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21 Feb 2007 : Column 81WH—continued
“whether they are affordable, whether they are consistent with progressive universalism”—
“and whether they promote independence, dignity, well-being”.
I say to the Chancellor, through the Minister, that not taking urgent steps to deal with the current problems in social care will deny so many of the elderly their independence, dignity and well-being. Whether that is affordable is a strange question in the fourth richest country in the world.
I hope that I have succeeded in making clear the urgency of the crisis. The British public need to be aware of how shoddily we are treating so many of our elderly citizens. I hope that the Minister will accept the urgency of the funding crisis and give a real indication of how it will be met in the short term. I hope that we will be given an indication of the Government’s view of the Wanless report and some details of the national debate—when it will start and whether the Wanless report will feature in a major way.
9.58 am
Mr. David Kidney (Stafford) (Lab): It is a pleasure to follow my hon. Friend the Member for Leeds, East (Mr. Mudie), whom I congratulate on obtaining a debate on such an important subject. He said that he was most conversant with the situation in Leeds, but he added reasonably that the picture across the country is serious and requires urgent attention. I wholly agree with all he said about that.
For many reasons, our starting point should be the NHS funding that has been delivered since 1997. Already there has been a doubling in cash terms of the NHS budget since then; by 2008-09, it will have trebled. That is relevant to the care of the elderly. In general, the older we adults get, the more we rely on having free health care services available when we most need them. It is incredibly reassuring to all older people that a health care service is available to them for free when they need it most.
That is an important starting point, but questions come beyond that. First, is the NHS more than a delivery of hospital services? Of course, it is much more than that; since last year’s White Paper “Our health, our care, our say”, the Government have tried to shape the national health service much more effectively around people’s needs in their communities. Now there are GPs who will see people within two days, and GPs provide a great range of care services, including innovative programmes such as one that I support in my constituency for exercise on referral. GPs can refer their patients to gymnasiums for exercise to keep them healthy. A large range of such innovations has been introduced thanks to the NHS side of the equation.
However, another significant aspect of the great increases in funding for the NHS and the ability to do more is the comparison between the services provided for health care and those provided for social care. The funding gap certainly has grown as there have been big increases in funding for the NHS but much more modest ones for social care, which is creating great problems across the country, as my hon. Friend said and as I shall explain in a moment.
Many people have said that the gap is causing an ever greater problem. As part of the comprehensive spending review process, the Association of Directors of Social Services produced an analysis to show the total gap in funding between what can be provided today and what ought to be provided, and the cost difference. Recently, the Local Government Association chipped in with its own contribution to the debate, and I am pleased to say that, having taken the temperature in my own constituency, I have made a representation to the Treasury about the comprehensive spending review and the need for social care to start catching up and closing the gap with health.
My hon. Friend made several references to Derek Wanless. The Treasury commissioned him to report on future trends in health care in this country, and the final report was published in April 2002. His recommendation in paragraph A.11 of that report stated:
“Health and social care must be considered together.”
Mr. Stephen O'Brien: Apart from anything else, the hon. Gentleman has a great reputation in this place for championing what is known as the F40 group, of which my local council in Cheshire is a member. He makes an important point about health and social care funding streams. Does he accept that part of the problem that he has been campaigning on, quite rightly, with the F40 group is that the divergence of different funding streams to local authorities makes it difficult to maintain levels of support on the social side, which is, in effect, funded by council taxpayers, because there is no ring-fencing and there is not the same per capita distribution across the country?
Mr. Kidney: Recently there has been a greater focus on how the health spending that I mentioned a moment ago is distributed across the country, and the same issue arises in respect of how social care money is distributed to local authorities. I shall deal briefly with the case of Staffordshire later.
I agree that there will always be arguments about how money should be distributed. It is the difficult task of any Government, of any political colour, to achieve a fair distribution of the available funds, but my basic point—certainly in the case of health—is that this Government could not be better or fairer in the total amount that they distribute.
I want to discuss the gap and how we might narrow it. First, we must look at our daily lives to find measures of how bad the situation is. I always think that a good barometer at local level is the number of delayed discharges from hospitals, because that tends to tell us that there are people in hospital beds who no longer need free health care in a hospital setting but who cannot go home because supports are not in place there or in their community to enable them to leave the hospital. I have seen ups and downs in Staffordshire—there have been good times and bad times for social care services in their ability to respond to their share of the challenges.
The 2002 Wanless report pointed to other measures. It gave as one example the number of older people admitted to hospital in an emergency caused partly by reductions in the availability of appropriate social care. Having reviewed that evidence, Wanless stated:
“In planning the delivery of care, health and social care must be considered together in order to ensure that both provide high quality services”.
As a result, another recommendation was that there should be in the future a greater focus on what he called “whole systems” to cover both sectors.
It was Wanless’s recommendation that, just as he had made a major report on the future trends in health care, there should be a similar investigation and report on future trends in social care. As my hon. Friend the Member for Leeds, East said, that is where the King’s
Fund stepped up to the plate, not for the first time, and funded another investigation and report by Derek Wanless.
We have the information and there are arguments about what should be done. As my hon. Friend said, it is now a matter of having the political will to do the right thing. Will my hon. Friend the Minister explain how social care services will keep up with future demand? There are many different ways in which they need to keep up. First, as my hon. Friend the Member for Leeds, East said, demographic change means that a growing proportion of people will live longer and require more services in their homes.
Secondly, there is growing public expectation about standards and quality of care; people expect care to be available when they want it, at their convenience. It is difficult to keep up with such demands. Thirdly, it will also be difficult to keep up with the excellent performance of the NHS as it continues to improve if similar resources are not available alongside in the social care sector. How does the Minister expect that social care services will keep up in such circumstances?
Can the Minister tell us whether the funding shortfall for social care will be addressed in the comprehensive spending review this year? My hon. Friend the Member for Leeds, East said that the soundings that he has taken are pessimistic, but surely, for the reasons that he gave, social care must be a top priority.
I shall illustrate the intensity of the pressures on social care services by explaining the position in Staffordshire, which starts from a slightly out-of-the-ordinary base because, until now, it traditionally retained direct ownership of more residential homes than many other authorities, thereby tying up more of its resources in bricks and buildings, and services delivered in residential homes, than most other comparable local authorities. In addition, Staffordshire is one of those shire counties that always seems to be near the bottom of the funding league table, whether for education, health services or, in this case, social care provision. The hon. Member for Eddisbury (Mr. O’Brien) referred to that.
Furthermore, Staffordshire is experiencing the same demographic changes as the rest of the country. The trends indicate that parts of Staffordshire such as my constituency in the middle of the county—Stafford—tend to have more people living longer who, because of their backgrounds, will be keen to insist on their fair share of services. Such demands on services certainly will not go away in the future—they will get stronger.
Staffordshire social services has found that because of its over-provision of directly provided residential home care, it has not been able to offer the range of services in people’s own homes that my hon. Friend said was available in Leeds when it had a Labour-controlled council. Staffordshire was not quite in that position to begin with, yet it faces the pressures I have described.
Last year, in “Changing Lives”, Staffordshire began to consider the reconfiguration of its social care services, including lessening the reliance on fixed buildings and providing residential care, but extending the range of home help services, such as those that my hon. Friend said used to be available in Leeds. The
council proceeded at a good pace. It involved everybody, consulted everybody, explained the path ahead and set out a good timetable—up to 2012—for making the changes.
Suddenly, last Thursday, under a document with the rather innocuous title of “Medium Term Financial Strategy”, the county council—it is still Labour controlled, of which I am proud, but in this case it is mistaken nevertheless—adopted a financial strategy that apparently requires it to close every one of the remaining 22 residential homes within the next 12 months, and to refocus all its finances on services in the community, which I shall describe more positively in a moment. However, I want people in the Chamber to imagine the position last Thursday as hundreds of residents in those homes heard without any previous consultation or notice that their home would close this year and that they could not expect to be there in 12 months’ time, and as thousands of residents’ relatives heard the same news at the same time. Imagine the hundreds of staff who work in all those homes who now have not the faintest idea of whether they will have a job in 12 months’ time. It has been a difficult seven days, as anyone can imagine.
There has been great heartache, anguish and not a little anger at the decision, yet the local authority’s motives are excellent. It wants to reach a position where social care services are available around the clock for anybody any time they need to call on them. It wants to extend respite care services and give greater support to the carers who do such fantastic work, as my hon. Friend the Member for Leeds, East said, out of love rather than for reward, and who save the state billions of pounds of expenditure every year. It wants to develop extra care housing so that there is a middle way, so that people who cannot live any longer in their own home, even with support, but who do not want to be in an institutionalised residential home can have their own home space with support on hand when it is needed. The local authority wants, too, to do more work in partnership with other organisations, especially those in Staffordshire’s splendid voluntary sector—or third sector, as some people like to call it now. Those proposals are all beneficial.
In the past, the range of services has been narrow and the number of clients who can be satisfied has been too few. The local authority wants to be able to say that a wide range of services, including re-ablement services, will be available to all who need them in the future. I support those ambitions and want them to succeed, but if the local authority is saying, as I think that it is, that its finances are suddenly so stretched and so tight that it has to upset thousands of people by instantly closing a lot of residential homes to have the right funding in place at the right time for its new policy, something is wrong. It is not merely a case of my saying to the Minister, “Could you send some more money to Staffordshire to solve our problem?” I have never been one to say, “Let’s throw money at the problem to solve it.”
If there is a problem of timing, and in getting the right sequence of investments and decision making in Staffordshire, and if we need some help from above to plan in a better way so that the finance is more stable
and lasts for longer than just 12 months, will the Minister give some attention to Staffordshire? Will he help the concerned Members of Parliament from Staffordshire who are trying to represent thousands of people who are angry and upset? We want them to be satisfied and reassured, and all of us in Staffordshire should have high quality services for the elderly. My hon. Friend the Member for Leeds, East described such services in Leeds in the past; can we get them for the first time in Staffordshire and make them sustainable for the long term?
My general contribution to the debate on the national importance of the subject has turned in the end to a narrow plea of self-interest for Staffordshire, but I hope nobody minds that in the circumstances. The problem is so pressing that I hope the Minister will be able to spare a couple of minutes to give it some attention.
10.13 am
Sandra Gidley (Romsey) (LD): I congratulate the hon. Member for Leeds, East (Mr. Mudie) on securing the debate. He spoke with compassion and concern. It is a shame that there are not more hon. Members in the Chamber. The subject is increasingly being mentioned at MPs’ surgeries and constituents are raising concerns. I am sure that the lack of presence in the Chamber does not reflect the unimportance of the subject, but rather that other things are going on.
The hon. Gentleman was right to highlight the problem of councils restricting their services, in many cases, to those with critical or substantial needs. The depressing trend is that an increasing number of councils over the past couple of years have decided to raise the threshold. They previously provided help for those with moderate and lower needs. Many people believe, and there is evidence to support it, that the provision of lower level care is an investment in the future, because it helps to keep someone slightly more mobile and active in their own home for longer. In many ways, the approach that is being taken makes only a short-term saving. Councils are allowed to do it, because they can take into account their budgetary pressures. Although I accept that a lot more money has gone into council services, far more money has been diverted towards the national health service.
There is a tension in Government policy. I support the principle that people should receive care in their own homes. Often, when an individual goes home an unseemly battle takes place over whether their care is health care, when it stops becoming health care and becomes social care or personal care, and who picks up the tab. Personal care is, of course, the responsibility of the local authority and services are means-tested. In cases of pure health care, the tab is picked up by the NHS. Far too much time and effort is wasted on an unseemly struggle over who will pick up the tab. That is not what older people want when they are probably not feeling at all well and when they are having to adapt to changes in their life circumstances. I would be pretty grumpy, too, if I were not well and could not go out and about and be as active—[Interruption.] I am sure that the Minister is saying something not entirely complimentary from his sedentary position, but I will leave that there.
The problem seems to be that when care is delivered at home sufficient money does not seem to come across from the health service to pick up the costs that it should be picking up. Hampshire county council is increasingly raising that particular problem with me, and it is having to pick up the bill for the provision of services for more acute needs, which it regards not as personal care, but as health care. Ultimately, somebody has to deal with the problem. Many people in local government do not want to see people suffer.
Mr. Stephen O'Brien: Does the hon. Lady recognise that there might be a deeply counter-productive result if a lot of care is not immediately available or provided in a straightforward way, not only for those who are cared for but for their families and carers? It has an effect on morale, which can have a health-deteriorating effect. For most old people, the last thing they want to do is anything that could constitute a nuisance. They simply want a straightforward approach to being cared for appropriately.
Sandra Gidley: I agree up to a point. I am reminded of my mother, who said, “When I’m old, don’t worry about me. I don’t want to be a bother to anyone, just put me in a care home.” When it comes to it, the reality is not so straightforward. She desperately wants to stay in her own home and is fiercely independent. She does not perceive that as a bother to anybody. It is quite a concern to those who live some distance away and worry about what granny might be up to. That is a problem these days, because families are dispersed. Often, it is easy to say that people should look after their family, but if an older person has friends and relatives in one part of the country they might not necessarily want to relocate to be with their daughter or son or to have to set up new social networks. It is not quite as straightforward as saying that we should all look after our loved ones. In today’s world, that is not always practical, although it is something that most people want to do.
Mr. Kidney: I was intrigued by the exchange between the two Opposition spokespeople. I wonder where we are going with that. The settlement in this country for more than 50 years has been that health care is free when needed, whereas social care possibly needs a contribution to be made. Is the hon. Lady saying that Liberal Democrat policy is different?
Sandra Gidley: The hon. Gentleman is trying to put words in my mouth. I am saying that the borderline between health and social care is muddied. There are increasingly arguments about what falls into which category. I did not say that social care and help should not be means-tested in any shape or form. However, there are clearly situations in which people are having to pay for services that once would have been free under the health service. People are struggling to understand why, given that they have paid taxes all their lives and have saved a little money for their old age, it should suddenly be eroded.
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