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House of Lords Hansard
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Adult Social Care Services
06 July 2017
Volume 783

Statement

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My Lords, with permission, I shall repeat as a Statement the Answer given by my honourable friend the Parliamentary Under-Secretary of State in response to an Urgent Question in the other place. The Statement is as follows:

“Mr Speaker, there are few things more important to any one of us than the way in which the eldest and most vulnerable are cared for in our society. First, let me pay tribute to the 1.4 million people who work in this country’s social care sector. They support many of the most vulnerable people in our communities 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, in a time of fiscal pressure, shows that 79% of providers were rated good or excellent.

The announcement that my right honourable friend the Health Secretary made on Monday set out a clear package of measures to reduce the variation highlighted by the CQC today. It is impossible to ignore the pressures that our ageing population and advances in medicine are putting on the social care system. We have seen the numbers of over-65s increase by nearly 1.2 million, or around 14%, over the last five years, and 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 the spring 2017 Budget announced an additional £2 billion to councils in England over the next three years to spend on adult social care services. This 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 for the future and address issues related to the quality of care and variation in practice.

My right honourable friend the Health Secretary updated the House on Monday about action we are taking to address delayed discharges from hospitals in advance of this winter. Last year, there were 2.25 million delayed discharges, up 24.5% from 1.81 million in the previous year. This Government are clear that no one should stay in a hospital bed longer than is necessary: it removes people’s dignity, reduces their quality of life, leads to poorer health and care outcomes for people, and is ultimately more expensive for the taxpayer.

Since February, there have been significant improvements within the health and care system, with a record decrease in month-on-month delayed discharges in April 2017. 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 A&E, which is why we have introduced a package of measures to support both the NHS and local government to reduce delays. This 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 CQC reviews. We have also been clear that we will consider a review, in November, of 2018-19 allocations of the social care funding provided at spring Budget 2017 for areas that are poorly performing. We have been clear that the Budget funding will all remain with local government to be used for adult social care”.

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My Lords, I am grateful to the Minister for repeating the Answer, but once again the Government seem to be in complete denial about the reality of the situation facing us in social care. A year ago, the Care Quality Commission first warned that social care could be approaching a tipping point. Today, Andrea Sutcliffe, Chief Inspector of Adult Social Care, has said that,

“the danger of adult social care approaching its tipping point has not disappeared. If it tips, it will mean even more poor care, less choice and more unmet need for people”.

Why have the Government neglected to tackle the issues facing our social care sector and failed to give it the money it needs? This report highlights safety concerns in one in four care homes. Age UK described choosing a care home as Russian roulette. Does the Minister believe that it is acceptable to force people to take these kinds of risks with their loved ones?

According to the Care Quality Commission report, 4,000 fewer nursing-home beds are now open than in March 2015. Is the Minister concerned about this drop, and what actions is he taking to ensure that there are enough nursing-home beds for those who need them and enough nurses to staff them?

This week marked the sixth anniversary of the Dilnot commission report into social care. The Government accepted the commission’s recommendations; they legislated for them; and they announced that the cap on personal funding would be £72,000, after which the state would intervene. Why did the Government abandon all that in favour of their ill-fated dementia tax? Why are this Government no closer to finding a solution for funding social care? Can the Minister tell the House why his Government have wasted seven years and failed to take any action to solve the social care crisis?

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I shall respond to the several questions that the noble Baroness asked. She is right that the CQC made that warning last year, and that is precisely why the Government have chosen to put in additional money—£2 billion extra was announced in the spring Budget—to support the social care system and provide real-term increases in funding.

It is worth pointing out that today’s report shows that 79% of care settings received a good or outstanding rating, compared with 72% last year. There are obviously differences in the kinds of settings that were inspected; nevertheless, it shows an increase in the number of good or outstanding settings.

I completely agree with the noble Baroness’s point about patient safety. I think that the phrase “the Mum test” is both accurate and evocative. Clearly, nobody wants to choose care settings that do not pass that, and any care that is inadequate is unacceptable. However, the reason we have that information about unacceptable care settings is that this Government, in coalition with the Liberal Democrats, introduced a very tough inspection regime in 2014. I believe that today’s report shows that four out of five settings that were judged inadequate on the first inspection had improved on reinspection, so the inspection regime is itself a critical part of dealing with the issue that she rightly points to.

The noble Baroness highlighted the number of beds and staffing. Around 165,000 more staff are working in the care sector, but of course care is moving more from residential homes to domiciliary settings, so the nature of care is changing there. However, more staff are going into the service and they are now being paid the national living wage.

Finally, it is fair to say that no Government have a completely unblemished record in getting to grips with the problem of funding care. The Labour Government had Green Papers, royal commissions, the Wanless review and so on; we have had other investigations. However, to go back to the beginning, the point is that we cannot wait any longer—we need to get on with this—and that is why I set out in the Queen’s Speech debate last week that the consultation that we will publish at the end of this year will look not just at an open question but at very specific proposals around floors and caps, and I hope that we will be able to build a consensus on the need to move forward.

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My Lords, quality improvement is really urgent given that, as the noble Baroness, Lady Wheeler, said, one in four settings was found by the CQC either to be unsafe or to require improvements in safety. Safety is fundamental when you are looking for a setting for one of your loved ones. Given that, according to the CQC, the rate of improvement is slowing down in some settings and in others has deteriorated, does the Minister agree that a shortage of well-trained staff is at the root of this problem?

While we wait for the Green Paper, will the Government respond to the CQC’s second warning that social care is at a tipping point and inject some urgent cash into it? Many authorities, which really understand these issues, told us last autumn, when the extra money was announced, that it was really only half of what social care required to keep it at the same level, let alone improve, so some extra cash is urgently needed.

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I reiterate the point I made to the noble Baroness, Lady Wheeler. I completely agree that safety is paramount: it is the beginning of any good care setting. As I said, the new regime highlights issues of safety where they exist so that operators and commissioners, whether that is local authorities or whoever, can demand turnaround in those services. As I said, the response to that has been demonstrated.

I mentioned that more staff are, of course, getting the national living wage, which will continue to attract people to the sector. The noble Baroness is quite right about skills, which is why we have the skills for care programme.

It is also worth pointing out that one thing the CQC report did show, as indeed you would hope it would, is that 79% of settings provided either good or outstanding care. There is no doubting the motivations of the people who work in this sector, and we all pay tribute to them. It is about making sure that there are enough of them and that they are properly skilled. That is precisely why we have put additional money into social funding, to enable real-term increases over the next three years to address the fact that we have an ageing and growing population.

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My Lords, I declare my interest as a member of the Dilnot commission. I am sure we all welcome the idea of a longer-term set of proposals for consideration later. However, does the Minister not realise that the money the Government have said they are putting in over the next three years, including the current year, merely puts back a lot of the money that was taken out before, and certainly does not meet the proposal for immediate funding made by your Lordships’ Select Committee on the sustainability of the NHS and by the King’s Fund? This year, the Government are about £1.5 billion to £2 billion short to meet the needs. Does the Minister understand that this is not just about quality but about quantity? People working in publically funded care are leaving in droves. Is this on the Department of Health’s risk register? What are the Government going to do if the tipping point is reached on providers not providing publically funded social care?

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First, I congratulate the noble Lord on the work he did on the Dilnot commission in setting out the challenges we face and the kinds of solutions that we need to put the sector on a long-term footing. I merely reiterate the point that extra funding is going in, at a time when we are still addressing the £150 billion deficit that the Government inherited in 2010. That is enabling real-terms increases. Of course we need to keep going with that, because there are more older people and their care is increasingly complex.

I want to come back to the changes we are making on delayed transfers of care. Making sure that the interface between the NHS and social care is as quick, smooth and suitable for patients as possible is critical. That is why there is renewed emphasis to make sure that the money going in is addressing one of the major problems that is preventing the quality of care that we want.

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My Lords, will my noble friend consult the CQC on a rather intimate but difficult problem? Elderly people admitted to busy trauma wards with fractures that result in them not being able to weight-bear very often find that, when they press the bell for the loo, they are not able to access a commode and there is no time for a bedpan. They end up being consigned to using adult nappies for an unnecessary long time. That has a knock-on effect on both their ability to rehabilitate and if they subsequently go into nursing or residential care. This is an outrage. Tackling this would save money and give more dignity to elderly people, but it is not something that one hears talked about very much. I have witnessed this happen with my elderly relatives and ask the Minister to take a look at it

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I am sorry to hear that my noble friend’s loved ones have experienced that. She is quite right: not only would that inhibit rehab but there is also the question of the dignity of the patient. I shall certainly look at the issue and write to her.

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My Lords, the Minister has reminded us just how many consultations there have already been on this subject, most of them not moving us very far forward, sadly. It is welcome news, therefore, that the consultation will focus on solutions, not just problems. Does the Minister agree that if we are doing this for the long term—and it essential that we are—a whole-population solution and, dare I say it, a cross-party solution is required?

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The noble Baroness is quite right. We need to move forward on the basis of consensus, which is one thing that has been lacking in the past. There is no doubting the point we have reached: we cannot wait any longer and we need to move ahead. That is why we will do so, on the basis of consensus.