18:57 - The House divided: - Ayes: 181 / Noes: 315 - Question accordingly negatived.
The Secretary of State for Health and Social Care (Matt Hancock)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes that the Government is committed to fixing the crisis in social care; and supports the Government’s commitment to find a long term solution for the growing need for care and commitment to an ambitious three point plan, including extra funding every year, seeking a cross party consensus and ensuring the prerequisite of any solution is a guarantee that no one needing care has to sell their home to pay for it.”
This is a welcome opportunity to debate social care—a subject of vital importance—and I want to set out how we must rise to the challenges and celebrate all that is good. We must recognise at the start of the debate that there is much to celebrate, including the millions of people who work in social care, to whom we pay tribute. I want to welcome someone who is new to working in social care: my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), who has joined the team as Minister for Care. I pay tribute to her predecessor, my hon. Friend the Member for Gosport (Caroline Dinenage), who led the care system so effectively and delivered a legacy of better training, better recruitment and a real focus on carers; that is a legacy to be proud of.
Let me start with the context for this debate. It is rightly about both adults of working age and older adults. The people of this country are living longer. Over the next decade, the population aged 75 and over is set to increase by 1.5 million, and over the next 20 years, the number of people aged 65 and over is set to increase by almost half. That is emphatically a good thing. More people living for longer is not some problem to be managed; it is an opportunity to be welcomed, and welcome it we do.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
My right hon. Friend is right to highlight the significant challenge that an ageing population with multiple medical co-morbidities presents to the health and care system. In that context, it is not just about extra funding, which is obviously welcome to the care system; it is also about transforming the way we deliver care. Is it not time to consider a single point of commissioning for health and social care? If we were designing the system today, given the demographic challenges he has outlined, it would look very different from the system we have.
Matt Hancock
My hon. Friend is right that it is about more than just money. The money is, of course, important, but it is also about how the system is structured. There are parts of the country where the co-commissioning he calls for already exists, and we can see the improvement in efficiency that we get out of that. The hon. Member for Worsley and Eccles South (Barbara Keeley) rightly mentioned those with learning disabilities and autism, of whom there are more than 2,000 in in-patient settings. We are reducing that number and supporting more people to move into the community, including in the example that she mentioned. She talked about the challenge of that requiring more money. Actually, community settings are often better for the patient and cost the taxpayer less. As my hon. Friend says, improving the commissioning and the system is a critical part of the solution, so that yet more people can be moved out of in-patient settings.
Liz Kendall (Leicester West) (Lab)
The Secretary of State talks about transforming care and services so that we focus more on prevention, early intervention and help in the community and at home. That is what we should be doing, so why, as the National Audit Office has just reported, have we seen less money spent on public health, primary care and community care under this Government in the last five years? This Government are obsessed with hospitals, which is not the way that we want to go—it is about care in the community and at home.
Matt Hancock
The hon. Lady is dead right, and I have changed that direction of travel. This year is the first year for a generation when there has been an increase in the proportion of the NHS budget going to primary and community care. That change was at the core of the long-term plan. I insisted on that because I entirely agree with her analysis that getting more support out into the community is critical. This has been going in the wrong direction for a generation, and we are just starting to fix it.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I want to pick the Secretary of State up on the point that he made a few moments ago. We had an exchange at the end of January about life expectancy. He says that life expectancy is increasing. It is absolutely clear from Professor Sir Michael Marmot’s report, and it has been clear since 2017, that life expectancy is stalling. Sir Michael said that
“life expectancy actually fell in the most deprived communities outside London for women and in some regions for men.”
I have written to the Secretary of State and I have not yet had a response, but he has an opportunity to correct the record now.
Matt Hancock
I saw the letter and I absolutely will reply to the hon. Lady. What I have said before, and I repeat now, is that life expectancy in this country is rising. There are parts of the country where that is not true.
Matt Hancock
It is not flat, it is rising, and it is really important that this debate, which is so critical, is based on the facts. The increase in life expectancy should be shared right across the country, and it is not, and we are determined to fix that. We are determined to ensure that life expectancy in this country rises everywhere. That is not the case and it needs to be the case, but life expectancy overall is going up. That is the fact.
Debbie Abrahams
The report says that it has almost ground to a halt since 2011. These are the facts, and there is an onus on the Minister to be absolutely clear about this. We cannot fudge this issue.
Jonathan Ashworth (Leicester South) (Lab/Co-op)
The Secretary of State will have seen Sir Michael Marmot’s report, launched today. Indeed, one of his own departmental officials spoke at the launch, because he could not make it, and said that no one could disagree with the analysis. Sir Michael Marmot says that life expectancy advances are flattening and even going backwards—they are decreasing—for the poorest 10% of women. Is Sir Michael Marmot wrong? Is that what the Secretary of State is saying?
Matt Hancock
No. What I am saying is that life expectancy, as I have repeated, is going up, but there are areas where it is not, and we will and we must tackle that. The challenge for us as a country is not to try to pretend that things are different to the facts. The challenge here, which Opposition Members will not accept, is that there are parts of the country where life expectancy is advancing rapidly and there are parts where it is not, and we must tackle that. We cannot have a decent policy conversation if half of the debate will not accept the facts on the ground.
The Marmot report was published this morning. It is absolutely critical that we level up life expectancy. The fact that in Blackpool a healthy life expectancy for men is 53 years yet in Buckingham it is 68 years is a disgrace, and we will put that right, but you cannot put things right if you ignore the facts when you are starting.
Barbara Keeley
I just want to round this point off. What does the right hon. Gentleman think happens with life expectancy when 1.5 million older people are going without care? Does he not think that the impact of the lack of social care, especially on women in deprived areas, is a key factor?
Matt Hancock
No, I do not recognise those figures because they are not the accurate representation of what is actually happening. There are many within that figure who are judged under legislation to need to pay for their own care, and they do. We have to start from a basis of fact and, frankly, until Labour Members start working on this from a basis of fact, it is very difficult to take their contributions seriously.
The critical thing is that, as life expectancy is increasing, more people are looking forward to ageing in comfort and dignity, and that is good news. Opposition Members may not like it. It is odd; they do not seem to want to think that life expectancy is going up. We have a duty to ensure that our social care system is equal to the task. There are many things we should be proud of in our social care system, although we would not have gathered that from the speech by the hon. Member for Worsley and Eccles South. Some 84% of providers of social care are rated as good or outstanding, and 90% of people who receive care are satisfied with its standard. The proportion of adults with learning disabilities living in their own home or with their family has increased every year since 2014-15. That is good news, which we should welcome.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Is my right hon. Friend not right to say that life expectancy is continuing to go up? We would expect it to slow down, because we are not all going to live forever. The key thing is not just how long we live for; it is how long we live a high-quality, healthy life for.
Matt Hancock
My hon. Friend is absolutely right, and that is the sort of analysis on which we can make decent policy progress, because it based on the facts, rather than on making things up.
Matt Hancock
I will give way to the hon. Lady one more time and then I will move on, because we need to make some progress.
Debbie Abrahams
Again, for the record, let me say, as a former public health consultant, that healthy life expectancy is also going down.
Matt Hancock
I will write to the hon. Lady to give her the facts. Do Members know what the facts will say? The facts show that life expectancy is going up—I think I have made that point. Opposition Members may not like the fact that things are getting better in this country, but we will make sure that we level up, so that things get better in all parts of this country. We welcome progress, but we demand more.
Several hon. Members rose—
Matt Hancock
I am going to make some progress and talk about the long-term solutions we are seeking on social care. For all its many strengths, it is clear that the system cannot remain as it is. Three out of four over-65s will face some care costs in their lifetime, and approximately one in 10 will face lifetime costs of more than £100,000. We need a long-term funding solution, so that the system can continue to do all that we ask of it long into the future. Crucially, we need a solution that solves the problem, commands the widest possible support and stands the test of time. We know in this House that that challenge has been ducked for many years; we have had more than a dozen commissions, reviews and reports, and more than two decades of inaction, from Governments of all political stripes. We do not need another commission —we need a plan. So in our manifesto we set out our three-point plan to solve the crisis, as referred to in our amendment tonight, which I hope the whole House will support.
The first point is to deliver the funding that is needed now to stabilise the system. The funding will provide certainty for local authorities and providers while we put in place the long-term solution. At the last spending round, we said that would make an extra £1.5 billion available in 2020-21. That includes £1 billion of additional grant funding and the 2% adult social care precept, allowing councils access to a further half a billion pounds. Overall, that is part of a 4.4% real-terms increase in local authority core spending in 2021, and that spending comes on top of £2.5 billion in existing social care grants that will be maintained. All in all, our investment since 2015 has allowed an 11% cash-terms rise in social care spending by councils. So the amount of money going into the system is going up, and I am very glad about that, but clearly further progress needs to be made.
Alison McGovern (Wirral South) (Lab)
Will the Secretary of State commit to publishing a distributional analysis of where that money is coming from and who it is going to?
Matt Hancock
The £1 billion comes from general taxation and the half a billion comes from the social care precept, and we have been absolutely clear about that.
The second part of the plan is to recommit to seeking a cross-party solution. In my view, past attempts at reform have not failed for lack of ideas or good will on the part of many people and many policy makers; they have failed because solving this problem is not just a task of policy making, but an act of political economy. The consequences of the decisions on the reform of social care will play out over decades and, as with past reforms—for instance, pension auto-enrolment—this is best done with cross-party support.
Louise Haigh (Sheffield, Heeley) (Lab)
Last year, the hon. Member for Chichester (Gillian Keegan), the right hon. Member for Ashford (Damian Green) and I set up the all-party group on social care. We produced a report on the professionalisation of the workforce, which looked, in particular, at the undervaluing of the wider workforce in pay, training and qualifications. Will the Secretary of State commit to looking at that report, as the basis of his cross-party consensus?
Matt Hancock
Yes, I have. As the hon. Member knows, my hon. Friend the Member for Chichester (Gillian Keegan) was my Parliamentary Private Secretary, and we talked about this a lot, so I welcome that work. Indeed, the amount of work from various Select Committees and groups in this House has been considerable, as my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) made clear earlier. There has been an awful lot of reports and of very good work, including the work to which the hon. Member has contributed.
Barbara Keeley
The right hon. Member knows that I raised with him on the day of the first Queen’s Speech, in October last year, the need for us to set up cross-party talks. He has done nothing about that since then—nothing has happened on that. There was some vague talk about sitting down with the former Minister for Care for a cup of tea, but that is not cross-party talks. Will he say now: is he going to set up cross-party talks?
Matt Hancock
We will fulfil all the commitments in the manifesto, which, as the hon. Member set out, includes one on this subject, and that is part of our plan.
Sir Desmond Swayne (New Forest West) (Con)
We have been talking for some time. Indeed, we legislated: we decided to legislate for Dilnot. Can the Secretary of State take us through why we resiled from that position?
Matt Hancock
The honest truth is that that decision was made in the 2015-17 Parliament, and it was a decision the Government made at the time. I think that we need to take action to solve this problem, and that is what we are planning to do. The third part of the plan—[Interruption.] Well, I am halfway through explaining the plan.
The third part of the plan is to seek a solution that brings dignity and security to all those who need social care, with a system in which nobody needing care is forced to sell their home to pay for it. Such a solution would go against one of the most basic human impulses, which is the drive to provide for one’s family. We want to encourage people to save and we want to reward them for the fruits of their endeavours. As we said in our manifesto, we want to guarantee that
“nobody needing care should be forced to sell their home to pay for it.”
We are determined to tackle this challenge in this Parliament, and to bring forward these reforms.
Fixing the funding, as my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said, is only half of the equation, and the other half needs attention, too. We should be helping more people to live at home for longer; finding a cure for dementia, because we refuse to accept that dementia is an inevitable part of ageing; and harnessing technology to improve care. The stereotype of social care as a kind of digital backwater is increasingly out of date; there are many examples of brilliant social care organisations, public and private, using wearables and new technology to support the round-the-clock care that they give. We should also be breaking down the silos between health and social care. We will always support our carers, both paid and unpaid alike.
Huw Merriman (Bexhill and Battle) (Con)
In the 1990s, the Germans were grappling with exactly the same problem we are grappling with now, with regional imbalances, a postcode lottery in funding and a lack of a cohesive social offer. They came up with social care insurance—there was cross-party consensus, and it is now not a political issue—and it works. Will the Secretary of State look at that model?
Matt Hancock
That is the sort of contribution I think we need in this debate. We should not be saying, “We have one answer, and we won’t engage on anything else”, but saying, “Here is an interesting answer, and let’s solve it.” We are committed to solving it in this Parliament. We will not duck the difficult decisions, we will take the action that is needed and we will secure the future of social care in this country. As we are increasingly an older society, let us also be a wiser society, and commit to fixing this problem once and for all.
The Minister for Care (Helen Whately)
I am delighted to be here at the Dispatch Box as Minister for Care. I thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his welcome, if not for everything else he said. I hope we will be able to work together on fixing social care.
I am aware that my new job comes with great responsibility. I am mindful of the many thousands of people who rely on social care and of all the challenges in our current care system, but with that responsibility comes an opportunity to take forward changes that we know are so desperately needed now and for the future.
Before I say any more, I pay tribute to the countless carers, social workers, nurses, friends and family members who care for people in this country. Their dedication means that so many people who need help receive it. Our social care system is utterly dependent on their skills, compassion and hard work.
Robert Largan (High Peak) (Con)
The Minister is generous in giving way.
I visited Goyt Valley House care home in New Mills on Friday and saw at first hand the amazing work done by the staff. I spoke to the relatives and residents and learned just how important the care home is. Unfortunately, its future is currently in doubt. May I invite the Minister to come and visit New Mills and see the care home for herself?
Helen Whately
I have already visited two care homes since becoming Minister for Care, and I want to visit many more. I hope I will be able to take up my hon. Friend’s invitation and see that good work for myself.
I pay tribute to my predecessor as Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage). I hear that she was visiting a hospice on reshuffle day—her actions illustrate the enormous commitment and compassion she brought to this role. I sincerely hope to follow in her footsteps.
I also thank all the hon. Members who have spoken today. Social care is important to many thousands of our constituents, and their interest and input are incredibly valuable.
Mr Perkins
I welcome the Minister to her post, and I welcome what she says about carers. Would it not be wonderful if, rather than just giving them her warm words, support and admiration, she were able to join a cross-party campaign to see that carers get paid more than burger flippers in McDonald’s so that we actually start recognising them with the same prestige as nurses and the same earnings as people in our health service?
Helen Whately
I thank the hon. Gentleman for his suggestion. It is almost as if he has seen my notes.
One thing I particularly welcome is the number of hon. Members on both sides of the House who spoke about the importance of careworkers, who provide such important care.
My hon. Friend the Member for Peterborough (Paul Bristow) mentioned that both his parents were nurses in the care sector. He drew on his knowledge of care and rightly said that the profession should be held in higher esteem and that, just as we hugely value NHS staff, we should hugely value careworkers. The hon. Members for Warrington North (Charlotte Nichols), for Blaydon (Liz Twist), for Dulwich and West Norwood (Helen Hayes), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker) and my hon. Friend the Member for Bury North (James Daly) spoke along the same lines, and I could not agree more.
Not long after I became the Member of Parliament for Faversham and Mid Kent, I joined a careworker, Kim, on her daily round. By the time I met her at 7.30 am, she had already started washing her first client. By lunch time, she had washed, dressed, fed, medicated and chatted with six or seven men and women. Some of them were grateful and some of them, quite honestly, were not grateful, but they were all utterly reliant on her care. That experience really brought home to me the skill, knowledge and compassion of our social care workers. For those who need help, there are amazing carers with hearts of gold, like Kim.
Our care system depends on an extraordinary workforce of capable and compassionate carers, but we need more people to choose care as a career. That means changing the perception of being a care worker. As a society, we must truly recognise the importance of the work. We must make sure that more people realise the range of jobs in care and the opportunities for progression. The Government are currently investing in an adult social care recruitment campaign with the strapline “When you care, every day makes a difference”. We are working with Skills for Care to support workforce development and there is funding for a workforce development fund. That is really important, but we know that we must go further in making sure that we truly value the important work that the care sector does and to make sure that the care profession attracts the workforce that we need and gives them the opportunities to lead a truly fulfilling career.
Several Members rightly talked about unpaid carers, who also provide so much vital care. We fully recognise the value of that work and know the importance of support for those people who do so much caring. That is one reason why the Government will introduce a statutory right to leave from work for one week a year for the 5 million people who juggle work alongside being an unpaid carer.
My hon. Friend the Member for Bury North talked about quality of care, and it was really important to hear that mentioned as part of the debate. He spoke about how good care is in his constituency, and he is absolutely right that we should talk about how good care is throughout England. Some 84% of adult social care providers are currently rated good or outstanding by the CQC. Let us recognise the high quality of care.
My hon. Friend also spoke about the importance of integration—of the NHS, local authorities and care providers working together—as did my right hon. Friend the Member for Ashford (Damian Green), who is knowledgeable on this subject. The interplay between the NHS and social care is critical. The better care fund and the improved better care fund are a success story in respect of enabling more co-operation between the systems. It is crucial that we continue to build on that success so that our care system meets the needs of the individual, not just of the system.
My hon. Friend the Member for Watford (Dean Russell) made some excellent points about how, paradoxically, we can use technology to help to achieve more human and more personal care for a more cohesive and effective care system.
Both my hon. Friend the Member for Thurrock (Jackie Doyle-Price) and the shadow Minister for Care, the hon. Member for Worsley and Eccles South (Barbara Keeley), mentioned those with learning disabilities and autism who are being cared for in in-patient settings. I am new to this job, but I absolutely appreciate the importance of making sure that we do better in this regard. People should be cared for in the best place for their needs. At the end of last month, the number of those in in-patient settings had been reduced by 24% compared with 2015—
Helen Whately
The shadow Minister is shaking her head; I know that there is more to do.
At times this has been a heated debate, but I heard on both sides truly constructive suggestions for how we can solve our social care challenges. That gives me much hope for cross-party consensus. I heard suggestions from my hon. Friends the Members for Newton Abbot (Anne Marie Morris) and for Meon Valley (Mrs Drummond), my right hon. Friend the Member for Ashford, the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Bexhill and Battle (Huw Merriman), whom I thank for his kind words welcoming me to my job. He set the bar high for me to meet.
I am fully aware of the challenges that face our care system and I have no illusions as to the scale of the challenge facing us. In the next 10 years, we expect the number of people over 75 to go up by 1.5 million, and the number of people under 65 with care needs is growing, too. We have a system that is under pressure and the demands are only going to grow.
Liz Kendall
In the spirit of being constructive, let me mention, as I did during my speech, the huge and rising pressures on social care. There are 120,000 vacancies here and now. We need more than half a million care workers in a decade’s time just to keep up with rising demand—that is not to improve the system, but just to keep pace with demand. The proposed points-based system of immigration will be catastrophic for social care. Will the Minister meet me and others who work in this area to explore the potential for a separate route into social care, so that we can avoid further pressure and worse care for the people for whom we love and care?
Helen Whately
What I would like to emphasise in response to the hon. Lady’s point is the importance of our recognising, valuing and making sure that social care is an attractive career. In that way, those who are already working in social care will continue to work in social care. It will be for us to build the workforce that we need for the future.
Helen Whately
I am conscious of time, so I must now come to my conclusion.
We all bring our experiences to our work, and, as I conclude this debate, I want to mention one of mine. When my grandmother was 100 years old, she was admitted to hospital and she stayed there for five months. She was signed off as ready to leave numerous times, but each time the failure to find a care package delayed her discharge, during which time she would acquire an infection, further delaying her discharge. She was eventually discharged, but only in time for her to die—thankfully, peacefully at home. This is a cycle with which too many people are familiar, and it means that our hospitals are looking after people who would be better off at home.
As I have said, I am under no illusions about the challenges that we face in social care. The problem that I have just described is nothing new, but let us be the generation that solves it. That is a commitment that we as a Government have made. We will fix the crisis in social care. We will deliver the funding that is needed now to stabilise the system. We will find a long-term solution to the growing need for care and seek to build a cross-party consensus on this. We are committed to the view that the prerequisite of that solution is that no one needing care will have to sell their home to pay for that care.
We will not be supporting the Opposition’s motion tonight, but where I think we can all agree is on the importance and the urgency of reform of social care. As we bring forward those plans, I look forward to working with colleagues from all parts of this House. Just as we had a consensus in the 1940s on the NHS, the time has now come for a new consensus on social care. Let us be the generation that works together and makes our care system work for all those who so badly need it.
Question put (Standing Order No. 31(2)), That the original words stand part of the question.