Health and Social Care Budgets

Ben Bradshaw Excerpts

Tuesday 14th March 2017 Westminster Hall

[Mr Ben Bradshaw (Exeter) (Lab)]

I think there is a consensus in Westminster Hall, informed by multiple Select Committee reports that have highlighted the crisis in our health and social care system. My clinical commissioning group is facing a £40 million deficit. My local hospital, which is one of the best run in the country, is facing a £20 million deficit. It is obvious that that simply is not sustainable.

As other colleagues have pointed out, accident and emergency figures are deteriorating, waiting times are lengthening and there are increasing difficulties in seeing a GP. In Devon, we face controversial plans to close community hospital beds and to close a number of community hospitals completely. That is not an accident; it is the result of seven years of the most stringent restraint on NHS investment in its history, combined with 40% cuts to social care when we have a growing elderly population and increasing demand. The issue was exacerbated by the disastrous Lansley reforms in the Health and Social Care Act 2012—the biggest structural upheaval in the NHS’s history— implemented at the same time as maximum spending restraint.

As well as that organisational upheaval, we face a workforce crisis in health and social care, as the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), pointed out. That has been exacerbated by the uncertainty over Brexit. Until recently, the Government have appeared pretty oblivious to all that. The £2 billion extra in the Budget was welcome, but it is a drop in the ocean compared with the amount of money that is needed.

I welcome the commitment in the Green Paper to look root and branch at a sustainable funding solution for health and social care. I worry, however, that a Green Paper is often a euphemism for kicking an issue into the green grass. I would like to see a policy announcement or a White Paper. As colleagues have pointed out, we have had much cross-party support. One proposal was scuppered in the run-up to the last general election. I worry that to grapple with the issue in the second half of a Parliament is not sensible timing. Governments need to get a grip on the issue at the beginning of a Parliament so that there is maximum time for cross-party working to get something in place. I am not optimistic that the Green Paper will come to a conclusion.

We also need to have an honest conversation with the British public about how we fund health and social care. I share Members’ regret that the Chancellor seems to have ruled out any sort of posthumous levy on people’s estates. We need to look at all options, including the excellent sugar tax that was recommended by our Select Committee. It is already having a dramatic effect in getting drinks manufacturers to reduce the sugar in their products and therefore improve public health.

Finally, we would like the Government to end the uncertainty over EU nationals working here in our health and social care system. They could do that today when the Prime Minister stands up in the House and gives her statement on article 50. That would give a huge boost to morale and end the uncertainty. People are already leaving, and the system is not able to recruit. That workforce crisis will do more damage in the short term than anything else.

--- Later in debate ---

[Mr Dunne]

As I just said, the STPs provide an opportunity for areas to place greater focus on respite care if they consider that to be required.

I would like to touch on the adequacy of the social care funding package. The announcement means that in the next three years councils will have access to some £9.25 billion of more dedicated funding. That includes extra money going to local authorities through the combination of the improved better care fund and the social care precept, which, for those councils introducing it with effect from next month, will raise some £1 billion extra. The £1 billion provided in the Budget and the £1 billion from the precept amount to the £2 billion called for by external sources for the coming year. That funding will allow councils to expand the numbers of people they are able to support and, in turn, address issues at the interface with the NHS such as delayed discharges from hospital, which as we know cause problems with patient flow through the system.

Questions were raised about how the social care funding is to be allocated. I inform colleagues that 90% will be allocated using the improved better care fund formula to local authorities that have responsibility for adult social care. That distribution takes account of the ability to raise money through the council tax precept for social care and means that it is well targeted at areas of greater need and market fragility. However, in recognition of the social care pressures faced by all councils, 10% of the funding will be allocated using the relative needs formula.

The response to the measures from external audiences reflects comments made by hon. Members today: they have been broadly welcomed. Of course, several hon. Members said that it is not enough, but that is a traditional response to any increase in money—it is always easier to say that it is not enough. Hon. Members have generally recognised that the Government have listened to concerns about social funding. Those of us with responsibility for the health service recognise that there has been a particular problem in dealing with delayed discharges from hospital. Through closer working in the sustainability and transformation plans as they are rolled out across the country, with local authorities working more closely with health service providers, we think that the money will provide a lifeline to help to remove some of those pressures and to improve patient flow through our hospitals.

I would like to touch on the medium-term challenge and how in the coming months we can try to use the development of a social care Green Paper to address the longer-term concerns. The Government are committed to establishing a fair and more sustainable basis for funding adult social care in the light of the future demographic challenges that the country faces. We will therefore bring forward proposals to put the state-funded system on a more secure and sustainable long-term footing, setting out plans in a Green Paper. Some hon. Members asked when the Green Paper will be published. If I was in charge of Government timetabling, I would be in a better position to answer. They will not be surprised to hear that I cannot give a definitive answer, but, to use traditional parliamentary language, it would be fair to say that it is expected to be published in the summer.

[Mr Bradshaw]

Will the Minister clarify the Government’s position on the idea of a posthumous levy on estates? The Chancellor ruled that out, yet we read in the newspapers that the Prime Minister slapped him down over that. Are the Government ruling it out or not?

[Mr Dunne]

I will not pre-empt anything in the Green Paper, and it is not for me to give the right hon. Gentleman any comfort on discussions that might or might not have happened around the Budget.

We recognise that the NHS and social care face huge pressures and that there is more for us as a Government to do. However, we can be confident that we have plans in place both to cope with the pressures that we currently face—winter, A&E pressures and delayed discharges—and to sustain the system for the future. We have a long-term plan in place through the “Five Year Forward View” and the efficiency work being undertaken and rolled out progressively this year. We have given extra funding to both the NHS and social care to support those plans, and we have plans to bring forward a Green Paper on social care. I am pleased that that was broadly welcomed and recognised by hon. Members and distinguished parliamentarians in the debate, and I am grateful for that support.