This is the text of the speech Sir George made in Westminster Hall:
Sir George Young (North-West Hampshire) (Con): It is a pleasure to follow the right hon. Member for Oxford, East (Mr. Smith), who spoke movingly about the needs of people in residential and nursing care homes. It so happens that I have an aunt in a nursing home in his constituency. She will be delighted that her Member of Parliament is concerned about these issues, although that might not be quite enough to persuade her to vote for him at the next election.
I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing the debate and on how he introduced it. By making a contribution, I am reducing, albeit marginally, the average height of Conservative Members speaking in the debate.
I hope that the right hon. Gentleman and the Minister will not take it amiss if I point out that both have served in the Treasury, and although they moved on to care and spending Departments, they must bear some responsibility for the structure and amount of money being spent in this area.
This is a topical debate because up and down the country social service departments are grappling with next year’s budget against the background of the revenue support grant announced in December. For my county, Hampshire, and, I suspect, others, it was a tough settlement. The formula grant for Hampshire will increase by 2.7 per cent., which does not cover inflation. The consumer prices index, which is relevant to the services that we are talking about, was up 3.8 per cent. in December last year.
This year’s increase follows an increase of 0.2 per cent. last year, once the ring-fenced grants that the Government abolished are stripped out. On top of that, next year’s supporting people grant has been frozen at just below the level for 2006. So far as adult social services are concerned, Hampshire receives the second lowest settlement in the country—even less than Shropshire.
With that as the background, if an authority banks further efficiency savings—Hampshire county council is efficient; it is lit up by beacons that have been bestowed on it by the Government—and then puts up the council tax by the maximum possible without being capped, there is still £10 million to be taken out of services. With education spending largely protected, the spotlight inevitably falls on the services that we are discussing this afternoon.
Expenditure on the elderly is the largest single element within social services, and expenditure on residential care is a significant part of that budget. I listened to what my hon. Friend said about ring-fencing, but the difficulty for the Government is that if they ring-fenced the amount that they think local authorities should spend on services, it would not be enough, and they would have to top it up from other sources. Many social services authorities certainly spent way above the standard spending assessment under the SSA system.
I asked my social services department how it was going to cope with the pressures that I have outlined, and the answer is as yet unclear. It is having to cope with demography, which has been touched on, and the increasing complexity and cost of many care packages, particularly for those with learning disabilities, which the right hon. Member for Oxford, East has just mentioned. My social services department said that there would be a move to help the most critical cases only, with little work done on prevention.
That is bad news for the individuals who will not get the care that they need and who may have to wait until their life really is threatened, they have a serious mental or physical illness or they are unable to carry out the majority of personal care and domestic routines. If the increasing trend of rationing services to deal with insufficient funding continues, all older people will, as early as 2009, receive care only when their needs reach the substantial or critical level. Clearly, that is not a situation that the ageing population deserve, or indeed expect. It might also be bad news for the taxpayer, who might eventually have to pick up a larger bill.
Residential care services face underlying pressures from higher standards and increased costs, both of which were touched on in earlier contributions. Increases in the national minimum wage have been more than twice the rate of inflation for several years. Fee increases have been tightly managed, but there is a real risk that supply will be lost as a result of closures, the refusal to accept social service rates or the inability to meet appropriate standards.
The Government might tell us that they have been putting more resources into social care and, to the extent that they have, I welcome that. However, as the Local Government Association’s autumn statement highlighted, general Government grant support for services such as social care has increased by just 14 per cent. in real terms since 1997-98. Yet, spending increased by 65 per cent. between 1994-95 and 2004-05, so Government funding for social care has clearly not kept pace with the demands of an ageing population.
Overwhelmingly, the extra resources that the Government have found have gone into the health service. With the prospect of insufficient Government investment for social care in the next spending period—I endorse what the right hon. Gentleman said about that—local authorities will clearly face some difficult decisions.
The Minister may tell us that efficiency savings and delivering care in a different way will bridge the gap, but that would be a very optimistic claim. Before Christmas, the leaders of 45 councils wrote to The Guardian, warning that
“services for the elderly are now teetering on the brink. The present situation is unsustainable.”
The pre-Budget report could have brought some good news, but it did not. The Chancellor put all his chipson one number—education. He could have increased education expenditure substantially, but by slightly less, and found some extra money for health and social services. However, he chose not to.
In fairness to the Government, they recognise that there is a problem and they have called for a
“shift in the centre of gravity of spending”,
“care undertaken outside hospitals and in the home”.
If that is their ambition, however, they will have to provide the resources to deliver the outcome.
At the same time as we have this downward pressure on resources, demand is increasing, as we have heard, and the number of those over 85 will double to1.8 million between now and 2028—the demographic clock is ticking away.
The Joseph Rowntree Foundation has estimated that the number of places needed in residential care homes, nursing homes and hospitals will rise to 1.13 million by 2051, which is roughly double the number now. However, supply has been falling, not rising. If we go back some time, we may find that there are good reasons for that, and people may have been inappropriately placed in residential care—indeed, that was a constant refrain of one of the Minister’s predecessors—but any slack has now been taken up.
Indeed, in Hampshire, the county council and local NHS trusts have joined together to build new nursing homes themselves because of the decline in the private sector. The Hampshire Care Association told me that many independent providers cannot carry on, because local authorities are not covering the cost of care home fees, while others have been unable to cope with the standards. However, care homes are not closing evenly throughout the country, and the problem is at its worst in inner-city areas. Those areas in which residential care has declined the most are not those in which home care services have grown the most, and the Rowntree report sheds some light on that.
There is a further pressure, on which the hon. Member for Stroud (Mr. Drew) touched: NHS deficits have been straining relationships between health trusts and social services, as the NHS is under enormous pressure to cut discretionary spending where there are joint budgets.
The pressure on social care also increased after NHS primary care trusts withdrew funding for joint projects from about half of all councils, according to the LGA report “Without a care?”.
I do not think that anyone will argue this afternoon that there is enough slack in the system or that there is ample room for economies. Somebody writing in Society Guardian on 10 January said:
“Fees for all but the very top end of the private sector have been forced down to unsustainable levels and many small private sector homes are hanging on by their fingertips. It’s dispiriting to watch this choice, which suited many older people, systematically choked out of existence.”
The Joseph Rowntree Foundation estimates that care homes are underfunded by £1 billion. I will not report again what Dame Denise Platt has said, because the right hon. Member for Oxford, East has just touched on it.
Finally, I want to put some questions to the Minister. First, it is too late to do anything about 2007-08—the die is cast. However, the comprehensive spending review that is under way for the next three years is an opportunity, and we need a fresh start.
Without giving away the negotiating hand, can the Minister reassure us that part of his Department’s bid for the next three years is a step increase in funding to eliminate the underfunding of the sector and provide a realistic baseline from which to move forward for the future?
Secondly, does the Minister really believe that policy for the elderly as a whole is embedded in the work of local and regional government? To take housing, social services and transport as examples, many elderly people could be forgiven for thinking that they are somewhat marginalised.
This problem is smouldering away, and if the Government do not get a grip on it and reach some solutions soon, they will find that it has become much more extensive.