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Adult Social Care: Funding

Volume 779: debated on Thursday 16 March 2017


Asked by

To ask Her Majesty’s Government when they expect to produce their proposals for a longer-term solution to the funding of adult social care.

My Lords, in order to meet the demographic challenges facing this country, the Government are committed to establishing a fairer and more sustainable system for funding adult social care. We will bring forward proposals in a Green Paper later this year.

I thank the Minister for that Answer, but can he confirm that the review which is ongoing will examine the lessons from Japan and Germany, where populations and politicians have recognised that, as we live longer, we have to prepare earlier for funding our long-term care? Can he also assure the House that, in securing a new funding system for social care, regard will be paid to the impact of that on the long-term sustainability of the NHS?

The noble Lord has done much work on the sustainability of social care, including his work on the Dilnot commission. He is quite right to point out that there are lessons to be learned from other countries, and certainly we will be learning them from Japan, Germany and elsewhere. He will know that the measures announced in the Budget are specifically designed not only to help adult social care but also to help the interface between the NHS and social care to provide exactly the kind of sustainability he is talking about.

My Lords, some of us in this House are veterans of social care reviews that have led to very little change. Can the Minister therefore tell the House whether he is confident that the Green Paper will lead to urgent action? Will it consider controversial issues such as helping families prepare for care, savings products in the insurance market and perhaps even care vouchers?

The noble Baroness is quite right that this issue has not been dealt with properly over a long time. The Green Paper has a wide remit and therefore will look at all the issues that she has brought to the attention of the House.

My Lords, in a recent answer to a supplementary question, the Minister agreed with me that social care and health would operate properly only when they were under the same budget. Will the Green Paper go a little further and consider bringing them under the same management?

As I said to the noble Baroness, Lady Pitkeathley, the Green Paper has a wide remit. It is trying to provide a comprehensive solution to social care funding, which has unfortunately eluded many Governments. In doing so, it naturally needs to look particularly at the interaction between health and social care. For many people now there is no particular distinction between those as they follow their journey, as it were, through the health and care system. The important thing is that the care is joined up and is of high quality.

My Lords, is the Minister aware that he does not need to go as far as Germany and Japan to find good examples of this? Could he go up to Scotland, in particular to Ayrshire, and talk to Ian Welsh, the chair of the NHS health and social care partnership? That is a very good example of two bodies working together under a joint budget and joint administration. If the Minister were to take a few days off and go up there, I think he would find it very valuable.

I will speak to the Chief Whip about taking a few days off. I thank the noble Lord for bringing that point to my attention. As he says, there are examples in the UK—in Scotland, England and Wales, and of course Northern Ireland has a joined-up system too—so clearly there are lessons to be learned from home.

My Lords, following the push by Norman Lamb MP for this review that the Government have been talking about and putting into the long grass, the independent specialist group that he convened gave its interim report this morning. It makes it absolutely clear that we have to look at how the NHS and social care are paid for. Can the Minister give an assurance that the Green Paper will address those Treasury issues, as well as the issues of care and the relationship between the NHS and social care?

As I have said to several noble Lords, the intention of the review is to put the adult social care system on a sustainable and long-term basis and to make sure that it is fair and transparent and that it delivers high-quality care. It will address all the issues required to do that.

My Lords, will my noble friend acknowledge that he does not start this process with anything like a blank sheet? In particular, does he recognise that there is continuing merit in the recommendations of the Dilnot commission? I will not elaborate on that, save to say that they include the fact that it was a manifesto commitment of the Government at the last election.

I thank my noble friend for bringing that to the House’s attention—some might describe it as a hospital pass, if noble Lords will excuse the pun. The Government remain committed to implementing Dilnot from April 2020. My noble friend is quite right that this is not a blank sheet of paper. There have been some really important reforms over the last seven years, including the better care fund and the Care Act. In the Budget, we have more funding for the short-term sustainability of the social care system, as well as a commitment to the Green Paper.

My Lords, I would like to ask a question about children’s social care, where I notice there is also a problem. For example, in the last year local authority support for palliative care services for children was cut by two-thirds, and it now provides only 1% of the expenditure on children’s social care. First, does the Minister acknowledge that there is a problem here as well and, secondly, what are the Government going to do about it?

The issue of children’s palliative care came up in the debate the other evening on palliative care. A review is taking place with the charitable sector of the distribution of funding, particularly for children’s hospices, over the next year. In terms of children’s social care—this may come as a surprise to some noble Lords; it certainly did to me—the fastest-growing part of the adult social care budget is for adults with learning disabilities. Of course, that often comes in at the point at which people leave the children’s social care system and the school system and move into the adult social care sector, so there is an important point about continuity from one to the other.

My Lords, does the noble Lord accept that the domiciliary care of people in their homes is in deep crisis, with 400 care home businesses declared insolvent since 2010? Large providers such as Mitie have recently been selling their home care health business—it sold it off for just £2, plus a £10 million pay-off to the new outsourcing firm for business trading losses and other costs. What impact do the Government assess that the £2 billion Budget cash spread over three years will have on halting home closures and reducing the risk of industry collapse? Will the future Green Paper look at finding a new, more sustainable model for providing and funding residential and domiciliary care?

The noble Baroness brings up the issue of care homes closing. Inevitably, there is churn in the system. There has been a stable number of residential care home and nursing home beds, which is one metric. The other is the fact that there are many more home care agencies, with a lot more domiciliary care going on, and over 150,000 more social care jobs, so I do not think that the picture is quite as the noble Baroness described it. However, making sure that we have a sustainable system is at the heart of the Green Paper plans.