have an alcohol or drug dependency problem? In my constituency an organisation called The Young Karers East Sutherland helps to support them. My mother died four years ago, but she was cared for at home very well. The younger carers—those who had left school and gone into the profession for the first time—were the most amazing. They embraced this profession, and one could see they had a vocation. I suggest that one way to sort out this problem is to encourage the recruitment of young people by giving them taster sessions and letting them come from school and see what it is like. Often, we might get converts who will stay in the profession for life.
That is an excellent intervention, and the hon. Gentleman is right to say that we must do more to recognise and support young carers. The hon. Member for Plymouth, Sutton and Devonport said that we must do more to help schools to identify young carers, and that was a key part of the carers action plan that was announced last summer. A young carers’ takeover day of Parliament is planned in the months ahead: every MP across the country will be encouraged to invite a young carer from their constituency, which will give us a real in-depth understanding of what an amazing job young carers do.
We all recognise the challenges that the social care system faces. As a population, we are getting older: by 2040, one in four people in the UK will be 65 or over, as the right hon. Member for Twickenham pointed out. It is also important to understand that social care is not just a service for older people; the number of people under 65 who have carers is growing and accounts for more than half of social care spending. That can have quite a disastrous impact on local authority budgets, as the hon. Member for Plymouth, Sutton and Devonport pointed out. I will certainly take forward the points that he made.
These long-standing trends put increasing financial pressure on local authorities. In response, we have taken steps to ensure that the social care system has the funding to meet urgent challenges in the short term. In 2017, we announced an additional £2 billion in grant funding for social care, which we supplemented with a further £650 million in the 2018 Budget. Councils have responded by increasing their spending on social care, which has risen in real terms in each of the past three years.
I will make some progress, if the hon. Gentleman does not mind.
As a result of our investment in social care, 65% of local authorities were able to increase home care provision in 2017-18. Local authorities have increased the average fee paid for older people’s home care by 4.7% in 2018-19, bringing some much-needed stability to the provider market. I am very pleased that the Care Quality Commission has rated 84.1% of social care settings as good or outstanding.
I am delighted to say that in our most recent spending round we announced further investment in adult social care. We will provide councils with access to an additional £1.5 billion for adult and children’s social care next year, including £1 billion in new grant funding over and above the £2.5 billion of existing social care grants. In the spending round, we confirmed that all the existing funding streams would be maintained next year—hard-wired into the Budget, if you like. The Government will also consult on a 2% adult social care precept that will enable councils to access a further £500 million. This increase in funding is part of the biggest increase since 2015 in overall core spending power for local government: it will increase by 4.3% in real terms next year.
The new funding from the spending round will support local authorities in meeting the rising demands that they face, while helping them to continue to stabilise the wider social care market. This additional funding is the first step towards putting adult social care on a fairer and more sustainable footing. We have already started preparing for the multi-year spending round due next year.
The challenges facing social care are not purely financial, as hon. Members across the parties, including my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter) and for Newton Abbot (Anne Marie Morris), have said. It is important to point that out, because stakeholders across the sector tell MPs: “Even if money were no object, we would not necessarily continue to provide this service in the current system.” The current system is not working in so many respects, and it is not working properly for some of our most vulnerable citizens, which is why we are continuing to support the system through a programme of sector-led improvements to help councils to make better use of funding to deliver high-quality personalised service, with more than £9.2 million committed by the Department in 2019-20.
We are also breaking down barriers to encourage much better integration of health and care, and we are looking at what more we can do to support the workforce and carers, as I have mentioned. In terms of integration, the better care fund has helped to enable much better co-operation between health and social care partners at a local level. It has also been instrumental in reducing delayed transfers of care, which has been mentioned: they have decreased by 2,147 since February 2017. We are looking at how we can use the fund to drive better integration.
My hon. Friend Derek Thomas spoke about bed vacancies and people stuck in hospitals. There is a lot more integration going on between care providers and health settings that are using those beds to provide the step-down care and discharge to assess that we want to see.
The better care fund and how it is applied on the ground locally varies across the country. Overall, the impact has been disappointing in terms of the ambition for that fund. I urge my hon. Friend to look at why there are two different commissioning systems for the NHS and social care. Unless we get that right, we are not going to drive improved integration or more personalised care.
My hon. Friend is right to say there were teething problems, but in the most recent reporting cycle, 93% of local areas agreed that joint working had improved as a result of the better care fund. We want to use it to drive much better integration and to look at how we undertake more joint commissioning in future.
We are committed to working alongside all partners in adult social care to attract and support a growing workforce with the right skills and the right values to deliver quality and compassionate care. Earlier this year, we launched the “Every Day Is Different” national adult social care recruitment campaign to raise the profile of the sector. We have secured a further £3.8 million for the next wave of that campaign, which will start later this month. We fund Skills for Care to support the sector in recruitment and retention.
I do not have time. We also fund the workforce development fund, and social care employers can bid for this funding to pay for their staff to gain training qualifications at all levels.
There were lots of questions raised across the Chamber and I want to deal with them all. The hon. Member for Totnes spoke about the impact of Brexit. As the Prime Minister has said, he wants our immigration system to help to attract the brightest and best talent from across the world. This includes delivering an Australian-style points-based immigration system as a first step. The Home Secretary has commissioned an independent migration advisory committee to review this and the appropriate salary threshold. Clearly, we want to attract people to work in adult social care.
We are aware that the system is already under pressure and recognise that EU exit could add to this. We have been working on this for a long time alongside partners, including ADASS, the Local Government Association and local authorities, to ensure robust contingency plans are in place. [Interruption.] I am going to have to make progress as I will have to sit down in a second.
There is still much more to do. The funding announced in the spending round is a down payment on much more fundamental reforms to social care that we need to introduce. As the Prime Minister said on the steps of Downing Street, the Government will set out plans to fix the crisis in social care once and for all, to give every older person the dignity and security they deserve. We want to ensure that nobody has to sell their home to pay for care. The Government will not shy away from the long-term challenges that face social care. Our proactive approach to funding and reform means that we will ensure that our social care system can respond to the challenges that lie ahead with confidence that the most vulnerable in our society will be able to live with dignity and respect and receive the care they deserve.
Sir Charles, thank you for safeguarding the last 10 minutes. I tried to approach this whole subject in a non-tribal way. I thank all the Members, including the Minister, who participated in that spirit. The debate was enriched by people drawing on professional experience, such as Karen Lee, and those drawing powerfully on personal case experience, such as Luke Pollard, Rachael Maskell, the hon. Member for Eastbourne (Stephen Lloyd), Emma Hardy and others.
The title of this debate included the ugly word, “funding”. However good our intentions, we do have to pay for this, and I commend Kevin Hollinrake for setting out clearly and succinctly the financial constraints and a good solution through social insurance for many of these problems. I also commend Bill Esterson and Anne Marie Morris for pointing out that we are trying to reconcile two fundamentally different systems of funding and organisation. As we integrate the system, bringing them together is not an easy task.
Perhaps I tried too hard to be non-tribal. I thought we were trying to get a bit of respite from Brexit. However, as my hon. Friend Martyn Day, and others pointed out, unfortunately we cannot get away from it. It has a major impact on resource availability and the labour market.
In conclusion, I wish to thank the Minister for her reply. She pointed out—and I should have acknowledged this at the beginning—that the Government have put in a little bit more in resource. However, that is growing at 2.5% while the demand is growing at 4% and the cruelty of compound interest is, I am afraid, rather powerful and painful over time.