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14 July 2009 : Column 58WH—continued
1.10 pm
The Minister of State, Department of Health (Phil Hope): I congratulate my right hon. Friend the Member for Oxford, East (Mr. Smith) on securing this debate. He rightly focused his remarks on the longer-term consequences of the transfer of responsibility for the commissioning and funding of social care services from PCTs to local authorities. However, if he will forgive me, I shall first place that in the wider context of the Government's strategy to make policy to meet the needs of all individuals, which is the general direction of travel.
The focus of policy making in the past couple of years has been on the critical issue of putting people with learning disabilities and the people who care for and support them in the driving seat, which my right hon. Friend rightly supports. The focus is on giving them more control over the care and treatment that they receive. That philosophy was absolutely integral to "Valuing People Now", which was our three-year, cross-Government strategy published in January, and more recently to "Valuing Employment Now", which is all about creating real jobs for people with learning disabilities.
I am pleased to be able to tell my right hon. Friend that people with learning disabilities now have more control. Two thousand or so now receive direct payments that they can use to pay for the care or services that they want. People with learning disabilities have more freedom. Many more live in homes of their own and have the opportunities to enjoy a richer and more varied social life, and-I am sure that this is true in his constituency-many have better community-based support. For example, the number living on NHS campuses has dropped from about 3,000 in 2006 to 1,000 today. Overall spend on adults with learning disabilities increased from £1.7 billion in 1997-98 to nearly £3.5 billion in 2007-08, which is a £1.8 billion increase, equivalent to a 96 per cent. real-terms increase between 1997 and 2008.
I hope that my right hon. Friend agrees that a great deal has been achieved. We have laid down the blueprint for a fairer deal for people with learning disabilities across all public services.
Mr. Andrew Smith:
I certainly endorse empowerment, independent living and the support to which people with learning disabilities must be entitled. The Minister referred to the 96 per cent. increase in spending. I am
not sure whether it is a coincidence, but between 1995-96 and 2003-04, local authority spending on services for people with learning disabilities increased by 96 per cent. That compares with a 72 per cent. increase in total spend on personal social services. Although the increase is welcome, does the discrepancy not show that meeting future needs will be likely to involve a proportionately greater demand from people with learning disabilities on social services budgets?
Phil Hope: I understand my right hon. Friend's point. Indeed, there has been a commitment by many local authorities to support adults in the social care system. That is to be welcomed and it is a sign of local authorities responding to the needs of their communities. The social care system has always involved a mixture of central and local government support for adults of all ages, including people who have retired. We could do more-despite the good things that have happened so far-to transform those health and social care services.
I shall explain what we are doing on transferring responsibility for commissioning and funding care for people with learning disabilities from the NHS to social service authorities, and the longer-term consequences of doing so. We want to promote better commissioning and services, both in PCTs and local authorities. I am very conscious that there is a patchiness across the country in that provision, which I believe reflects the lack of consistency in the commissioning standards of PCTs and local authorities.
My right hon. Friend will be aware that the consultation document, "Valuing People Now: From progress to transformation", proposed the transfer of learning disability social care commissioning and funding from PCTs to local government from April this year. We received more than 2,000 responses to the consultation on that principle, which he said he supports, involving more than 10,000 people. Seventy-six per cent. agreed with the specific proposal to transfer commissioning responsibility. That change will allow the NHS to focus on its primary health care responsibility for people with learning disabilities and, at the same time, give local authorities a lead role in delivering high-quality, community-based care services.
Of course, local authorities already have a role in delivering the transformation of social care and the goals set out in "Valuing People Now". That role will be strengthened when funding and commissioning are fully aligned. We are confident that that will result in better services for people with learning disability and services that are built around the needs of individuals.
In August last year, we issued guidance to all PCT chief executives and directors of adult social care setting out that policy intention. The guidance set out the key areas for transfer and those that will remain in the NHS. The transfer does not include resources for generalist or specialist health care, for forensic and offender services, or for continuing care.
For 2009-10 and 2010-11, the transfer of specialist social care funding for people with learning disabilities will be made locally from PCTs to local authorities. All agreements should have been reached with the full involvement of learning disability partnership boards. I emphasise that because my right hon. Friend spoke
about engaging people with learning disabilities and their carers and families in the process. By involving the boards, we are ensuring that people with learning disabilities and their families are fully involved in the decision-making process.
Where are we now? We asked local authorities and PCTs to reach a final agreement on the amounts to be transferred for 2009-10 by 31 March 2009 and asked them to confirm to the Department of Health that the transfer had been made locally by 30 June, which was a few days ago. More than 130 returns were made by 31 March and 50 per cent. of areas reported that they had transferred funds by the 30 June deadline. The latest estimates show that more than £1 billion has been agreed for transfer. However, we are still in the process of analysing the results as they come in.
Agreement has been reached in Oxfordshire, as my right hon. Friend probably already knows, and it is recognised as an area of good practice, with an established pooled budget and a strong commitment to joint working from Oxfordshire county council and Oxfordshire PCT. I am pleased to say that there are many examples of local authorities and the NHS successfully working their way through a multiplicity-that is how he put it-of difficult issues to agree a transfer sum in their report on the commissioning transfer process.
Mr. Smith: Did I hear the Minister correctly? If 50 per cent. had confirmed by the end of June, 50 per cent. had not. Does he share my concern about that? When will the figure become 100 per cent?
Phil Hope: My right hon. Friend swiftly picked up on the figures that I gave. He is right: the figures mean that half are yet to be completed. We have evidence from the returns that we have received of under-reporting in many areas, and there is a wide variation in the amounts that have been declared for transfer. He and I share that concern. It is critical that we have accurate returns on the total spend on social care by NHS bodies. For those returns whose figures look unusual or cause concerns, we are considering how the Department, in collaboration with regional colleagues, can support and validate transfer amounts. We are in the process of ensuring that we achieve outcomes across the country, but I am delighted that his local authority and PCT have reached an agreed figure.
What will happen from 2011 onwards? The intention is that allocations of social care resources will be made directly from the Department of Health to local authorities. That is how the future system will work; it will no longer go through the PCTs. We will consider the best way to achieve the allocation beyond 2011 after PCTs and local authorities have reported the outcomes of their local agreements and the results have been analysed at a national level in discussion with other Departments, including, as my right hon. Friend hinted, the Department for Communities and Local Government and the Treasury. He asked that I come away from this debate with that purpose in mind; he can be assured that his request is already in train. We are aware of the issue of different authorities being at different stages. It is a cross-Government concern that I, as the Minister with responsibility for care services, must discuss with my colleagues in other Departments, not least the Treasury.
Mr. Smith: Can my hon. Friend give me an assurance that the position of authorities such as Oxfordshire that are on the revenue support grant settlement floor and therefore subject to that particular situation will be addressed specifically?
Phil Hope: My right hon. Friend is trying to lead me into territory in which he, as a former Secretary of State, probably knows that I am unable to give commitments. I cannot say exactly what the outcome of the negotiations on 2011 and beyond will be. However, he has made a powerful point as a constituency MP on behalf of his county, pointing out in his earlier remarks and his question to me the consequences and possible impact of the system of floors and ceilings. I will ensure that his questions and comments are brought to the attention of those making such decisions. We are certainly mindful of his and others' concerns with regard to that question.
Not only will we have internal discussions about such questions, but we will consult on the determination of the allocations before we allocate directly to local authorities. We will of course consult local authorities, as well as NHS bodies, the Association of Directors of Adult Social Services, the Local Government Association and the NHS Confederation. We will consult others through the partnership boards, as I said, so that organisations such as Mencap that are represented on disability boards throughout the country will have their opportunity to contribute on questions such as those asked by my right hon. Friend.
Whatever happens, we know that PCTs and local authorities will need to work together to commission services. Although the transfer will move across local authorities, there is an important role for greater integration of health and social care services through joint commissioning, joint strategic needs analysis and joint working, so that individuals' needs are always treated in the round and they are provided with seamless services, whether care services, health services or both. The outcome must be in the best interests of those with learning disabilities. I cannot give my right hon. Friend the categorical assurance that he seeks in advance of those debates, but I can assure him that the consultation will allow those questions to be fully articulated so that Ministers in different Departments, not least the Treasury, will hear individuals' concerns.
Mr. Smith: I appreciate those commitments on consultation. Can my hon. Friend give any indication of the time scale in which the ultimate method for allocation for 2011-12 will be settled? Although 2011 seems a long way off in terms of planning local authority and central Government budgets, it is not. The firmer and earlier an indication is given, the better people will be able to plan.
Phil Hope: I am not sure that I can give my right hon. Friend a time scale today, as we are in 2009, although I take his point that the earlier that discussions can be had and concluded, the better, in order to enable planning. I emphasise that we must understand the patterns fully from this year's returns on the transfers being made in order to plan and model what the future should be like. Once the returns are in and we have analysed them, we will be in a better position to do that modelling and arrive at a timetable, which is an even bigger job of work to be done.
The transfers are not straightforward, as my right hon. Friend knows; he discussed how complex they can be. There must be sufficient resources to cover the job of commissioning, as well as other expenditure. Even if the transfer continues, we wish commissioning to be a joint process between PCTs and local authorities. There will be issues involving the Transfer of Undertakings (Protection of Employment) Regulations 1981 and so on that will need to be taken into account. The issues are not straightforward, but his point about "the earlier the better" is well made, and I will certainly draw it to the attention of those concerned.
It is worth reminding my right hon. Friend that the allocations to local authorities represent a range of factors in the decision about what should be allocated. Issues such as inflation, different demographics, relative need, deprivation, ethnicity and so on were all included in the discussions about working through formulas. We certainly want to ensure that local commissioning, through whatever allocations are made, take such factors into account as well.
I have emphasised the importance of joint working between the NHS, local PCTs and local authorities, whatever the transfer of resources is. We want to ensure that not only social care but health care improve. My right hon. Friend will know that we recently introduced a new directed enhanced service for annual health checks for people with learning disabilities. I stress that because it is important that doctors keep a close eye on the health of people with learning disabilities in order to pick up on any early warning signs and to be able to give them the necessary advice and referrals if they need help. We must ensure jointly that people with learning disabilities receive personalised plans to support both their health and their care needs.
My right hon. Friend will know that the NHS operating framework makes it clear that primary care trusts must secure health services that make reasonable adjustments for people with learning disabilities. We are working a lot with strategic health authorities on those issues as well. There is a lot going on. The system and the transfer are complex, but they need to be done at a pace that suits the issues that he raised about what will happen beyond 2011. We must ensure that we root our conclusions properly in factual analysis.
In conclusion, the transfer process is about improving services for adults with learning disabilities. It is the right thing to do, and we must take the time to get it right, not just for this year and the next but, as my right hon. Friend put it, so that future negotiations can ensure that needs continue to be met. I do not apologise for saying that we have put a huge amount of extra resource into the system, as have some local authorities. At one point, there was an £8 billion growth in spend. That demonstrates this Government's commitment to the people in most need.
Working in partnership, local and central Government, health and social care services and the third sector and other local providers must consider the needs of people with learning disabilities and how we can put resources in place to meet those needs and ensure quality of care and the principles of choice and control, in order to give people independence in living and to move away from old-fashioned ways of caring for people with learning disabilities into new ways of working. The personalisation of our services is critical. My right hon.
Friend is right to raise the issue of funding for the future. I hope that he will work with me as we publish our care and support Green Paper today to take forward the bigger agenda of transforming our social care system.
Gypsies and Travellers
1.30 pm
Steve Webb (Northavon) (LD): I begin with a quote:
"members of the gypsy and traveller communities should have the same rights and responsibilities as every other citizen."
That is a statement of Government policy, as set out by the Office of the Deputy Prime Minister in circular 01/2006. I endorse that statement wholeheartedly. I recognise the important and diverse needs across our communities from Gypsies and Travellers to the settled population. I agree with the Government that both groups have the same rights and responsibilities.
I initiated this debate because I wanted to alert the Minister to the way in which the implementation of that strategy is failing on the ground. It appears to be an entirely proper process. Unmet need should be identified systematically and sites for Gypsies and Travellers found proactively and strategically. However, there is a feeling among the people who have contacted me that people do not have equal rights and responsibilities, but that there are separate rules and outcomes for different groups. The Government's goal of fostering community cohesion and undermining conflict is not being achieved because of that perception. I want to consider how the situation could be improved.
I will begin with the example of green belt development on the edge of communities. Many villages in my constituency are surrounded by green belt. When the children of families in such villages grow up, there is often nowhere in their village for them to live. When a house becomes available, it is unaffordable for a young adult. Such people would dearly love to buy a piece of land on the edge of the village, build a house and live there, but they cannot because it is green belt. All too frequently, such land is sold to a Gypsy or Traveller family because the land is cheap. It is cheap because it is not possible to get planning permission to build on it, otherwise it would be expensive.
In some cases, the Gypsy or Traveller family will move on to the land at 5 o'clock on a Friday night, just as the council is clocking off. By Monday morning, there are hard-standings, driveways and connections to mains services. When the council enforcement process grinds into action, a planning application for a residential pitch is submitted. Because there is a planning application, the council holds off on enforcement. The application grinds through the process of site visits and so on over many weeks and months and is eventually turned down. The applicant then appeals and the case goes to the Planning Inspectorate, which says that although the land is green belt, there are not enough proper Gypsy and Traveller sites in the authority, and it therefore gives permission. That happens time and again in my area.
Many Gypsy and Traveller sites are immaculate. I can think of one not far from where I live that looks lovely and is well maintained. We are not always talking about some scruffy caravans down the road. Some sites are a credit to the area that they are in. However, the problem is the sense that such things would not be allowed for the settled community and that a different set of rules apply for Gypsies and Travellers.
Mr. Andy Slaughter (Ealing, Acton and Shepherd's Bush) (Lab): Will the hon. Gentleman give way?
Steve Webb: I will not, because I am short of time.
The Minister might say in his response that, if the council had provided enough sites in the first place, such things would not happen. In 2006, my local authority, South Gloucestershire council, was directed by the Secretary of State for Communities and Local Government to produce a Gypsy and Traveller development plan document. The goal was for 53 residential pitches and 25 transit caravans, based on the Gypsy and Traveller accommodation assessment. We are halfway through the two-year consultation, but that process is being forestalled and undermined because sites that have been submitted as potential sites are suddenly coming forward for planning permission.
The Minister's office kindly contacted me before the debate to ask what I wanted to raise, and I mentioned the application at Hall End in Rangeworthy. That site has a complex history, but, in a nutshell, the council has been taking enforcement action for six years. It started when someone moved a caravan on to the site and started operating a transport business. They created track and hard-standing in a rural area. An appeal was dismissed in 2004. Even the High Court ordered enforcement by July 2008. For five or six years, the council has said that this is not a good site for caravans or buildings.
There have been planning applications for the site. In 2004, there was an application for a bungalow. That was rejected
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