Emily's closing speech:
Emily Thornberry (Islington South and Finsbury) (Lab): I do not believe I have served under your chairmanship before, Mr Brady, and it is a pleasure to do so.
I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate, and on his excellent contribution and the moving examples that he put before us. The truth is that not enough time is spent in the House on this fundamental issue, which is vitally important to many of our constituents; but we have had a very good debate today.
There seem to be two issues here: the structural problems and the cuts. My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) touched on standards of care and on ensuring proper status for social care workers. My hon. Friend the Member for Blaydon (Mr Anderson) made a very important political analysis of the ongoing problems, and my hon. Friend the Member for Nottingham South (Lilian Greenwood) demonstrated her great expertise in this area.
My hon. Friend the Member for Wolverhampton North East (Emma Reynolds) yet again raised the importance of ensuring a long-term solution, and expressed our continued regret that this issue was essentially bombed before the last election by the Conservative party, which decided that it was better to make cheap political points than for us all to work together. I assure the Minister that when the Dilnot commission reports we will not be emulating the behaviour of the Opposition at that time, and that we will approach the matter with an open mind.
We need a fair and sustainable solution, and we want to be able to work together on that. In the end, the issue is more important than party politics, and we must work together not just to find a solution but to implement it.
During the comprehensive spending review, the Government flourished the fact that they were giving an additional £2 billion for social care, but a few months later, local authority budgets were slashed by 8%. Given that social care is top-tier councils’ biggest area of discretionary spending, it was simply inconceivable that it would not be hit.
The Local Government Group and the Association of Directors of Adult Social Services both raised concerns about the implications for social care of the CSR local government settlement, warning that the extra £2 billion was simply not enough to meet demand. They argued that the spending gap during the period was likely to be between £3.5 billion and £4 billion due to increasing demand from our ageing population, which will add another 4% a year to social care costs in upcoming years.
Of course, some efficiency savings can be made, but they will never be enough to meet the shortfall. Personalised budgets and various reforms might be able to save some money, but the Minister should listen to those who know, such as ADASS and the Local Government Group, when they say that they will be billions of pounds short when it comes to social care. In those circumstances, they will not be able to protect the most vulnerable in our society. The much-vaunted £2 billion is simply not enough, especially as it is not ring-fenced. Will the Minister tell us whether the whole £2 billion, half of it or a quarter will be spent on social care? Can he do anything if not all of it is? Furthermore, can he confirm that he does not know whether it will be spent or not?
Not only are the Government cutting back on social care through local authorities under the cloak of localism, they are no longer doing centralised assessment of adult social care provision. In other words, they simply do not know what is going on. It is extraordinary that unprecedented cuts are being made at a time when local authority provision of social care is no longer being monitored, yet the Government steadfastly maintain that there need be no cuts to front-line services.
The Secretary of State for Communities and Local Government said that
“cutting front line jobs and hitting front line services isn’t inevitable—it doesn’t have to be an option at all”,and the Minister said:
“It is wrong to scare people about cuts. The coalition Government has prioritised social care—the spending review announced significant extra funding for social care for each of the next four years, increasing to an extra £2 billion investment in 2014-15…This extra money means no councils need to reduce access to social care”.
It is simply not good enough for the Minister to put his fingers in his ears and sing “La la la.” The truth is that cuts in social care are being made now. Although he might not know about them, I can tell him, because ADASS, the BBC and I have done surveys. Last month, I surveyed directors of adult social care in England and got 61 replies, representing a 40% response. I appreciate the detailed responses by 27 Conservative councils, 29 Labour councils and four Liberal Democrat councils; that was, obviously, before the last local elections. The responses showed that 88% were increasing their charges,16% were increasing eligibility criteria and 7% were considering charging more in the longer term. Many were closing day centres and care homes, 54% were cutting the voluntary sector and a further 24% were considering it for the future.
As predicted by everyone who knows, cuts are happening. Councils have not been able to meet increasing demographic pressure, which ADASS believes amounts to £425 million in 2011-12 alone due to the rising number of older people and people with learning disabilities needing substantial support. The ADASS survey shows that, far from increasing spending to meet rising needs, local authorities in England have cut adult social care spending by £1 billion.
We have heard in this debate about the terrible consequences of cuts to front-line services for the most vulnerable in our community. The fact of the matter is that as a result, an elderly woman might no longer get up at breakfast time but at lunch. She might not have an advocate, but we have a duty to ensure that such people are protected. It is not good enough for the Minister to remain in Whitehall saying that there need be no cuts to front-line services. He must listen to the reality of what is going on. Not to address the funding shortages in local authority social care is reckless and wrong.
Funding cuts also mean that local authorities cannot invest in preventive services, so the cuts being made now will have knock-on effects in the long term. If someone does not have a regular visit—if their shopping is not done for them, or if they are not got up in the morning on time—they are more likely to go downhill faster and to end up in hospital. Some 52% of respondents to my survey said that the cuts adversely affected the development of new preventive services. Services that could reduce the need for long-term care and promote independence are among the first to go, but that only increases the strain on health and social care services in the long run.
It is irresponsible of the Minister to continue to say that no cuts need be made to front-line services. Will he admit that he was wrong not to listen to the warnings and to say that front-line services would not be cut? Will he also admit that efficiency savings alone cannot deliver the huge cuts being forced on local authorities? What is he doing to increase the provision of social care now that he has heard the truth about what is going on?
The holy grail, as we all agree, is integration of social care and health, but the difficulty is that the Government are, on one hand, cutting local authorities extensively and, on the other, taking the health service by the ankles, turning it upside down and shaking it hard. Those are not ideal circumstances for the two bodies to integrate properly. The Bill calls itself the Health and Social Care Bill, but it contains precious little social care. There is a great deal of talk about integration, but words are not enough.
When it released the results of its survey recently, ADASS recommended that, as the Government are pausing to reconsider the Health and Social Care Bill, perhaps they might pause long enough to hear the results of the Dilnot inquiry and radically reconsider their plans for long-term care. If they want to be radical on health and social care, that is the area of need. We do not need the fundamentally misguided Health and Social Care Bill as it is drafted. We do not need competition driven into the heart of the NHS. What we need is co-operation and collaboration. We need health and social care to work more closely together.
If the Government are to pause, let them pause and think about that. Let them pause and ensure that, for example, we can keep the elderly out of hospital for as long as possible by allowing social services to provide proper social care, and that once someone is in hospital, they can get out quickly. That is the only fair way to treat people. Frankly, it also saves a great deal of money. If the Government spent more time, energy and resources on solving such issues and a little less on introducing competition into the national health service, we would all be a lot better off. I know that in his heart, the Minister agrees, but he has unfortunately found himself in the difficult position of having to defend this extraordinarily awful Bill.
I may have argued those points when the Bill was discussed in Committee, and I am glad to hear that ADASS now agrees with me in general. I am also glad to hear that the right hon. Member for Charnwood (Mr Dorrell), never one to allow a bandwagon to pass him by, said that the legislation should be rethought:
“A clear commitment should be written into the Bill to achieve full institutional and managerial integration of the NHS and adult social care in England.”
The Select Committee Chair agrees with us as well.
I ask the Minister to reconsider funding and the reality and to give us an undertaking that he will no longer make false claims that there need be no cuts to front-line services, and that he will do something about the matter. I also ask that the Health and Social Care Bill be worthy of its name, if it is not killed off completely. It needs major change so that social care can be integrated properly into health care. Worthy words are simply not enough to achieve that.