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Social Care Funding

Volume 618: debated on Monday 12 December 2016

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the crisis in funding in social care, and the effect it is having on the NHS and on the care of vulnerable older people.

I thank the hon. Lady for raising today’s question. All Members of this House will agree that there are few areas of domestic policy that touch on so many lives and that are so important to so many of our constituents.

I wish to start by acknowledging the work of more than 1.4 million professional carers, the vast majority of whom provide excellent, compassionate care. I also wish to acknowledge the 6 million informal carers who also do so much.

Spending on long-term care in our country is more than the OECD average—in particular, it is more than comparable economies such as France and Germany. Nevertheless, I accept that our system is under strain, and that pressure has been building for some years now.

The Government response has been to ensure that councils have access to funding to increase social care spend by the end of this Parliament. We estimate that the increase could be around 5% in real terms. Additional funding comes from the better care fund, the additional better care fund and changes to the precept.

Another response has been to put into place and enforce a robust regulatory system. Between 2014 and early next year, all homes and domiciliary providers will have been re-inspected. Seventy-two per cent are classified by the Care Quality Commission as good or outstanding. Where homes are inadequate, powers now exist to ensure improvement or force closure. Those powers are being used.

Another Government response has been to work with local authorities to ensure that a continuing market exists. In the past six years, the total number of beds has remained constant, and there are 40% more domiciliary care agencies now than in 2010. Finally, the Government have responded by driving further and faster the integration of the care and health systems. We have seen that those councils that do that best demonstrate far fewer delayed transfers than those who adopt best practice more slowly.

Any system would benefit from higher budgets, and social care is no exception—but quality matters too. Today is not a budget statement or a local government settlement. I wish to end by commending again the many hundreds of thousands of carers who work hard to make the current system work for so many.

That was a disappointment. Before the autumn statement, we debated the funding crisis in social care—it is not a strain but a crisis—and the serious concerns expressed by local government health and clinical leaders. We on the Labour Benches called on the Government urgently to bring forward promised funding to address that crisis. The Chancellor did not listen and did not bring forward any funding for social care—he did not even mention it. Will the Minister tell us in his response why Health Ministers do not stand up for vulnerable and older people in this country and fight harder to get extra vital funding for social care?

Over 1 million older people in this country have unmet care needs, 400,000 fewer people have publicly funded care than did so in 2010 and, as he recognises, a heavier burden now falls on unpaid family carers. The crisis in social care has been made by this Government as a result of £5 billion being cut from adult social care budgets. Can the Minister confirm what is reported by The Times—that the Government intend to dump this funding crisis on local councils and council tax payers by increasing the social care precept?

The King’s Fund has called that proposal “deeply flawed” because local councils in the least deprived areas would be able to raise more than twice as much as those in the most deprived areas. This year that means that the precept raises £15 per head of the adult population in Richmond, but only £5 per head in Newham and Manchester. That would widen inequality of access to social care across the country. Is it the care Minister’s intention to support a solution that widens inequality of access and denies social care to hundreds and thousands of vulnerable older people?

The hon. Lady fought the last election on a manifesto that said not one penny more for local government spending. She is against the change to the precept that we brought in in the spending review. She talked this morning about being against taxpayers and council tax payers having to meet the cost of increased social care. That raises the question who she thinks should be paying for it. Is it borrowing, or is it the magic money tree? She said that the precept increases inequalities because some councils are able to raise more than others from it. That would be true, if it were not for the fact that the additional better care fund is distributed in a way that balances that. That is precisely what we do.

Order. I should advise the House that there are three urgent questions to be taken today and I want all to be properly contributed to, but it is important that we also provide time for subsequent business, so I am looking at finishing the UQs by 5.30 or thereabouts. Perhaps colleagues could tailor their contributions accordingly. We will be led in this matter by Mr Andrew Selous.

Thank you, Mr Speaker. I hope that in looking at co-ordinated policy across Government, the Minister will look not only at good join-up between the Department of Health and local government, but at other policies, such as lifetime homes, family strengthening and flexible employment policies, all of which will help us deal with these issues. Can he give us some encouragement on that score?

My hon. Friend is right. There is a raft of measures that need to be taken on informal carers and on the holy grail of better integration of health and social care funding, and we are pursuing that vigorously.

This was the substance of the letter from the Health Committee to the Chancellor, calling for extra money not for the NHS, but particularly for the capital budget and social care, because the back pressure from social care is what is causing the NHS to struggle. I totally agree with the Minister as regards integration. In Scotland, where we have the integrated joint boards, it has brought a change more quickly than we would have hoped. Our delayed discharges are down 9% in a year; in England they are up more than 30%. But this is not easy and it needs to be funded. We have debated the sustainability and transformation plans, which could be the basis for the future integration of the NHS, but all we hear within those plans is community hospitals being shut, losing the opportunity to have step-up and step-down beds, A & E departments being shut, and beds within hospitals being shut. This is the wrong way round. STPs could work, but they cannot start with the number they must reach—they have to design themselves around a service that keeps patients at home and keeps them well.

The hon. Lady made two points, both of which I agree with. The first was that in Scotland there has been a 9% reduction in delayed transfers of care. It is also true that in England many parts of our system, particularly those that have integrated most quickly, have achieved reductions of that size and more. She is right that the STPs are part of the process of re-engineering the system. Adult social care and the integration of adult social care are a big part of that and we need to ensure that we deliver.

Does the Minister agree that better integration could be driven by better patient data, which could help to show us where quality practices exist and how to spread best practice?

I do agree. I had a discussion with the Care Quality Commission on the dataset that is reported, and I hope that over the next months and years we can improve how we do that.

I think that the Minister completely missed the point made by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) from the Front Bench about the unfairness of asking councils to deal with the problem. A 1% rise in council tax in Doncaster raises 21% less than would the same rise in a council in the Prime Minister’s constituency. Does that not mean that the problem is being pushed on to the areas that can least afford it?

The right hon. Lady would be right that I had missed the point, had I not said that that issue is addressed by how we distribute the additional better care funding, which uses a formula that takes into account relative need.

The Minister will know that following recent events I have taken a particular interest in this issue. Does he agree that saying that it is just about money is too simplistic, and we see a wide variety of the quality of care from homes with the same funding packages? Does he also agree that we need to improve the inspection regime to ensure that concerns are taken seriously?

I agree and I commend my hon. Friend for his work on the Morleigh homes in his constituency, which had significant issues and have now been substantially closed down. He is right that the issues there were not principally about money; they were about quality and about people doing their jobs properly.

Does the Minister share the view of the CQC that the system is close to tipping point, and does he understand the impact that has on many frail elderly people? Does he not agree that now is the time to bury our differences and work together to come up with a long-term settlement for the health and care system?

Today is not the day on which to announce a royal commission on the funding of care in the future, but I do agree that it is important that we put care funding on to a better structural footing for the future. The right hon. Gentleman is right to say that.

I applaud the Government’s commitment to £10 billion to the NHS by 2020, but does my hon. Friend agree that social care and healthcare must be better integrated across the whole country? Somerset County Council’s sustainability and transformation plan has that at its heart. It is a good model. Does my hon. Friend agree that such models should be copied, but that councils must be given the tools?

The STP for Somerset is excellent in that regard and my hon. Friend is right to raise it. She is also right to emphasise again the integration of health and social care, which is the holy grail of this. Those councils and health systems that do it best are making a huge difference.

But is the Minister aware that in the course of the past few years local authorities—let us say in Derbyshire—have lost more than £200 million from cuts promulgated by the Government? On top of that, they are closing community hospitals in Derbyshire, including Bolsover, with a total of more than 100 beds between them. Does it make sense when those community hospitals bear the burden of looking after people who cannot occupy other hospital beds?

The hon. Gentleman is right that there have been changes to the funding regime, but councils such as Knowsley and St Helens have virtually no delayed transfers of care and they have the same budget issues as his council.

An ageing population, the welcome introduction of the national living wage and the rightly greater expectations on services provided are causing exponential growth in adult social care costs, to a far greater amount than can simply be found through efficiency savings. Although the council tax cap has delivered financial discipline, we have to be realistic, so may I urge the Minister to explore further flexibility with the social care precept?

I said in my answer to the hon. Member for Worsley and Eccles South (Barbara Keeley) that this is not a spending statement or a statement on the local government settlement, so I will just leave it at that.

It would be a huge mistake to think that the Minister can plug the gaping hole in care funding with the social care precept alone. The poorest areas, which most need publicly funded social care, are the least likely to be able to get it by raising council tax. If not today, when will the Minister come to the House with a plan to solve this crisis and help families, care users and the NHS?

I have acknowledged that the system is under pressure, but I have also acknowledged that different councils respond to that pressure in different ways. For example, Leicester City Council has increased its adult social care budget for next year—2016-17—by 7% in real terms.

Shroud waving by the Labour party is particularly depressing given that it did virtually nothing on this issue during 13 years in power. Does my hon. Friend agree that it is important for the Department for Communities and Local Government and the Treasury to use fiscal incentives to encourage the construction of more extra care facilities? Does he also agree that it is important to iron out the disparities between different local authorities in the quality of care delivered?

Yes, there is disparity—still—in the marketplace and between local authorities, and we need to do everything we can, working with the CQC, to ensure that it is eliminated.

Does the Minister not realise that his statement today is totally inadequate for the crisis in social care and that the complacency he shows is totally unrealistic, given what has happened in the country? What we require is a very different response from what we have been given today.

I am tempted just to say, “No, I don’t acknowledge that,” but I make the point again that I am not complacent. We understand that the system is under pressure, and we acknowledge and accept that. That is not the same as saying that there are not things that we can do in terms of quality provision to manage better, and that is what we are trying to do.

Adult social care accounts for about 45% of Lancashire County Council’s budget, and that is a growing share. The key to addressing this challenge will be the better integration of health and social care to better manage demand. What funding is being provided to Lancashire County Council to allow that transformation to take place?

The better care fund is predicated on the assumption that we will drive that integration. I also make the point that not just Leicester, for example, but many councils right across the country—something like 40%—have increased, and will increase, their social care budget in real terms next year.

By 2020, we will see a national shortfall of £2.6 billion in adult social care funding. If the Government are forcing councils to increase council tax, what percentage will they be expected to increase it by? How much of that percentage increase would go solely to adult social care services? How will the Government ensure that that happens?

The spending review increased the precept by 2%—that is what we brought in at that time. As I said earlier, this is not the local government settlement, and I have nothing to say on council tax.

Many people on, I think, both sides of the House feel that the social care system is broken because we have councils and the health service involved. Would it not be a good idea for the Secretary of State or the Minister to work with Members on both sides of the House, with good will on both sides, rather than for us to have this petty point-scoring from the Opposition? [Interruption.] No, this is much more serious than politics—we have to get this right for future generations. Should we not work together and come up with a solution that both sides of the House can agree on?

My hon. Friend is right that this whole system is more important than politics: there is nothing more important to more people—and more old people in terms of the dignity and quality of their lives—than getting this right, and it is essential that we do that.

Liverpool City Council has seen £330 million cut from its budget since 2010—58% of all its money. A further £90 million has to be found by 2020. In those circumstances, how will it be possible for the council to increase, as we all wish it could, the money it spends on adult social services, when it already spends more on them— £146 million—than it can raise in council tax?

It is not my role to lecture Liverpool City Council on how to deliver adult social care. I make the point, though, that Knowsley and St Helens, which are very close to Liverpool, have virtually no delayed transfers of care, and so possibly some best-practice sharing would be in order.

Thank you, Mr Speaker. I think it is right that you chose the younger before the older this time, because you did the opposite last time.

In the Wirral we have an above-average number of older people, yet we have a very low council tax base, which means that we cannot raise enough money through council tax to deal with the shortfalls in adult social care. As the Minister knows, £5 billion has been cut from social care since 2010, and his better care budget is £3.5 billion, so there are huge issues here. Why was this not mentioned in the autumn statement, and what is the Government’s response to this ongoing crisis?

I have made the point already, and I will make it again, that we acknowledge that the precept is uneven in the way that it was announced in the spending review. That is why the additional better care fund component is allocated on a basis that remedies that.

Thank you, Mr Speaker; this is a timely moment to call me, given what the Minister says about remedies. I put in a freedom of information request about the adult residential weekly rate across every single council in the country. Buckinghamshire gets £615 a week, while Birmingham, including the home where my grandparents both died, gets £436 and has to make an additional charge of £55 per week on the residents who live there, who are no doubt poorer than those who live in Buckinghamshire. Does that sound like a discrepancy that is being solved by the Government’s system? Are nans and granddads in Buckinghamshire worth more than they are in Birmingham, Yardley?

In terms of quality in Buckinghamshire and Birmingham, we look at the CQC reports right across the system, and we are not finding a geographic variation based on those sorts of statistics. That is just the fact of the matter.

I have heard nothing from the Minister to demonstrate that he understands the severity of the situation facing social care. Last week, the Local Government Association met a cross-party of group of MPs. It said that local government needs £1.3 billion to stabilise social care, and pointed out that that money cannot be raised by a council tax increase, especially because that raises the least money in the areas with the highest need.

In terms of council tax increases, this is not about the local government settlement that has already been announced. The additional better care fund will start to deliver more money from next April, and will deliver more money after that. During the course of this Parliament, there will be a 5% increase, in real terms, in money spent on adult social care.

I hear what the Minister says about the better care fund, but that obviously applies from next April. How is it fair that this year the area I represent—the 19th most disadvantaged constituency in the country—will be able to raise only half of what an area like Kingston upon Thames can raise? We can raise about £5; it can raise about £10. How can that be fair for social care?

This year, 42% of councils are increasing their adult social care funding in real terms. The discrepancy caused by the precept is addressed by the way in which we allocate the additional better care fund component and the formula that is used for that.

I think the Minister recognises that there is a crisis and that the precept alone will not address it, so does he agree with the former Health Secretary, Stephen Dorrell, who said this morning that it was a missed opportunity in the autumn statement not to invest in social care?

I am not giving the autumn statement, but I will say again that there is a 5% increase in real terms in adult social care funding during this Parliament, and that 42% of councils are increasing the budget in real terms this year.

The Minister needs to recognise that not only can it be more difficult for cities to raise money—we have already heard from colleagues comparing the amount that would be raised by increasing council tax in cities as opposed to more affluent rural areas—but demographic concerns make delivering health services more challenging in cities such as Bristol. We are already looking at £92 million of cuts or savings that we have got to find over the next five years. Will the Minister come to Bristol to talk to the Mayor and see what challenges we are facing?

Cities do have issues with delivering social care, but so do rural areas, which quite often have a very high proportion of older people. That, in itself, can absorb a great deal of cost. The truth is that, as I have acknowledged, the whole system is under pressure, including in Bristol. We acknowledge that, and we are increasing the total spend by 5% during this Parliament.

We have heard from my hon. Friends about the failings of the social care precept model to address this issue, but what of councils such as Cambridgeshire, which chose not even to take the meagre resources available? Offered 4%, the council took just 2% this year, leaving the local hospital with 100 over-85-year-olds with nowhere to go. When are the Government going to stand up for older people in Cambridgeshire?

That was a decision made by Cambridgeshire County Council, and a number of other councils, such as Hammersmith and Fulham, made the same choice not to increase the precept. Presumably, they did not feel as though they needed to use that money for adult social care. That is a choice that those councils have, and it is a choice that they must take to their voters.

Sheffield is about to lose its last emergency respite care centre for patients with complex dementia needs. Those patients cannot be cared for in the community, and people desperately do not want to see that centre go. Sheffield already has the second-largest better care fund in the country. If today is not the day for the Minister to issue a royal commission, when will he act?

I am not aware of the specific issue that the hon. Lady has raised about the respite care centre in Sheffield that is on the point of closure, and I would be happy to discuss that with her so that I understand it better. I can only repeat that today is not the day that we are going to announce a royal commission into funding.

Care providers in my constituency tell me that they are losing staff to Asda because they cannot compete on pay and conditions, because the council cannot commission care at a price that enables them to do so. What is the Minister going to do to stem the haemorrhaging of careworkers from the profession and, therefore, the haemorrhaging of the provision of care?

There is an issue with that, and that issue exists in various parts of the country. We acknowledge it and we need to manage it. We also need to manage the total number of beds in the system and the total number of domiciliary providers in the system. The total number of beds, as I said earlier, is the same now as it was six years ago. The total number of domiciliary providers is around 40% higher.

The Minister, in a debate on 16 November, congratulated

“both Halton and Warrington Councils on being two of the best performing councils in the country on delayed transfers of care and on increasing their budget.”—[Official Report, 16 November 2016; Vol. 617, c. 350.]

Halton still has a massive shortfall, because the precept goes nowhere near meeting the demand on the services in the area. The simple fact is this: there is no coherent national strategy or funding package in place to solve this crisis we now face. The Government are abrogating their responsibility, and the system will tip over.

The hon. Gentleman is quite right. I congratulated Halton and Warrington Councils on being two councils that have particularly low rates of delayed transfers of care. The fact that they are achieving that in spite of the budget constraints that he mentions demonstrates that this is not just about money; it is about quality, it is about leadership and it is about best practice.

The chief executive of Care England has said that under the current regime,

“about 40% of care services will no longer be viable,”

meaning that a number of services will be lost. When does the Minister intend to do something about this crisis?

The number of beds available in the system right now is about the same as it was six years ago. There is an issue with managing the financial performance of significant care providers. One thing we brought in two years ago was a robust process, led by the CQC, to look at the financial performance of the biggest providers and to warn us of any issues that may arise. We are very keen on pursuing that and making sure that it happens.

This is a national crisis that this Government have wilfully ignored for years. The Minister said in his opening statement that there is no issue that cannot be solved by throwing money at it. Is it not about time that he put his money where his mouth is?

The hon. Lady paraphrases what I said rather inaccurately. I said that money would help with any system, but the issues are about quality, leadership and best practice as well. All those things are within the ambit of my job, and that is what I am pursuing.

Everything we have heard today from the Minister seems fundamentally to deny that the council tax precept is no solution to the problem and in fact exacerbates it. Is he aware that Ray James of the Association of Directors of Social Services has said:

“The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality”?

If that is what experts in the field are saying, why does the Minister think he knows better?

I often discuss this and other issues with Ray James. It is true that the precept on its own would result in an uneven distribution of revenue, which is why the additional moneys coming from the better care fund will be allocated using a formula that corrects that.