Examination of Witnesses(Questions 207-219)
RT HON
ALAN MILBURN
MP AND JACQUI
SMITH
TUESDAY 5 NOVEMBER 2002
Chairman
207. Colleagues, can I welcome you to this session
of the Committee on the expenditure inquiry and particularly welcome
the Secretary of State and Minister of State as our witnesses.
We are very pleased to see you once again. Can I repeat my thanks
that I gave to your officials for their co-operation in this inquiry.
We do appreciate that there is a lot of work involved and we are
grateful for the efforts made by the Department in responding
to our questions. Could you briefly introduce yourselves before
we start.
(Mr Milburn) Alan Milburn, Secretary
of State for Health.
(Jacqui Smith) Jacqui Smith, Minister of State in
the Department of Health.
208. Thank you. I was conscious when we had
the officials a couple of weeks ago that we did not perhaps do
justice to the personal social services side of your responsibilities.
I wondered whether we might start with some of the issues arising
from this report and also some wider concerns within the Minister
of State's responsibilities. I do not know who would want to answer
these questions; I leave that to you. I wanted to ask a question,
first of all, about the figures on looked after children which
I found of interest because I think it is fair to say that in
the early 1990s we reached a post-War all-time low of about 45,000
children in the care system, but from 1997, looking at the figures
from the current Government, these appear to have increased. It
is a trend that I find worrying and I am not quite clear of the
reasons behind it. If you look at your figures from 1997, it was
51,400 gradually increasing until the 2001 figure of 58,900. I
have not got the latest figure although you may have it. Bear
in mind the steps that have been taken by the Government to very
seriously address social exclusion, things like the Sure Start
programme and other initiatives (which I certainly very strongly
welcome) why do we apparently have more children coming into care?
(Jacqui Smith) I think, Chairman, you have probably
answered your own question. Certainly our view would be—and
yes there has been an increase—our latest survey suggests
that the numbers in care are about 61,000—
209. So it is a significant increase then on
2001?
(Jacqui Smith) It is a small increase. I know that
one of the things you have been concerned about is the balance
between the sort of preventative work that we can do and the spending
that relates to children that are in care. There is a suggestion
that, whilst you are right there has been a shift towards the
number of children in care, the amount of spending on those for
whom social services departments have responsibility but who are
not in care has remained at the same sort of proportion, even
though the numbers there have gone down slightly. So there does
seem to be a slight shift of priority in terms of the overall
spending patterns towards prevention. To go back to your original
question, yes, the numbers of children who are in care is of concern.
I think it relates to some of those broader issues, as you suggested,
to which the Government has to pay attention, whether or not those
are general issues around social exclusion like some aspects of
child poverty (not that I am suggesting that children always get
taken into care because of issues around poverty), wider action
in relation to drugs, or broader issues with relation to social
exclusion. That is why some of those cross-cutting initiatives,
for example Sure Start, are likely to have an impact, I would
expect, in the future in a preventative way on the numbers of
children going into care. What is also important is what happens
to those children when they are in care. That is why there has
been quite a big emphasis of the Quality Protect programme and
the investment there has been on how we provide stability for
children when they are in care and what we need to do in some
cases to get them back out of care again.
210. In looking at what we can analyse from
the figures that your Department provides, are you satisfied that
the methodology of the SSIs on local authority performance in
this area is carried out in a way that is meaningful in respect
of comparisons that are actually made? We are working around averages
without detailed analysis of performance. How are we in any way
able to measure the preventative work to which we are referring?
To me if we were taking steps with prevention then we would not
have had a 10,000 increase in the number of children in care.
I find this very worrying and inconsistent to me with the wider
policy directions being taken by the Government. This is not a
trend I would have expected to see.
(Jacqui Smith) There are two questions there. Firstly,
am I confident about the SSI approach to prevention—
211. Not the approach but the measurements used
in terms of performance.
(Jacqui Smith) You are right, it is difficult to have
hard performance indicator measures about prevention and what
we need to have is some sort of proxies in terms of children's
outcomes with relation to spending on prevention, but that is
also, of course, why we need—and this really links into
the second part of your question, Chairman—to take action
across government on prevention, and I am sure the Committee will
be aware of the work announced by John Denham in relation to how
we get the different agencies—so social services and the
other agencies who are working together at the local level—to
bring their strategies for prevention together. And this is not
about "let's have a new strategy"; this really is about
much better joint working across the considerable areas where
the Government is both investing money and has already seen benefits
in terms of the way in which agencies work best together.
Siobhain McDonagh
212. I know it is a very London-based point
but I wonder how far the increase in numbers is related to the
numbers of unaccompanied minors that come and claim asylum. I
know that the most devastating impact on the numbers in care in
my own borough of Merton normally happens between Christmas and
New Year when they regularly get 10 or 12 children arriving at
Heathrow and it falls on Merton to pick them up. On quite a small
borough that has an enormous impact. I do not know whether that
has something to do with the increase.
(Jacqui Smith) That has a very big impact on particular
social services departments. Kent, for example, we know has had
particular problems. I will write to you if I am wrong but I suspect
that the largest number of those unaccompanied asylum seeker children
are generally supported by social services departments outside
care. So they tend to be 16 and 17-year-olds and they are not
taken into care. Some of the younger ones may be but on the whole
there are other ways of supporting them. I know that in London
there are some good projects that we are supporting as a department
along with the Department of Health on how we can provide, for
example, better housing support for unaccompanied 16- and 17-year-old
asylum seekers, and link that into the other sort of support that
they need as well, but that would not be included in the numbers
of children in care.
Mr Burns
213. Minister, as you will be aware, for a number
of years local authorities have consistently on average overspent
on their SSA on social services and some of them have diverted
money from the care for the elderly to meet their statutory requirements
for children's care, for example. All of them agree that there
is not enough money, despite the funding settlement for this year
and the next two years, and I was wondering, given that this has
led a number of local authorities to use their, to put it crudely,
bulk purchasing power to force down prices in the private sector,
if you could elaborate more on your written answer about the impact
that the Competition Commission Appeal Tribunal decision in Better
Care will have on local authorities?
(Jacqui Smith) There is a series of assumptions in
that question, Chairman. Firstly, I have to say your interpretation
of diverting of resources can also be interpreted by local authorities
as making correct decisions about what their priorities are locally.
214. I am not arguing that.
(Jacqui Smith) Secondly, on the implication that bulk
purchasing power has been used to force down fees, of course,
evidence from this year—and that is not our evidence, that
is (?) evidence—is that as we have increased investment
into local authorities, and specifically, as local authorities
have looked at the way in which they are using their Building
Care Capacity Grants bringing £300 million in, there has
been evidence of fees actually increasing to care homes, and we
do consider that to be important. Alan made very clear when he
announced details of the older people's package some of the details
about how the additional investment over the next three years
would be spent, but where it is necessary to maintain capacity
in the care sector it is appropriate that some of that extra investment
is used for fees. On the specific point about Better Care, our
view of the Better Care judgment is that, if you like,
it goes some way towards clarifying, although of course in a very
different situation to the situation that most English social
services are in, that there was justification in that particular
case for defining the authority as an "undertaking"
with relation to the Competition Act. If what you are trying to
create is a case that has very wide implications in England, we
do not subscribe to that view because we do not believe that that
is a conclusion of that particular judgment.
215. Why not?
(Jacqui Smith) Because it was based on the very particular
circumstances of that individual case. What it did was it made
a particular judgment about whether or not, as I have suggested,
the authority in that case was an undertaking; it did not make
any judgment about whether or not they were correctly or incorrectly
using their purchasing power in those particular cases. If what
you want to say is that there is a broader issue about how local
authorities should work in partnership with their private partners
in order to commission care, that I would very much take on board.
I think that that is a very important area in which in very many
cases local authorities, in the terms of the way in which they
act both now and with the extra resources that will be coming
into their older people's services, need to improve on the way
they are operating. That has been a focus, for example, of our
Change agencies in working with specific local authorities on
better commissioning, it has been a focus of the Strategic Commissioning
Group that I chair and, of course, it was the subject of the ground-breaking
agreement we published about good practice on commissioning.
216. Would you be prepared, given that there
is some confusion about the Better Care decision, to provide
each one of us on this Committee as soon as conveniently possible
with an explanation of exactly what the decision means and how
you think it relates to the world of care for the elderly?
(Jacqui Smith) I would certainly be willing to provide
our view of what the implications of it are.
217. That is great, but can I now move closer
to home because you did mention that there was evidence that fees
were rising in the long-term care sector from local authorities.
That is an interesting point because, of course, as the Member
of Parliament for Redditch you will be acutely aware of what is
going on in Birmingham where I do not need to remind you (but
I may need to remind the Committee) that there is, by any definition,
a crisis in care in Birmingham because one is seeing a significant
closure of homes, and loss of beds and capacity because of what
Birmingham City Council social services department is prepared
to spend on beds in the private sector. I know that you have had
representations from the different organisations in Birmingham,
as have Birmingham MPs and one of your colleagues Stephen McCabe,
of course, has tabled an Early Day Motion calling on your Department
to do something to help the problem that is continuing. Given
your proximity to Birmingham and your knowledge of the problem,
who do you think is in the wrong and how do you think the situation
can be resolved to put an end to the loss of capacity and the
driving out of business of badly needed homes in that city, because
it seems that not the Department of Health but Birmingham City
Council has got its head in the sand and will not recognise there
is a problem.
(Jacqui Smith) Firstly, Simon, can I say what a pleasure
it was that you came to my constituency and took such a close
interest in what is going on there.
John Austin
218. I hope the rest is going to be more truthful!
(Jacqui Smith) But with relation to Birmingham, I
think I have to say once again that I would dispute with you the
suggestion that there is a crisis in Birmingham.
Mr Burns
219. Speak to Stephen McCabe, he is the Labour
backbencher.
(Jacqui Smith) I do not think he has called it a crisis.
I would not disagree with you that there are considerable problems
in the Birmingham social services department. That of course is
why when we did our first star ratings of social services departments
Birmingham had a zero star rating and therefore has been working
with a performance action team that we have sent into the city
since then on a variety of issues, some to do with their children's
services, some to do with their older people's services. I also
know that there is a lot of concern amongst members of the Birmingham
Care Consortium about the relationship between Birmingham City
Council and care home owners. I also know that there is a split
in the Birmingham Care Consortium. What is quite interesting is
that recently I had a meeting with representatives from Birmingham
City Council who brought with them care home owners because I
had specifically said publicly to Birmingham that I was concerned
about the breakdown in the relationship between the City Council
and those partners in the private sector that, you are quite right,
they depend on to provide the quality of care. I was somewhat
reassured by the fact that certainly the care home representatives
that came with that particular delegation spoke about the efforts
that the City Council was making to rebuild that relationship
with private providers in the city, and I know that they have
worked quite hard to negotiate a package not only of fee increases
but also, for example, using some of the considerable extra resources
that they got as a City Council from the Building Care Capacity
Grant. Remember. Remember, we recognise that Birmingham did identify
the fact that there were areas where there were particular problems
with delayed discharge, for example, and that is why out of the
£300 million, Birmingham has got somewhere around £9
million of that money. They have been able use that both to look
at fee increases and to look at how they could support private
providers in training their staff, so I think some progress has
been made and, of course, the key determinant of the progress
that is being made there is the fact that they have had some success—they
still have a long way to go—in reducing levels of delayed
discharge and I think the general consensus in the health and
social care environment in Birmingham is that there is a better
and more constructive working relationship than there was perhaps
this time last year.
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