Social Care Funding

Matt Hancock Excerpts

Wednesday 17th October 2018 Commons Chamber

[Barbara Keeley]

The hon. Gentleman asked me the same question six months ago, on our last Opposition day debate on this subject, and I will give him the answer I gave him then: he should really be trying to influence his own party. I thank those Committees for the work they did, as the Prime Minister did today. Labour has got as far as producing a White Paper—not a Green Paper. We have a 2010 White Paper, and I have a copy with me. I recommend that Conservative Members who keep asking about this look at the extensive proposals in that White Paper, which followed a Green Paper and an extensive consultation. The party being left behind is the Conservative party.

[The Secretary of State for Health and Social Care (Matt Hancock)]

For the information of the House, will the hon. Lady answer the question from my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake)? Does she support the measures recommended by the Select Committees—yes or no?

--- Later in debate ---

[The Secretary of State for Health and Social Care (Matt Hancock)]

Each and every one of us in this House recognises and values those who care, from care workers to nurses to the millions of unpaid carers who look after loved ones. I think the whole House can unite behind the statement that how we care for the most vulnerable is a mark of our civility as a society. Across our country, in our NHS and in our care homes, so many people dedicate their lives to caring for others. I want to address the pressures we face in our social care system in the short term, as well as the long-term reforms we must take to ensure that our social care system is sustainable and fit for the future.

Right at the start, I want to address the individual case of Bethany, which the hon. Member for Worsley and Eccles South (Barbara Keeley) rightly raised. On seeing the reports of the case in the media, I immediately asked for an investigation inside the Department, along with NHS England and the Care Quality Commission. This is clearly a distressing case—it was initially brought to my attention by Ian Birrell—and we will get to the bottom of it. More broadly, the number of in-patients is now down to 2,375, a fall of 17% from March 2015, including 600 who had previously been in hospital for five years or more. So there has been some progress, but there is clearly more to do and the hon. Lady was right to raise the issue.

[Barbara Keeley]

I gave the House a statistic of 2,600. Bethany’s dad, who is campaigning on her behalf, wants to see her in a proper community placement, but there are thousands of Bethanys. This is a serious matter. We had a debate here on transforming care a few months ago, but very little has happened since.

[Matt Hancock]

As I said, progress has been made. There has been a reduction of 17% in the number of in-patients—down from 2,875 in March 2015 to 2,375 on the latest figures—but I would fully acknowledge that there is more to do and I am determined to see that happen.

Our population is ageing. More people are living longer and, as a society, we must address the challenge that that creates for social care. To put that into context, over the next 25 years, the number of people aged 75 and over is set to double and the number of people aged 85 will rise by more still. Of course, this is good news. It is down in part to the hard work of our NHS. Cancer survival rates are at a record high and strokes are down by a third, but with such successes come new challenges. For instance, we are seeing a rise in dementia and in age-related conditions, with 70% of people in residential care homes now suffering with dementia.

[Debbie Abrahams]

Will the Secretary of State agree to support a dedicated dementia fund, as proposed by the Alzheimer’s Society, to recognise the inequity given the additional care costs that such people would be paying?

[Matt Hancock]

I have seen that proposal from the Alzheimer’s Society and we are looking at it now. At the same time, we are working on both the Green Paper for the future of social care, which will come before the end of the year, and the long-term plan for the future of the NHS. The interaction between the two is important.

[Andrew Selous (South West Bedfordshire) (Con)]

Does the Secretary of State accept that there is actually a lot of support on the Government Benches, the Opposition Benches and, indeed, across the country for the Joint Select Committee’s proposals. The concept is that, if everyone who can afford it pays something, that means that no one has to lose everything, and that is not only worth while, but urgent.

[Matt Hancock]

I will come on to the proposed funding reforms. My hon. Friend is right that there is support for reform across the House, but there is support for different types of reform in different parts of the House. I respect the shadow Opposition spokeswoman, but it would help if she could bring more clarity to the Opposition’s position, updating the proposal that they put forward in 2010, which I will come on to in some detail. That will help if they want to genuinely contribute to this debate.

Of course, social care is not only a challenge of old age. The number of people of working age with care needs is also growing. Many of us in this House will know the pain and difficulty of helping a loved one who needs constant care or faces dementia. Such pressures bring long-term challenges, and we must ensure that both the NHS and our social care system can respond to the challenges we face.

[Janet Daby (Lewisham East) (Lab)]

There is an acute nursing shortage in this country. According to the CQC, nursing homes may need to re-register as residential homes, possibly due to the difficulty in recruiting enough nurses, which would have disastrous consequences for some of the country’s most vulnerable old people. With the looming prospect that Brexit will further restrict our ability to recruit nurses from Europe with the necessary skills and talent, does the Secretary of State agree that he needs to do everything he can to ensure that the nursing home sector does not collapse?

--- Later in debate ---

[Matt Hancock]

There are more nurses on our wards than in 2010, but it is important that we have more in the future, and a whole run of work is going on to ensure that we can get more nurses right across the NHS and the social care system, including community nurses. As we put £20 billion extra into the NHS, we are going to need more nurses as a result. The nursing associate route is now available in social care, and there is a policy programme to try to ensure that we answer the exact question that the hon. Lady rightly identifies.

[Damian Green (Ashford) (Con)]

In the light of what my right hon. Friend just said about the long-term nature of the challenges, may I put to him the question that the Chair of the Health and Social Care Committee put to the Opposition spokeswoman? Does my right hon. Friend agree that the only way to get a decent long-term solution for all the people who will need social care is by doing so on a cross-party basis with a wide degree of consensus?

[Matt Hancock]

I pay tribute to my right hon. Friend’s work in this area. He is incredibly thoughtful and has been prepared to ask some of the difficult questions and give his answers to them. I agree that this is something that we should take forward on a cross-party basis wherever possible. I will come on to the long-term funding in a moment, but I just want to address directly the question of short-term funding.

I query the Labour party’s motion because 80% of local authority funding was reliant on the central Government grant in 2010, and that is no longer the case. Looking only at the central Government grant is an inaccurate way of assessing the question. For instance, we introduced the social care precept directly to address some of these costs. It would be far better if this debate took place in the context of the available budget for social care, which is increasing by 8% in real terms over the four years from 2015-16 to 2019-20. The debate should be based on facts rather than partial facts, and that is how I will seek to proceed.

Quality is important, too, and 83% of adult social care settings are now rated good or outstanding by the CQC. The figure has risen from 79% in just the last year, and it is the highest since measurement started in 2014, but I want to see it rise further still.

The links between the social care system and the NHS are important, too. No one should stay in hospital longer than necessary.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My right hon. Friend is right to highlight the link between healthcare and social care. If we are to care properly for people with the long-term conditions he has outlined, we need to have a more joined up and integrated system. It is hard to deliver that when we have a taxpayer-funded NHS and a social care system in which many people now have to pay for their own care. In looking for a cross-party solution, which he is open to, will he consider that we may need to look at a taxpayer-funded solution for funding social care so that we can deliver the transformative integrated care we want for older people?

[Matt Hancock]

Part of the social care system is, of course, tax payer-funded, but I also value the contributions that people make to social care. They are an important part of keeping the system strong. We dismiss those contributions at our peril, but I agree with my hon. Friend that we need to make sure we get more funding and better integration between the healthcare and social care systems. We can do that with different funding sources, as long as we have better organisation on the ground.

We must make sure we have the appropriate amount of care available so that people can leave hospital at the right time; people should not have to stay in hospital longer than necessary, as it reduces their dignity and quality of life and leads to poorer health outcomes, as well as putting unnecessary pressure on the NHS.

Since February 2017, more than 1,900 beds have been freed up in hospitals by reducing NHS and social care delays, yet we know that the winter months bring increasing pressure on adult social care services, which can have a knock-on impact on hospitals. On top of the rising social care budget, we are providing an additional £240 million for adult social care capacity this winter, which will help councils to get patients home quicker and free up hospital beds for more urgent and acute cases.

Today I have published the allocation for every local authority in England, and the Barnett formula will apply to allocations in Scotland, Wales and Northern Ireland. Individual allocations include, for example, £1.3 million in Salford and £1.5 million in Leicester.

[Julian Knight (Solihull) (Con)]

My constituents and my local council are thankful for the funding increase of £870,356, which will help the adult social care situation in Solihull. We have a lot of people over the age of 65, including 40% of the Silhill ward alone.

[Matt Hancock]

I am grateful for my hon. Friend’s work in making the case for more support for adult social care in Solihull, and to support the NHS in Solihull through that. I hope the funding we have announced today will help in Solihull, and the people of Solihull should know they have an excellent champion who has helped them to get that funding.

[Rachael Maskell (York Central) (Lab/Co-op)]

To address delayed discharges, it is crucial that we have transitional care and extra care in place. Will the Secretary of State look at York’s proposal for building facilities on an adjacent site to make that happen?

[Matt Hancock]

That is an interesting proposal, and I have seen others similar to it. We are looking at the link with housing as part of the Green Paper, and I have been discussing that with the Department concerned. The point the hon. Lady raises is important. I note that £731,800 has been allocated today to improved adult social care in York, to take the pressure off the NHS in York this winter. I hope that she will acknowledge that fact.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

In Scotland, like in England, Wales and Northern Ireland, we have seen unbearable cuts to councils, which have made the problems of funding social care get worse. Does the Secretary of State agree that the Tories and the Scottish National party have to get a grip of the situation and give the councils more resources? They have given out figures for the Barnett formula. What is Scotland actually getting?

[Matt Hancock]

Through the Barnett formula, we have made available funding for Scotland today, which in England we are spending on adult social care. I very much hope the SNP Government in Holyrood will make sure they do the right thing by this funding and ensure that it goes to helping people get out of hospital when they medically can leave hospital but need care once they get out. I think we are agreed between us that the SNP Government in Holyrood should spend this money wisely.

[Melanie Onn]

I am keen to learn how much extra my constituency is getting, given that the Secretary of State is doing a roll call of all that. I also wish to ask him about the comments he made about the streams of funding for social care and healthcare. Is he proposing that funding would be ring-fenced? There is a concern that when we try to integrate the two, urgent healthcare will always come before social care.

[Matt Hancock]

That need not necessarily be the case. It was slightly disappointing that the hon. Lady, who is normally a great champion of cross-party working, did not welcome the £780,000 extra for Grimsby, but you can’t win them all. The people of Grimsby need to know that we are there to support them and to support their local NHS.

I now turn to the long-term funding pressures. The lifetime care costs of a 65-year-old today are about £45,000 on average, but those total average costs that people face are not distributed evenly. Some people face no care costs at all, whereas the care costs for someone with dementia who lives into their 90s can run into hundreds of thousands of pounds. As a society, that is the challenge we face, yet right now there is no way to predict or insure this potential financial burden. We are committed to ensuring that everyone has access to the care and support they need. However, as has always been the case, that must be based on the principle of shared responsibility. With sensible planning, people should not have to fear the risk of losing everything. The adult social care Green Paper, which will be published later this year, will bring forward a range of ideas to address the long-term challenge. We want to learn from what has been proven to work, with one example being the auto-enrolment pension reforms, which have been taken forward on a cross-party basis over a decade. The rate of opting out has been remarkably low, and this has put in place the foundations for the strengthening of our pensions system over time. The Green Paper will propose a range of options and ideas, learning from both the UK and from around the world.

[Andrew Lewer (Northampton South) (Con)]

The Secretary of State has said that he wants this debate to be based on fact, not partial fact, so may I have his assurance that research behind the Green Paper has taken full account of overseas options, which provide insurance models and choice, taking us well beyond these simplistic more tax solutions to address this complex problem?

--- Later in debate ---

[Matt Hancock]

Yes; I enjoyed reading that report on my summer holidays and thought the research that underpinned it was very interesting. Of course, the taxpayer does contribute to the system, but we cannot rely only on the taxpayer to support the growing cost. Some people propose the answer that the taxpayer should simply fund everything, but I do not think that that is a valid solution.

Alongside the reforms to the funding, we need to transform our care system, so we will look into how the Government can support innovation and encourage new models of care provision. That will include looking at the role of housing and how we can replicate the very best models that combine a home with quality of care. For instance, I love the examples of combing care provision for the young and the old. I pay tribute to the doctors behind the “Old People’s Home for 4 Year Olds” project, which is good viewing on Channel 4. We also need to better support people through well-designed aids and adaptations, and we must ensure better support for carers, too.

[Kevin Hollinrake]

The Secretary of State is making some good points, but may I press him on the point made by my hon. Friend the Member for Northampton South (Andrew Lewer) about the social insurance recommendation in the Select Committee report? The shadow Minister refused to confirm whether she would consider the findings in that report; will the Secretary of State agree at least to consider the proposals and recommendations that were delivered on a unanimous cross-party basis?

[Matt Hancock]

Yes, absolutely. I am considering them. In fact, I shall go further and say that I am attracted to the insurance and contribution model. There are many different potential details in how such a model can be delivered, but I am very much taking that Select Committee report into consideration as we draft the Green Paper.

Alongside ensuring that the funding is in place, we need to make sure that we support carers. In June, we published the carers action plan, a two-year package of support for carers to ensure that they are properly recognised, helped and valued in a way that supports their health and wellbeing. The Green Paper will go further and propose how society can strengthen support for carers as a vital part of a sustainable health and social care system.

The guiding principles behind the Green Paper will be sevenfold: first, improving the quality and safety of care; secondly, integrated care, with the NHS and social care systems operating as one; thirdly, giving the highest possible control to those receiving support; fourthly, better practical support for families and carers; fifthly, a sustainable funding model supported by a diverse, vibrant and stable market; sixthly, greater security for those born with care needs or who develop those needs in later life; and seventhly, a valued NHS and social care workforce. Those will be the principles behind the Green Paper, and I hope that we can build cross-party support for it.

As a society, we need to rise to the unprecedented social care challenge that our generation faces. For the sake of future generations, we must act now to build a better and more sustainable social care system, in the short term and the long term, that ensures that people are properly valued: a system both for those in need of care and for their carers, a system that supports carers—not only those who work in care homes but those who care for loved ones at home—and with the goal of building a sustainable health and social care system of which we can all be proud.

[Several hon. Members rose—]