Ensuring a better, fairer system for social care - Liz Kendall MP speech to National Care Forum Annual Conference
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Liz Kendall MP, Labour's Shadow Minister for Care and Older People, at the National Care Forum Annual Conference today, said:
The National Care Forum plays an absolutely critical role as the voice for not-for-profit care providers in the UK.
Together, your members provide care and support services to over 50,000 older and disabled people in their own homes and more than 900 residential care homes.
The Forum is engaged in a vital mission – to transform quality and outcomes for people who receive care and support. You are passionate about involving the people who use care, investing in the staff who provide care, and in championing innovation.
I share your mission, passion and ambition.
Not only because I have seen how important care and support services are in my constituency and my own family. But because the work you do - day in and day out - is crucial to addressing one of the biggest challenges we face as a society and a country: meeting the needs of our ageing population.
Facing up to this challenge is crucial.
It’s crucial for the growing number of older and disabled people who deserve to have the best possible life, no matter where they live or what their income.
It’s crucial to millions of families – on low and middle incomes - who want to help care for their elderly relatives but need support to do so.
And it’s crucial for our economy too.
Last year the independent Office for Budget Responsibility published its first ‘Fiscal Sustainability Report’.
The report made it crystal clear that the primary pressure on the public finances is our ageing population, and that without major changes - to pensions, the NHS and social care – the long term growth of our economy and the sustainability of our public finances could be put at risk.
As I’m speaking, most of my fellow MPs will be at Prime Ministers Questions – the weekly House of Commons ritual that’s very important to politicians, if not perhaps the rest of the country. Being an effective Opposition means scrutinising what the Government is doing and holding them to account for their actions.
But proving Labour is a credible Government in waiting, also means demonstrating we are serious about addressing the long-term challenges facing Britain.
Ensuring we have a better, fairer, more sustainable system of care is essential to meeting the needs of our ageing population – and at the top of Labour’s agenda.
I’m under no illusions about the scale of the task ahead.
Let’s be clear: local council budgets for adult social care have been under pressure for many years, well before the current financial crisis began.
That’s why Labour put forward bold plans to reform care and support, including how it is funded, at the last general election.
But we didn’t win the election.
And now this Government’s determination to focus on austerity at the expense of growth, and their huge cuts to local council budgets, have pushed an already pressurised care system to breaking point.
Nationally, adult social care makes up around 40 per cent of council budgets and is their biggest discretionary spend. So when council budgets are cut by a third, services for older and disabled people inevitably suffer.
The Government says they’ve put more money into social care. But the money wasn’t ring-fenced. And the result – according to figures from their own Department for Communities and Local Government – is that more than £1 billion has been cut from local council budgets for older people’s care since the Coalition came to power.
I am extremely concerned about the impact these cuts are having on the ground.
That’s why I recently convened two summits – on residential care and home care– to hear directly from providers in the not-for-profit, voluntary and private sectors.
90 per cent of residential and nursing home care, and 84 per cent of publicly funded home care, is delivered by the independent sector.
So your views and experiences are crucial.
I want to take this opportunity to thank Des Kelly and the National Care Forum for helping me organise the residential care summit, alongside the English Community Care Association, and the UK Home Care Association for helping me host the summit on domiciliary care. Providers who attended both meetings told me in no uncertain terms about the huge difficulties and challenges you face.
As local authority budgets are squeezed, councils are raising their eligibility thresholds, so 8 out of 10 councils now only provide services for those with substantial or critical needs.
One of the consequences is that many older people who go into residential care are now much frailer than before.
One residential care provider from Oxford told me that whilst a couple of years ago the average length of stay for their residents was two years, this has now dropped to only 9 months.
Yet despite the fact that older people who require care have higher needs, and inflation is running at 3 to 4 per cent, most councils are freezing and in some cases reducing the price they pay for residential care. There are also huge variations in the fees councils pay in different parts of the country.
Many providers told me the funding they get simply doesn’t meet the costs of providing good standards of care – standards you and the National Care Forum rightly champion. As a result, self-funders are increasingly having to subsidise council funded residents, and top-up payments are growing too.
Some providers at both the residential and home care summits told me they won’t be able to rely on local authority funding in future.
I am extremely concerned this will drive further inequalities in the system - as some providers reduce services to council funded users and others opt out of providing council funded care altogether.
It’s not just the impact on older and disabled people that care providers are worried about.
It’s the impact on staff too.
1.5 million people work in adult social care. These staff provide vital, intimate, personal services to some of the most vulnerable people society.
This predominantly female workforce is already low paid and low status.
As council budgets are cut, and incomes for providers squeezed, staff pay and training budgets are coming under even greater pressure, fuelling high turnover and vacancy rates, and ultimately risking the quality of care too. This vicious circle costs us all.
It costs older and disabled people - who don’t get enough early, preventive care and support to help them stay living well for longer, either in their own homes or in residential care.
It costs families - who face ever-increasing charges for home care and residential care, which vary hugely across the country.
It costs staff – who struggle to cope with increasing workloads, without the training or pay they need to do their job properly and make it worth their while.
And it costs taxpayers – who end up footing the bill for a failing system, as more older and disabled people have to go into hospital, or get stuck in hospital when they don’t need to.
Delayed discharges from hospital have gone up by a staggering 29 per cent in the last two years, and now cost the NHS more than £18 million every month, because people can’t get the right services and support in the community or at home.
Our care system is in crisis.
And we face a choice.
A choice between a race to the bottom where fewer people get worsening standards of care, unless they can afford to opt out of the system altogether, with ever increasing pressure on family budgets, the NHS and our economy as a whole.
Or fundamental reform in the way services are provided and funded to secure a better, fairer, more sustainable system for the future.
I believe the only viable, decent option is reform.
Although I couldn’t be here yesterday, I know you’ve talked a lot about how care and support needs to change.
First, services need to be more personalised to meet the needs of older and disabled people and their families, and to give them more say and greater control. Unleashing the capacity within families and communities to help provide support for our ageing population is crucial here.
Second, services need to be more integrated, so people don’t have to struggle between different agencies or face being passed from pillar to post. We must end the false divide between services for people’s physical, mental, social care and housing needs. People’s needs aren’t separate and the way we provide services shouldn’t be separate either.
Third, we need to shift the focus of care out of hospitals, into the community and more towards prevention and early intervention, to help older and disabled people staying living as well as possible, for as long as possible.
Most older people want to stay living independently in their own homes, if they can get the right help and support. But for many older people, this simply won’t be possible for at least some of their lives. So high quality residential and nursing care must be an integral part of a reformed system too.
Finally, whilst there can be no national blueprint, or single model of care delivered from ‘on high’, we do need clearer national standards - on local council eligibility criteria, on the outcomes services should be seeking to achieve and on ensuring a realistic and fair price for providing high quality care and support.
At this point, I suspect many of you are sitting there thinking – “We’ve heard this all before; we’ve been saying this for years.”
You’re right. You have.
10 years ago, long before I became an MP, I led a project at the Institute for Public Policy Research called “From Welfare to Wellbeing: the Future of Social Care”. This work was supported by David Behan, who you heard from yesterday, when he was President of the Association of Directors of Adult Social Services.
Our research called for radical changes to shift the focus of care towards prevention, early intervention and integration, to give users and families genuine choice and control, and to deliver better value for taxpayers money.
Since then, real progress has been made.
The last Government introduced Personal Budgets and Direct Payments to give people more choice and a greater say over their care. Between half and three quarters of users say these budgets have had a positive impact on most aspects of their daily lives.
Labour also backed greater housing choice for people with care needs, for example through the £227m we invested in Extra Care Housing projects. The national evaluation of these projects shows they’ve led to real improvements in the physical and cognitive functioning of older people, as well as boosting their social life.
And we championed integration and prevention too. One of the best examples were the Partnerships for Older People Projects. These brought together local NHS, council and voluntary services to help people stay living independently in their own homes. They showed that very small services that provide practical help and support to older people can make a big difference, particularly in reducing loneliness, which is a huge issue facing many older people today.
They also demonstrated the potential for integrated services to deliver big savings. Every £1 spent on the Partnerships for Older People Projects led to an additional saving of £1.20 in hospital emergency bed days alone.
Use of A&E decreased by 29 percent. Use of physiotherapy and occupational therapy clinics and outpatient clinics were also reduced –producing savings of over £2,100 per person.
Yet – despite these improvements - too often the rhetoric about providing integrated care isn’t matched by the reality on the ground.
We still don’t have the right incentives to promote a genuine shift in services into the community and more towards prevention, and to ensure care and support are focused on improving quality, not price alone.
There are real concerns about the system of regulation: how the Care Quality Commission works, the role of local authorities, and the new job the Government wants Monitor to play as the economic regulator of health and social care.
And in many places, partnership working is becoming more difficult, not less – as councils and providers struggle to cope with cuts to their funding, at the same time as making sense of the Government’s huge NHS reorganisation, which has created an even more complex structure than before.
The Government says its long-awaited White Paper on social care will address these problems. I hope it does.
However, reforming the way services are provided won’t be enough on its own. The key test for the Government is whether they will also grasp the nettle and reform how social care is funded in future.
I said earlier that Labour put forward bold plans before the last election, including on social care funding. We tried to get cross party agreement for our proposals. We didn’t succeed, but we’re determined to try again now.
The recommendations of Andrew Dilnot’s Commission on funding long-term care and support provide a huge opportunity for progress.
These include capping the costs of care that people would be expected to pay to between £25,000 and £50,000, and raising the means-tested threshold above which people have to pay for full care costs, from £23,250 to £100,000.
Labour has warmly welcomed these proposals as a step towards a better, more sustainable system.
Following Dilnot’s recommendations, Ed Miliband initiated cross party talks on care funding. These talks are ongoing, and Labour is absolutely committed to trying to secure political consensus on the way forward.
Unfortunately, the Queen’s Speech only included a draft Bill on reforming the legal framework for social care, not on reforming social care funding.
But there’s nothing to prevent the Government from committing to legislating in this Parliament, even as the cross party talks are ongoing, which is what Labour is calling for.
Deciding how we pay for long-term care is an issue that has bedevilled Governments for years: this Government, the previous Government, and the one before that.
But we must address the issue.
Our population is ageing.
Demand for care will grow.
The system is in crisis and reform is essential - for older and disabled people, their families and the future sustainability of the public finances.
I know you share this passion for change. I hope we can work together to make it a reality, in the months and years ahead.