1. [endif]Budget
In the Spring Budget 2017, on Wednesday 8th March, Chancellor of the Exchequer Phillip Hammond announced new measures to ease pressure on the social care sector. £2bn will be allocated to social care, over the next 3 years, with £1bn made available in 2017/18. The new funds will be delivered to local authorities and aligned with the Better Care Fund, with 90 per cent of the new funding to be allocated using the improved Better Care Fund method and 10 per cent using the relative needs formula for adult social care. The Government also promised to introduce a Green Paper in the summer, to outline measures to address the long term funding and sustainability of the sector.
Care England has welcomed the Chancellor’s announcement that the Government will introduce a Green Paper on the long term funding of social care, but has warned that this must be followed by action.
Professor Martin Green OBE Chief Executive for Care England says: “The Chancellor’s Spring Budget has quite rightly acknowledged the precarious state of adult social care. Whilst the £2 billion additional funding over three years for adult social care is welcome, it will only be an efficient use of tax payers money should the Green Paper on Adult Social Care deliver the reforms that are necessary to put the system on a stable footing”.
[if !supportLists]2. [endif]Statements
Immigration: on 16 March Robert Goodwill, Home Office Minister, gave the following statement to the House of Commons: “My Rt Hon Friend the Home Secretary is today laying before the House a Statement of Changes in Immigration Rules [HC 1078].
The changes include a new requirement that individuals over the age of 18, who are applying for entry clearance under the Tier 2 General route to work in education, health and social care sectors must provide a criminal record certificate from any country in which they have lived for 12 months or more in the previous ten years. This requirement will also apply to the partner of the applicant and a partner applying to join existing Tier 2 migrant in one of these work sectors.
This is the second stage in a phased implementation of the requirement. It currently applies to individuals over 18 applying for entry clearance under Tier 1 to come to the UK as entrepreneurs or investors, and their adult dependents. The Home Office will continue to monitor implementation with a view to extending the requirement to other migrants in the future.
On 24 March 2016 the Government announced two phases of reforms to Tier 2, following a review by the independent Migration Advisory Committee. The first phase was implemented on 24 November and the changes being laid today implement the second phase of the announced reforms. The changes also update the codes of practice relating to skilled workers, and make other minor updates to the rules for work routes.
Further changes are being made to amend or clarify other provisions in the Immigration Rules.
[if !supportLists]3. [endif]Parliamentary Questions
Precept: on 7 March James Cartlidge MP (Con) South Suffolk tabled a question asking what plans the CLG had to audit local authorities to assess what proportion of funding raised specifically through the social care precept was spent on frontline social care. Marcus Jones MP, CLG Minister said “The Government is keen to ensure that any money raised by councils using the new flexibility is spent on adult social care. We were clear about this in the consultation document to the provisional Local Government Finance Settlement which was published 15 December which states:
“To ensure that councils are using income from the precept for adult social care, councils will be required to publish a description of their plans, including changing levels of spend on adult social care and other services. This must be signed off by the Chief Finance Officer (section 151 officer). Councils wishing to use the extra freedom to raise their precept by 3 per cent instead of 2 per cent in 2017-18 must also show how they plan to use this extra money to improve social care.”
Councils have also been required to publish their returns concerning the social care precept on their websites to ensure local accountability”.
Dementia: on 7 March Julie Elliott MP (Lab) Sunderland Central, asked what steps the DH was taking to ensure that there was adequate funding for social care for people with dementia. David Mowat MP, Care Minister, said that the Government was committed to implementing the PM’s Challenge on Dementia 2020 and he outlined the ‘new’ monies for local authorities to use for social care.
Sleep Ins: on 8 March Dr Tania Mathias MP (Con) Twickenham asked whether the Government would encourage HMRC not to pursue back dated tax which predates the guidance issued on the NMW and sleep in payments. In response Margot James, Parliamentary Under-Secretary of State BEIS said there were currently no plans to issue a direction requiring HMRC not to pursue care providers for arrears of pay or penalties relating to periods that pre date amended Government guidance.
Social Care Expenditure: on 8 March Luciana Berger MP (Lab) Liverpool, Wavertree enquired about the proportion of GDP spend on social care and where the UK was ranked among other countries in the EU. In response David Mowat MP, Care Minister, said: Public spending on adult social care as proportion of gross domestic product spent was approximately 1.1% in 2010/11, and approximately 1% for each year between 2011/12 and 2015/16”. He gave the following table:
PQ66474 attached table (Excel SpreadSheet, 151.5 KB)
Care Homes in Ilford: on 8 March Wes Streeting MP (Lab) Ilford North asked enquired about the proportion of care homes in Ilford North and their CQC ratings. In response David Mowat MP, Care Minister, gave the following information from CQC:
Care home1 locations in Ilford North Parliamentary Constituency latest overall ratings as at 6 March 2017
Number of Rated Care Homes, by Status and Latest Overall Rating
Number of Rated Care Homes, Total
Percentage of Rated Care Homes, by Status and Latest Overall Rating
Percentage of Rated Care Homes, Total
Latest Overall Rating
Active
Inactive-Dereg
Active
Inactive-Dereg
Good
11
1
12
91.7%
100.0%
92.3%
Requires improvement
1
1
8.3%
0.0%
7.7%
Total Care Homes With Overall Published Rating
12
1
13
100.0%
100.0%
100.0%
1 Care homes are defined as locations with one or both of the following service types: care home service with nursing; care home service without nursing.
The CQC has been inspecting and rating general practitioner (GP) locations under its new approach since 1 April 2014.
The following table shows how many and what proportion of GP locations in Ilford North have been rated and what the most recent ratings are as at 6 March 2017. Table 3 shows how many and what proportion of GP locations in Ilford North had been rated and what the ratings were as at 31 March 2016.
GP Practice locations in Ilford North Parliamentary Constituency latest overall ratings as at 6 March 2017
Number of Rated GP Practice Locations, by Status and Latest Overall Rating
Number of Rated GP Practice Locations, Total
Percentage of Rated GP Locations, by Status and Latest Overall Rating
Percentage of Rated GP Locations, Total
Latest Overall Rating
Active
Inactive-Dereg
Active
Inactive-Dereg
Good
6
6
75.0%
66.7%
Requires improvement
2
1
3
25.0%
100.0%
33.3%
Total GP Practices With Overall Published Rating
8
1
9
100.0%
100.0%
100.0%
GP Practice locations in Ilford North Parliamentary Constituency latest overall ratings as at 31 March 2016
Number of Rated GP Practice Locations, by Status and Latest Overall Rating
Number of Rated GP Practice Locations, Total
Percentage of Rated GP Practice Locations, by Status and Latest Overall Rating
Percentage of Rated GP Locations, Total
Latest Overall Rating
Active
Inactive-Dereg
Active
Inactive-Dereg
Requires improvement
1
1
2
100.0%
100.0%
100.0%
Note:
The Newham CCG area was one of the last areas to be inspected and most inspections were completed in 2016.
Care Homes in Lancashire: on 8 March Mark Hendrick MP (Lab) Preston North asked about the number of complaints made about discharge packages for nursing and residential homes and other settings. Care Minister, David Mowat MP, said that such data was not collected centrally.
Learning Disabilities: on 9 March Ian Austin MP (Lab) Dudley South asked what steps were being taken to ensure that social care funding was available for people with a learning disability at the same level as that for elderly people. Marcus Jones MP, Parliamentary Under-Secretary of State CLG said “Local government has autonomy to determine how best to manage its own finances to ensure it delivers the appropriate level of services for its residents whether that is for people with learning disabilities or elderly people receiving social care”.
Apprenticeships: on 9 March Dr Sarah Wollaston MP (Con) Totnes asked whether the revenue raised by the Immigration Skills Charge applied to NHS and social care sponsors of Tier 2 visas will be hypothecated for investment in apprenticeships in health and social care. Furthermore more, Dr Wollaston asked about the cost of the Immigration Skills Charge to NHs and social care sponsors of Tier 2 visas in 2016-17. In response Robert Halfon MP, Minister of State at DFE, said “The income raised from the Immigration Skills Charge will support the provision of skills for the resident population, to address the skills gaps that employers face. Further information will be set out in due course. We have not estimated the potential annual cost to NHS and social care sponsors. The cost will depend on employer use of the Tier 2 skilled worker route”.
Care Homes in Leeds: on 14 March Hilary Benn MP (Lab) Leeds Central asked how many places there were in registered care homes in Leeds. In response David Mowat MP, Care Minister, gave the following table from CQC data:
August 2011
August 2012
August 2013
August 2014
August 2015
August 2016
Leeds local authority
5,641
5,518
5,369
5,442
5,347
5,483
England
454,896
464,126
463,909
463,887
462,153
460,642
Care Home Standards: on 14 March Diana Johnson MP (Lab) Kingston upon Hull asked a follow up question on data regarding care home closures in Hull. David Mowat MP, Care Minister, gave the following information from CQC:
Number of care home1 services that de-registered under the Care Standards Act between 1 April 2004 and 31 March 2010 in England, East Riding of Yorkshire and Kingston upon Hull local authorities by financial year.
Number of care homes that De-registered
Financial Year of De-registration
England
East Riding of Yorkshire
Kingston upon Hull
2004-05
1,784
23
12
2005-06
1,875
27
20
2006-07
1,651
17
8
2007-08
1,431
14
11
2008-09
1,047
10
6
2009-10
960
10
4
Total from 1 April 2004 - 31 March 2010
8,748
101
61
Tier 2 Visas: on 14 March Dr Philippa Whitford MP (Central Ayrshire) asked how many people working in the UK health and social care system were doing so on a Tier 2 Visa. Responding Robert Goodwill MP gave the following information: Information/data relating to the issuance of Tier 2 Certificates of Sponsorship can be found at https://www.gov.uk/government/publications/immigration-statistics-october-to-december-2016/list-of-tables#sponsorship
Green Paper: on 14 March Teresa Pearce MP (Lab) Erith & Thamesmead asked what plans the DH had to consult with the social care sector before publishing the social care Green Paper as announce din the Budget. In response David Mowat MP, Care Minister, said that he would bring forward proposals in a green paper later in the year to put the state funded system on a more secure long term footing. He went on to say that the Secretary of State for Health and his team and officials met regularly with stakeholders from the social care sector.
Incontinence: on 15 March Rosie Cooper MP (Lab) West Lancashire asked whether CQC was responsible for carrying out inspections on the standards of continence care in hospitals, residential homes and nursing homes. Care Minister, David Mowat MP, gave a fairly non committal answer stating that “the CQC has advised that the lack of adequate continence care could breach a number of CQC fundamental standards.
Care Homes in the West Midlands: on 15 March Jim Cunningham MP (Lab) Coventry South asked the Care Minister for data on care homes in the West Midlands.
August-2012
August-2013
August-2014
August-2015
August-2016
Coventry
1,860
1,867
1,983
2,055
2,092
West Midlands
46,370
46,732
46,996
47,113
47,534
England
464,126
463,909
463,887
462,153
460,642
The figures are published by the Care Quality Commission.
[if !supportLists]4. [endif]Debates
Adult Social Care: on 22 February Alan Johnson MP (Lab) Kingston upon Hull West & Hessle introduced a short debate on council funding and adult social care. He said that any funds raised by the precept will be cancelled out by the cost of the National Living Wage and that the Better Care Fund will not balance out discrepancies in local need, with rising demand, reduced funding and the introduction of 100% business rates retention permeating funding gaps faced by councils, especially in deprived areas. He stated social care needs to be funded not from general taxation, but either through inheritance tax or national insurance contributions for those over 65.
Sir Hugo Swire MP (Con) East Devon, suggested there is a need to encourage the public, through either fiscal incentives or behavioural change, to care for people at home, stating “it cannot all be left to the state”. Diana Johnson MP (Lab) Kingston upon Hull North put forward an alternative solution, suggesting the government gave £1.8bn of the £6.6bn additional funds from business rates receipts to councils, to help relieve pressures in social care. She also called for a National Health and Care Service to be funding from general taxation to stop the existing postcode lottery in care. Kate Green MP (Lab) Stretford and Urmston proposed the Government look at how an annual property tax could release excessive wealth held in London and the South-East to balance disadvantage and Neil Gray MP (SNP) Airdrie and Shotts, described health and social care integration implemented by the SNP as a successful model from which the Government could learn.
Jim McMahon MP (Lab) Oldham West and Royton, accused the Government of having no appetite to look beyond this Parliament for a solution, let alone to the 10-20 years needed to fully embed a re-structured model of care funding. He advised corporation tax cuts, costing £5bn, could have been used to offset the £2.6bn adult social care deficit. A cross-party solution must be found, he emphasised.
Marcus Jones MP Parliamentary Under- Secretary of State for Communities and Local Government responded by underlining the value of the precept, the Better Care Fund and the Adult Social Care Support Grant, but reminded the Hall that innovation and reform is equally important. The Government is soon to publish an Integration and Better Care Fund Policy Framework to help to support local authorities implement the new measures effectively, he said, as well as the Department of Health leading development on a new national carers strategy to raise awareness on caring and supporting carers. https://hansard.parliament.uk/Commons/2017-02-22/debates/4C8A20C7-3440-46FD-B168-DE20E08F8EC7/CouncilFundingAndSocialCare#contribution-5E60BBFB-49B5-4057-8707-465AFEEC8DE1
Liverpool: on 7 March Louise Ellman MP (Lab) Liverpool, Riverside introduced a short debate on health and social care in Liverpool. Ms Ellman opened the debate by saying that it was the third time within the last two months that she had raised social care in Parliament, but went on to say
“The provision of adequate adult social care enables many people to remain safely and confidently in their own homes, rather than feeling vulnerable or having to move to more expensive and much less satisfactory residential care”.
The debate focused on problems specific to Liverpool but also highlighted the difficulties around severe delayed discharges.
Summing up David Mowat MP, Care Minister, hinted that the increasing tendency for care to be provided in people’s own homes was where the money needed to go rather than in care homes.
“If we look at the care home market over the past decade, we see that roughly speaking there are the same number of beds today as there were 10 years ago, and that is clearly in the face of a considerable increase in demand. That is because far more people are now being looked after through domiciliary packages in their own home, and that is the market we need to get right and make effective”.
https://hansard.parliament.uk/commons/2017-03-07/debates/17030780000001/SocialCare(Liverpool)
Budgets for Health and Social Care: on 14 March Meg Hillier MP (Lab) Hackney South & Shoreditch introduced a debate on budgets for health and social care. A large cross party selection of MPs spoke in the debate including Dr Sarah Wollaston MP (Con) Totnes (Health Select Committee Chair) who spoke about the additional funds in the Budget “However, I would nuance some of that, because the point about social care is that we must not consider it “job done”. The £2 billion over the next three years is very welcome—it is also welcome that it has been profiled to address the back-loading of the previous settlement. However, I would like the Minister to say how we will ensure that it gets to the frontline and is distributed fairly according to need, and also that that reflects the different abilities of councils to raise their own money through the social care precept, because that is important for public confidence about how the money is spent”. Furthermore she called upon the Minister to widen the Green Paper on social care to take in health and social care on a consensual, cross party basis.
Clive Betts MP (Lab) Sheffield South East (also CLG Select Committee Chairman) spoke about training, pay and long term commitment.
Rt Hon Norman Lamb MP (Lib Dem) North Norfolk summed up many of the contributions from MPs by saying: “No party has come up with a full solution to the crisis facing our NHS and care system. We have to be honest about that. Collectively, we are letting down the people of this country. It is remarkable how many speakers today have called for the Government to embrace a cross-party process. A load of MPs—senior MPs, Select Committee Chairs and former Ministers—have come together to call on the Prime Minister to establish an NHS and care convention to engage with the public in the mature discussion that we know we need to have but keep putting off. So I call on the Minister to support us within government, be audacious and recognise that this is a once-in-a-lifetime challenge. The Government will get credit for working with others to achieve the solution that this country badly needs”.
Philip Dunne MP, Health Minister, summed up the debate with the following remarks: “I congratulate you on chairing this substantial debate so efficiently, Mr Bailey. Some 31 colleagues were present—that is a very high turnout for Westminster Hall—of whom 18 spoke, including three distinguished Select Committee Chairs and two Opposition spokesmen. Certainly I have not attended such a significant debate in Westminster Hall, and it reflects our common interest in ensuring that the NHS and social care services in this country provide as high-quality a service to the public as possible.
Virtually all speakers welcomed the developments in last week’s Budget, and I welcome that broad consensus across the Chamber. Only one discordant note was struck—reference was made to a march in the streets of London led by the shadow Chancellor, the right hon. Member for Hayes and Harlington (John McDonnell). That march obviously demonstrated a degree of concern, but it happened before the Budget, which, as I shall touch on, responded to many of the concerns that have been raised.
We all recognise that the NHS faces a significant challenge, given the increasing demand for health services as a consequence of our ageing and growing population, new drugs and treatments, and safer staffing requirements, and that in turn is increasing the pressure on social care services. We know that finances are challenging for both areas, which is why we have ensured that spending on the NHS has increased as a proportion of total Government spending each year since 2010.
We backed the “Five Year Forward View” as part of the spending review in late 2015. That ensured that real-terms NHS funding will increase by £10 billion by 2020-21 compared with the year before the spending review. Some hon. Members said that they wanted to see a plan. We have supported the NHS’s own plan—the “Five Year Forward View”—and announced that we will publish a Green Paper this summer looking at how social care is funded in the long term, which hon. Members have welcomed, so it is churlish to deny that this Government are providing long-term strategic thinking about the way we fund both those services. I remind colleagues that the NHS budget was £98 billion in 2014-15 and will be £119.9 billion in 2020-21. That is a £21.8 billion increase in cash terms, which seems to get lost from time to time in these discussions.
We are almost at the end of the financial year. The NHS received a cash increase of more than £5 million in 2016-17. That was front-loaded, as NHS chief executive Simon Stevens requested. For the year that starts on 1 April, there will be another significant increase in funding once the mandate is settled. The hon. Member for Bristol South (Karin Smyth), who is a member of the Public Accounts Committee, asked when we will see that document. It has to be published by the end of this month, and I assure her that it will be.
The measures announced last week, which many hon. Members referred to, have three features. I will not go into them in detail, because they have all been covered. Much of the focus has been on the additional £2 billion that we will provide for social care over the next three years, half of which will start to come in next month, when the new financial year begins.
Some hon. Members are aware of the numbers for their areas and some are not, and one colleague came up with a slightly incorrect figure. I will not go through every area, but I applaud the presence of Devon MPs in particular, given the manner in which they have massed themselves with colleagues from across the House. Devon will get a £30.3 million increase in its social care budget over the next three years and will receive half of that in the year that is about to start. My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) referred to an £18 million increase for North Yorkshire. I can give him a bit of good news: it will actually be £19.6 million over the next three years. I am grateful to the Chair of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), for her support for the Budget measures. Hackney will receive £12.8 million, as she acknowledged. Like many colleagues, she sought a long-term funding settlement.
The spending review provided a settlement for the NHS. The Chancellor indicated that there will be a social care Green Paper this summer. Several colleagues called for a cross-party consensus. The Green Paper will provide an opportunity for debate and consultation, and such discussions should focus on that.
The second Budget measure was a £100 million increase in funding for A&E services, so that people who present at A&E who do not need intense or urgent care can be diverted to GPs or clinics run by nurse practitioners. That best practice has been proven to work in A&Es that have such a streaming service, so we are looking to provide facilities for basic capital spend to ensure that every A&E hospital across the country has streaming in place by next winter. I am pleased that that has been welcomed by hon. Members from across the House.
The third measure—this was touched on in the debate, albeit not in such detail—is the £325 million capital investment in the first set of sustainability and transformation plans. Those who make the strongest case for investment and can deliver better, more joined-up services, which can bring real improvements to patient care, will benefit from the funding. We look to that to be an exemplar for other areas whose plans are less well developed, to encourage them to develop a better, more integrated approach to patient care for the future, including closer working with local authorities for the provision of social care. That should encourage areas to bring forward more comprehensive plans for the next wave of STPs, which will be supported. As hon. Members have said, we look forward to explaining more about that at the time of the next Budget.
In the sustainability and transformation plans there is the opportunity for commissioners of care and health services to look holistically at the demands of the residents in their area, which to a degree includes palliative care and respite care. As we move towards an STP, there is a greater opportunity for those things to be considered as well.
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 auditors 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.
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.
End of Life Care: on 14 March Baroness Finlay of Llandaff (CB) introduced a short debate questioning how the Government intended to ensure that clinical commissioners respected the undertakings made in Our Commitments to You for End of Life Care: The Government Response to the Review of Choice in the End of Life.
Baroness Lane Fox of Soho (CB) made three recommendations concerning technology one of which directly concerns care homes: “Our second recommendation was around wi-fi. We need beautifully designed wi-fi in care homes. I use that word “beautiful” carefully. Some 70% of care homes have no wi-fi at all; and 80% of people living in care homes say that they are scared to leave their room. How brilliant would it be if by having better wi-fi across the estate, they could chat to someone just down the corridor, or even better perhaps, back home or even in another country? Sometimes, simple tech solutions can provide imaginative leaps for problems that people are not seeing”.
Long term Funding Solution for Social Care: on 16 March Lord Warner (Lab) introduced a short debate on a long term funding solution for social care. The ‘usual suspects’ made eloquent contributions attempting to press the Minister on the scope of the forthcoming Green Paper. Lord O’Shaughnessy ended the debate on a slightly less positive tone:
“The noble Baroness brings up the issue of care homes closing. Inevitably, there is churn in the system. There has been a stable number of residential care home and nursing home beds, which is one metric. The other is the fact that there are many more home care agencies, with a lot more domiciliary care going on, and over 150,000 more social care jobs, so I do not think that the picture is quite as the noble Baroness described it. However, making sure that we have a sustainable system is at the heart of the Green Paper plans”.
Sustainability of the NHS: on 5 April Lord Patel (CB) will introduce a short debate on the sustainability of the NHS and adult social care.
