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Care Homes: Severely Disabled People

Volume 825: debated on Wednesday 30 November 2022


Asked by

To ask His Majesty’s Government what assessment they have made of reports that some care charities have been forced to evict severely disabled people from their care homes because of disputes with local authorities about fees.

The disruption of care where it negatively impacts vulnerable service users is unacceptable. Under the Care Act, local authorities have a duty to shape their markets and provide services to those with eligible needs. The Government are providing up to £7.5 billion over the next two years to support adult social care and discharge. This historic funding boost will help local authorities to start addressing waiting lists, low fee rates and work- force pressures in the sector.

I thank the Minister for that Answer, but I cannot say that any of it was a surprise to me. Will he acknowledge that this is just the latest manifestation of a long-standing problem? For years, the social care system for adults with complex disabilities has been held together by charities and not-for-profits that have poured literally millions from their reserves into subsidising the services they provide for the NHS and local authorities. Now these organisations are in financial trouble and can no longer afford to do so. Those who are suffering are those in greatest need. Does the Minister agree that the whole system of funding for social care is broken and that the only solution is complete root-and-branch reform, not the piecemeal solutions offered by the Government?

I thank the noble Baroness and echo the sentiment of thanks to the charitable sector for the work it is doing in this vital space. We have shown that we have listened in this area through the £7.5 billion—a 22% increase over two years, which I think everyone would agree is substantial. At the same time, we are in touch with these bodies; we reached out to the charity Leonard Cheshire, which is involved in this, to try to understand the issues. If there are ways in which we can directly help, we will do so.

My Lords, does the Minister agree that there was a time when, if the local authority asked to see the parents, they assumed that this was for a review of what progress had been made by their offspring in residential care? More recently, parents are saying that they fear any approach by a local authority, because it may say that it will have to move their child to a different arrangement because it cannot afford to pay the fees now being set.

As I say, we are working on this. The CQC has a vital role to play and we had a discussion recently with the Association of Directors of Adult Social Services, which welcomed the relief the Autumn Statement brings in this area. I can only reiterate that we have listened and acted.

My Lords, I draw attention to my registered interests. Do not these cases underline the need to ensure that the additional costs of severe disability, whether incurred in charitable establishments, commercially run accommodation or at home with families, should be met consistently from central sources rather than falling on local authorities, which may have neither the expertise in the degree of disability nor the resources to meet them?

As ever in these areas, there is a debate to be had on centralism versus localism. I happen to believe that local authorities and healthcare systems are best placed to understand the needs of the people in their area, and I will continue to support that. Clearly, where help is needed, we are there. I reiterate that we have funds to support them from the centre, including a £2.3 billion increase for mental health, to give one example. Generally, I would keep to the principle that it is best that local people and authorities identify and meet local needs.

My Lords, the Minister just referred to mental health funding and referred earlier to the increased funding to cover delayed discharges and get more people coming out of hospital into social care. Neither of those affects severely disabled adults; funding for them from central government to local government has not been increased. I repeat the question of the noble Baroness, Lady Pitkeathley: does the Minister think that the provision and arrangements for this particular group of people are broken?

No—it is for local authorities to decide how best to use the funding we have put in place, as I said. That means looking at the needs of local people and how best they will put this in place. The 22% increase in funding can be channelled to exactly these types of places and people if a local authority believes that that is in the best interest.

Does my noble friend accept that many disabled people in residential and nursing care are of an age such that there are no parents or close relatives left and there is no one with a lasting power of attorney? How can that vulnerability be coped with by the state in a way we would all approve of?

My noble friend identifies an ageing demographic, the challenges that brings to all of us and the pressure on adult social care and the centres. As I have said, this is a challenge, but there are high levels of satisfaction in the sector: 89% of people are satisfied and 64% are very satisfied. So, although we have not got this right in every case, we are broadly on the right track and getting good results.

My Lords, eight out of 10 of the largest providers of care for the disabled and children are at least in part private equity owned and, in many cases, wholly so. Their interest rates are already their major concern, and these are going up. Is the Minister concerned that these private equity-owned homes will be forced either to cut what they do and serve their customers less well, or close? If he is concerned, what is he doing about it?

The financial health of this sector is an area of interest; we all of course recall some of the problems and failures about 10 years ago. I had a meeting on this subject just this week, identifying the health of the providers to see if that is of concern. The margins made in this space are fairly typical of other industries, so they are not indicative of an area under particular stress. But I have my mind on this issue and will keep an eye on it.

My Lords, ADASS reports that in the past four months,

“64% of councils … reported that providers in their area had closed, ceased trading or handed back council contracts”

either through an inability to recruit staff or escalating care home running costs. We all know that the extra funding to councils, which the Minister repeats in almost every response, just about props up existing services and does not provide the sustainable and long-term funding that was promised to commence with the again delayed social care cap. When will the Government fulfil their pledge to fix social care?

My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.

My Lords, has my noble friend yet had an opportunity to read the Economic Affairs Committee report on social care, a “national scandal”, which points out that in care homes in both the private and the charity sectors, people who pay their own costs subsidise others to the tune of 40%? The local authority rates are simply unsustainable, and this issue is therefore urgent and needs to be addressed. Simply talking about inputs all of the time is no good; we need to see what is happening to the outputs, which is a tragedy.

Funnily enough, the meeting on the sector’s financial health that I mentioned was precisely in response to the Question last week, so that I can make sure that proper work is being done in this space. I will not pretend to have the answers to that yet because, as my noble friend mentioned, a long-term review needs to be done. But rest assured that I am working on this.