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House of Lords Hansard
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Social Care: Funding
05 July 2018
Volume 792

Question for Short Debate

Asked by

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To ask Her Majesty’s Government what steps they are taking to ensure that social care in England is adequately funded.

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My Lords, today, the country marks the 70th anniversary of the NHS, but another equally important anniversary next month is not getting the publicity it deserves. The Seebohm report, which laid the foundations for adult social care, was published 50 years ago in August. It was an important next step that set out the way for society to provide the right support for those in our communities who needed care, whether at home, in sheltered accommodation or in a residential or nursing home. I can remember, as a schoolgirl in the late 1960s, visiting a lady in my home town’s elderly care home. It was the old workhouse, with long wards and little communal space. It was a grim and desolate place to live. Most of the residents had no visitors. How different many of today’s services are, where the focus is on keeping our elderly active and independent for as long as possible, with rooms of their own for privacy. We know that good adult social care is an absolutely vital service that transforms people’s quality of life and that it is inextricably linked with the NHS. The sustainability of the NHS cannot work without a sustainable social care system.

Much has happened in the intervening 50 years since the Seebohm report but, shockingly, over the last few years much has also gone backwards. Many of us were encouraged when the 2011 independent Dilnot Commission on Funding of Care and Support proposed a carefully structured new integrated system with a cap on social care costs, which could enable people to plan for their old age. However, since 2015, the Conservative-majority Government—and now Conservative-minority Government—have dithered and delayed, repeatedly promising that they would sort out the social care funding problem. We still await the Green Paper promised in the Conservative manifesto last year, and have seen the side skirmish of the dementia tax, a form of inverse Dilnot which so outraged voters it was dropped by the Prime Minister mid-general election.

The aspirations for a sustainable social care system, fully integrated with the NHS, are, I think, all agreed in principle. However, the current funding mechanisms make it impossible to deliver. Local authorities have faced massive cuts to all services, making £6 billion of savings in adult social care since 2010. They are still being asked to make more each year at the same time as coping with increased numbers of elderly living in their communities and an increasing number of disabled adults and children. Worse, public health, one of Seebohm’s key pillars, has taken a double hit, with £200 million cut in 2015 and a further reduction of over £300 million proposed.

These numbers are shocking enough, but the reality of reductions in funding is a reduction in services for vulnerable adults, increased charges to clients and distressing waits for people to be discharged from hospital to receive care in their communities. It is also affecting our NHS, minute by minute, hour by hour, day by day. The A&E crisis, with ambulances queuing for hours, typifies how failing to tackle social care funding impacts on the NHS. I applaud the recent announcement by the Government to rename the Department of Health as the Department of Health and Social Care, but the renaming will do nothing without the funding. The King’s Fund has identified a local government funding gap of over £2.5 billion by 2020, which is close to the Local Government Association’s own estimates. The NAO said, as it published its recent report on the health and social care interface:

“The report finds that the financial pressure that the NHS and local government are under makes closer working between them difficult and can divert them from focusing on efforts to transform services. Short-term funding arrangements and uncertainty about future funding make it more difficult for health and social care organisations to plan effectively. Although the report acknowledges the recent announcement of extra funding for the NHS, additional funding has, at times, been used to address financial pressures, rather than to make essential changes to services or adopt new technologies”.

It is those efforts to transform services that are most affected.

That is why it is good to hear that a number of think tanks and other organisations are researching this. For example, Independent Age has commissioned a series of ground-breaking data to identify the costs of social care. The project will look at the social care funding gap going up to 2031 and hopes to offer financial options that can help provide the resources needed for free personal care, as well as reporting on how these funding options will affect different social groups across the regions. The data from these reports will highlight how much the social care gap will increase without intervention, but will also offer solutions on how the Government can fill the void by modelling various revenue-raising streams, such as changes to income tax, national insurance, an age-related levy, council tax, business rates and corporation tax. It hopes also to calculate the income distribution across local authorities for each funding option.

I have one main question for the Minister. The long-promised government Green Paper must have exactly this sort of data and research sitting alongside it, along with a promise of how services will be funded. This must happen as soon as possible—there can be no more delays. Can the Minister guarantee that there will be no further delays in bringing forward a proposal to provide a real, fully funded way forward? This is necessary because behaviour in both the NHS and the social care system is being driven by financial constraints, not by the needs of individuals.

One of the more shameful periods of our history has been the warehousing of children and adults with learning and physical disabilities, who were removed from their families and even their communities. That was the norm 50 years ago, and 30 years ago there was a recognition that this was—to use a parliamentary word—inappropriate. It was more than that: it was just wrong. Over the last quarter of a century, we have moved to a better—but not perfect—system of providing where possible tailor-made support to individuals. Surely that is what a society should do for its most vulnerable members. But cuts are now driving a different behaviour.

The disability champion Lucy Watts, who was awarded an MBE for her services to young people with disabilities, lives at home with her family, who help to provide her social care support, alongside a complex care package to meet her needs. In March, when her mother was taken into hospital with a brain tumour, Lucy was told by Castle Point and Rochford Clinical Commissioning Group that she would have to move into an elderly nursing home or a learning disability home instead of staying in her own home. She is neither elderly, nor does she have a learning disability. Worse, she was told that she would not be allowed to go out, not even to visit her mum in hospital, because as a resident she would have no right to be independent. There is a happy ending to Lucy’s story: the CCG backed down. I have to say that taking on one of the country’s best young advocates for disability did not work well for it, but there are increasing reports of new care packages not offering supported living at home but a cheaper, institution-based package that removes independence but may save the funders money.

Other behaviour is worrying too. Your Lordships may know that I work closely with the Disabled Children’s Partnership, and especially with parents of the most severely disabled children in Hertfordshire, who have been fighting to keep their short-break centre open. Nascot Lawn, funded by the CCG, is special because it offers proper medical support, which these children need. The Disabled Children’s Partnership report that short-break support and social care support, whether provided by the NHS or by local authorities, is being limited and cut across the country. In the case of one family, this has meant they cannot manage their child 24 hours a day, seven days a week, 52 weeks a year, and their child has now been moved to a long-term hospital. Instead of costing the state a few thousand pounds per annum, the cost is now closer to £250,000. Some CCGs now have funding people sitting on assessment panels. That is wrong. The law is clear: an education and healthcare plan for someone aged under 18 must address the needs of the child.

The better care fund, created by the coalition as a pilot for the sharing of good practice and for helping more funds to go into local authorities to ensure that people are moved out of the NHS and back into their communities with social care support, is important and remains an excellent interim plan. Since 2015, the Government have increased the funding going into it, but they have repeatedly delayed the new funding mechanism for social care. Specifically, the delays to the Green Paper, at the same time as announcements about the long-term funding of the NHS, demonstrate that there is a failure to grapple with the social care system in England and its systemic fault lines with the NHS.

Integration is essential, with new partnerships across England—real partnerships, with joint funding and shared KPIs. A long-term funding settlement, owned by government, Parliament, all political parties and the people, is essential if we are to have a social care system of which we can be proud.

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My Lords, I declare my interest as a vice-president and former chairman of the Local Government Association. I start by thanking the noble Baroness, Lady Brinton, for initiating this important debate.

Adult social care is a vital council service that helps to transform people’s quality of life. It supports adults of all ages with a range of different needs and it supports their carers. Despite the fact that it is so vital to the fabric of our society, there is a crisis in social care. We are grappling with the challenges of rising demand, people living longer and needing extra support in older age, care providers closing and contracts being handed back to councils. In my view, we need to invest new money into social care and we need to do it urgently. Despite this point being recognised across the Floor of this House, successive Governments have to date struggled to get political consensus on the long-term solutions to our national care crisis.

In my time as chairman of the Local Government Association, I was involved with many initiatives and we put forward solutions that in the end did not lead to positive change. From my many years’ experience in politics, I have to say that unfortunately sometimes our electoral cycle hampers our ability to deliver long-term solutions. But it does not need to be like that. Pension reform is a recent example of consensus and, of course, the post-war experience showed what was possible as our modern welfare state emerged.

This is not just about past precedent. Only last week, a cross-party group of Members from the Health and Social Care Committee and the Housing, Communities and Local Government Committee published their report on this issue. They called for new funding for adult social care and made it clear that bold decisions are needed if we are to solve the crisis facing the sector.

Last week’s commendable report is not the only one that has contributed to establishing cross-party support for a new way forward. The noble Lord, Lord Warner, led an excellent inquiry last year and his committee’s report, The Long-term Sustainability of the NHS and Adult Social Care, made a significant contribution to moving this conversation forward.

We also know that Members of this House and the other place recognise the need for additional funding for social care. A recent ComRes poll commissioned by the Local Government Association found that the vast majority of parliamentarians agree that additional funding should go to councils’ social care budgets to tackle the funding crisis. There is agreement among many national and local politicians that we need new money for social care. We need to work with the Government to deliver this.

As I said, there is now a clear political consensus that new money must go into social care via councils to help them to protect care services. Many council services, including housing, leisure and libraries, also help to save the NHS money. Without essential council services, we will almost certainly see further rises in demand and the accident and emergency crisis spiral to an unresolvable, year-round problem. Investing in social care will help to prevent crises in the NHS by reducing the number of people who are admitted to hospital in the first place.

Local government is absolutely essential to resolving the problem and helping people to live independent lives. Councils are the most efficient, transparent and trusted part of the public sector. They are effectively managing ever tighter budgets to maintain their track record of delivering quality services. The latest figures show that councils have reduced delayed transfers of care from hospital due to social care by 33% since July 2017. This has been at a faster rate than the NHS. This should surely help to persuade the Government to fully fund our social care system.

To conclude, I am sure that all sides of the House will welcome the new money for the NHS; the 70th birthday bonus funding is great news and much needed. We now need a similar funding boost for social care and prevention services. We need more money spent on preventing ill health. This is good for our communities and an efficient use of taxpayers’ money. I look forward to the publication of the Government’s Green Paper on social care in the autumn and with it, I hope, new money for social care services and new innovations to create a system fit for the people of the 21st century.

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My Lords, I congratulate the noble Baroness, Lady Brinton, on securing this debate, although it is slightly overshadowed by the following debate, which seems to be concerned with the same issue. As a result, attendance in this debate is slightly thinner than it should be. Nevertheless, the noble Baroness has addressed an important question and I am happy to participate in the debate.

For purely historical reasons, healthcare and social care have been separated in Britain. Both were established in 1948 but under different Acts and based on different operational and funding models. The NHS was largely free at the point of delivery, whereas social care was needs or means tested. That created inequality. For example, a cancer patient could get full state funding, whereas somebody suffering from dementia could not. The question is how, in the eyes of neutral people, to justify this moral or medical asymmetry.

There is a further question. NHS funding came from central government taxation, whereas social care funding came from non-ring-fenced local authority budgets or private individuals. That was contingent, as local budgets change a great deal and do not have the same degree of certainty as central government funding does. For all those reasons, we have two separate streams with different consequences. The lack of integration between the two has cost quite a bit of money. In October 2017, there were 145,000 delayed days, as they are called, when hospital beds are taken by people for whom no home help can be found for them to be discharged to. There is a need to look at this binary distinction and see how the two can be brought together.

Need will be greater, because the population is ageing and younger people with a disability are living longer. The number of adults aged 85 or over has increased by 31%, whereas the population as a whole has increased by only 8%. So the question of social care is important. How should we handle this? What are the means to deal with it? Should we look to central taxation, which would be my suggestion? The question is whether such care should be entirely free at the point of delivery, in the same way as healthcare. I am not entirely sure that it can be, for at least two important reasons. The first is the issue of intergenerational fairness. Older people are wealthy, own houses, have assets and savings, and receive pensions, while many young people are paying off student loans, have family commitments and face higher housing costs, so they are not as well off as some elderly people. The second reason is that the personal care component of social care is different from the other components, and while that care can be guaranteed by the state, factors such as the accommodation cost component of social care perhaps need not be. We have to discuss these matters because they involve issues of moral principle. The two parties are bound to disagree, but it is important to build a cross-party consensus in this area.

There is a further question: when social care payments are made, what are the best ways of handling that? You could give cash to the individual being cared for, and in turn she or he might give that cash to the friends and relations who work for them. There are ways and means of handling social care and of getting the funds required, but again, some kind of cross-party consensus needs to be established. For me, that is a priority.

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My Lords, I too join in with the general rejoicing on this the 70th anniversary of the NHS, but as others have observed, I am glad that this debate has been brought forward by the noble Baroness because it is a necessary counterpoint to that. I join the noble Lord in expressing slight surprise at how few people have wanted to contribute to this debate, but that does give those of us who are speaking a little longer to do so.

As the recent National Audit Office report, referred to by the noble Baroness, into the interface between health and social care indicates, the two areas are inextricably linked. Indeed, the dividing line can be quite hard to define, and that is one of the difficulties. For example, an exchange earlier today in your Lordships’ House touched on the different regimes in the two different worlds in terms of pay and conditions and the issues that that raises. That is but a single, tiny dimension of the challenge of joining up these two worlds. In a speech in March the Secretary of State talked about,

“whole-person integrated care with the NHS and social care systems operating as one”.

That is of course a laudable aspiration which many of us have already affirmed. He also spoke of the desire to find a sustainable funding model, and therein lies the challenge given the tendency over many years for social care always to find itself the poorer of these two siblings. Along with others, we await the Green Paper and what it might say.

Perhaps I may approach this subject in a slightly different way from other speakers by focusing on two specific areas in which I have some experience. As Bishop to Her Majesty’s Prisons, a few months ago I visited HMP Stafford, which is a prison with a growing elderly population. Carers commissioned by the local authority go into the prison to provide personal care for elderly prisoners, and when I met the governor and his senior team they were thinking positively and practically about adapting buildings and regimes to provide, in effect, a care home within the prison. As the Prisons and Probation Ombudsman observed in a report last year,

“prisons designed for fit, young men must adjust to the largely unexpected and unplanned roles of care home and even hospice”.

The challenge in HMP Stafford was clear, and while I commend those on the ground there for seeking a response, it did feel rather as if they were working on their own to find solutions; perhaps something more substantive, structured and deliberate is needed.

Some 17% of the prison population is now aged over 50. While, dare I say it, that in terms of your Lordships’ House that may not seem very old, it is the case that people in the prison population by and large age 10 years in advance of the general population, so it is a serious issue. A possible way forward was suggested when, later in that series of visits, I went to HMP Oakwood where I met fit, young prisoners who were offering informal care and support to older, infirm prisoners. While not wanting to let the public purse off the hook, I did wonder whether prison training programmes might be extended to include training and qualifications in care, thus enabling properly trained prisoners formally to support those prisoners who are their neighbours and in need of some care. Not only would the training do that, but it would give those prisoners a qualification which would enable them to find employment on release from prison. Perhaps the Minister might care to discuss that in due course with colleagues in the Ministry of Justice.

I also wonder whether there is a mechanism whereby local authority funding formulae might be adjusted where there is a prison within the local authority area which houses a disproportionate number of elderly prisoners, given the demands that that places on the local authority concerned.

My second area of comment concerns partnerships between the voluntary, community and faith organisations with statutory and other agencies. Voluntary action and activity does not mean that it is unprofessional, nor does it mean that it should come on the cheap. Many voluntary and community sector organisations employ seriously professional people at proper wages. There is also, however—I hesitate a little in talking about this because again I do not want to let the public purse off the hook—a role for that which is voluntary, in terms of time and remuneration, where people offer their expertise and their skills.

In my own diocese of Rochester, we are working with a national charitable initiative called “The Gift of Years”, with funding from the Henry Smith Charity, to establish a network of Anna chaplains and Anna friends—Anna being an elderly woman mentioned in the gospel of St Luke. Our particular focus is the pastoral care of those living with dementia and that of their carers. After a relatively short period, we now have more than 30 trained and commissioned volunteers. We have one paid professional specialist, funded by the Henry Smith Charity, and our first remunerated dementia chaplain who is funded locally by churches in Bromley. On the partnership side of this initiative, we are finding that—surprise, surprise—the local authority is increasingly beating a path to our door. There are opportunities to work closely with other organisations such as the Abbeyfield housing society and the Heart of Kent Hospice, where our pastoral carers go in to offer support to residents and patients, and of course to their families.

I hope that as government policy develops in this area and as the Green Paper is brought forward, some attention might also be given not just to, as it were, the voluntary and community sector in its big institutional forms but also to the role of local initiatives and how the relatively modest funding that is needed for them might be provided in various ways, possibly by means of grant funds for which people could apply.

I believe that there may be patterns in both of the examples I have given for other places and in other dimensions of care. In relation to the Anna chaplaincy model, it is worth noting that many of those who offer their time and skills as chaplains and friends are themselves relatively elderly people. They find huge fulfilment in serving the needs of those in their own communities.

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My Lords, I declare my interests as set out in the register as chair of a charity providing services for adults with learning disabilities, and I thank my noble friend Lady Brinton for securing this important and timely debate.

The social care sector provides invaluable support to some of the most vulnerable adults in society: those who are old, frail and unable to look after themselves; those with a learning or physical disability or suffering from mental health issues or alcohol and substance abuse; and people with severe dementia. Their care is delivered thanks to the recommendation made in the Beveridge report and the subsequent legislation, but more of that in the next debate.

Learning disabilities account for one-third of the adult social care provision in England, and it is also the fastest growing sector. In 2005, only six of the 151 local authorities in England spent more on care for working-age adults than they did on care for the elderly. By 2017, 57 authorities did so. Adults with learning disabilities are living longer, although, sadly, they will still die 28 years younger than non-disabled adults. I would say to the right reverend Prelate that there are also many people with learning disabilities in prison.

In general, people with learning disabilities are leading better lives. They are moving out of institutionalised, health-based settings into supported living settings in the community. Although supported living undoubtedly delivers better life and health outcomes, it is also a more expensive option for providers. This increase in costs is increasingly not being factored into the rates paid by local authorities.

The funding gap in adult social care has been widely reported and debated in your Lordships’ House on several occasions. Several organisations have now agreed that there will be a funding gap of around £2.8 billion by 2019-20 unless we have decisive action from government. As financial pressures—such as costlier methods of support, unfunded increases in the national living wage and the apprenticeship levy and the uncertainty surrounding historical liabilities for sleep-in pay—all continue to plague the sector, a sustainable funding solution becomes increasingly vital.

The learning disability sector would like to see an annual uplift in funding of 5% each year to remain financially viable. According to the IFS, the total amount spent on adult social care in 2015-16 was £16.8 billion. To remain stable, the sector would have needed an additional £840 million for 2016-17. Instead, the IFS reported a cut of £300 million, with total expenditure falling to £16.5 billion in 2016-17. The CQC has already reported that the social care sector is at “a financial tipping point”. Earlier this year, the Government were warned that the number of providers in the learning disability sector, now reported to be running at a deficit, has more than trebled, rising from 11% in 2016-17 to 34% in 2017-18.

The sector was denied a place in the social care Green Paper, being instead part of a so-called parallel body of work that is to encompass all working-age adult social care, while the Green Paper focuses almost exclusively on older people. With the recent announcement that the Green Paper is to be postponed until the autumn and with little public detail on the parallel body of work, local authorities and social care providers alike are becoming more concerned about the financial viability of essential support services for vulnerable adults. In their recent joint report on the future of adult social care, the House of Commons Health and Social Care, and Housing, Communities and Local Government Select Committees called on the Government to widen the scope of the Green Paper to incorporate all of adult social care. When can the sector expect to hear more concrete proposals about the parallel body of work? What are the work streams? Who is on the panel? Who has given evidence and when might it report?

All of this uncertainty is overlaid on the anticipated costs as a result of sleep-in. For the sector as a whole, this should be around £400 million. I appreciate that the Government are now engaged with this situation and the results of a judicial review are awaited, so any way forward is unclear, but I would be grateful if the Minister could give me details of what consultation was done on these regulations, or even an impact assessment. If she does not have the details, I would be grateful if she would write to me and place a copy in the Library.

The funding situation is now so critical and our care and support system is in crisis. This message comes from right across the sector, the CQC and the LGA. Of course, any failure in the social care system impacts directly on the ability of the NHS to function effectively. We also need interim funding to stabilise the system as a whole. Then, new money will be needed until well into the next spending review period in order to be sustainable and to maintain quality. Without funding, we risk implementing Green Paper reforms on to a system that is too destabilised by financial pressures.

Do the Government have plans to deal with failing providers, and do they understand that the tipping point is nearer than ever before? How many organisations will need to fail before the Government come out of their corner to defend the most vulnerable people in our society?

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My Lords, I refer to my local government interests and I congratulate the noble Baroness, Lady Brinton, on securing this debate. When I chaired Newcastle’s social services committee in the 1970s, we trebled the meals on wheels service and doubled home care provision. We created a welfare rights service—one of the first in the country—that is now helping citizens in Newcastle to receive £8 million of benefits, and we improved residential care. Forty years on, we see a service struggling to cope with the growing needs of an ageing population, while the council’s budget, like those of councils up and down the country, has suffered savage cuts. Never before in a long political life have I witnessed Conservative councils, and the national local government bodies they lead, being as critical as they now are about the policies of a Conservative Government and their impact on local authorities and communities.

The funding cuts have been dramatic. Critically, they include £890 million in preventive services, including measures to avoid the need to admit people to hospitals, thereby adding to the problems of a radically overstretched NHS. Yet the Government expect councils somehow to reduce the number of what are described as “social care attributable delayed transfers of care”. As the LGA points out, such delays are a symptom of the problems of pressure on the NHS, not its cause. Even if the funding gap were closed, this would still leave the service significantly less well funded than in 2010, before taking into account the increasing demand of an ageing population and greater recognition of the need to tackle issues such as mental health in adults and children, which have manifested themselves increasingly over time.

Meanwhile, the Association of Directors of Adult Social Services point out that, in addition to an extra £2 billion by 2020,

“just to stabilize the market and to enable key statutory duties to be fulfilled”,

an additional 29%—£3 billion—would be required to bring social workers’ pay into line with their NHS counterparts. The 1.5 million people working in social care, as the association states, deserve such parity of esteem and should have a common structured training programme and a defined career pathway

There are also issues, as the LGA points out, with the public health budget, which has also been hit hard, with cuts of £200 million a year and plans for a further reduction of £331 million. Such cuts, in what is essentially a preventive service, are likely to generate more demand for the NHS and social care, in addition to impacting on the lives of those the service should be protecting and enhancing. Furthermore, the early intervention grant has been slashed by £500 million since 2014, with an anticipated further fall of £183 million by 2020.

The prevention of hospital admissions per se demands a higher focus. The LGA cites evidence from a Public Health England report on falls prevention, demonstrating that for every £1 spent on assessing the home and modifications for elderly people—I declare my interest in that respect—£2.17 is saved on primary and secondary care while reducing hospital admissions by 23%. Of course, this group is growing. As Age UK reports, 1.2 million—12.5% of the age group—are living with unmet care needs.

Alarmingly, less than a third of directors of adult social care are confident that their authorities will meet their statutory duties this financial year. Councils and other providers, including charities, have hanging over them potentially large claims for payment of the national minimum wage for care workers on sleep-in shift, with HMRC pursuing providers for up to six years’ back pay. Charities estimate that HMRC could be seeking as much as £400 million to meet this bill. Given that the Government instructed local authorities to make such payments only as recently as last July, will they meet this cost? If not, what is their estimation of the impact on councils and providers?

The sector, as ADASS has pointed out, is fragile, with the percentage of the budget of county and unitary authorities spent on social care rising from 34% in 2010 to 38% now. There is concern that the growth in the number of older and younger adults with complex needs is likely to cost an additional £448 million this year. In addition to that, the so-called national living wage will cost around £585 million—essential if quality staff are to be retained and recruited. On top of all this, the expectation is that by 2025 another 350,000 people will need high levels of social care from councils.

Moreover, although the return of public health some five years ago from the NHS to local government and Public Health England is welcome, there are profound concerns about funding. Councils suffered a £200 million cut five years ago and now face a further cut of £331 million, while the early intervention grant faces a further cut of £183 million by 2020, in addition to the £500 million cut since 2013. At the time, the Conservative-led Local Government Association protested that this risked underresourcing councils in delivering early support to the children, young people and families who needed it most. It warned that councils would be,

“less able to provide support for children and families affected by disabilities or existing/potential development delays”.

All of this will surely generate greater needs and greater costs.

In Newcastle, where we are losing £280 million a year, the number of people receiving home care has fallen from 3,000 to 2,000, while adults with learning difficulties are getting four hours less of support per week. We have 71 fewer social workers than in 2014—a 12% reduction—while there has been an 86% increase in the number of safeguarding alerts. The Government have belatedly announced an increase in funding for the NHS, albeit less than is needed. When will they realise the need to increase funding for social care substantially, which would contribute to reducing the burden on the NHS? I join Sir David Behan, chief executive of the Care Quality Commission, in,

“calling for a bold and courageous settlement for future social care because we must address the quality and experience of care that older people receive”.

I would add all other people in need of such care to that.

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My Lords, I thank the noble Baroness, Lady Brinton, for bringing this important debate on social care funding to the House. I thank all noble Lords for their valuable contributions. I want to take this opportunity also to personally wish the NHS and our social care system a happy 70th birthday. I thank all the people who work in it for their commitment and dedication in often difficult and challenging circumstances.

Everyone is entitled to good-quality care and support; as the noble Baroness, Lady Brinton, and the noble Lord, Lord Beecham, said, they are vital. We recognise that, as the noble Lord and others said, there are challenges, and we are doing something about them. Although 81% of adult social care providers are rated “good” or “outstanding” by the CQC, as of March 2018, it is completely unacceptable that standards in some settings fall below those rightly expected by care users and their families. That is why the Government have introduced tougher inspections, led by the Care Quality Commission, to make sure that services meet quality and safety standards.

The noble Lords, Lord Parekh and Lord Beecham, the noble Baroness, Lady Jolly, and my noble friend Lady Eaton stated that social care spending has stopped or has gaps in funding, but over the years, more money has been spent on social care. However, the growing population and the fact that people—including people with disabilities—are living longer are contributing factors, as acknowledged by my noble friend Lady Eaton. The noble Baroness, Lady Brinton, acknowledged that in the short term, the Government have given councils access to up to £9.4 billion more in dedicated funding for social care over the three years up to 2019-20. This means that overall funding for social care is increasing by 8% in real terms over this spending review period.

The additional resources are helping councils to commission care services that are sustainable and diverse, offering sufficient high-quality care and support for people in their areas. As I have already said, I recognise that there is much more to do, as stated by the noble Lord, Lord Beecham, the noble Baroness, Lady Brinton, and my noble friend Lady Eaton. Performance is not just about money. Funding will be supplemented with targeted measures to ensure that the areas facing the greatest challenges improve services at the interface between social care and the NHS.

My noble friend—he is a noble friend—Lord Beecham mentioned Newcastle. Thanks to a range of government actions, Newcastle-upon-Tyne received an additional £20.4 million for adult social care in 2018-19. We have already seen a real difference to services across the country. Social care-related delayed transfers of care had been rising year on year between 2014 and February 2017, but since taking action last year, we have achieved a reduction of 40%. Some councils, such as Darlington, Slough and Telford, had no delayed discharges, which I know my noble friend Lady Eaton will be pleased to hear.

Looking ahead, it is right that social care funding be agreed alongside along the rest of the local government settlement at the forthcoming spending review. Decisions on future reforms must be aligned, which is why we will publish the Green Paper in the autumn, around the same time as the NHS plan. As identified by the noble Baroness, Lady Brinton, yesterday’s NAO report also made it clear that,

“the changing needs of the population require changes to the way health and social care services are organised and delivered”.

I cannot give the guarantee that the noble Baroness requested regarding the timing of the Green Paper, but I will return to some of the issues that she raised. The NAO also stated that carers and those who need care must be put at the centre of any reform. The Green Paper will take its report into account.

The noble Baroness, Lady Jolly, and the noble Lord, Lord Beecham, raised the issue of the Competition and Markets Authority report, which also presented important findings on the care market, the need to strengthen consumer protections and the importance of supporting people to make choices about their care. Having accepted all of the CMA’s recommendations earlier this year, we are now working closely with industry, wider stakeholders and the CMA through the implementation phase. Those issues will be further addressed in the Green Paper.

As stated by a number of noble Lords, through the better care fund, local areas voluntarily pooled more than the minimum required in both 2015-16 and 2016-17, taking the total to £5.3 billion and £5.9 billion respectively. In 2015-16, 90% of local area leaders said the better care fund had already had a positive impact on local integration. I agree with the noble Baronesses, Lady Jolly and Lady Brinton, that people with disabilities and people of working age with care needs face a number of challenges. As indicated by the noble Baroness, Lady Jolly, we are taking forward a piece of work—led by the Department of Health and Social Care and the Ministry of Housing, Communities and Local Government—that will consider any issues specific to working-age adults and therefore not covered in the Green Paper. We will set out the results of this work in due course. I will write to the noble Baroness, Lady Jolly, to answer her specific questions on impact assessments and the consultations that have taken place, and place a copy in the Library.

As mentioned by a number of noble Lords, the recent Select Committee report, Long-term Funding of Adult Social Care, suggests that a tax on the over-40s or a social care premium similar to the German-Japanese model is the right way forward. The Government are committed to ensuring that everyone has access to the care and support they need, but we are clear that people should continue to expect to contribute to their care costs as part of preparing for later life. I can confirm for the noble Baroness, Lady Brinton, that the Green Paper will set out proposals for a sustainable system. Reforms must be affordable and fair across generations, including to working-age taxpayers. As noted by the right reverend Prelate the Bishop of Rochester, the Green Paper will bring forward proposals to build on the seven principles set out by the Secretary of State: quality and safety in service provision; whole-person, integrated care with the NHS and social care systems operating as one; better practical support for families and carers; and a sustainable funding model for social care supported by a diverse, vibrant and stable market. However, we are looking at the exact proposals in the Select Committee’s report and the Government will of course respond in due course.

Noble Lords did not mention the parliamentary commission, but I want to say that we welcome parliamentarians across the House and people in the NHS and social care coming together to look at how we can improve and make a more sustainable system.

The right reverend Prelate commented on informal carers and voluntary work. The Government are committed to continuing to support carers to provide care as they would wish, and to do so in a way that supports their own health and well-being, employment and other life chances. On 5 June, the Government published the Carers Action Plan which sets out a cross-government programme of targeted work to support carers over the next two years. As noble Lords have stated, a sustainable future for social care will simply not be possible without focusing on how our society supports carers. They are vital partners in the health and care system. I would be delighted to look at the Ministry of Justice system and learn from that experience. Indeed, as the Minister is here, I will ensure that that system is also drawn to his attention.

The noble Baronesses, Lady Brinton and Lady Jolly, and the noble Lord, Lord Beecham, also identified NHS mental health services. Of course, mental health services are important and are available for people with poor mental health, including carers. The improving access to psychological therapies programme provides treatment for adult anxiety disorders and depression in England.

My time is nearly up. I think I have answered most questions and as I said, I will write to the noble Baroness, Lady Jolly, about the two questions she asked. If there are any other questions outstanding, I will write to noble Lords and put a copy of my response in the Library. I conclude by thanking all noble Lords for their contributions and I look forward to us working together to find a long-term, sustainable solution—a sustainable way forward—to meet the care needs of some of the most vulnerable people in our society. I end by saying to the noble Baroness, Lady Brinton, that I was very sorry to hear Lucy and her family’s story. Those sorts of issues should not be in the system. I acknowledge that they are and we will try to sort them out. Thank you.