Urgent Question: Care funding House of Commons

Order, order. Urgent question, Barbara Keeley. Thank you. To ask

the Secretary of State for Health to make a statement on the crisis in

funding in social care and the effect this is having on the NHS on

the care of vulnerable older people. Minister David Mowatt. Thank you, Mr

Speaker. I think the honourable lady for raising today's question. I

think all members of this House will agree that there are few areas of

domestic policy which touch on so many lives and is so important to so

many of our constituents. I would like to start by

acknowledging the work of so many carers who provided excellent and

passionate care. I would like 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 a

powerful economy such as France and Germany. I accept that our system is

under strain and that pressure has been building for some years. In

response, the Government has insured the councils have access to funding.

We estimate 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. To put into place and in force a robust

regulatory system between 2014 and early next year, all homes and

domiciliary providers will have been re-inspected. 72% by the sea QC as

good or outstanding. Powers now exists to ensure closure. These

powers are being used. To work with local authorities to ensure that a

continuing market exists. In the last six years, the total number of

beds has remained constant. There are 40% more riders than in 2010.

Finally, the care and health systems, we have seen that those

councils which do this best demonstrate far fewer delayed

transfers that those who adopted best practice more slowly. Any

system would benefit from higher system would benefit from higher

budget and social care is no exception. Quality matters too.

Today is not a budget statement. Nor a local government settlement. By --

I wish to end by thanking the carers who work so 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. Not a strain,

expressed by local government, expressed by local

health and clinical leaders. On this health and clinical leaders. On this

site, we called on the Government to urgently bring forward promised

funding to address that crisis. The Chancellor did not listen. It did

not bring forward any funding for social care. Nor mention it at all.

Can the Caird Minister tell us in his response why health ministers do

not stand up for vulnerable and older people in this country and why

they don't fight harder to get extra vital funding for social care? Over

1 million older people in this country have care needs. And as he

recognises, and heavier burden falls onto unpaid family. This is made

possible by this Government has of the cuts. Can the Minister confirm

what is now reported by The Times that the Government intends to dump

this funding crisis onto local councils and council taxpayers to

increasing the social care precept? The King 's fund has called it

deeply flawed because in that least deprived areas could raise twice as

much as most are private. -- most deprived. That would widen

inequality of access to social care inequality of access to social care

across the country. Is it the care Minister's intention to support a

solution that widens over quality -- widens inequality and stops health

care for older people? The honourable Lady fought the last

election on manifesto that said not 1p more for local government

spending. That is what she fought the last election on. She has made a

statement today and she is against the change to the precept we brought

in in the spending review. She talked this morning about taxpayers

and council taxpayers having to meet the costs. That rather begs the

question, who she thinks is going to be paying for it? Borrowing or the

magic money trade? She made the point about the precept. She said

that the precept increases inequality is because the councils

are able to raise more than others. That would be true if it wasn't for

the fact that the additional better care fund is distributed and away

which balances that and is precisely what we do. -- distributed in a way.

I'll advise the house that there are three urgent questions to be taken

today and I want all to be contributed to. I am looking at

finishing the U Qs. I hope in looking at coordinating policy

across Government, the minister will look not only at join between local

health and local government, but also other policies like lifetime

homes, a flexible employment policy. All of which will help us deal with

these issues. Can he give us some encouragement on this? Thank you. He

is quite right. There is a whole raft of measures that need to be

taken on informal care. Also the holy grail of better integration of

health and social care funding. We are pursuing that vigorously. Thank

you. This is the substance of the letter from the health select

committee. Not calling for more money, but calling for capital

budgets and social care. Because basically the back pressure from

social care is actually what is causing the NHS to struggle. I

totally agree with the Minister in regards to integration will stop in

Scotland, where we have the integrated joint boards, it has

brought a change quicker than we would have hoped. Our delayed this

discharges are down. This is not something that is easy, it is

something that needs to be funding. We have debated the plans which

could be that the basis for the future integration for the NHS. All

we hear is within those plans, community hospitals being shot.

Losing the opportunity to have stepped up and step-down beds. A E

being shot and beds within hospitals being shot. This is the wrong way

round. STPs could work, but they can't start with a number that they

must reach. They have to design themselves around a service that

keeps patients at home and keeps them well. She made two points, both

of which I agree with. The first is of which I agree with. The first is

that in Scotland 9% reduction but it is also true that many parts that

have integrated so quickly have also achieved reductions of that or more.

She is right, the STP is part of the process. Re-engineering the system.

Adult social care and the integration of adult social care is

a big part of that. We need to make sure we deliver. Would the Minister

agree with me that better integration could be driven by

better patient data and help show us where quality practices exist and

have just read this best practice? I would agree. I had a discussion with

the CQ see on that subject. What is reported. I am hoping that over the

next months and years, we can deal with how we do that now. I think the

Minister has completely missed the point raised by my honourable friend

from the front bench. About the unfairness of asking councils to

deal with problem. A 1% rise in council tax in Donk Doncaster rate

is 20% less than a raise in the Rye Minister's constituency. Surely that

means that the constituents are having more to pay. I would have

missed the point, but it takes into account relative need. The Minister

will know that following recent events, this issue is something I've

taken particular interest in. Saying it is just about money is too

simplistic and we have seen a wide variety of the quality of care from

homes under the same funding packages. Does he also agree with me

that we need to improve things to ensure the concerns are taking

seriously? I agree with that. I commend the member with the work

that he did with the Morley home in his constituency which had

significant issues and now which has been substantially closed down. He

is right in saying that the issues there were not principally about

money, but about quality and people doing their jobs properly. Does the

Minister share the view of the Care Quality Commission that the system

is close to tipping point? Does he understand the impact that he has an

very many frail, elderly people. Does he not agree that now was the

time to bury our differences, come up with a long-term solution? Today

is not the day in which we are going is not the day in which we are going

to announce the Royal commission on the funding of care into the future.

I do agree that it is important that we put care funding on a better

structural basis. The honourable member is right to say that. I

applaud this Government's commitment the 10 billion pounds to the NHS by

2020. Does my right honourable friend agree that social care and

health care must be better integrated across the whole country?

Somerset County Council sustainability and transformation

plan has this at its part. It is a good model. Would you agree that

models like this should be copied but must be given the tools? The STP

for Somerset is excellent in this regard and she is right to raise it.

integration of health and social integration of health and social

care is the holy grail of this and those councils and health systems

which do it best making huge difference. Is he aware that the

local authorities in the court of the past few years have lost more

than ?200 million in cuts that have been propagated by the Government?

On top of which, they are closing community hospitals and arbiter --

when these community hospitals bear when these community hospitals bear

the burden of looking after people the burden of looking after people

that can't occupy hospital beds? He is right to say that there have been

changes to the funding regime. The facts are such as Mosley and St

Helens have got virtually no delayed transfers of care. They have got the

same budget issues as his own counsel. With an ageing population,

a welcome introduction of the national living wage and the

expectation on services provided. This is providing exponential growth

in the adult care arena. Whilst the council tax cap has delivered... I

would urge the Minister to explore other opportunities. I said today is

not a spending statement, it is not a statement on a local government

settlement either. I will leave it at that. May I say to the Minister

it would be a huge mistake to think he can plug the gaping hole of

funding with the social have preset is the lead back alone. People who

need social care will be least likely 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, K users and the NHS? I

have acknowledged that the system is under pressure, but I've also

acknowledge that different councils respond that pressure in different

ways. For example, next year, 16, 17, Leicester council have increased

their budget by 7% in real terms. It is depressing that the Labour are

saying things because they did nothing when they were in power. It

is important to use fiscal incentives and respected DC LG and

the Treasury to encourage the construction of more extra care

facilities and also to iron out the disparities of the quality of care

delivered between authorities. Yes. There is disparity still in the

marketplace and between local authorities and we need to do

everything we can working with the CQ seeks to ensure that is

eliminated. His statement is totally inadequate for the crisis of social

care. The complacency that he shows is totally unrealistic to what is

happening in the country and what we require is a very different response

than what is given to day. I am than what is given to day. I am

tempted to say no, I don't bollards that. I make the point again. I'm

not complacent. I understand that this system is under pressure and we

acknowledge and accept that. That is not the same as saying that there

aren't things that we can do in terms of quality provision to manage

it better. That is what I'm trying to do.

It is a growing share cost of the key to addressing this challenge

will be better integration of health and social care to better manage

demand. What funding has been provided to Lancashire County

Council to allow the transformation to take place? The better care fund

is accredited on the assumption that we will drive that integration. I

also make the point that many councils right across the country,

not just Lester, have increased and will increase their social care

budget in real terms next year. Something like 40%. By 2020 we will

see a national shortfall of ?2.6 billion in adult social care

funding. If the Government is forcing councils to increase council

tax, what percentage would he be expected to increase it by hand what

of this percentage increase would go solely to adult social care

services, and how would the Government ensure this? Mr Speaker,

the Spending Review increased the precept by 2% and that is what we

brought in at that time. As I said earlier, this is not the local

government settlement and they have nothing to say on council tax. Many

people on both sides of the House revealed that the social care system

is broken because there are councils involved and the Health Service and

all. Would it not be a very good idea if the Secretary of State or

Minister could work across the House with goodwill on both sides, rather

than this petty point scoring from the other side... No, this is much

more serious than politics. We have got to get this right for future

generations. Should we not work together and come up with a solution

that all sides of the House can on? He is right that this whole system

is more important than politics. There is nothing that is more

important to more people in terms of the dignity and quality of their

lives in getting this right and it is essential that we do that. An

eagle! Liveable city council has seen ?330 million cut from its

budget since 2010 and 58% of all its money, a further ?90 million has to

be found by 2020. Can he say in that circumstance, how it is going to be

possible for Liverpool City Council to increase, as we all wish it good,

the money that it spends on adult social services when it actually

already spends more on adult social care, 146 Milibands, than it can

raise in council tax? -- ?146 million. I make the point that

Knowsley and St Helens, close to liveable, are virtually no delayed

transfers of care and probably some best practice sharing would be in

order. I do not want to see a festering sibling rivalry! Angela

Eagle. I think it's afraid that you chose the younger role for the

older. You did the opposite last time. In the world, we have an

above-average older -- average number of older people, but we have

a very low council tax base, so we cannot raise council tax to raise

enough money to deal with the shortfalls in adult social care. 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 made the point

already and I will make it again, we acknowledge the precept is uneven in

a way when it was announced in the Spending Review, which is why the

additional better care fund component is allocated on a basis

which remedies that. Jess Phillips. A timely moment to call me. Just to

talk to what the Minister says about the remedies. I put in an FOIA about

the weekly adult residential rate across every single candle in the

country, but Buckinghamshire gets ?615 a week -- county in the

country. But Birmingham gets 436 and has to make an additional charge of

?55 per week to the residents who live there, who are no doubt poorer

than those who live in Buckinghamshire. Does that sound

like a discrepancy that is currently being solved by the Government's

system, and are grandparents in Buckinghamshire with more than they

are in Yardley? The reports in terms of quality from Buckinghamshire and

Birmingham are things that we look at rate across a system and we are

not finding a geographical variation which is based on the sort of

statistics. That is just the fact of the matter. I have heard nothing

from the Minister this afternoon to demonstrate that he understands the

severity of the situation facing social care. There was a cross-party

meeting last week, it was said they needed ?1.3 billion immediately to

stabilise social care in this country. They pointed out that the

money cannot be raised by council tax increase, and especially because

it raises the least money in the areas with the highest need. In

terms of council tax increase, this is not the local government

settlement. There has already been announced that the additional better

care fund will start to deliver more money from next April and the better

care fund 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. That is obviously from next April. This

year, can the Minister tell me how is it fair that the area I

represent, the 19th most disadvantaged constituency in the

country, will only be able to raise half of what an area like Kingston

upon Thames can raise? We can raise about ?5, they can raise about ?10.

How can that be fair for social care? This year, 42% of councils are

increasing the adult social care funding in real terms. In terms of

the discrepancy caused by the precept, in terms of the

discrepancy, it is addressed by the way that 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 I think he

recognises that the precept alone will not address that. Does he agree

with the former Health Secretary when he said this morning that it

was a missed opportunity in the Autumn Statement not to invest in

social care? Mrs Pickard, 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 the course of this Parliament and that

42% of councils are increasing the budget in real terms this year.

Thank you, Mr Speaker. I think the Minister needs to recognise that

with cities, it is not just that it can be more difficult for them to

raise the money, as we have already heard from colleagues comparing the

amount that would be raised by raising council taxpayer as opposed

to more affluent rural areas, there are also demographic concerns

meaning there are more challenging, it is more challenging to deliver

health services in cities such as Bristol. We are already looking at

?92 million of cuts that we have defined over the next five years.

Can I ask him to 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 high proportion

of older people, which in itself can absorb a great deal of cost. The

truth is, as I have acknowledge, the whole system is under pressure,

including in Bristol. We acknowledge that. We are increasing the total

spend by 5% during the course of this Parliament. We have heard from

honourable friends about the failings of the social care precept

model, but what are councils like Kim Butcher, who choose not even to

take the meagre resources available? Offered 4% and they took just 2%,

leaving the local hospital with 100 85-year-olds with nowhere to go. --

councils like Cambridgeshire. That was a decision made by Cambridge

Council, and there were a number of other councils like Hammersmith

which made a similar choice not to increase the precept and presumably

not to feel as though they needed to use the money for adult social care.

That is a choice those councils have and it is a choice they must take to

the voters. Sheffield is about to lose its last emergency respite care

for patients with convex dimension needs. These patients cannot be

cared for in the community and people desperately do not want to

see it go. Sheffield already has the second-largest better care fund in

the country. If today is not the day the Minister to issue a Royal

commission, when will the Minister act? Well, I am not aware of the

specific issue she has raised in terms of the respite care centre in

Sheffield that is on the point of closure, I would be happy to discuss

it with her so I understand better. But I'm afraid I can only repeat

today is not that they were going announce a Royal commission into

funding. Voters in my constituency tell me that they are losing staff

to Asda because they cannot compete with pay and conditions because the

council cannot commission care at a price that enables them to do so.

What will the Minister do to stem this haemorrhaging of care workers

from the profession and therefore the haemorrhaging of the provision

of care? There is an issue with that and that exists in various parts of

the country, and we acknowledge and need to manage it. But we also need

to manage the total number of dead is that in the system and the total

number of domiciliary providers in the system. The total number of beds

is the same now as it was six years ago, the total number of the

massively red providers is run about 40% higher. -- domiciliary

providers. The Minister congratulated Holton and Warrington

councils on being two of the best performing the country on delayed

transfers of care and increasing their budgets. But Holton still has

a massive shortfall because the precept goes nowhere near that the

band of the in the area. The simple fact is this, there is no coherent

national strategy on a funding package to solve this crisis we are

now facing. The Government is abdicating its responsibility and it

will tip over. The honourable gentleman is quite right, I did

congratulate Halton and Warrington councils has been those who have

particularly low delayed transfers of care. The fact they are doing

that in spite of the budget constraints that he mentions

demonstrates that this is not just about money, it is about quality,

about leadership and best practice. The Chief Executive of Care England

has said of the current regime, around 40% of care service will no

longer be viable, so a number of services will be lost. When does the

Minister intend to do something about this crisis? Mr Speaker, the

number of beds available in the system right now is around about the

same as it was six years ago. However, there is an issue with

managing the financial performance of significant care providers and

one thing we brought in two years ago is a robust process led by the

CQC, in which they look at the financial performance of the biggest

providers to give us warning of issues that might arise. We are very

keen on pursuing and making sure that happens. This is a national

crisis which this Government has wilfully ignored for years. As the

Minister said, there is no issue which cannot be solved by throwing

money at it. Is it not time he put his money where his mouth is? I

think she paraphrased what I said in my opening statement rather

inaccurately. What I said is that money would help with any system,

but the issues here are about quality as well, about leadership as

well, and about best practice as well. All of those things are within

the remit of my job and that is what I am assuming. Everything we have

heard today from the Minister seems to fundamentally deny the council

tax precept is no solution to the problem. In fact, it exacerbates it.

Is he aware that Ray James of the Association of directors of adult

social services has said the council tax precept will raise the least

money in areas of greatest need, which risks heightening inequality?

If that is what the experts in the field are saying, why does the

Minister think he knows better? I discussed this and other issues with

Ray James often. It is true that the precept, if it was only the precept

on its own, would result in an uneven distribution of revenue.

Which is why the additional care fund and the money that comes from

the additional care fund are allocated using the formula which

corrects that.