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Mr. Nick Hawkins (Surrey Heath): The hon. Lady mentioned facilities that have closed. Does she agree that throughout the county, private sector care homes are closing because the people who have run them successfully for many years have chosen, when faced with huge new additional bureaucracy from this Government, to close down completely rather than try to wrestle with it? Does she agree that the Government's policies have directly led to a substantial reduction in the number of care home beds, which is only making the delayed discharges problem—the bed-blocking—worse?
Sue Doughty: I thank the hon. Gentleman for making that point and I agree that that additional bureaucracy and work is driving people out of business. Indeed, only today, I spoke to the manager of Surrey Care Homes, the umbrella organisation, and he made that point to me. The owners do want to do a good job and to stay in business, but they are finding that the climate is against them.
We have many problems with the places for people with learning disabilities. For example, demand for those places does not follow social need in the same way as
other problems. We have a very large number of people who need places with high costs, but we have a smaller amount of money to pay for them. We have problems with older parents caring for sons and daughters who should have other accommodation, but it does not exist. I can tell the Minister that Mencap has asked me to raise those concerns.Many people were on preserved rights which have now ceased, and Surrey has taken over the management of their funding. The Government revenue grant for Surrey is £14.429 million. That covers 1,200 people, of whom 700 are known to the council, and they are already having their fees topped up as Government funding is inadequate to cover the purpose stated, which included shortfall in fees and care assessment costs. A further 500 people are not currently known to social services.
The transfer fund is estimated to be £100 million short. Care providers are already demanding an increase as the rates are not high enough to cover costs. That fee pressure is likely to be a further £1.5 million, but Surrey social services has calculated that if the preserved rights rates were allowed to escalate to the current market level of fees, that figure of £1.5 million would rise to £4.6 million. Not all the information is available because the Department for Work and Pensions has not provided details of the rates paid to individuals, so social services are still hacking through the details.
We want to know how Surrey should deal with this problem. We want our people living in their own home for as long as possible, happy and healthy. To achieve that, and to avoid the problems that send people to hospital in the first place, more resources should be allocated to prevention. We need the total integration of health and social care, rather than costs shunting between providers, to nobody's benefit.
I hope that the Minister will tell us that she has recognised that Surrey is doing as much as it can out of its own resources but is prevented from reaching the minimum standards that are decent, let alone meeting its aspiration to be a top-performing local authority. I await her response.
10.41 pm
The Minister of State, Department of Health (Jacqui Smith): I congratulate the hon. Member for Guildford (Sue Doughty) on raising the very important matter of social services provision in Surrey. Like the Government, she is clearly keen to see high-quality health and social care provided for her constituents.
The hon. Lady made much of her concern about social services funding in Surrey. The Government have already made a considerable investment in social services which has been growing substantially in real terms. Resources for personal social services have increased by 20.4 per cent. in real terms between 1996–97 and 2002–03—an average real-terms increase of 3.1 per cent. per year. That compares with an average real-terms growth of less than 0.5 per cent. per year between 1992–93 and 1996–97 under the previous Conservative Government.
Surrey has benefited from that investment. Last year, it received an increase of 6.4 per cent. in its total personal social services resources, compared with a national average increase of 4.7 per cent. This year, Surrey's
personal social services standard spending assessment will increase by a further 4.6 per cent., its carers grant by a further 21 per cent. and its children's grant by a further 12.8 per cent. Increases of that size demonstrate the Government's commitment to social care, throughout the country and in Surrey.The hon. Lady suggested that when it comes to the standard spending assessment formula, Surrey is hard done by. I am sure that she is aware that the Government are reviewing the SSA formula. The Department of Health has already presented to representatives of local government some of the research that we have commissioned for this process. During the summer, consultation will take place on a range of options for possible changes to the formula, and I am sure that Surrey will want to make its views known. However, I note that Surrey's personal social services standard spending assessment per capita in 2000–01 was the same as that for comparator local authorities. So although I recognise the need for detailed consideration of the formula, we need to be clear about the basis on which that is being carried out.
The hon. Lady raised particular concerns about older people's services.
Mr. Hammond: For all the Minister says about the SSA and personal social services spending, does she believe that the funding available to Surrey county council is adequate to provide satisfactory levels of personal social services to the elderly in particular?
Jacqui Smith: The Chancellor made the decisions that he did in the Budget last week because the Government believe that all local authorities, including Surrey, should get extra investment if they need it. Conservative Members voted against that Budget and it is a bit rich for them to turn up to an Adjournment debate to argue a case for which they were not willing to vote last week.
The hon. Lady raised particular concerns about older people's services, and delayed discharges in particular. She is right that delayed discharges are bad not only for system but, most importantly, for older people themselves. That is why, last October, the Government announced a further £300 million of new funding for social care over two years. That is closely linked to the work of a strategic commissioning group to give greater direction to the commissioning of care for adults. Incidentally, that covers good practice in commissioning residential care for people with learning disabilities as well as focusing on the commissioning of care for older people.
The group published the agreement on building capacity and partnership in care on 9 October, and we expect local social services and health authorities to adopt it. It will lead to real improvements in the planning and commissioning of services and ensure continuing good-quality care for those currently using such services.
The funding was targeted on the 55 councils that have the most severe problems with providing a sufficient range of services in the community to allow people to leave hospital. That recognises some of the concerns that the hon. Lady outlined with respect to Surrey, which is one of the authorities that was targeted for extra support. The money was also to be used to stabilise the care home market, and there is evidence nationally of its being used to increase fees and to buy more places.
Sue Doughty: I hope the Minister understands that Surrey has, with great reluctance, increased prices.
That was in response to the lack of beds and because care homes close when prices fall below a particular level. In addition, I hope the hon. Lady understands that the social services department has done much to work with care homes to ensure that there is ongoing provision. It has done that when the funding has allowed it, but the funding is finite.
Jacqui Smith: Obviously, but the Government have increased funding and will increase it in future. We also need to ensure that the long-term commissioning activity at a local level between the private independent sector and the commissioners allows us both to maintain and to improve capacity.
Of the £100 million available last year, Surrey county council's share was £2.4 million. This year, its allocation is £5.2 million. Those are significant sums, and the council's proposals aim to reduce the number of delayed transfers of care and to sustain the independent sector market. I understand that last year the council utilised its extra funds to provide more long-term residential and nursing home care packages. That allowed 163 people to be discharged from hospital whose discharge would otherwise have been delayed.
The increased investment resulted in decreases in delayed discharge of 15 per cent. in the East Surrey health authority and 18 per cent. in the West Surrey health authority between 2 September last year and the end of the financial year. So the increased investment and the way in which it is being used by local authorities throughout the country and in Surrey has helped to deliver lower levels of delayed discharge.
The hon. Lady also raised the issue of allowing people to remain independent in their own homes. I understand that the rate of households receiving intensive home care packages in Surrey is relatively low, although I am pleased that it increased by 8 per cent. between September 2000 and September 2001. That is an important trend throughout the country, because the people concerned and their families tell us that they want the choice of being independent in their own home. The fact that by September 2001 the number of people receiving intensive domiciliary care had increased by 6 per cent. compared with the previous year is an important sign of how the system is changing to provide the necessary capacity, particularly for older people.
There is also increased capacity in intermediate care. Those important services are key to the prevention of some avoidable hospital admissions and allow a faster discharge for those who are admitted. Further strategic planning is required to ensure that development is carried out effectively, but we have already seen progress in intermediate care in the south-east, including Surrey. In the region as a whole, an additional £21.5 million has been invested in intermediate care since 1999–2000. In Surrey, that means that there are plans for 1,500 extra people to receive intermediate care compared with the figure for 1999–2000. Investment is making a difference in the provision of services for older people.
The hon. Lady raised concerns about preserved rights. The changes that the Government have introduced from this month bring those residents within the existing community care arrangements. They will benefit from local council involvement in their care assessment, management and contract negotiations. The transfer
removes anxiety from those who were struggling to pay their fees under the old system, and it promotes independence, giving some people in residential care the opportunity to move to more suitable accommodation, such as sheltered housing.In 2002–03, councils are receiving £614 million in a special grant to meet the costs of their new responsibilities for that group of residents. As the hon. Lady said, Surrey county council will receive £14.429 million this year to fulfil its responsibilities. Out of the £614 million total, £86 million is to meet the shortfall and assessment costs. That is generous. Councils were already meeting many of the shortfall costs from their existing resources. Consultants Laing and Buisson and the Joseph Rowntree Foundation suggested in a report that the cost to councils of assuming responsibility for the shortfalls would be less than the money that they were being given for that purpose.
The hon. Lady also raised the important issue of support for people with learning disabilities. I am sure that she is aware that the White Paper "Valuing People" set down for the first time the sorts of services that people with learning disabilities should receive and, importantly, how they should be involved in decision making. People with learning disabilities will clearly benefit from extra health and social care investment, but they will also benefit from much better use of the £3 billion that is already spent on learning disability services throughout the country.
The Government have recognised the need for development money to help to make the changes necessary to fulfil the aspirations set down in "Valuing People". That is why, this year, the learning disability development fund will be £20 million of capital and £22 million of revenue. Surrey has been allocated over £350,000 this year from revenue allocation alone to support priorities for service change. The hon. Lady made an important point about how we ensure that health and social care work together for the benefit of those who need the services, so I point out that that money needs to be spent as part of a pooled budget, emphasising the importance of partnership in ensuring good-quality services.
In his Budget, my right hon. Friend the Chancellor was able to put NHS finances on a sustained footing for the next five years and begin to reverse the decades of underfunding. For personal social services, the plans deliver annual average growth in real terms—the hon. Lady asked me whether this was a real-terms figure—of 6 per cent. from 2003–04 to 2005–06. That demonstrates the Government's firm commitment to social care. Details of the way in which the money will be allocated will be made available later this year, but the settlement puts health and social care on a much firmer footing. The people of Surrey will undoubtedly benefit, as will people throughout the country, from increased investment in social services. They will also benefit from other Government actions, including a recruitment campaign.
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