Fifth Standing Committee on Delegated Legislation
Thursday 6 April 2000
[Mr. JONATHAN SAYEED in the Chair]
Local Government Finance (England) Special Grant Report (No. 57)
The Minister of State, Department of Health (Mr. John Denham): I beg to move,
That the Committee has considered the Local Government Finance (England) Special Grant Report (No. 57) on the Promoting Independence: Prevention Grant for 2000–2001 (House of Commons Paper 338).
The Chairman: With this it will be convenient to consider the Local Government Finance (England) Special Grant Report (No. 56) on the Promoting Independence: Partnership Grant for 2000–2001 (House of Commons Paper 337) and the Local Government Finance (England) Special Grant Report (No. 58) on the Promoting Independence: Carers Grant for 2000–2001 (House of Commons Paper 339).
Mr. Denham: The Government understand that money and the modernisation of services must go together and that the investment of cash must be matched by clear outcomes.
The three promoting independence special grants, which were introduced last year, were the first social services grants that linked extra cash to clear performance outcomes. We are determined to ensure that they are used by local councils to improve the services that they provide to the people in their communities. I am glad that the grants are being used to deliver those improvements.
The Government made social services a priority in our comprehensive spending review. For the first time, we guaranteed that national resources for social services would increase over a three-year period. In the three years that are covered by the spending review and by the three grants, social services are receiving an additional £3 billion, which is an average of 3 per cent. more than inflation each year. Our objective is to make the promotion of greater independence a key focus of social services for adults. Our intention is to put a new emphasis on helping people to achieve and to maintain independence wherever possible.
The three grants promote independence by breaking down barriers between health and social services, by encouraging early intervention to prevent crises and by supporting carers who wish to continue to care. All three ring-fenced grants promote partnership between health and social services. The partnership grant was £253 million in 1999–2000, and it will be £216 in 2000–01 and £178 million in 2001–02. The grant represents a significant injection of new ring-fenced money into the system and it will ensure that the partnership agenda is delivered. Over the three years, joint working will become part and parcel of the way in which local authorities go about their business. Partnership working is one of key initiatives of the agenda of my right hon. Friend the Prime Minister for modernising the national health service. The grant emphasises the need for local authorities, working in partnership with the NHS, to introduce or improve arrangements for multi-disciplinary assessment; hospital discharge, including rehabilitation and recuperation services; the prevention of unnecessary admissions to hospital or residential and nursing homes; and people's rehabilitation and their ability to enter or to continue in employment. The need to reduce the rate of growth in emergency admissions to hospital is also involved. Authorities use the grant to make contingency arrangements to deal with emergency pressures—for example, during the winter. Evidence after the first year of the grant is that it is being used to pump-prime and to develop innovative, user-centred services. New models of services are appearing, including rehabilitation and recuperation, which give people more choice and independence.
Although we are not specifying the processes by which the outcomes are achieved, we want to ensure that the grant is delivering better outcomes for local people. We will therefore develop monitoring systems to ensure that the targets that local authorities are required to set as a condition of the partnership grant are met and that the grant money is used to meet the national targets on emergency admissions and delayed discharges for the over-75s. We will also be monitoring the use of the partnership grant in relation to planning for winter pressures. Last year, most authorities specifically identified part of the grant for expenditure on winter pressures or other contingency planning. In some areas, the partnership grant contributed significantly to the capacity of local health and social care systems to cope with additional demand. We intend that that good practice should increase.
The requirement for joint planning goes with the grain of the partnership agenda. Health authorities and social services departments already work together to produce joint investment plans—they set out the resources that they intend to invest and the way in which they propose to develop services for specific client groups. Many authorities will be using their older people's joint investment plan to set out the proposed use of the partnership grant. We welcome the use of the JIP to do that. It ensures that the use of the partnership grant stays within local strategic planning and contributes to local priorities that have already been identified within the JIP and the more strategic local health improvement programme.
There is a continuing challenge to translate the partnership agenda into real benefits for individuals. On 1 April, new powers came into force under the relevant health legislation which allow the NHS and local authorities to make much closer partnership arrangements, including money transfers, lead commissioning, integrated provision and pooled budgets. That approach will free local organisations from some of the constraints that have previously prevented them from delivering genuinely individual-centred, integrated services to people.
It is clear that the joint planning involved in using these new flexibilities is a crucial part of the process. The experience of using the partnership grant last year and during the next two years means that local partners will be ready and able to use the new flexibilities in ways that will deliver the improved services that we all want. We specifically included the ability to use the partnership grant in a pooled budget so that innovative models involving the partnership grant would not be fettered.
The second grant is the prevention grant, which is intended to stimulate the further development by councils of preventive strategies among community care services for adults. In that way, we hope to ensure that councils can target their resources to slow down or to prevent deterioration among people who have been assessed as being at risk of losing their independence. That should help councils to identify people who could benefit from lower-intensity services, which would prevent or significantly delay admission to a residential or nursing home or to hospital. The prevention grant should help people to gain or to re-enter employment and to enhance their quality of life.
Mr. Tony Baldry (Banbury): If the standard spending assessment is based on need, why is the money not simply distributed through the SSA mechanism? Why are the extra grants needed? They serve only to make local government finance more complicated and they make it harder for local councils and others to know about the resources that are available. I ask that not as a trick question, but because I am genuinely interested.
Mr. Denham: When there are gaps in services, or when the Government identify a need to change the way in which services are developed, it is legitimate to add to the system money that is essentially of a pump-priming nature. The partnership grant functions in that way—it facilitates the faster development of partnership services with the NHS at a local level, although the clear intention is that those services should become mainstream over time.
In relation to the prevention grant, we identified a strategic need to rebalance services. The tendency has been to have a heavy, but not exclusive, concentration on high-intensity services to the exclusion of low-intensity services. The client group—the users and beneficiaries of the grant—are likely to be people who do not need high-intensity services, but who could end up in a nursing home or in residential care if there was no intervention or support. It is legitimate for Governments to identify such needs across the whole of health and social services provision and to include a targeted, ring-fenced grant in the appropriate way—that was our approach.
The grant should be used to begin to restore a better balance between high and low-intensity services and to help councils to develop their preventive strategies.
Mr. Paul Burstow (Sutton and Cheam): Is the Minister arguing that the partnership grant, like the special transitional grant, should result in upward adjustments of the SSA to reflect the mainstreaming of new services?
Mr. Denham: Certainly the size of the partnership grant is decreasing, but, as a result of the standard spending assessment, over a three-year period there will be a significant increase in real terms in the resources available to social services. The increase in the SSA over that period is significantly greater than the step-change reduction in the partnership grants in each of those years. Therefore, there is no arithmetical link of the kind suggested by the hon. Gentleman. There is scope in the extra resources going into social services for local authorities to develop into mainstream services the innovative services that they are obtaining through the partnership grant.
The primary condition of the prevention grant is that it must be used only for additional, non-intensive community care services in the financial year 2000–01. ``Additional'' means services that were not provided before 1 April 1999 or services provided to people who did not receive them before 1 April 1999.
The grant stipulates that at least 85 per cent., compared with 75 per cent. in 1999–2000, must be spent on additional services. That change recognises that the prevention strategy and plan no longer need to be prepared from scratch, although they must still be kept under review. The services on which the grant can be spent focus specifically on lower levels of intervention for people who, on the basis of risk assessment, are likely to benefit most from them in terms of preventing deterioration in their independence. The success of the preventive strategy will depend on the involvement of other relevant agencies. We issued guidance on developing a preventive strategy together with a social services inspectorate report, in April 1999, identifying examples of good practice policies and processes.
The carers special grant was intended to stimulate the diversity and flexibility of community care provision that enables carers to have a break from caring. I am glad to be able to confirm that it has already begun to make a great difference to carers' lives. The Carers National Association, for example, described the grant as an excellent exercise in pump-priming activity on carers' support services. The King's Fund reported that it appeared to have provided a positive incentive for authorities to develop or update joint strategies and review local support to carers, to map services offering a break, to consult carers and raise public awareness, to take action on carer assessments and to aim for better quality, more flexible breaks and a broader range of services offering a break.
We have seen a positive beginning to the process that the grant was designed to achieve in the major shift by local councils to address the needs of carers for breaks. However, we want to do more to give carers the break that they so richly deserve and that research and hon. Members' constituency experience tell us they need. That is why we have changed some of the conditions attaching to the grant for 2000–01.
The first main change to the conditions is an increase in the amount required to be spent on breaks services for carers from 75 to 95 per cent. According to the King's Fund, which did an independent analysis based on 142 of the carers plans provided by English local authorities, in year one 74 per cent. of all planned spending by local authorities was on breaks services for carers.
Although many local councils exceed the target of 75 per cent. on breaks, not all are meeting it. The Department of Health has accordingly listened to concerns expressed by carers and their organisations and has judged that, with the grant more than doubling from £20 million to £50 million, it is appropriate to set a new target of 95 per cent. for spending on breaks. That figure includes any costs directly associated with developing and providing the breaks. The remaining 5 per cent. may be spent on revising and monitoring the carer plans and consulting carers, which we see as a continuing process.
The second main change in conditions relates to children's services. In year one, the grant was aimed at community care services only. The Government were already increasing help and support for parents of disabled children by introducing new objectives for children's services and provided £375 million to local authorities under the quality protects programme.
However, we have listened to the arguments of parent carers of disabled children, together with carers, children's organisations and local authorities, who argue that powers to develop children's breaks services should be included in the grant. That will also allow spending on leisure and social activities that young carers need to make the most of a break from caring. Therefore, the grant is now truly a grant for all carers. We say in the guidance that local councils should spend about 20 per cent. of their total grant on services that allow parent carers or young carers to have a break. That gives them flexibility to take account of the strengths and weaknesses of their local services.
We have also responded to the view expressed by voluntary organisations and local authorities that we should be more flexible in reaching out to hidden carers. Last year, local councils could apply grant moneys to provide breaks for carers only where the person they cared for—their relevant person—had been assessed as needing community care services. We are aware, however, that some carers support people who may be wary of contact with social services, but will allow voluntary organisations to become involved. Young carers and their families, for example, may fear the involvement of social services, thinking that their family will be broken up. Minority ethnic carers and their families may sometimes find that systems are not culturally sensitive. Therefore, we are giving local authorities a new power to spend up to 10 per cent. of the total grant on breaks provided direct by voluntary organisations with the right skills and contacts, on their own assessment. The changes in conditions, combined with the need for tighter monitoring, have led to the need for revised plans for 2000–01. We have stipulated that local authorities should provide them by the end of May 2000.
The three promoting independence grants are important levers of change. In partnership with the health service, we are modernising social services and the way in which they work. Most important, we are ensuring that people receive the services that they need in more flexible and integrated ways, that people whose needs are not yet severe have timely support to prevent them losing their independence and that carers who want to go on caring get the breaks that they need to do so.
I commend the reports to the Committee.