Health and Social Care

Kate Green Excerpts

Monday 13th May 2013 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I, too, want to talk about social care. First, however, let me reinforce the comments made by my right hon. and hon. Friends about the announcement on compensation for sufferers of mesothelioma. That devastating illness affects a number of families in my constituency, as well as many workers in Trafford Park over many decades. Work was begun by Labour on a system of compensation for asbestos-related illness where employers and insurers cannot be traced, and we now at last have a proposal from the Government although it is disappointingly limited in its reach.

The proposed scheme will apply only to diagnoses made after 2012, and it completely misses half the victims of asbestos-related cancers because it is limited to mesothelioma sufferers and a cap is imposed on the level of payments. The deal favours insurance companies; it is not good enough for victims or for the public purse because many sufferers will continue to rely on payments from the Department for Work and Pensions as they will not be eligible for the compensation scheme. Although the proposals in the Queen’s Speech for a system of compensation are welcome, I hope we will be able to improve the legislation as the Mesothelioma Bill passes through the House.

On social care, everyone agrees that people would prefer to be cared for in their own home for as long as possible, but community-based provision must be in place for that to happen. As many right hon. and hon. Members have said, a lack of community provision is placing excessive strain on the NHS with regard to A and E and bed blocking, and my local authority in Trafford has received repeated reports that a lack of access to rehabilitation, physiotherapy, speech and language therapies—for example, after a stroke—and to support and care packages means that it is often impossible to discharge someone, even when they are medically fit to go home. That backdrop is of particular concern at a time when a significant reconfiguration of our national health service is being proposed in Trafford. There must be real concern about a squeeze on NHS services when community provision is not in place.

I am pleased that the Secretary of State has recognised the need for a single named professional to have oversight of an individual’s health and social care needs, but the fragmentation and contracting of NHS services does not help. Competition works against the integration of primary, secondary, tertiary and social care and, as many colleagues have said, cuts to local authority budgets are having a massive effect. Trafford is cutting nearly £3 million this year from social care budgets, which means cuts to day services, for example, or increased costs for meals. Curiously, the local authority intends to achieve a large part of those savings through the introduction of personalised budgets, which we understood were not intended as a savings measure.

Families want to help and keep loved ones at home, but they are under great pressure and rely particularly on day services and respite care. They tell me that assembling a personal package is complex. One constituent —a highly resourceful and articulate businessman—told me of his struggle to use a personalised budget to assemble a care package for his partner. He called seven potential providers, but most could not cope with assembling the package she needed to meet her complex needs. If my constituent could not put together that package, how—as he rightly asked me—will the more marginalised and excluded manage? He pointed to the importance of decent brokerage services, yet at the same time we are seeing cuts to advocacy services. There is already evidence that personalised budgets do not work so well for elderly people or those without family and friends to help.

It is not clear what the long-term effects of spreading personal budgets will be, but they could lead to further fragmentation of services or exacerbate inequalities. For example, there is evidence of a lack of cultural awareness among brokers and providers, and the complexity of putting together a personal care package may leave the most excluded even further behind. I invite Ministers to tell the House what steps they will take to monitor the impact of personal budgets on inequality and outcomes for the elderly and most vulnerable.

[Norman Lamb]

rose—

[Kate Green]

I am pleased the Minister is seeking to intervene.

[Norman Lamb]

Does the hon. Lady accept that there has sometimes also been a lack of cultural awareness in the traditional way of delivering services when people make assumptions about someone’s care needs and the right way to deliver them? Putting the individual in charge and letting them determine their priorities gives us a better chance of getting it right and meeting the cultural choices that are so important to people.

[Kate Green]

I accept what the Minister is saying but evidence suggests that for certain more disadvantaged and vulnerable individuals, articulating those needs is very difficult and so culturally appropriate advocacy, representation and brokerage services will be of huge significance. Evidence from research carried out so far suggests that the effects of personal budgets are patchy. I am sure the Minister will wish to raise standards across the board, and I look forward to the further work that we—collectively and with local authority colleagues—can do to ensure that that is the case.

Work force issues relating to social care are also a concern. As others have pointed out, many of those working in social care earn the national minimum wage and contract pressures mean that they have little time to do more than rush in and out of appointments and provide the basic physical care that clients need. There is little time to stop for a chat or a cup of tea, or for some of the social interaction that is so valued by those in receipt of social care. Many providers have told me they are anxious and that they are being screwed down on pricing as a result of local authority spending pressures, which could lead to their contracts becoming unviable. Poor levels of pay— as my hon. Friend the Member for Bridgend (Mrs Moon) said, staff are often not paid as they move from one appointment to the next—mean that they will not be motivated to provide the best care in those circumstances, and some will be forced to give up their jobs.

Finally, I welcome the development of extra care for those in need of residential care, and some good projects are under development in Trafford. I hope the proposed development in Old Trafford will receive approval. As colleagues have pointed out, the Dilnot recommendations, as taken forward in a more limited form by the Government, will leave many families in my constituency with substantial costs but without liquid savings with which to meet them, meaning they are still likely to be forced to consider the sale of the family home.

Overall, the Queen’s Speech needed a much bolder approach to prepare us for an ageing society, including policies for maximising saving in working age—difficult when the Government are putting family budgets under such pressure—and a bolder approach that looks at combining health and social care budgets, investment in primary and community health provision to keep people out of hospital longer, integration over competition, personalisation accompanied by a service investment programme, and serious attention to work force development. I regret the many missed opportunities in those areas in the Queen’s Speech.