Thank you, Mr Speaker—take two.
There are few things more important to any of us than the way in which the oldest and most vulnerable are cared for in our society. First, let me pay tribute to the 1.4 million people who work in the country’s social care sector. They support many of the most vulnerable people in our communities, often in the most difficult of circumstances. I am proud that we have done more than any Government before to improve the quality of social care, introducing a tough system of CQC ratings, new qualifications for care workers, and new standards to ensure that everyone receives the highest-quality support. I am heartened that today’s CQC report shows that even in a time of acute fiscal pressure, 79% of adult social care services are now providing good or outstanding care.
However, it is impossible to ignore the pressure that our ageing population and advances in medicine are putting on the system. We have seen the number of over-65s increase by nearly 1.2 million, or about 14%, over the past five years. Today’s CQC report shows that in some areas, it is completely unacceptable that standards in some settings are below those rightly expected by care users and their families. This Government view social care as a priority, which is why in the spring Budget this year we announced an additional £2 billion over the next three years for councils in England to spend on adult social care services. That means that, in total, councils will have access to £9.25 billion more dedicated funding for social care over the next three years—enough to increase social care spending in real terms. We have also been clear that later this year we will be consulting widely on the future of social care in this country to put it on a stable footing.
My right hon. Friend the Health Secretary updated the House on Monday about action he is taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up by 24.5% from 1.81 million in the previous year. The Government are clear that no one should stay in a hospital bed longer than necessary—it removes people’s dignity, reduces their quality of life, leads to poorer health and care outcomes for people and is more expensive, ultimately, for the taxpayer. Since February, there have been significant improvements in the health and care system, with a record decrease in month-on-month delayed discharges in April of this year.
However, we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on accident and emergency departments. That is why we have introduced a further package of measures to support the NHS and local government in reducing delays. That package includes guidance, a performance dashboard, plans for local government and the NHS to deliver an equal share of the expectation to free up 2,500 hospital beds, and of course CQC reviews. We have also been clear that we will consider a review in November of the 2018-19 allocations of the social care funding provided at spring Budget 2017 for poorly performing areas. We have been clear that the Budget funding will all remain with local government, to be used for adult social care.
I thank the Minister for that response, but I really must ask him whether he shares my deep concern about the state of adult social care, as highlighted by today’s report by the Care Quality Commission. Some 3,200 care services were rated as “requires improvement”, with more than 340 rated as “inadequate”. That means that some 92,000 vulnerable people are receiving poor care and some 10,000 people are receiving inadequate care. The picture is even worse in nursing homes, with one in three receiving the poorest ratings.
Does the Minister share my concern about safety, with one in four care locations failing on protecting people from abuse or avoidable harm? That means thousands of vulnerable people not getting prescribed medicines, being ignored when they ask for help and not having enough time for their home care visits.
The Labour party has repeatedly raised the damaging impacts of budget cuts, with more than £5 billion having been cut from social care since 2010. Does the Minister now accept that that has caused the crisis in care staffing, which is at the heart of the poor care that is being reported? Poor staffing levels and staff training are key factors in those providers with the poorest ratings.
In his written ministerial statement earlier this week, the Secretary of State suggested that the £2 billion allocated in the spring Budget to local councils for social care, to which the Minister has just referred, will now be dependent on performance against targets for delayed transfer of care. That means that some councils could lose funding that they have already planned to spend. Does the Minister accept that threatening local councils with the loss of planned funding could lead to a worsening of the quality and safety issues highlighted today? With social care in crisis, this is not the time to be threatening joint working with local councils, so will he reverse that threat and match the Labour pledge of an extra £8 billion for social care, including an extra £1 billion this year?
I thank the hon. Lady for that response. This subject was much discussed during the general election, and I think it will be greatly discussed during this Parliament.
Nobody is making any threats. The Government are very supportive of the best-performing systems, where local government and the NHS work together to tackle the challenge of delayed transfers of care. We have said that, depending on performance, we will consider a review in November of the 2018-19 allocations of social care funding provided in the spring Budget for areas that are poorly performing. As I have said, that funding will all remain with local government, to be used for social care.
Obviously, we recognise that there are real pressures in the system. That was why we responded—I think the hon. Lady’s party was pleased with this at the time—with an additional £2 billion for social care in this year’s Budget. We have also given councils the chance to raise the council tax precept. My authority, Hampshire, has done that, and I think that has been well received.
Turning to the actual report, it would be easy to duck all of this. Dare I say that I hope we can conduct this debate in a sensible spirit? People out there working in the system who want to pass the mum test, as was said this morning, want us to do that and are watching things closely. Of course, it would be easy to bury our heads in the sand, but let us remember that had we had the rigorous inspection regime that the Secretary of State put in place earlier, a lot of problems, including those in the hospital sector when the hon. Lady’s party was in government, would not have been heard of. We know about the current situation only because of the inspection regime that has been put in place.
The CQC report found a number of things, and obviously we will digest it over the days and weeks ahead. It found that the adult social care sector performed best in how caring its services are: 92% of services were rated good and 3% outstanding. We can kick this issue around all we like, but today’s report shows exactly why we introduced the inspection regime. It is uncovering the care that is good—the vast majority of it—and it is also uncovering the care that is not, which is where we want to help and support local authorities to make sure that improvements are made for the people we represent.
It is concerning to note from the CQC’s state of adult care report that staff turnover rates have risen from 22.7% to 27.3% in the three years to 2015-16. Will the Minister meet me to discuss the important role that supporting skills and opportunities for career progression can play in reducing turnover, improving morale and, most importantly, improving the quality of care that people receive? Will he visit my constituency to see the excellent joint working that has been done by the trust and South Devon College towards just that?
I thank my hon. Friend for that. I think she knows that I will be in the vicinity of her constituency at some point over the next few months, and I would like to take her up on her offer. I wish her well in her current campaign.
The workforce is critical. Adult social care is a rapidly growing sector, and there are about 165,000 more adult social care jobs than there were in 2010. It is imperative that we get the right people into the right jobs, to deliver the improved quality of care and services that we all want to see. We are working closely with our delivery partner Skills for Care to improve the level of skills in the adult social care workforce, and we are making the profession more attractive with the introduction of the national living wage, from which up to 1.5 million people in the social care sector are expected to benefit. I might point out that that policy has come in only as a result of this Prime Minister and this Government.
I want to point out that the report rates 92% of services as good and 3% as outstanding on caring. That comes from the commitment of staff, who, sadly, have not been given a breaking of the 1% cap. The issue of safety has been raised, with one in four providers failing to provide safe care. That comes down to workforce and funding. Brexit threatens the workforce; as the hon. Member for Totnes (Dr Wollaston) said, there is a turnover of one in four. Funding has been reduced by 9%, and that has to be tackled.
Does the Minister recognise that one in five emergency admissions could be avoided if alternatives were provided? Although the measures are different in Scotland, delayed discharges are falling in Scotland while they are rising in England. Will he get rid of fragmentation and look at real integration of health and social care in the sustainability and transformation plan reorganisation?
I said at the very start of my response, did I not, that we should salute the 1.4 million people who work in this country’s social care sector? We should also salute the families who support people who are in and out of care settings all the time. I did also say—I am grateful that the hon. Lady responded to this—that it does not surprise me that the caring side of the sector came out as one of the good bits in the report.
The hon. Lady spoke about keeping people out of the emergency setting, and that is absolutely what the STP process is about. We are one NHS, and there is one public sector. This is about the NHS getting delayed transfers of care right, but it is also about the work of local government. The STP process works at upper tier authority level as well as across the NHS—in my area of Hampshire, the NHS is working closely with Hampshire County Council—to deliver a one-system response. She is absolutely right, as usual, to point that out.
It is absolutely vital that we improve adult services that are failing and falling behind, but let us not lose sight of the fact that most adult social services are of high quality and many are improving. Nearly four out of five of our adult services are good or outstanding. We all know that there is a looming crisis in social care, which is why the Chancellor announced further investment of £2 billion in this area. Is that investment starting to show some results?
Yes, we believe it is. The CQC has completed its ratings, and the proportion of providers rated good or outstanding increased to 79% by July 2016; the previous figure was 72%. It is also worth noting the CQC’s statement that 81% of services rated inadequate improved their overall rating following re-inspection. Obviously, there is a challenging element to the report. As I have said, we do not hide from that or shirk it—nor should we—and that is why we set up the inspection regime. It would not be right or fair to people who work in or rely on the sector to say that everything is going to hell in a handcart, because I do not believe that it is.
I hope the Minister will agree that these widespread failures of care are intolerable in a civilised society. Does he share my view that we will have to confront the need to increase taxes to ensure that we have an efficient, effective and compassionate system, and will he embrace a cross-party approach to come up with a long-term settlement?
Of course I want to work—as will the current Care Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price)—with the respected former Care Minister, and with any other Members who have any sensible suggestions. Taxation is of course a matter for the Chancellor at financial events, and there will obviously be a Budget later in the year.
On the areas where there are care challenges, we have picked up 12 local areas for review, as the Secretary of State said earlier this week. We have published the details that are suitable for the review, which we have developed from the dashboard criteria. We will give those involved every possible support, as we do with the inspection regime for hospitals, for instance. Such inspections are to get hospitals out of special measures and get them to a better place, and we will do the same for those areas. I will be very happy to meet the right hon. Gentleman. In fact, if he had not asked me, I would have offered to meet him.
If the Government’s plan is to reduce the pressures on adult social care, will my hon. Friend explain why the Dorset clinical commissioning group is proposing to close down the St Leonard’s community hospital, which provides really good services at the moment and is approved of by the community?
No, I cannot go into the detail of why that is, as I suspect my right hon. Friend realises. There will be a one-NHS STP process in his area, and it will have to come up with proposals that meet the five criteria for any reconfiguration. As he will know, there were previously four criteria that had to be met, but there are now five; Simon Stevens, the chief executive of the NHS, has added a fifth on patient safety. My right hon. Friend mentioned St Leonard’s hospital, and any reconfiguration or change of service in relation to it will have to be considered in that context.
The Minister has just elevated the hon. Member for Christchurch (Mr Chope) to the Privy Council, of which he is not currently a member. Whether that was inadvertent on the part of the Minister or a gentle hint to the powers that be remains to be seen. It would be only a very modest elevation for somebody of the hon. Gentleman’s experience.
Mr Speaker, I have no advance knowledge of the future career prospects of my hon. Friend the Member for Christchurch (Mr Chope), but I am sure it is only a matter of time before he becomes a Dorset knight.
I do not agree with the hon. Member for Colne Valley (Thelma Walker), whom I welcome to her place. I do not think that what the sector needs right now is nationalisation. I would gently say once again that public ownership is not the answer to every challenge in our public services.
When visiting a constituent at home last week, I discovered that he has had dozens of carers. Many of them have delivered excellent care, but he was really concerned about the sheer number of different carers that he had had. What does my hon. Friend have to say about proposals or plans to ensure that people receive consistent care from as few carers as possible, which benefits both the patients and the carers?
As ever, my hon. Friend is on the money. Across primary care, the named GP policy is a huge step forward, and that idea is absolutely something we should aim for in this sector. That may come out during the consultation later this year, and I feel certain that my hon. Friend will respond to that consultation.
One among many, Mr Speaker.
This Government have pushed a national crisis on to hard-pressed local councils and hard-up local residents, forcing council tax rises that will barely cover the minimum-wage salaries paid to carers. The Minister says that the precept has been welcomed, but I would ask: by whom?
I have found the CQC’s inspections of struggling care homes in Amber Valley to be a very useful way of making sure that they improve care for local people. Is the Minister confident that the CQC is sufficiently resourced and skilled to carry out those inspections in a timely fashion and to a sufficient quality?
Yes, I think that the CQC does a fantastic job. Andrea Sutcliffe, its chief inspector of adult social care, whom Members will have heard on the media this morning, was absolutely right when she talked about services needing to meet the mum test or the dad test. Ultimately, we are all affected—I have ageing parents, like many Members of this House. The mum test or the dad test is what we want, because when people go into adult social care settings we want to feel that they are as well looked after as we could manage ourselves.
Loneliness can be extreme in housebound adults and the level of mental health issues such as depression is often high but unrecorded. Will the Government ensure that there is a holistic approach to social care that includes key indicators of mental health and wellbeing?
Okay. The Prime Minister has been very clear about the importance of tackling this issue. As she said, we will look after 2 million more over-75s in the next 10 years and we have to find a sustainable way of caring for older people. As I have said, we will consult on detailed proposals, which will include a capital floor and an absolute limit on the amount people can be asked to pay. Our objective will be to get the widest possible consensus.
Did the Minister see the recent “Dispatches” programme featuring Bupa’s Crawfords Walk care home in my constituency, which had shocking levels of care? If large, well-known providers such as Bupa are caught putting profits before patient care, what can the Minister do to ensure that smaller, less high-profile providers are not doing the same?
I am sorry, but I did not see that programme. I shall look out for it on “watch again”. What we can do is put in place the toughest, most rigorous assessment and inspection regime, and that is what we have. That has come from this Secretary of State, not from the previous Government, who ducked the issue. What we can do is ensure that there is rigorous inspection to root out poorly performing services. That is the same in the hon. Gentleman’s constituency as it is in mine.
With an increasingly ageing population, does the Minister agree that it is deeply cynical to pretend that there is some financial solution to this issue that does not involve very difficult decisions both within and across generations?
Yes, I do. There were many disappointing things for me about the recent general election—[Laughter.] To be serious, one of the more disappointing things was that the debate around the future of adult social care was reduced to the use of the words “dementia tax”, which did the sector, our constituents, our public life and this Parliament an enormous disservice. We do need to have a grown-up debate in this country about this issue, and that is why we will bring forward proposals for consultation.
This week marks the sixth anniversary of the Dilnot commission report on social care, yet the Government are no closer to finding a solution on funding social care. Will the Minister tell the House why his Government have wasted six years and failed to take any action to solve the social care crisis?
Honestly, now I am being tempted into politics. The bottom line is that the Labour party had 13 years in government to sort out the social care system, and it never did. It was in the Labour manifesto in ’97, there was a royal commission in ’99, there was a Green Paper in 2005, there was the Wanless review in 2006, the Labour Government said it would be solved in the 2007 comprehensive spending review and then there was another Green Paper in 2009. I honestly think that lectures from Labour Members about wasting time on this subject are for the birds.
Yes, and my hon. Friend is absolutely right that one of the most disappointing aspects of the discussion over the past few months is that the current situation is hardly perfect. If it was, we would not be debating it, and if it had been easy to solve we would have solved it years ago—and the last Labour Governments would have done so as well.
Order. This is a hugely important subject and there is extensive interest. I would like to accommodate it all, but we do have another urgent question to follow, then business questions, and then a heavily subscribed debate. May I please now ask colleagues to be good enough to pose single sentence, pithy questions, and of course appeal to the Minister to provide comparably pithy replies?
We have an appalling case of abuse in a small private care home in my constituency that resulted in prison sentences for the two people involved. What is the Minister going to do to raise standards in small private care homes?
I welcome the Care Quality Commission inspections of care homes in my constituency as it is helping to drive up standards and highlight problems, but many older residents tell me that they want to stay in their own homes for longer. What is the Minister doing to help make that happen?
That is exactly why I said that this has to be a one-system solution. We need the NHS to work on delayed transfers of care, but we need local authorities to work with us as well, which is what the better care fund is all about. We know that it is better for people to be cared for in their own home, but that is not always possible, which is why we need a long-term solution to the funding of adult social care that deals with not only residential but domiciliary, care—and that is why we tried to introduce that debate during the election.
Liverpool City Council spends more on adult social care than it is able to raise in council tax, yet still has more of a cut to make, and pays a very low level of fees as a consequence. Can the Minister give an assurance that councils such as Liverpool will not be further disadvantaged when he rolls out the extra funding he is promising to try to improve this situation?
As I said, councils have access to a total of just over £9.25 billion more in dedicated funding for social care over the next three years as a result of measures introduced by this Government since 2015. That is enough to increase social care spending in real terms. And let me just put this on the record for the House: the UK spends more as a share of GDP on long-term care than other industrialised countries, including much-vaunted Germany, Canada and the United States.
I gently say to the Minister that the only reason the Labour party was able to mention the “dementia tax” was that the Conservative party had put something stupid in its manifesto. This matter is far too important for party politics. Does the Minister agree that the social care system is broken and that we need a cross-party agreement on how to move forward?
I do think we need a cross-party, cross-country solution to the long-term funding of adult social care, which is why we started a debate during the recent election campaign, and why we need a proper consultation, which will be coming online later this year. My hon. Friend is absolutely right: this is far too important for the knockabout of party politics.
That is an absolutely fair question. This is why I said in my statement that, through the dashboard, we have picked the 12 most challenged local areas for review. The reviews will cover providers and commissioners of services, looking at the interface between social care and general primary care and acute and community health services. It will include an assessment of the governance in place for the management of resources. I am sorry to have had to read that out, but I wanted to get it absolutely clear for the record. That is why those reviews are being put in place. We are not just pointing the finger and saying, “You’re bad.” We want to support those areas to deliver the care we are getting in the vast majority of other areas.
Improvements in medicine have enabled people to live longer, but we also want them to live more healthily. We know that investment in reducing loneliness, in improving activity and in treating conditions such as macular degeneration, which causes blindness, will help to reduce the need for social care. What is the Minister doing in this regard?
Although I am not specifically the Minister with responsibility for care, I am the public health Minister and the primary care Minister. We have brought those two subjects together because we want to see a healthy population across the board. I am pleased that my hon. Friend has mentioned the Commission on Loneliness. It was probably set up before she entered this House; it was started by the late Member Jo Cox, who did some really good work that is rightly being taken forward in this Parliament.
Carers in Northern Ireland who provide for elderly and disabled loved ones save the NHS some £4.6 billion, and that figure rises to £132 billion across the whole of the United Kingdom. How does the Minister intend to ease the pressure on them by funding more respite places, to allow families to have the much-needed breaks that enable them to carry on caring in the long term?
I will look into that. The hon. Gentleman makes an important point. I am sure that Members across the House take part in carers week events every year. I certainly do that in my constituency. It is at those events that we meet not only the staff who work in the system but the people who, day in and day out, do not have the life that they would like to have because they have caring responsibilities. We also meet young carers who do incredible work. The hon. Gentleman is right, and we should all say a clear thank you to those people for the work that they do.
The extra money in the last Budget for social care is helping Kent County Council to provide more people with access to care, particularly at home, but the cost of social care is going to keep rising. Does my hon. Friend agree that we as a society need to have an honest conversation about how we fund those growing costs fairly across the generations?
Yes. This is no different from the conversation that we are having about the funding of every other public service. It is very easy to take to the streets with placards saying “Spend more!” Indeed, I think the Leader of the Opposition spent the national debt several times over just in his response to the Queen’s Speech. This is why we need a proper debate and a consultation on long-term funding. Ultimately, it could come out of general taxation, but we have to have a debate as a country on how much we can afford to do while funding all the other public services. I have not noticed us being short of requests to increase funding in other areas as well. We have to have that honest debate as a country.
If we are going to have that honest debate, the Minister, whom I welcome to his place, has to accept that the decisions of his Government have fuelled the social care crisis. My council, the third most deprived in the country, has had the 17th highest cuts to its budget, including having £40 million taken out of social care by 2020. The social care precept that the Minister has introduced does not raise the amount of money in my area that it could in wealthier areas. Will he please accept some political responsibility for the mess we are in?
Of course Governments of all colours have delivered us to the place where we are at this very moment, but have this Government put more money into the social care system? Yes. Did we provide more money in the Budget this year? Yes. Are we allowing councils to raise more money? Yes. As I said earlier, we spend more on long-term care as a share of GDP than other industrialised countries, including Germany and Canada and the massive economy of the United States.
As the Minister knows, about 2.8 million adults over the age of 65 are currently in receipt of formal or informal social care. Can he confirm that a recent Care Quality Commission report showed that, despite the pressures, the proportion of care services rated good or outstanding is actually increasing?
Indeed I can. We introduced the new, tougher system of CQC inspections, for the reasons I set out. We introduced a care certificate for support workers and healthcare assistants, and we introduced the new quality standards to clarify what excellence actually looks like in care. We brought in new criminal offences of ill treatment and wilful neglect, and we introduced a fit and proper person test to hold directors to account for care. Those are all things that have happened under this Secretary of State that never happened before.
The care sector is a significant employer in my Bristol South constituency, but people are being lost to other sectors. I listened carefully to the Minister’s response to the hon. Member for Totnes (Dr Wollaston), but I urge him to be much more ambitious in supporting the sector to recruit more people and build on career pathways between health and social care to encourage people who want to do those jobs.
They have not all been sensible, but yours was marginally more sensible.
As I said earlier, this is a rapidly growing sector and it is imperative that we get the right people into the right jobs. That is why it is so important to work with organisations such as Skills for Care to improve the level of skills, and people in this sector are expected to benefit from the national living wage.
Worthing has the highest proportion of over 85-year-olds in the country. They tend to be not particularly well off, and their major asset is their property; so can the Minister ensure that, in welcoming the fact that we will have a grown-up debate at last, any sustainable solution recognises that people who have worked hard, paid their dues, looked after their family and done the right thing should be appreciated, not penalised, for having done so?
More care homes may face closure if they cannot access migrant workforces. What steps will the Government take to ensure that migrant workers, who are happy to work in our care homes and who provide excellent standards of care, will still be able to come to the UK after Brexit?
Adult social care funding has been raised with me across Eastleigh. Delayed discharge is also being prioritised by the clinical commissioning group, but Eastleigh’s Lib Dems on Hampshire County Council chose back in February not to support a further £27 million for the county’s social care budget. Will the Minister highlight the fact that some parties talk about action but simply fail to make a difference locally?
My hon. Friend is a doughty champion for her Eastleigh constituency, and I also represent part of the borough. What she says surprises me, but I am sure she will raise it in the national debate in the months leading up to next May’s borough council elections.
In March, the Select Committee on Communities and Local Government agreed a report on adult social care. We called for significant extra funds in the short and medium term, but we said that, in the long term, a lasting solution will be found only through cross-party working. The Minister seems to agree in principle, but will he confirm: that he will engage with Opposition Front Benchers and other parties on the consultation’s terms of reference; that he will fully involve them in the consultation; that he will approach the consultation with an open mind, and not rule out any alternatives; and that the Select Committee will be involved in the consultation?
I have visited many nursing and care homes in my constituency of Wealden and have met committed and caring care staff. Does the Minister agree it is the inspection system introduced by this Government that is finally shining a light on poor care and driving up standards?
Yes, I do. As I said, this inspection regime is a good thing. It is important for families and for people in the system, but it is also important for the staff—they want to know that they are benchmarked as giving the best possible care. It is as important for the staff as it is for the punters, for want of a better word.
Yes, I agree with my cheery hon. Friend, and this is a good place to finish. There is so much good practice in the sector, and the report highlights that today. We should celebrate that, as we do, and learn from it, as we will, while ruthlessly picking out those areas that need support in order to improve the care they are giving.