Social Care

David Mowat Excerpts

Wednesday 16th November 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

We have had a good debate, with a number of very good speeches from both sides of the House. I will try to respond to the points, or the themes of those points, that have been made.

First, I want to address the accusations, made by Labour Members, of criminal behaviour in relation to the minimum wage not being adhered to. If such evidence exists—I think the hon. Members for Sheffield Central (Paul Blomfield) and for Tooting (Dr Allin-Khan) raised this issue—please bring it to me. I will see that it goes to Her Majesty’s Revenue and Customs. Those involved will be named and shamed. Such behaviour is illegal and is not to be tolerated. I think the hon. Member for Tooting also said she had evidence that a care home or domiciliary supplier was forging attendance sheets. Again, if there is evidence of that I would like it to be brought forward. It should not just be bandied about here in a political way. We should investigate it and we will. If she brings that evidence to me, we will look at it.

One of the big themes in this debate, and one with which Members on both sides of the House can agree, is the importance of carers. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about that and, rightly, about the need for a better career structure and clearer training requirements, a point the Cavendish report also addressed. Some 1.5 million people work in domiciliary and care homes, but—this is a very difficult statistic—the annual turnover is about 25%. That is caused not just by poor pay—I am proud to be part of a Government who have increased the pay of many of these people—but by a lack of career structure and, frankly, of regard, and we need to do more on that. She was right to raise it.

My right hon. Friend the Member for North East Bedfordshire (Alistair Burt) made the important point that, as well as the 1.5 million paid carers, there are 1.1 million unpaid carers. In many ways, these are the unsung heroes of the entire system, and we can all agree we need to do better by them. When he was doing my job, he kicked off the carers’ strategy, which we will be coming forward with. It is a cross-Government initiative and will result in concrete actions to make the 1.1 million-strong unpaid carer cohort better off.

Several people talked about finances and money. Of course they are tight. The Secretary of State made it clear that in the last Parliament, in order to respond to the situation we inherited, there were cuts to local government funding. During the course of this Parliament, there will be a real increase in the rate of adult care funding, but that is not to say we do not understand that the system is under pressure. We understand that, as Simon Stevens said, if more money was available, it would be good if it went into the social care system.

Members on both sides of the House spoke about bed-blocking caused by a lack of money, and about delayed transfers of care, and it is true. Of course there is a correlation between the amount of money in the system and the number of delayed transfers of care, but one of the most extraordinary things about the numbers is that, between the best and worst 10% of local authorities, in terms of the number of DTOCs, the difference is a factor of 20 to 25. That is not just about budgets—budgets are not 20 to 25 times different—it is about leadership; about good people doing good work; about spreading best practice; about shared assessments, early discharge and discharge to assess; and about integration in the widest sense, as my right hon. Friend the Member for North East Bedfordshire said. Those councils, local authorities and health systems that have gone fastest and furthest with integration—the holy grail that the right hon. Member for Leigh (Andy Burnham) talked about—are those at the top end of the DTOC statistics. We should all think about that when we say, “We want more money.” We should all think about the reasons for that difference.

I would make another point about finance. An Opposition Member talked about the GDP equation getting worse in this Parliament. That is not true, but I would just make this point: in 2016, the OECD looked at the money spent on adult social care right across the major economies of Europe, and we in the UK spend about 20% to 25% more than other major industrialised countries such as Germany and France. That is not to say that the system is not under pressure in our country—it clearly is—but the facts are that other countries do a better job in terms of long-term saving, social insurance and some of those types of things. We clearly have an issue with this. Let me repeat that Germany and France, which in the round spend more on the entire health system than we do—about 1% more as a proportion of GDP—spend 25% to 30% less on adult social care. It is critical to spend what we can spend better.

[Andy Burnham]

I hear what the Minister says, but it seems to me that, in common with the Secretary of State, he is avoiding the main issue. The main issue is the urgent financial crisis that councils are facing. They have not got enough money to care for the people who need care. Will the Minister answer a direct question? Has he or the Secretary of State made a submission to the Treasury for more funding for social care as part of the autumn statement—yes or no?

[David Mowat]

We are not having the autumn statement today, and we are not going to give a commentary on what will come out of the autumn statement. We—the Secretary of State and I—have accepted that the care system is under pressure. I was just making the point that other countries spend less, and that we need to spend every penny we can as effectively and as well as we can. During the course of this Parliament, moreover, there will be a real increase in the amount of spending on social care.

[Several hon. Members rose—]

[David Mowat]

Let me make some progress, and I shall give way again later.

Another theme has been closure. Several Members have talked about contracts being handed back, and there is a bit of that going on in both domiciliary care and care homes. Let me put on record the fact that the number of bed places in care and nursing homes is broadly the same as it was five years ago. There has been no reduction. As for domiciliary care providers in the market, the number is now 47% higher than it was five years ago. There has been, rightly, a trend away from care homes to domiciliary care—and we should all welcome that, because people broadly want to spend more time in their own homes. I was asked a good question about the issue of 15 minutes of domiciliary care and what we are doing about the problem. When the CQC is doing its quality reviews, it has a specific question to ascertain whether 15 minutes is the norm, and if so, it would result in a poor quality assessment.

Members have raised broader issues of quality. Let me therefore say that 72% of care homes—a sector that is under a great deal of stress—are good or outstanding. This Government have been the first to do any kind of inspection to find that out. Of course some care homes are inadequate. As the Secretary of State said, inadequate care homes go into special measures and can be closed down after six months. That is the right thing to do, and we should be pleased and proud that that happens.

Also, users of care homes have been asked whether or not they are satisfied, and just under 70% said that they are either extremely satisfied or very satisfied with the level of care provided for them. Members of all parties should come together on this point and thank the people who work in these care homes for the dedicated care and the humanity that they provide.

The former Minister, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is no longer in his place, talked interestingly about the vanguards, the STPs and what we are doing to bring in leading-edge better care models. A lot of work is being done on the STPs, and I heard a couple of Opposition Members say favourable things about their STPs.

The hon. Member for Halton (Derek Twigg) asked me a number of specific questions about his STP. I will probably not have time to answer in detail, but I can say this. His STP and my STP are the same, and it is being published today—[Interruption.] It is certainly not secret, and we should have some dialogue about it. The hon. Gentleman made the point that his council was under pressure, and councils are under pressure. I think we should join together to congratulate both Halton and Warrington Councils on being two of the best performing councils in the country on delayed transfers of care and on increasing their budget.

I finish by—