|Local Government Finance (England) Special Grant Report (No. 57)
Mr. Paul Burstow (Sutton and Cheam): The three grants are welcome. We support their underlying principles. I have issues of detail to raise, including concerns about the quantums that relate to the figures. The idea of using special grants to pump-prime and initiate new services is legitimate, but there is an important caveat: the Government must recognise that new services need to be sustained. The methodology that underpins standard spending assessments needs to be capable of accommodating that.
The Minister suggested that, although the comprehensive spending review may provide additional resources for social services departments, there is no direct formulaic link between the changes in the grants and the standard spending assessment. The services that are established by the grants must be sustained beyond the three-year period within the envelope of resources that is provided by the standard spending assessment, among other things.
It is right to promote independence. It is also right that we all seek to enable people not only to live longer but to do so with a better quality of life. We want policy to be moved in that direction and practice directed to that end in local authorities and the health sector, with the investment to make that possible.
I want to spend a few minutes on each of the grants, starting with the carers grant. It is one of the smaller grants, but is nevertheless important. The extra £30 million available in 2000–01, which will mean a total of £50 million available this year, is of course welcome.
From talking to the Carers National Association, it is clear that the experience of the first year of the grant has been mixed. The Minister referred to that point. There have been examples of excellent practice and examples of the conditions not necessarily being followed as faithfully as we might want them to be. Some local authorities have been innovative about the way in which they have consulted. They have gone out of their way to find hidden carers and others, and they have worked closely with carers' organisations in drawing up their plans. Others have not been so good at trying to find more marginalised carers, such as young carers and others not so easily engaged or even found. That situation must be addressed and rectified in the coming round of service development.
The Minister referred to the report's target of 75 per cent. of grant moneys going into providing breaks last year. A report by the CNA on its work, entitled ``Give us a break'', estimates that the figure for achievement is probably nearer to 65 per cent. I am told that one in three local authorities is planning to allocate about 40 per cent. of the funds to breaks.
We know from the national carers strategy, from most of the evidence in our correspondence and from dialogue with local carers' organisations that the provision of breaks and respite care is the No. 1 item on the agenda. The failure of local authorities in year one to allocate even the percentage of funds that the grant report sought last year must be pursued. I hope that the Minister will say what follow-up steps the Department is taking with local authorities that demonstrated in their returns that they got nowhere near the 75 per cent. target.
Where did the money go instead? It went to supporting core services. One can understand why that happened. Arguably, many authorities found it difficult to sustain the core services that social services departments must provide. That is at least partly because of the understandable pressure on many local authorities to direct additional resources towards education. Considerable pressure is put on social services budgets, often the second biggest budget in a local authority. It is hardly surprising that they come under pressure.
I mentioned good practice in local authorities. My local authority—the London borough of Sutton—consulted widely when reaching a view on the way in which it would spend the money. It went further than just coming to a view. It worked closely with known carers and worked hard to find others. It then gave the task of drawing up the plan to the carers community care planning group in the area.
That work has led to a range of new initiatives in Sutton. A carers centre that has been up and running for some time has employed an additional member of staff to work with young carers, going out to bring them in and to enable them to take a break. That effort is important in terms of supporting and sustaining those people and in terms of what they may do with their education and their opportunities in future.
I have two questions. First, reference is made to greater flexibility—the 10 per cent. that could be allocated to voluntary organisations to provide breaks. It is unclear from the grant report what level of assessment will be needed to allow decisions to be made. From what has been said, I believe that the local authorities' only role will be to provide the grant. What assessments will the Department expect voluntary organisations to make?
Secondly, how does the grant report link to the provisions of the Carers and Disabled Children Bill, which, for the first time, separates the assessment of carers' needs from the needs of the cared-for person? The Bill is still before the House, but it will probably be enacted during the period of the grant report. The Bill provides for the use of vouchers and other improvements and developments to services, and it seems a pity that the report would preclude local authorities immediately exercising the new powers that the Bill will give them. Will the Minister tell us whether the report would give local authorities sufficient scope to be able fully to exercise those new powers?
I turn to the prevention grant. Again, the £30 million going to local authorities is welcome. It would be interesting to know what changes of practice will take place in year one. Investing in services that tackle both the physical and mental well-being of older people is crucial if we are to promote independence and help people to remain in their homes for longer. However, given that the majority of local authorities social care budgets are locked up in high-intensity support and care for people at home and in residential settings, is it enough to inject only £30 million? Will that be enough to lever the change that the Government seek? What research is being done to determine whether that sum will achieve the changes that the Government seek? We all want to achieve those changes.
The partnership grant is the largest of the three. That grant, too, is set to fall year on year. It is falling by 6.8 per cent. in the coming year from last year's figure. Given the stated purpose of the report, which is undoubtedly important, I am puzzled; I wonder how the Government can justify that reduction. The report states:
The Minister spoke about pump priming and getting services under way. To withdraw the funding that would enable those services to get under way begs the question of whether the services can be sustained. He should respond on that point. I asked the Library to make inquiries of the Department about its rationale for reducing the grant, but the Department would give us no detailed explanation of the assumptions that underlie that reduction. Given the fallout from ending the special transitional grant in 1998–99, and the time lag that will invariably follow attempts to reorganise services in order to meet the conditions set in the grant report, it is hard to see how the reduction can be justified.
When the grant was introduced last year, local authorities did not receive detailed guidance on spending the money as the Government wished until September 1999, six months into the financial year. That made it difficult for local authority social services departments to plan effectively. They had six months to spend the money in accordance with the guidelines and were then told that they would receive 6.8 per cent. less money next year. That begs the question whether the money for year one could have been spent more effectively and whether it achieved what the Government expected.
The pressure on social services budgets means that social services departments' spending is still about 10 per cent. above the standard spending assessment. We know also about the demographic pressures that the departments face. Thankfully, more people are healthy and are living longer. People entering residential care are older and frailer, as the hon. Member for Meriden (Mrs. Spelman) said. Such factors place acute pressures on the provision of social services. Although the Government are right to want more home-based care, there is still pressure to provide for people who need residential or nursing care.
There is also greater pressure to provide more services for people with learning disabilities. The report rightly adds an additional target for this year in respect of discharges and admissions, on which there is a lot of pressure, both political and otherwise. The way in which health and social care services work together is important in that respect. A new target has been set to reduce the percentage of delayed discharges, about which I shall ask the Minister in a moment.
Staffing pressures are at the centre of the reason why cutting this year's grant will make the Government's aims far more difficult to achieve. The introduction of the minimum wage, although welcome, is putting pressure on some sectors. Similarly, the working time directive has led to increased costs. In the private sector, and especially for domiciliary and residential care, the message repeatedly given to me and to other hon. Members is that local authorities are passing pressures down the line and are setting unrealistically low fees, to the extent that many private sector providers are questioning whether it is worth operating in the local authority sector. That is a serious concern. The Government rightly want more investment in training. Better-trained staff are right to demand higher salaries, but these salaries have to be generated through higher fees, and local authorities do not have the money to fund such increases. Cutting the grant will make it even more difficult for local authorities to find the money to pay for them. We will wind up with staff shortages and an inability at the grass roots to provide the services that should be available.
The Minister claimed—as Ministers always claim—that social services budgets will increase significantly during the next three years. During the past year, there was a 3.5 per cent. real-terms improvement. However, when the loss of STG is factored in, the real increase is revealed as 1.3 per cent. There are wide variations throughout the country, but some local authorities have been left struggling. In Oxfordshire, the actual reduction has led to an overall reduction in the resources given to the social services department. It is no wonder that more local authorities are introducing more charges because of such changes. If the Government are serious about having greater collaboration and tearing down the Berlin wall, what would be worse than introducing more charges to get in the way of effective partnership? However, more and more charges are being introduced. For example, increased charges apply to non-residential day care services. People are finding themselves means-tested in respect of services that they are assessed as needing, but for which they feel they have paid through their council tax and other taxes and should not have to pay again.
That issue was raised last week at a meeting of the all-party disablement group, where a presentation given by the Needs Must campaign. The presentation included hard evidence of the impact of the Gloucestershire judgment and of the pressures on social services budgets, which, as a consequence of the level of resources available, are felt through denial of access to services and longer waits to obtain it.
I should like to conclude with a couple more comments on the Government's assumptions on efficiency savings. It is assumed that 2 per cent. efficiency savings will unlock cash. All too often, however, the quality of services is not up to the mark and efficiency savings lead simply to a quality improvement. The amount of money being spent is the same, but the quality will go up. There is an assumption that greater efficiency will result in cash savings, but the money is often rightly recycled into providing better services for the people receiving them.
The report rightly deals with the promotion of independence, but it also recognises the importance of residential care. As I said, the margins on which many residential care homes currently operate are a serious cause for concern. The current over-supply of places in the residential sector is only short term; we all know that more residential care places will be needed in the next 10 years or so. There might not be enough private sector providers. They might not want to return to a sector in which they have had their fingers so badly burnt.
If we are to have greater collaboration between the health service and social services, why does the grant not provide for local authorities to be able to invest more in IT? Could we not have flexibility so that there could be more IT investment? Social services departments often say to me that they had funding for the initial establishment of community care but now need additional resources to invest in new modern IT to make improvements.
I want to touch briefly on discharge and admission policies. Will the Minister comment on what quality standards will apply to discharge? There is a clear need to enable investment in advocacy services. If discharge is to work properly, the process must begin almost from the time someone is admitted to hospital. All too often, it starts at the fag end and is too late. People wind up being given bad advice and being inappropriately placed, often in residential care. That is one reason for the delays with which the Government rightly want to deal.
There must be more augmentation and integration of discharge teams. The targets should be about choice and about measuring delay and the satisfaction of people and their carers—the recipients in the discharge process. Social services departments get it in the neck for the delays that occur, when those delays are often borne of the management of the discharge process in the hospital. I hope that the Minister will tell us that more will be done to improve that situation.
In conclusion, we welcome—[Interruption.] I am glad that someone was listening sufficiently to pick up the fact that I mentioned a few minutes ago that I was going to conclude.
The underlying principles and the conditions attached to the grants are welcome. The partnership grant should not have been reduced after just one year in existence. It should at least have been sustained at its current level to allow local authorities to benefit from a full year's working to it.
The carers grant is undoubtedly a welcome innovation, but at just 18p a week for each carer it is not making the necessary difference to the provision of the respite care and flexibility that carers want. Respite care is too often provided not when the carer wants it but when the provider organisation wants to give it. Additional resources are required if the situation is to change and if carers are to have real choice. We welcome the reports and additional money, but wish to see further investment in those two key areas.
|©Parliamentary copyright 2000||Prepared 6 April 2000|