Mr. Bill Olner (in the Chair): Before I call the hon. Member for Romsey (Sandra Gidley), I should say that a few Members have indicated their wish to speak, and I should like to bring in everyone if I can, so I ask those who participate to make their remarks clear and succinct.
Sandra Gidley (Romsey) (LD): I welcome the opportunity to discuss this important subject. I was moved to apply to debate the issue following the comprehensive spending review, but this is not a new issuethe hon. Member for Wyre Forest (Dr. Taylor) told me that he has been trying to secure a debate on it for some months.
A welcome 4 per cent. increase for health was announced in the CSR, which builds on the welcome investment of previous years. However, unfortunately, the settlement for local government, which is responsible for providing social care, was less rosy. The Secretary of State for Health provided further details in a recent statement to the House. He told us that the social care settlement is divided in twothe local government grant and direct Department of Health funding targeted at social care. The local government support grant will increase by £2.6 billion by 2010-11, but the Local Government Association estimated that it will cost an additional £2.682 billion simply to provide care for the increasing numbers of older people in the next three years. It also raised concerns that the additional funding could be taken up entirely by social care, despite the fact that many other services funded by the general grant are subject to financial pressures.
Direct funding from the Department will increase by an average of 2.3 per cent. a year to fund carers and the social care work force, but that funding is based on the idea that the situation will stand still. The LGA believes that the increases will not enable local authorities to meet the budget pressures that they anticipate for 2009. One south-east council claimed that, as a result of demographic and other pressures, expenditure will need to rise by 4.6 per cent. in real terms if services are not to be cut. That is a much greater increase than the CSR settlement allows for, however we might dress it up.
Many organisations have reacted angrily. Help the Aged claimed that there is not enough money in the Chancellors provisions to take account of the growing needs of an ageing population. It also said that the settlement grant increase will be less than 1 per cent. in future years, and that that is below the growth rate of the vulnerable population and the likely rate of inflation in the cost of providing care.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I am delighted that we are debating this matter, but will the hon. Lady make it clear, and put on the record, whether the Liberal Democrats would be committed to spending more money on social care than is spent at the moment and where she would expect any increase to come from?
Sandra Gidley: It is mischievous of the Minister to attempt to deflect the point. I am raising a serious point about the relative balance of money between health and social care. [Interruption.]If the Minister listened to my whole speech, he would hear some suggestions towards the end.
allow the current system to creak on in the short term.
It is interesting that both France and Germany spend more than double the amount spent by the Government on care for older people. The relatively lowly settlement has come against a background of significant pressures on social care. The Wanless social care review identified considerable funding shortfalls in the current system if it is to meet peoples needs and forecast increasing needs in social care in the next 10 years, which will come as no surprise to anybody.
There have been significant pressures on social care services. The minimum wage, for example, caused cost pressures a few years ago, although I do not begrudge care workers the minimum wage; in fact, it is scandalous that some are paid so little for their valuable work. However, there is an increasing demand for more expensive, intensive care services, and the age of the population is increasing and more people are living longer. As a result, councils are left with some tough choices.
The biggest inequity surrounds the phenomenon of eligibility criteria. People might say that health care provision is a postcode lottery, but the biggest lottery in Britain is the postcode lottery for social care provision. Simply put, access to care depends on where a person lives, their income and their local authoritys charging policy and eligibility criteria.
Peoples needs might be broadly categorised as critical, substantial, moderate or low. Local authorities must now ration care provision by raising the eligibility criteria. Despite the rising numbers of older people, the number of households that receive domiciliary care services has fallen by more than a quarter in the past 10 years. The LGA predicted that, by 2009, not a single local authority in the country will provide care for those with moderate needs. Many councils have already tightened their criteria and now meet only critical needs.
Services are also means-tested, and there have been steep increases in charges for people who access them. A Counsel and Care survey backed that up. It is almost impossible for older people to access support in the community if their needs are not severe. Two thirds of local authorities fund only substantial or critical needs, and Counsel and Care believes that the number of councils that restrict services in such a way will increase.
In 2007-08, 15 per cent. of local authorities further raised their thresholds and not a single authority has extended its criteria to become more flexible. Only 16 per cent. of local authorities continue to offer support services for older people with moderate needs, compared with a third as recently as 2006. Yet more worryingly,
12 per cent. of local councils provide support only for older people with the most acute critical needs. Liberal Democrat research corroborates those statistics. We found that almost one in five councils has increased provision in higher-level categories since 2003.
Low-level social care is a thing of the pastthe number of households that receive low-level care has decreased dramatically. As a consequence of the fact that care is delivered to fewer households, the proportion of households that receive only one weekly visit of two or fewer hours has dramatically decreased from 42 per cent. in 1992 to 17 per cent. in 2002the latest year for which we could find figures. The funding of low-level care needs might be a cost-cutting measure in the short term, but it could store up problems for the futureit might benefit the state if a person is happy to stay at home.
Supposedly, the thrust of Government policy has been to treat people in their homes, which, for many, is a welcome approach. However, people often get to the stage at which they need help with some practical matters if only to keep on top of things. If a person does not feel that they are on top of the upkeep of their garden, for instance, and that they cannot manage as well as they might, they might become depressed and their mental health might suffer.
As the older person is not coping, there is a risk that they will become institutionalised at an earlier stage. Research has backed that up; it is not some wild theory that I keep expounding. Age Concern and Help the Aged have done quite a lot of research to examine the impact of withdrawing the type of service that I have described, and it has shown that continued independence can increase an individuals life expectancy and reduces the number of days spent in an acute setting or a care home.
Pressures have been even more acute over the past year, as NHS financial pressures have had a knock-on effect on social services. Even though the Government have tried to tighten up the continuing care criteria, there are still far too many cases in which there is an unseemly tug of funding between the health and the social care services. There is a feeling in many county councils that they had to take an unfair share of the burden last year and were funding services that should have been paid for by the health service.
In Hampshire, we faced particularly acute pressures. I have talked to officers in the social care services at the county council, who said, Somebody had to pick up the bill for these people. We couldnt go on arguing, but we feel that we ended up bailing out the health service and spending money that we didnt really have.
How is all this working in practice throughout the country? In Hampshire, there was at one stage a proposal to restrict the eligibility criteria to critical and substantial needs. Understandably, that caused an outcry, and the council thought again about whether there was another way of doing it. It was portrayed in some ways as though things were then fine and those needs were being funded; but in practice, many people who had had a care package for some time suddenly found that they were reviewed. A stream of people came to my constituency surgery. They had had packages that fitted their lifestyle and seemed to help, but for no reason that
they could understand, part of that package was withdrawn. I do not know whether other Hampshire MPs had similar experiences, but those people all came forward at once, and it seemed to be part of an overall picture. The good news was that everyone still seemed to get something, but clearly it was hard for those who had to take a cut in services and share the pain.
I shall cite a few examples of other parts of the country where similar things have happened. In Stockport, it has been estimated that, by 2020, 27 per cent. of the population will be over 85 and a further 21 per cent. will be over 65. Stockport has estimated that it provides some sort of support for one in four of the over-65s and for half the over-85s, so more rapid growth in the number of over-85s will have a disproportionate effect on the budget. Stockport also cited an increased demand for funding by people with learning disabilities and estimated the inflation uplift for the private sector to be 5 per cent. Again, the settlement will not cover that.
People in Bristol highlighted the fact that this is not just about elderly care. One of their huge pressures came from adults with learning difficulties transferring from school. Transitions were not being fully funded, which meant that an extra £500,000 had to be spent on top of other financial pressures. Bristol also raised the issue of supporting people. That was one of the Governments better ideas. It has been rather depressing and demoralising to see the funding for supporting people cut in recent years, so that people find it much more difficult to access support services. In Bristol, the budget has been cut by £3 million in two yearsit is now £27 millionand the belief is that it will be further cut to £19 million.
In the royal borough of Windsor and Maidenhead, referrals for social care increased by 20 per cent. in 2005-06. Not only did that put extreme strain on the system, but the nightmare was exacerbated by the closure of 54 beds in local hospitals. We just cannot separate health and social care as we go into the future, because increasingly any changes in health services are having a significant impact on social care.
Somerset highlighted the problems with the number of people with learning disability increasing. It estimated that the rate of increase was about 35 people a year. That may not sound very much, but it equates to an extra £1 million a year having to be found.
This is not just about adult services; there are problems in childrens social care, too. There is an increase in the number of children with complex needs, set against the overall context of a falling population of children and young people. Nationally, the prevalence of severe and complex disabilities among children aged five to 14 is projected to increase from 0.4 per cent. in 2001 to 0.76 per cent. by 2011. We are talking about children with very complex needs requiring very expensive and detailed care packages.
Wherever we look in the country, councils are highlighting a picture of overspend, health pressures and increasing financial pressures. The overspend is not occurring because councils are out of control; they have never had a better grasp on where the money is going and what the future demands will be.
I want briefly to mention failings in the way in which local authorities fund care homes. Local authorities are supposed to pay the going rate for care, but the going rate in many areas is significantly lower than the actual
price of virtually all the care homes in the area. That is particularly so in my part of the country. Relatives are therefore routinely expected to make a top-up payment to fund the difference between what the local authority will pay and the actual rate. We have the perverse situation locally in which Southampton and Hampshire pay different amounts for care homes and nursing homes, so people in adjacent rooms in a home may be funded differently. That makes a mockery of the system.
In other cases, people did not need a top-up when they entered the home, but because local authorities have not increased fees in line with inflation, the homes often have no choice but to start charging a top-up. That is an increasing phenomenon and there is a perverse consequence of that underfunding. There is growing evidence that it is having a knock-on effect on those who fully fund their own care home place, as they are often charged a higher rate than people with equivalent needs who are funded by the local authority. Clearly, by any measure of fairness, that does not meet the criteria, and it desperately needs to be addressed.
Another aspect of the pressures is that carer support is being cut. Many carers say that they could cope much better and for longer if only they had a break occasionally, but respite care is often one of the first services to be axed.
A number of things clearly need to be done if we are to live in a fairer society. I contend that most councillors, whatever their political colour, want to do their best for the elderly and vulnerable people whom they represent, but that cannot be at the expense of other vital council services. We need to consider a number of issues in the longer term, set against the background of the ageing population and the increase in the number of people with complex needs. It might be helpful if the Minister, when he sums up the debate, says whether the Green Paper will address some of these issues.
The postcode lottery of eligibility criteria needs seriously to be examined. There needs to be a fully comprehensive assessment, taking into account the ageing population, the increasing numbers of adults and children with problems and the impact of housing build in an area. Often, local government settlements are on a per year percentage increase basis, and in the south of England, where we face acute pressures for housing build in the future, funding is very often not increased accordingly. That definitely needs to be considered.
The assessments should focus on the individual, not just whatever happens to be available as a care solution. Greater clarification is needed of what the NHS will pay for. I accept that the Government have made efforts in that direction, but the continuing care criteria are still far too open to individual interpretation.
We must address cross-subsidy in care homes and set a fair independent rate. The time has come for a serious look at how better to join up health and social care, so that people do not fall through the gaps but get what they need and deserve after a lifetime of paying into the system.
Mr. Bill Olner (in the Chair): Order. Four Members have risen to take part in the debate. I advise again that I intend the winding-up speeches to start at about 10.25, so if Members can discipline themselves to fit into that timetable, I should appreciate it.
Ian Stewart (Eccles) (Lab): I congratulate the hon. Member for Romsey (Sandra Gidley) on securing this important debate. It strikes me that some of us were in this room last week debating health inequalities throughout the country, so we are clearly on a roll. Health inequalities and care inequalities are clearly foremost in our constituents minds, and they should therefore be foremost in MPs minds.
I rise not only to say well done to the GovernmentI do not mean that sycophanticallyfor their progress, but to carry out my responsibility to highlight issues about how the settlement has been allocated. We are approaching a three-year settlement, and I shall place on record for the attention of the Minister and the Government some of the issues for cities such as Salford, which is in my constituency.
We are facing unprecedented demographic change in this country, in common with other western societies. For the first time, this year there are more people aged 65 and over than 18 and under. We are also facing a steadily rising number of people with long-term conditions. The effects of obesity, smoking, alcohol and drug misuse, diabetes and conditions such as strokes and dementia all have an impact on individuals and families that increases their likelihood of requiring adult social care.
One of the biggest growing sectors of the population is those over 80. We know that it is older people who are the biggest users of adult social care, and particularly those aged over 70. Once people are in their 80s, the incidence of dementia steadily increases, with one in five people suffering from some form. We also know that, due to medical advances, more children and adults are surviving with multiple disabilities, requiring high levels of social care services throughout their lives. As more and more of us come into contact with social care services as users, carers or friends, relatives or neighbours, we now expect much higher-quality, flexible and individual personalised services.
Those are not my words but the words of Anne Williams, president of the Association of Directors of Adult Social Services, in an address to the local government national children and adult services conference at Bournemouth last week. Although they are not my words, I identify with them, and I am sure that hon. Members present agree with them, too.
In her day job, Anne Williams is the excellent strategic director of community health and social care in Salford. Anne and Councillor Maureen Lea, the lead member for adult services, have assured me that relations with respective Departments are increasingly good and that partnership work with them is better than it has ever been, which is welcome. That is all the more welcome, because in Salford we start from such a low base. It is of concern that Salford is ranked 12th in the 2004 multiple index of deprivation. We are a paradox: Salford city council has been identified as one of the most improved councils in the UK, but at the same time it is struggling with the Government to build and increase care services from a low base.
Some people would call this subject boring, because we must refer to statistics, but it is important that we consider how the detail affects our constituents, so I make no apology for doing so. I shall address the issue of an ageing population. The Minister is, of course, responsible for all the areas of care, but I shall concentrate mainly on adult care today. I am sure that other hon. Members will cover the other areas.
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