Social Care (Liverpool)
(7 years, 2 months ago)
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Mr Philip Hollobone (in the Chair)
Would those who are not staying for the next debate please be kind enough to leave quickly and quietly? I see we have some of Liverpool’s finest in the Chamber.
Mrs Louise Ellman (Liverpool, Riverside) (Lab/Co-op)
I beg to move,
That this House has considered social care in Liverpool.
It is a great pleasure to serve under your chairmanship, Mr Hollobone. This is the third occasion on which I have raised the issue of adult social care in Liverpool in this place over the past two months. That is because major cuts in Government funding combined with rising needs are creating a situation where too many people are left feeling vulnerable in their own homes. Scarce hospital beds are occupied by people who are clinically fit to be discharged but cannot leave the hospital because social care is not available. That is bad for those individuals and for the national health service.
I realise that this is a national issue, but the debate puts the focus on the specific challenges that Liverpool and the Liverpool city region face. Mayor Anderson and Liverpool City Council have done their very best to protect the people of Liverpool from the impact of unprecedented Government cuts, but adult social care has not escaped the consequences of the Government’s actions over a long period.
Adult social care covers a wide range of services, including domiciliary support—helping to dress, feed and bathe people in their own homes and, where appropriate, ensure that the correct medication is taken. Depending on the individual situation, that could involve several visits a day to an individual’s home. In other cases, it might require one visit a day, but whether it is one visit or several, it is absolutely essential to allow that individual to lead an independent life. The provision of adequate adult social care enables many people to remain safely and confidently in their own homes, rather than feeling vulnerable or having to move to more expensive and much less satisfactory residential care. Adequate adult social care can bring peace of mind and provide a lifeline.
Let us look at what has been happening to Liverpool City Council’s funding. Liverpool has now lost 60% of revenue support from the Government since 2010, and by 2020 that figure will have risen to 68%. Furthermore, having looked at revenue support systems, the Government plan to eliminate revenue support entirely under a new funding settlement. That will have serious consequences for a city with a low tax base and with 80% of its population in council tax bands A and B.
Liverpool council is a very responsible authority and has already identified £90 million of additional cuts that it is required to make in the coming financial year. The council continues to do its best to protect services, but it has not been able to stop substantial cuts to its spending on adult social care, which has been reduced from £220 million in 2010 to £154 million in 2016. It is anticipated that that figure will be reduced to £130 million by 2020.
Yes, the Government have their better care fund and yes, the local authority has a limited ability to raise an extra precept. The better care programme is expected to allocate £39 million to Liverpool when its funding is due to be reduced in such a significant way, but that will still leave a massive gap. Neither the Government’s better care fund nor the council’s ability to raise extra tax can fill the gap caused by the withdrawal of central Government funding. The scale of that withdrawal is unprecedented.
At the same time as the Government are reducing support, demographic pressures and costs are increasing. The Office for National Statistics estimates that the percentage of people in Liverpool aged 65 years or more will rise from 14.6% in 2015 to 16.1% in 2024. It is wholly unrealistic to expect people in the fourth most deprived local authority in the country to fill the gap. The sums simply do not add up. To illustrate the situation, a 1% increase in council tax in Liverpool will raise £1.4 million; a 1% cut in central Government funding means a loss of £3 million. That is a totally unacceptable situation and one that cannot continue without inflicting severe cuts on services that are very important to the people of Liverpool.
I said that Liverpool was the fourth most deprived local authority in the country, which is correct, and there is great poverty in the city, but Liverpool City Council, through its pioneering spirit, its enterprising approach and its ability and willingness to innovate and work with others has been able to move Liverpool from being the most deprived local authority in the country to that No. 4 position. It is bad to be the fourth most deprived authority, but it is a tribute to the city council and its partners that they have been able to make progress in Liverpool. Furthermore, that progress has been made without proper funding from Government—indeed, Government funding has reduced, and that is the critical feature.
Social care packages in Liverpool have already been cut from £14,000 to £9,000, which has affected many vulnerable people, and many more are anxious. Many people in great need are being reassessed to see whether the care they receive can be maintained, which often induces great anxiety and apprehension, even if ultimately their care remains similar to what it was. That, too, is an important factor that is not always considered.
On the day that I visited the Royal Liverpool university hospital, 135 patients who were clinically fit to be discharged remained in their beds because social care was not available for them at home. That was in spite of the efforts of hospital and local authority staff to find suitable care packages for them—the money was simply not there. That figure, the accurate one for the day I visited the hospital, reflects the general situation and shows one of the problems caused by the cuts to social care in Liverpool. Those cuts have arisen solely because of cuts in Government funding.
The situation affects many people, and it can only deteriorate unless action is taken. What should be done? Let us look at what is happening now. Mayor Joe Anderson, cabinet member Paul Brant and Liverpool City Council as a whole must be commended for their work to promote partnership with the NHS and innovation, which involves new work with the clinical commissioning group and GPs to integrate health and social care. “Step Up” centres for intermediate care are being pioneered and the council plans to promote innovatory joint work with community health services. A joint working party is considering new ideas.
All those things are extremely important and demonstrate the city council’s willingness to innovate and work with other partners. Such work should be supported better by central Government. Whatever innovation takes place in Liverpool and however much the council is willing to work with other people and for integration, Ministers cannot escape the fact that more funding is needed. The issue is long term, but the crisis is now and immediate action is required. It is a crisis that Liverpool City Council cannot resolve on its own, nor can the people of the city fill the financial gap unaided.
I call on the Government to recognise their responsibilities and to announce an immediate allocation of targeted funding for adult social care in Liverpool. I recognise that that must be part of a national approach, but funds must be targeted to meet the needs of local communities. That will enable vulnerable people to live independently and safely in their own homes, as well as enabling the NHS to deploy its resources efficiently. Liverpool City Council should be congratulated on the resilience, innovation and flexibility that it has displayed, but it cannot resolve the crisis alone. I call on the Minister to act as a matter of urgency.
Mr Philip Hollobone (in the Chair)
I am required to call the Front Benchers at 5.40 pm and the debate may run until 6.03 pm. That gives us 32.5 minutes of Back-Bench time and three Members have given me their names, the first of whom—who wrote a very nice letter—is Maria Eagle.
Maria Eagle (Garston and Halewood) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hollobone.
I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on obtaining this crucial and timely debate. She set out in full and with great clarity the situation facing Liverpool and other local authorities in the city region, as the council seeks to set a lawful budget while desperately trying to keep going the public services on which so many of our constituents depend. She set out in great detail and with pertinent facts and figures many of the things that I was going to say about Liverpool. I endorse her speech fully—it was excellent.
Liverpool has had £420 million cut from the city budget since the Lib Dem-Tory coalition imposed cuts in 2010. There has also been the never-ending slashing of public services provision by this Government and their predecessor, and another £90 million has to be found. To illustrate that, Liverpool raised £147 million in council tax in the last financial year, but it spent £151 million on adult social care. I will emphasise that: Liverpool is having to spend more on adult social care alone than it can raise in council tax.
My hon. Friend set out some of the other concerns and problems. The demand for social care assessments is rising. Despite the cuts she described to the money that can be spent on adult social care, the demand for help of those depleted services from our citizens and constituents has increased by 15%. The demand for social care assessments in Liverpool has gone up from 18,000 a year in 2020 to 21,000 a year now. As she set out, Liverpool supports 9,000 people annually to some degree with a care package at home. That is fewer than half of the people who have asked to be assessed, so it is clear that only those with the highest needs get help, and they may well not get a level of support from which they benefit and which might keep them out of more acute services for longer with a better quality of life.
Liverpool City Council announced in its budget proposal that it intends to increase council tax. It will of course do so reluctantly, because many of our fellow citizens will find it difficult to afford an increase, but that course of action must be taken. I say in all sincerity to the Minister that it is not credible to claim that the shortfall that results from resources being cut by 70% can be made up by efficiency savings. I could not lose 70% of my resources and make up the difference in efficiency savings.
My constituency of Garston and Halewood also covers part of the Knowsley metropolitan borough, which is a smaller authority but, thanks to this Government and the Lib Dem-Tory coalition Government that preceded it, it faces financial challenges that are just as severe. Its revenue is currently £148 million. It has had to make cuts of £86 million since 2010 and will have to find a further £17 million over the next three years. That is a total loss for a small authority of more than £100 million. Both Liverpool and Knowsley are among the top five hardest hit local authorities. Knowsley’s income will have gone down by 56% by the end of this process.
Knowsley raised £43.2 million in council tax in the last financial year, yet it spent £47.1 million on adult social care alone. Are we seeing a pattern here? Just like Liverpool, Knowsley had to spend more on adult social care alone than it was able to raise in council tax this year. The pressures on the social care budget are huge. Because the population is ageing and people are living for longer—something we should all celebrate—Knowsley expects to face additional pressures of £10 million in the next three years for adult social care alone.
Mr George Howarth (Knowsley) (Lab)
Does my hon. Friend agree that the picture she paints is grim, particularly for Knowsley? Does she, like me, envisage a time in the not-too-distant future when Knowsley simply will not be able to meet its legal responsibilities unless additional funds are found to ensure that adult social care is available?
Maria Eagle
I well understand my right hon. Friend’s concerns. Indeed, the fear is that it will simply be impossible. Knowsley has not had 56% of its statutory obligations removed—just 56% of the money with which it is supposed to meet them. Knowsley, too, is looking at a council tax increase of 4.99%, with 3% ring-fenced for adult social care. This will be the first time that it has increased council tax in five years, and it will do so reluctantly, but that will generate just £1.9 million a year—a total of £3.8 million over the three-year period. That will pay for only just over a third of the pressures that are expected in adult social care alone.
Some additional money will come through the improved better care fund, and there will be one-off allocations—albeit of less than £1 million—through the adult social care fund, but none of that will meet the pressures that are apparent now. I say again to the Minister in all sincerity that one-off payments cannot deal with permanent pressures that are increasing relentlessly day by day when budgets have been cut so drastically.
Unfortunately, Government actions elsewhere mean that those pressures could easily increase rather than decrease because of what is happing in the health service, as my hon. Friend the Member for Liverpool, Riverside mentioned. Greater pressures on our NHS hospitals and acute services, which have financial problems, the Government’s never-ending austerity mania and real-terms reductions in resources for the NHS over the next few years mean that our NHS services, too, are under enormous pressure. That is where the Merseyside and Cheshire sustainability and transformation plan comes in, but that aims to offset £908 million of financial pressures on the local NHS. It has changed from something that was welcome as a way of improving co-operation and transforming our services into something that is simply about saving money over the next few years. I am afraid that that will not make things easier.
There has been a lack of consultation between the STP leaders and the councils. Neither of the councils that I have mentioned feels like they have been consulted at all about the proposals that are supposed to be going ahead for the NHS, despite the fact that they will face pressure from hospitals that want to get people back into the community—but to what? There is ever-decreasing resource in the community to help look after them.
Tomorrow’s Budget is a chance for the Chancellor to tackle some of those problems with vigour. We hope that he will, but if the Government’s briefing in the newspapers is to be believed, it looks like he will not. It is reported that he will announce an emergency fund of £1.3 billion to tackle the social care crisis. That is only half of the £2.6 billion that the Local Government Association estimates the spending gap will reach by 2020, and it appears that the Chancellor will direct it at schemes that aim to tackle bed-blocking. Knowsley will not benefit from such money, because it has tackled that problem already. Indeed, the Minister always prays Knowsley in aid when he tries to say that bed-blocking is not a problem in some authorities. Knowsley has lost 56% of its resource, and it now looks like it will be punished for being efficient while less efficient local authorities get a slice of the money that the Chancellor will give out tomorrow.
Apparently, the Chancellor will also establish another long-term review of social care funding. Although that is welcome, because this needs to be tackled in the end as a proper long-term policy issue, it will not tackle the problems that Liverpool and Knowsley face now. I must also observe that both Governments the Minister has been a member of have done the same, and they simply ignored the proposals that ended up emerging. The shadow Cabinet of which he was a prominent member before 2010 sabotaged the attempts by my right hon. Friend the Member for Leigh (Andy Burnham) to have cross-party talks about a solution seven years ago for a cheap election poster alleging that Labour was proposing a death tax. So we will see.
Meanwhile, the social care crisis in Liverpool and Knowsley worsens and the Government simply pass the buck, play politics and offer zero leadership—I am afraid we have come to expect that from them. Those who lose out are the elderly and the vulnerable, who rely most on the services that this Government’s actions decimate the most.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I apologise for being a moment late in coming over from the Select Committee on Health. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on securing this important and timely debate on behalf of all our constituents.
Mr Philip Hollobone (in the Chair)
Order. If the hon. Lady would like to sit, she is most welcome to do so.
Luciana Berger
That is kind, but I am fine. Thank you so much.
This is a pertinent and serious issue that affects thousands of people across the area that my hon. Friends and I are privileged to represent. I also endorse the comments made by my hon. Friend the Member for Garston and Halewood (Maria Eagle). I will seek not to reiterate but to add to the comments that have already been made. I will raise some of the additional pressures that Liverpool has faced in the nearly seven years since the cuts were first introduced in 2010 and add some personal reflections from constituents who are experiencing those cuts at first hand. We are ultimately here on behalf of our constituents, and we should share their experiences with the House so that we understand the tragic human element and implications of the cuts. I will also reflect on my own experience of being in an accident and emergency department in Liverpool on a Friday night just a couple of weeks ago and seeing the number of ambulances waiting there. At least 10 paramedics were waiting to book people in, many of whom were older people. We know from the figures that delayed discharge is a significant challenge, and I believe that issues in accident and emergency departments are compounded by cuts to social care.
As we heard from my hon. Friends the Members for Liverpool, Riverside and for Garston and Halewood, 5,000 fewer people in Liverpool are receiving support via care packages than in 2010. I have connected with two constituents about that issue in the past week alone. One, a lady called Sobia, is paralysed. She used to receive overnight care, but despite her condition becoming worse and even though her children are now of an age when they are going to university and are not as available to care for her as they were previously, she has seen that care stopped because of the cuts to social care in Liverpool.
In the past few weeks I have intervened on behalf of one of my constituents called Veronica, who had additional support to help her with various things. She is still waiting for some of that care to be reinstated. I have every sympathy with Liverpool City Council for the difficult decisions it is having to make in the current circumstances; the council is under significant pressures, as we have heard. Those pressures do not look set to get any easier. In particular, in the Liverpool city area we have demographic pressures—as many places do across the country—with the growing, ageing population. We know that the 65-plus age group is set to grow by 50% in the next 20 years. That is a significant challenge for any area to contend with, particularly given the cuts that have been incurred so far.
Liverpool City Council faces financial pressures as a result of the introduction of the national living wage. It is to cost £13.9 million in 2017-18, rising to £24.7 million by 2019-20, which is not an insignificant sum for the council to contend with. The Law Commission is also reviewing a specific piece of legislation, and I hope that changes will come forward soon to help Liverpool City Council cope with the 400% increase in deprivation of liberty safeguards applications, which cost £1 million a year. We know that that needs some attention, and I hope that changes to the legislation will have some impact, because that is £1 million of the significantly larger sum that the council has to contend with.
The demand pressures we see locally are also significant. We know that every week Liverpool City Council is arranging care packages for up to 100 people leaving hospital, which is a 51% increase compared with last year. There are also a lot more complex home care cases, which cost a significant sum and may require two carers calling four times a day. We know that adult social care assessment requests have risen by 15% since 2010, up from 18,000 a year to 21,000, and are expected to rise to nearly 23,000 by next year. There were also 5,715 requests for support from new clients, which was a 10% increase on the previous year.
We as constituency MPs, on behalf of our constituents, are contending with the challenges today. I have shared just a few of the additional challenges—financial pressures, demand pressures and demographic pressures—that mean that Liverpool City Council faces even more challenges as the years progress. It is on that basis that I endorse the comments made by my hon. Friends. We need the Government to give serious attention to this matter.
Social care cannot be dealt with separately from our wider health service. The two go hand in hand. It is no surprise that more people are turning up to our accident and emergency departments or our GP surgeries when 5,000 fewer people get care packages today than did in 2010, given that we know need has increased. The Chancellor will give the Budget tomorrow, and I look forward to hearing in the Minister’s response what representations he and his Department have made to ensure that social care is given the attention and resource that it desperately needs and deserves on behalf of the thousands of constituents who do not receive care but deserve it and the thousands more elderly people who will need it in the future.
I have not reflected specifically on constituents who might need mental health support but are not getting what they need and deserve today and going into tomorrow. This situation cannot be allowed to continue. We see and experience in our surgeries and weekly visits constituents who have to contend with the daily realities of not getting the support they need and deserve. We anticipated something in the autumn statement but there was nothing. On behalf of all our constituents, I sincerely hope that the Minister will give us some glimmer of hope that tomorrow there will be something that positively impacts on all of our constituents’ lives.
Steve Rotheram (Liverpool, Walton) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman), my constituency neighbour, on securing this important debate and on her speech, during which she laid bare any claim by the Government that they have any intention other than passing the buck for the health and social care crisis.
The Minister will be aware that, in the past few weeks, one of the main local hospitals in Liverpool has reported that an almost unprecedented 20% of its capacity has been taken up by people who do not need to be there. That, of course, has a knock-on effect and reverberates across the whole NHS system. The Government’s myopic approach has led to cancelled elective surgery, delays in A&E and ambulances backing up at hospital entrances, resulting in an incredibly inefficient use of already overstretched NHS resources. More importantly, it is not in the best interests of patients and patient care.
Keeping people who do not need to be in hospital in expensive NHS beds, instead of making provision for their illnesses to be treated at home or through other resources, is a wasteful and nonsensical way to spend taxpayers’ money. The Secretary of State has claimed that delayed discharge is not just about social care funding. Perhaps when the Minister responds, he would care to identify a single local authority that has had the same Government funding cuts inflicted on it as those in Liverpool and yet has managed to avoid a delayed discharge crisis. I await his response with anticipation.
A recent report by the Chartered Institute of Public Finance and Accountancy and the Institute for Government identified that people were waiting longer for critical hospital services such as A&E and cancer treatments. It highlighted the fact that delays in transferring people from hospitals into social care have risen by 40% since 2014. The Government cannot wash their hands of the crisis that has been created in Downing Street. They cannot simply shift the blame for the shambles they have presided over for the past seven years on to the shoulders of councils such as those in our area.
I should declare an interest in what I will say next, as a candidate in the Liverpool city region metro Mayor contest. If I am elected in May, I offer to work with the Minister’s departmental officials and the leaders of the six districts in the Liverpool city region to convene a health and social care summit, to examine the current situation and look at how we might work together across the piece at what could be done better. As my hon. Friend said, there are some innovative approaches and best practices in our area, and the Government might even learn something if they took part. Councils in our area have already shown the leadership on social care that the Government are singularly failing to, so that summit is a chance for the Government to answer their critics, see for themselves the pressures that local authorities are having to contend with on a daily basis and work to tackle the problem at source.
We have a duty of care to ensure that health and social care work is as seamless and joined up as possible within the current structures of responsibility and funding restrictions. However, the Government need to accept their duty in relation to health and social care. In our area, the so-called social care precept would not even go close to backfilling central Government cuts to date, as we have heard, and it is seen as a scam to shift the burden of funding on to the shoulders of local taxpayers. Liverpool has a predominance of terraced streets—what we used to call two-up, two-downs—so the imbalance of band A and B properties means that for every 1% increase in council tax in our area, we raise about £1.4 million to £1.5 million. However, with a similar 1% increase in some of the leafy suburbs down here, councils can raise more than £5 million. That situation perpetuates the growing gap between the haves and the have-nots, and we will see tomorrow whether the Chancellor recognises that the cuts being inflicted on councils such as Liverpool, Halton, Knowsley, St Helens, Sefton and Wirral have gone too far, and whether a fairer settlement is offered.
We are doing our bit in our city region. The Government now need to accept their responsibility to the elderly and their families and carers. They have often tried to use a sticking plaster to offer a solution, but they know that a sustainable solution must be found to this growing problem. I hope that all the relevant factors—including demographic, socioeconomic and health inequality data—are included in any formula that the Treasury uses to calculate additional funding need. Perhaps tomorrow’s Budget will see yet another sticking plaster applied to the crisis in social care and in our hospitals, but mark my words: it will be no more than a temporary measure at best. At worst, it will be more smoke and mirrors that will fall apart just days afterwards upon further scrutiny. I cannot believe the Government will allow that to happen.
At Prime Minister’s Question Time, the Leader of the Opposition mentioned that Liverpool’s director of adult social care, Samih Kalakeche, had handed in his notice because he was tired of being held responsible for axing services for the elderly and vulnerable in our city. Mr Kalakeche told The Observer:
“Frankly I can’t see social services surviving after two years. That’s the absolute maximum. If we don’t do something within the next six months, I believe social services will not exist by 2018-19. This isn’t scaremongering, this isn’t me asking you to feel sad for me—whoever is making decisions out there has looked at social care as the Cinderella of the service…People are struggling, people are suffering, and we’re really only seeing the tip of the iceberg.”
I think those comments are directed fairly and squarely at the Government’s door.
However, it is not only Samih who claims that. Last month, the Conservative chair of the Local Government Association, Lord Porter, said that services supporting the most vulnerable people in our communities were at breaking point. He said that
“extra council tax income will not bring in anywhere near enough money to alleviate the growing pressure on social care both now and in the future. The social care precept raises different amounts of money in different parts of the country. Social care faces a funding gap of at least £2.6 billion by 2020. It cannot be left to council taxpayers alone to try to fix this crisis. Without genuinely new additional government funding for social care, vulnerable people face an ever uncertain future where they might no longer receive the dignified care and support they deserve. This is not only worse for our loved ones but will also heap further pressure and wasted expense on the NHS.”
Opposition Members could not agree more.
I know that our area, like the other 150 councils in England, will not get a sweetheart deal from the Government—sorry, I of course mean a memorandum of understanding allowing for a pilot of business rate retention. In any case, such deals are yet another example of the Tory approach that “to those that hath shall be given”. For example, Westminster City Council raises so much money in business rates that it could probably afford to actually pay its residents to live there instead of taxing them. However, there are certainly limits to what can be achieved in our area at a local or even sub-regional level with the current inadequate resourcing.
I slightly disagree with my hon. Friend the Member for Garston and Halewood (Maria Eagle), who welcomed the Government’s social care commission. I do not think we need another commission; I think we all know what is happening in our areas. The Government need to start listening to people—to patients, carers and families who have to go through terrible circumstances on a daily basis. It is time for action, not for commissions. Our elderly family members and our overstretched and all-too-often under-rewarded social care workers deserve nothing less. I hope the Minister will talk about action in his response.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on securing the debate and on the excellent way in which she opened it. We have heard about the real pressures on social care in Liverpool from my right hon. Friend the Member for Knowsley (Mr Howarth) and my hon. Friends the Members for Garston and Halewood (Maria Eagle), for Liverpool, Wavertree (Luciana Berger) and for Liverpool, Walton (Steve Rotheram). We have heard about the 5,000 people who have lost care packages, about cancelled surgeries and about patients stuck in hospital.
To be clear, the funding crisis in social care is, in my view, one of the Government’s own making. The Chancellor failed to recognise the crisis and provided no extra social care funding from central Government at the autumn statement. Indeed, Ministers continued what they had already started in shifting the burden on to councils and council tax payers through increases in the social care precept. I will say more about that, but we have heard very well in the debate how that is not a sustainable solution.
As my hon. Friend the Member for Liverpool, Riverside said, Liverpool still has to make a further £19 million of cuts by 2020, taking the cuts to its Government funding to a staggering £420 million—the equivalent of a 68% reduction since 2010. The cuts to grants and the increased reliance on council tax have hit cities such as Liverpool very hard; we have heard about some of the impacts. As my hon. Friend the Member for Liverpool, Walton said, a serious weakness of using council tax to fund social care is that both demand for social care and the relative value of the council tax base vary so much across the country.
Mr Philip Hollobone (in the Chair)
Order. I am sorry to interrupt the hon. Lady when she is in full flow, but there is a Division in the House. We will come back in 15 minutes and carry on where we left off.
Mr Philip Hollobone (in the Chair)
Welcome back. The revised finish time is now 6.18 pm.
Barbara Keeley
As I said, a weakness of using council tax to fund social care is that both the demand for social care and the relative value of the council tax base vary across the country. Census data show that in Surrey 40% of over-65s have a long-term condition that limits their day-to-day activity, but in Liverpool that figure is much higher, at 62%, and there is a strong link between long-term conditions that limit day-to-day activity and care needs. A 1% increase in council tax would raise £6.2 million in Surrey, whereas an equivalent rise for the same size population in Liverpool would raise only about half that sum—£3.4 million. Therein lies the problem.
As we heard in the debate, this year the 2% social care precept raised £2.8 million in Liverpool. That is not enough to cover the £9 million that Liverpool reports is needed in the care sector just for increases in the national living wage. Liverpool’s Mayor did some months ago suggest a 10% council tax increase to pay for social care, which would have needed a referendum. That proposal was similar to the one for a 15% increase from Surrey County Council. As we know, Surrey appears to have got a sweetheart deal from the Government when it suggested that increase in council tax, so I would like the Minister, when he responds, to tell us where Liverpool’s deal is.
As we heard, last month Liverpool’s director of adult social care resigned, stating that councils are in danger of failing to meet their statutory requirements. He said:
“People are struggling, people are suffering, and we’re really only seeing the tip of the iceberg.”
Only those with the highest needs are getting help. I worry that financial pressures in social care are now leading to failures and serious reductions in the quality of care that people receive. That was underlined by the Care Quality Commission bringing prosecutions against the owners of Mossley Manor, in the constituency of my hon. Friend the Member for Liverpool, Riverside. The neglect and poor care of residents at that care home was shocking. The CQC said that there was
“a continued and serious risk”
to the lives, health and wellbeing of residents. It is welcome that the owners have been prosecuted by the CQC, but I am worried that failures such as that are now a symptom of a wider problem.
The number of care home providers forced to cease operations because of deregistration has increased from 34 two years ago to 54 this year. A recent BBC “File on 4” programme reported that 23,000 allegations of abuse had been made against care staff working in people’s homes. In the programme, the new local government ombudsman, Michael King, said that there is a growing problem with standards of home care. The CQC says that more than one quarter of care homes require improvement or are inadequate, and that figure rises to 41% for nursing homes. The King’s Fund has said that adult social care is rapidly becoming a “threadbare safety net” for the poorest and most needy older and disabled people.
Falls in the quality or availability of social care are clearly having a knock-on effect on the NHS. We heard, rightly, about examples of that from Liverpool. My hon. Friend the Member for Garston and Halewood talked about sustainability and transformation plans and the need for STPs to make savings, which is the ridiculous position we seem to be in, but as the Health Foundation has said:
“The vision contained in many STPs…on preventing ill health and deterioration of illness, of care delivered closer to people’s homes…will be impossible without a vibrant social care sector.”
As we heard in the debate, it is impossible to have a vibrant social care sector with the funding issues in Liverpool. The Government have tried to shift the burden of funding social care on to councils. In the Budget tomorrow, I hope that the Chancellor of the Exchequer takes responsibility and both makes available the £2 billion needed immediately and suggests a longer-term plan, which is needed to put social care on a more stable footing.
Those who lose out are the thousands of people who need social care in cities such as Liverpool, but are now living with unmet care needs. That also hits their families, particularly the unpaid family carers, and the thousands of people in the care workforce, who are now working under very poor terms and conditions. A very large proportion of them are on zero-hours contracts; often, they are not even paid the minimum wage, are not paid for their travel time and have very poor prospects or no pension.
My hon. Friend the Member for Liverpool, Walton has offered to convene, if he is elected Mayor—I wish him all the best in the forthcoming election—a health and care summit to look at the issues and explore solutions. I hope that he is able to do that, but I know that my hon. Friends and I are not happy to accept a threadbare safety net. We want a decent and fair social care system, and we want it to be funded.
Mr Philip Hollobone (in the Chair)
If the Minister would be kind enough to conclude his remarks no later than 6.15 pm, that would allow Mrs Louise Ellman three minutes to sum up the debate.
The Parliamentary Under-Secretary of State for Health (David Mowat)
I thank all those who have spoken in the debate. This is a serious subject, and we have had a number of serious contributions. I will answer some of the points that have been made, before talking more generally about the Government’s approach to adult social care, both now and for the remainder of this Parliament.
I congratulate the hon. Member for Liverpool, Riverside (Mrs Ellman) on bringing this debate to the Chamber, because this subject matters. If there is one thing on which we can all agree, on both sides of the political divide, it is that the whole care agenda is very important to very large numbers of people. The care industry employs more people than the NHS: it employs 1.5 million people. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, many of them are not well paid. I think she said that some of them do not get the minimum wage. If she has evidence of that, she needs to come forward with it and we need to prosecute, because that is illegal.
However, it is right to say that 1.5 million people work in social care—more than in the NHS—and that number will grow over the next decade or two decades. Depending on how he gets on in the forthcoming election, the hon. Member for Liverpool, Walton (Steve Rotheram) may find that his responsibility in that regard is increased greatly. As well as those 1.5 million people, to whom we should all be grateful—I do not think I could do that work very well—6 million people across our country give informal care. Of those, some 300,000 are aged under 18. It is estimated that one in 30 people in schools are giving informal care to an adult or sibling. We should all reflect on that, because that number will also increase over the next decade or so.
A number of Members have made the point that the precept raises less in Liverpool than it does in Surrey. The hon. Gentleman said that many more houses are in council tax bands A or B, and the consequence is that the precept will raise less. That is self-evidently true, and the Government accept that. That is why the way in which the improved better care fund is and will be allocated to councils takes into account the moneys that are available from the precept, so that the total is in accordance with the relative needs formula.
There is one thing I want to get absolutely straight. I do not want to spend the next 18 minutes bandying numbers around, and I am happy to write to all the Members here about the numbers that I am about to give. The hon. Member for Liverpool, Riverside correctly said that the Liverpool spend on social care was £154 million in 2015, and she said that it is budgeted to be £130 million by 2020. I think those were the numbers she used. The number that we have in cash terms—I will write to Members with this—is £194 million by 2020. That is a real-terms increase of 18% between now and 2020. I have spent quite a long time with officials today to make sure that those numbers are correct. The amount that Liverpool City Council will receive from the improved better care fund in 2019-20 is £26 million. That dwarfs the amount that the precept will raise.
Barbara Keeley
The Minister said that he does not want to keep on bandying figures about, but as we all know, the difficulty is that the funding that he and the Government keep talking about is back-loaded. The problem is happening now—5,000 people have lost their care packages now, and the problem has been happening since 2010. It is not helpful, in this totally stressed situation, to talk about money in 2019-20.
David Mowat
I was just making the point that the figure the hon. Member for Liverpool, Riverside used was £130 million and the figure I have is £194 million. I accept that that number is not for today, and I also accept, as I have said many times in the Chamber, that the social care system is under pressure throughout the country, and Liverpool is part of that.
Steve Rotheram
I am trying to be helpful to the Minister. I quoted a former director of adult social care in Liverpool, Samih Kalakeche, who said:
“If we don’t do something within the next six months, I believe social services will not exist”
by the time that the Minister believes we will get the additional funding.
David Mowat
Today is not Budget day. I accept that the systems are under pressure. The precept has raised something, and Liverpool’s budget for social care is increasing next year, but it is fair to ask whether it is increasing enough given the pressures we are under—that is a reasonable point. My point about the £194 million figure was in response what was said earlier. Although I and the Government accept that there are pressures, it is important that we share accurate numbers with each other.
The hon. Member for Liverpool, Riverside also made the good point that there is now an increasing tendency for care to be provided in people’s own homes. If we look at the care home market over the past decade, we see that roughly speaking there are the same number of beds today as there were 10 years ago, and that is clearly in the face of a considerable increase in demand. That is because far more people are now being looked after through domiciliary packages in their own home, and that is the market we need to get right and make effective.
The hon. Member for Garston and Halewood (Maria Eagle) raised the potential issue of councils being punished in the Budget for being efficient. I will be very disappointed if that is the case—it is not my understanding of what will happen—but it is a fair challenge, and we will have to see about that when the Budget comes out.
The hon. Lady raised a number of points about the STP. We all share the STP area, and there is work to do on it. I will make this point, however: she talked about cuts of £908 million, but those are cuts against an increase in demand—they call it the counterfactual—of 4% or 5% over the next period. The truth is that Cheshire and Merseyside will be getting real-terms increases in funding for every year up to 2020. Nevertheless, that does not mean that there are not challenges, for some of the reasons we have heard, such as demographics and all that goes with that.
The hon. Member for Liverpool, Wavertree (Luciana Berger) asked for a glimmer of light and hope; hopefully, between myself and the Chancellor tomorrow, we can achieve that. She also raised the cases of Sobia and Veronica and their care packages. It is difficult for me to respond to that, other than to say that the Care Act 2014 set out statutory requirements for what councils need to do. If those statutory requirements are not being met, and the way she described those cases implied that might be the case, that is clearly against the law and there is recourse either to the local authority itself or to the ombudsman. I would be happy to talk to her about that in more detail.
The hon. Member for Liverpool, Walton made a number of points and started by talking about delayed transfers of care. He rightly said that I have talked on a number of occasions about variations between councils in delayed transfer of care performance. I will say that DTOC is not the only measure of the effectiveness of a social care system; it just happens to be one the easier ones that we can get a metric around. The fact is that if we look at the 10% worst and the 10% best councils in the country—Liverpool is round about the middle—the level of delayed transfers differs by a factor of around 20 or 30. I absolutely concede that social care systems work better with more money, but it is not just about money, because that is about different working practices and different people doing things in different ways. It is right that we have the debate about that, as well as about the need for more money.
The hon. Gentleman challenged me to name some councils that were much better than Liverpool in terms of delayed transfer of care, within a similar budget environment. I do not know what the budget environment is, but I have a list I can give him of councils that have fewer delayed transfers of care. As I said, Liverpool is not a particularly bad council, and I do not want to imply that it is, but Durham, Kirklees, Sunderland, Barnsley, Newcastle-upon-Tyne and St Helens all have at least 10 times less delayed transfers of care than Liverpool. I was taken to task at a recent Conservative councillors meeting, in which people said that having a good social services department is not just about delayed transfer of care; it is to do with a whole lot of other things. I absolutely accept that, but in a sense the hon. Gentleman started it, so I wanted to give him those figures.
Steve Rotheram
Will the Minister therefore pay tribute to Liverpool for what it has done and its innovative approach? My question was about councils that have had similar cuts to Liverpool of around 60%. None of the councils that he mentioned has had the same degree of cuts as Liverpool City Council.
David Mowat
The hon. Gentleman mentioned some councils that were in the south and I picked some that were not, but fair enough—I accept his point. He mentioned that, depending on the result of his election, he would have a summit. I would be delighted to attend, if he were to invite me—although who knows where I will be by then.
David Mowat
Indeed. On Thursday, I am going to Liverpool to give a talk at a care conference. I would be very happy during that visit to come along and talk to the council about some of the issues raised here today. As the hon. Gentleman rightly said, I am sure that the Government can learn from Liverpool. Frankly, we can all learn from each other. When I went to Whiston hospital and saw discharges to St Helens and to Liverpool, I saw some wonderful things happening there. Anyway, the offer stands.
Maria Eagle
I am sure that all councils in Merseyside would be happy—I know that Knowsley would—to see the Minister on Thursday if he has a bit of spare time. Does he agree that it will be a bit of a blow if the Chancellor’s reported actions tomorrow reward those with a poorer record with smaller cuts to their resources than Knowsley’s? Knowsley has a good record on delayed discharges, but according to the formulation listed in some of today’s newspapers, it will end up getting very little, if anything.
David Mowat
I thought that I had said that I agree with the hon. Lady that it would be wrong to punish those that are doing better. She mentioned that Knowsley is one of the stronger councils in that regard; St Helens is even stronger. It would be completely wrong if that were the basis of the allocation. Frankly, that is not my understanding.
I want to talk a little about what the Government plan to do on social care. Part of that involves recognising the pressures that exist. One thing that we get into quickly in social care discussions is a debate about adult social care and frail people—people on the borderline between being ill and being old. If they are ill, they are in hospital under the NHS, and if they are not, they are old, and care is either means-tested or provided by the council. That is a difficult area.
One third of the pressure on councils such as Liverpool arises not from older people but from people with severe learning difficulties, autism and disabilities more generally. Over the past decade, thankfully, the health inequality from which that cohort suffers has decreased considerably, and the life expectancy of people in those categories has increased. The cost to local authorities is clearly severe. In addition, the Government are determined to press ahead with a programme called Transforming Care, which came out of the Winterbourne View case. Too many people with severe learning difficulties were in institutions and long-term hospitals, with all that goes with that. We are moving them into communities with the help of local authorities. There is a plan to move some 3,000 people out of institutions—places hopefully much better than Winterbourne View—and into care. All of that creates pressures of the sort that we have been hearing about in this debate, but that does not mean that it is not the right thing to do.
Luciana Berger
Does the Minister acknowledge that those 3,000-plus people should have been moved a lot sooner? According to various reviews, we should not be in the present situation, with too many people still in that type of accommodation who should not be there.
David Mowat
That is a fair challenge. We have a plan, and we are implementing it in that process. Winterbourne View was about seven years ago now. I have met a number of parents of the children affected and there has been a lot of pressure from them to go as far and as fast as we can. I make the point that every one of those facilities is a project of its own in terms of finding other accommodation and putting in place care—sometimes round-the-clock care. To answer the hon. Lady’s question directly, I would like us to go faster, but I think that we are doing as well as could be expected given the starting point. However, it is a fair challenge.
Barbara Keeley
I do not know whether the Minister watched last week’s Channel 4 “Dispatches”, “Under Lock and Key”, which showed some serious cases of young people who were not better off in their institution, a private hospital. It seemed very difficult to get them moved out into the community. I know that it was a different part of the country, but there were young people in that institution from across the country. It is great to have a plan, but we see programmes week in and week out showing failures, as I have highlighted.
Mr Philip Hollobone (in the Chair)
In responding to the intervention, the Minister needs to make his last point.
David Mowat
I beg your pardon. I will finish at 6.15.
I saw the programme, and it gave us great food for thought. It is a Government priority to get those people moved. We have done some 1,500, but yes, there are 3,000 left in places like the one in Northampton, and it is not good enough. It is a long process, and it is not something that any of us from either side of the House can do just by clicking our fingers.
I will now sit down. This has been a good debate. I will write to all Members here with the figures that I have given, because the figures are right. It is fair to have this discussion, but it must be had on the basis of correct numbers. Even with those correct numbers, I accept that some of the pressures that we have heard about exist.
Mrs Ellman
I am very pleased that so many of my hon. Friends who represent Liverpool are here today; in fact, we almost have a full house. My hon. Friend the Member for Liverpool, West Derby (Stephen Twigg), although he is abroad with the International Development Committee, which he chairs, is here with us in spirit and in thought. It shows how important the issue is to Liverpool and to the city region. We may dispute specific figures, but there is undoubtedly a massive gap in the funding to meet the needs of people in our area, and the biggest reason for it is the massive and ongoing cuts in Government funding. Whatever individual figures we might dispute, those are the basic facts, and they are not in dispute.
I thank the Minister for much of what he said, for his recognition that there is a problem and for his willingness to meet representatives of Liverpool City Council when he is in Liverpool on Thursday. I accept that invitation on their behalf; I am pretty sure that they will agree. It is a welcome move, but nothing can detract from the fact that we need significant additional funding to make services available to all the people who need them. The problems are in two areas. The issue relating to the NHS and discharges from hospital is very important, but it is not the only issue. Care packages that enable people to live independently in their own homes are essential, but in Liverpool the number of packages has already been drastically reduced from 14,000 to 9,000, and we do not know how much lower the figure will fall.
I was pleased to hear the Minister talk about light and hope—I thought that it was very encouraging—but the first test will be tomorrow in the Budget. I am sure that we will all scrutinise what is said carefully; let us hope that it brings light and hope to the people of Liverpool.
Question put and agreed to.
Resolved,
That this House has considered social care in Liverpool.