Mr Speaker We now come to the first Select Committee statement. Mr
Clive Betts will speak on the joint report of the Health and Social
Care Committee and the Housing, Communities and Local Government
Committee for up to 10 minutes, during which, I remind the House,
no interventions may be taken. At the conclusion of his statement,
the Chair will call Members to put questions on the subject of the
statement and call Mr Clive Betts to...Request free trial
We now come to the first Select Committee statement. Mr Clive
Betts will speak on the joint report of the Health and Social
Care Committee and the Housing, Communities and Local
Government Committee for up to 10 minutes, during which, I
remind the House, no interventions may be taken. At the
conclusion of his statement, the Chair will call Members to
put questions on the subject of the statement and call Mr
Clive Betts to respond to these in turn.
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I begin by thanking the Backbench Business Committee for
allocating time today for me to present the Housing,
Communities and Local Government Committee and Health and
Social Care Committee joint report on long-term funding
of adult social care.
In 2017, the then Communities and Local Government
Committee undertook a lengthy inquiry into adult social
care. We concluded that spending on social care would
need to rise significantly in the coming years, and that
after successive failed attempts at reform, political
parties across the spectrum needed to be involved in the
process of reaching a solution. With that in mind, we
returned to the issue in a joint inquiry with the Health
and Social Care Committee, aiming to identify funding
reforms that would be supported by the public and
politicians, and to feed its findings into the Green
Paper. I thank all members of both Committees for the
constructive role they have played, and particularly the
Chair of the Health and Social Care Committee, who is so
knowledgeable on these matters and with whom it has been
a genuine pleasure to work on this inquiry.
To find out the public’s views on how social care should
be funded, we commissioned a citizens’ assembly, which I
understand is the first held by the UK Parliament.
Following a process of learning, deliberating and
decision making, which took place over two weekends in
April and May, a representative sample of nearly 50
members of the public was asked how best to fund social
care. We have listened carefully to the assembly members’
views. They have been vital in informing our thinking,
and are reflected throughout our report. We have taken
the unusual step of specifically addressing our
recommendations to both sides of the political divide,
asking that both Government and Opposition Front Benchers
accept them.
What are the challenges facing social care and what
funding is required to address them? The critical state
of social care and the very serious consequences for
people who receive care, and those who do not, and their
unpaid carers and families, as well as the NHS, is well
documented. The evidence was clear that the combination
of rising demand and costs combined with reductions in
funding to local authorities has placed the social care
system under very great and unsustainable strain.
Despite the welcome additional funding provided by the
Government in recent years, local authorities face a
funding gap of around £2.5 billion in 2020. This has been
confirmed by the National Audit Office, the King’s Fund
and the Nuffield Trust, as well as the Local Government
Association. The consequences are extremely serious and
widespread, leading to people going without the care they
need, and the time and quality of care not being
sufficient for many who receive it, leading to unpaid
carers having to step into the breach and placing
significant pressures on care providers and the care
workforce.
A witness to the inquiry, Sir Andrew Dilnot, chair of the
2011 Dilnot commission, told us that the system was
consequently now at risk of “fairly significant
disaster”, which were very strong words indeed. We
concluded that considerable extra funding in the order of
many billions of pounds would be needed in the coming
years for the following reasons.
We need to meet the funding gap that I just referred to
and we then need to provide additional funding to meet
future demand. The personal social services research unit
at the London School of Economics projects that spending
on both social services for older people and younger
adults will more than double by 2014, even without the
improvements to the service that we suggest. It is also
important to meet the care needs of a wider group of
people—not just those whose needs are critical or
substantial, but those who have moderate needs that are
currently largely unmet. Age UK estimates that around 1
million who need care currently do not get it. Finally,
and very importantly, we need to ensure that the care
provided is good care from a stable, well-paid and
well-trained workforce and viable care providers.
The difficult question for the Government and the
Opposition to grapple with is where the additional
funding for adult social care and social care for people
of a working age with disabilities should come from, what
it should be spent on, and how the care should be
delivered. On care provision, we are strongly of the view
that the responsibility for the delivery of social care
should continue to rest with local councils at a local
level. Social care provision should not, however, be seen
in isolation. There is a need for better integration at a
local level particularly within the NHS, as well as
housing services. After all, most people receiving care
get it in their homes. Integration should be seen not as
a matter of bureaucratic convenience, but as a way of
improving the care that individuals receive. The
integrated care partnerships and health and wellbeing
boards have an important role to play in that.
Our citizens’ assembly members expressed strong support
for a social care system that, like the NHS, is free at
the point of use. We acknowledge that this would increase
costs substantially and be unlikely to be affordable
immediately. We believe, however, that it is an ultimate
objective for the personal care element of social care to
be delivered free to everyone who needs it, and that
accommodation costs should continue to be paid on a
means-tested basis. This direction of travel should begin
with the extension of free personal care to those deemed
to have critical needs.
Now for the important question: where should the funding
come from? Given the scale of the additional funding that
is likely to be needed, which I have explained, we
recommend that a combination of different fundraising
measures are needed at local and national levels. At a
local level, there should be a continuation for the
foreseeable future of the existing local government
revenue streams. We recommend that, in 2020, this funding
is enhanced through using the additional revenue from 75%
business rate retention, rather than the Government’s
proposal to use the money to replace grants such as the
public health grant. In the medium term, we recommend a
reform of the council tax valuations and bands to bring
them up to date. As other funding streams develop, the
contribution from council tax and business rates to
social care funding could reduce, allowing councils to
better fund other important services.
However, local government funding will only ever be one
part of the solution for social care, given the scale of
the challenge. It is clear that extra revenue will also
need to be raised nationally to be spent on local
provision. The citizens’ assembly was strongly in favour
of any extra taxation being earmarked, wanting the clear
assurance that the money raised would be spent on social
care. We therefore recommend that an additional earmarked
contribution, described as a “social care premium”,
should be introduced, to which employers, as well as
employees, would contribute. For fairness, it would be
paid on earnings above a threshold and with the current
national insurance limit lifted. We suggest that this
premium could either be as an additional element to
national insurance, which would ensure the accountability
desired by the public and the citizens’ assembly, to be
placed in an appropriately named and dedicated fund, and
regularly and independently audited, or be paid into
independent insurance funds, similar to the German
model.
We strongly believe that a funding solution must fall
fairly between generations and therefore recommend that
those aged under 40 should be exempt from the social care
premium, and that it should also be paid by those who are
still working after the age of 65. We also recommend that
a specified additional amount of inheritance tax should
be levied on all estates above a certain threshold and
capped at a percentage of the total value. This is
intended to avoid the catastrophic costs for some
individuals, who currently have to lose the vast majority
of their assets, including their homes, to pay for care
costs. It would pool the risk and spread the burden more
fairly, a key recommendation of the citizens’ assembly.
My view is that, if everyone who can afford it pays
something, no one should have to lose everything.
After successive attempts at reform, the forthcoming
social care Green Paper must be the catalyst for
achieving a fair, long-term and sustainable settlement.
It also ought to recognise the care needs of those of
working age with disabilities, as well as the care needs
of the elderly. To ensure that, we recommend that our
work should now be taken forward by a cross-party
parliamentary commission.
I say, on behalf of both Select Committees, to Government
and Opposition Front Benchers that if we, on a
cross-party, cross-Committee basis, can unanimously reach
difficult decisions and make clear recommendations, can
they not do the same? Use our proposals as a basis for
building the wider consensus that we need to create a
long-term, sustainable funding solution for those who
need care now and in the future.
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I thank my co-Chair for the dedicated work that he has
put into this joint report, as well as all members of
both Committees and our wonderful supporting Committee
teams. Like him, I thank not only all those who took part
in the citizens’ assembly and those who advised and
supported them, but the very many people, and their loved
ones, who depend on social care, who wrote to us and whom
we visited on our Committee visit. They told us moving
stories about the level of unmet need and the
consequences, both for themselves and their
families.
The situation could not be more stark. As we approach the
70th anniversary of the NHS next week, would my hon.
Friend say more about the impact on the NHS if we fail to
address the unmet need in social care?
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I thank the hon. Lady, the Chair of the Health
Committee—I think on this occasion, my hon. Friend,
because we have worked on a friendly basis on this
inquiry. She is absolutely right. One of the important
recommendations is about trying to extend the scope of
care provision to include those with moderate needs. If
we provide care for them, it is quite likely that we will
stop them from getting into the substantial and critical
phase and ending up in hospital in the first place. In
terms of the NHS, it is about stopping people getting
into hospital by getting them proper care and having care
available for people in hospital, so that they do not
have delayed discharges. In those two ways, that can be
beneficial. Of course, we can also join up services. Can
the NHS district nurse who goes into someone’s home and
looks at their needs not assess their care needs at the
same time? Can we not get that sort of joined-up
approach?
It was remiss of me not to thank the staff, as the hon.
Lady did, and I will name Laura and Tamsin. The work they
did on this was exceptional. To produce a report of this
quality in the time available was absolutely first-class,
and we should congratulate them on it.
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I thank the Chairs and the members of the Select
Committees for their work on the report, and my hon.
Friend the Member for Sheffield South East (Mr Betts) for
his statement introducing it. The key points from the
report for me are that in its present state the care
system is not fit to respond to current needs let alone
predicted future needs, and that spending on social care
needs to rise. Next week is the 70th birthday of social
care, as well as of the NHS, but there is no funding
settlement and no celebrations for social care. Does my
hon. Friend agree that the time for a funding settlement
for social care is now or at least soon, not years down
the road?
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Yes, I completely agree with that. We have got to get on
with it. If we agreed everything now, it would probably
take two or three years to put it in place. That is why
we suggested the stop-gap measure of the extra business
rates in 2020 being made available for local authorities.
We thought that was a very important solution. If we get
it right, we can have stability for the long term. The
Germans did this over 20 years ago. They have a stable
system and it works. They have just put extra money into
it with general public support, because everyone trusts
the system. That is the position we have to get to.
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I, too, pay tribute to the hon. Member for Sheffield
South East (Mr Betts) for the way he chaired the
Committee; it was very collegiate and consensual, which
really helped us in our deliberations. He may remember
that when we visited a care home the residents and
families of those receiving care accused this Parliament
of a lack of courage for not having addressed this
difficult issue for so long. Does he agree that there is
a real sense of urgency? When the Government produce a
Green Paper in the autumn, we need to get on with it.
There is no reason why we cannot move this forward quite
quickly. As he said, Germany has done it since 1994.
Frankly, it shames this country that Germany has had a
good system in place for so long, while we have not.
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I completely agree. If we are still talking about this in
two or three years’ time we will have failed. We have to
get some decisions and get on with it. As politicians, we
are often very good at coming up with ways to spend
money. In this report we have actually come up with ways
to raise money, which is the difficult part. We have done
the heavy lifting for both the Government and the
Opposition Front Benches. We now say, “We’ve handed the
pass over to you. Get on and run with it and make it
work.”
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I, too, welcome this cross-Committee report and note that
it aspires to provide free personal care, as we have in
Scotland, and to extend it to those in need under 65,
which we will start next April. While that has
significant costs, does the hon. Gentleman agree with the
assessment of the Scottish experience by the King’s Fund
and the Health Foundation, which suggested that overall
it saves money, because people can remain in their own
homes rather than care homes and rather than being
admitted to hospital?
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I saw the King’s Fund report and I have seen the
analysis. That was an aspiration eventually. However, the
Select Committees’ felt that the immediate pressures of
the funding gap, which will grow if we do not do anything
about it—because of the demographics over the next few
years, the fact that we are not meeting the needs of
those with moderate care needs, the fact that we are not
paying our workforce properly and that many care
providers are in financial difficulties—mean that those
issues have to be addressed and then, eventually, we can
move on to the free care aspiration set out in the report
over the longer period.
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I congratulate the hon. Gentleman on his statement, and
both Select Committees on their report. He said that if
everyone contributes something, we should be able to sort
out the funding problem. He put great emphasis on the
need for a social care premium and praised the German
model. In the report, he specifically says that under 40s
should be exempt from the social care premium. The
argument from the older generation will be that they have
paid taxes throughout their lives, so why should they be
unfairly burdened? What is the experience in Germany with
regard to the social care premium? Does Germany exempt
people under 40?
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It is a difficult decision. Germany does not exempt
people under 40, but there are other tweaks to the
system. For example, people without children pay extra
and people who are not working pay extra in retirement
because they do not have an employer contribution. We
have not just mirrored the German system absolutely. We
have taken elements from it, which I think is quite
right. Japan’s system is not dissimilar and it does
restrict payments to those over 40. We have looked at
different systems. It is a challenge, but in the end we
felt that there were considerable pressures on younger
people at this point in time: family pressures, housing
pressures, job pressures. We therefore felt that to start
at 40 was a reasonable benchmark, bearing in mind that
for the vast majority of people it will mean that they
will pay into the care system at some point in their
lives.
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Is it not remarkable, given the failure of successive
Governments to grasp this nettle, that two cross-party
Committees with Members holding widely different views
and ideologies managed to agree a unanimous report? Does
that not make it even more incumbent on the Government,
given the acuteness of the crisis, to take this report
very seriously and to implement its recommendations as
quickly as possible?
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I completely agree with my right hon. Friend. The
fundamental question is: if we can do it, why can’t they?
We have done the difficult part. We have set out a
framework. Those on the Government Front Bench may not
want to accept every detailed element of it, but it is
there to work from. It should mean that we ought to be
able to get to a consensus and an agreement about what
should be done in a much shorter period of time than the
years the Government were perhaps initially
contemplating.
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I thank both Chairs for the very constructive nature of
the inquiry and the discussions around it, which have led
to the report. We need to depoliticise this issue—that is
critical—and I believe we have done that in the report.
Does the hon. Gentleman agree that one of the most
important parts of the report is not just the money it
would raise, but how it would be delivered? Individuals
who are in receipt of care can direct the payments to
their loved ones, the people who know them best and can
give them the best possible care. That care being
delivered by the people who understand them best and love
them the most will strengthen the social fabric of our
communities.
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Yes, I completely agree. I could not refer to every
specific recommendation in my statement. The hon.
Gentleman is referring to paragraph 78 of the report,
where it states that instead of care being delivered to
people, they could receive a cash payment so their family
members could do it in a way that suits them best.
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I congratulate my hon. Friend on the report and on the
work of the Committee to deal with this very difficult
subject. In my constituency, we have a problem with
nursing care homes closing and being converted into
residential care homes, because of a problem with
recruitment and retention of nursing staff. I am glad he
mentioned that the care being given has to be good
quality. Will he say how the increased funding would help
with that situation and give us the nursing home beds we
need?
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It is about getting a well-paid, well-trained workforce.
NHS staff who do a similar job get paid about 29% more. I
am not saying they are well paid, but clearly social care
staff are not well paid. That funding gap has to be
addressed and people have to be properly paid. The
Committees signed up to the Unison charter for the
workforce in social care.
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I congratulate my hon. Friend and the hon. Member for
Totnes (Dr Wollaston) on their leadership on this issue.
The inquiry’s report provides incontrovertible evidence
of the crisis facing social care funding. I particularly
welcome the recommendation that social care should be
provided to those who need it free at the point of
delivery, and the very practical recommendations for
raising the additional funding we so urgently need. I
come to the House from a meeting of supported housing
providers, which provide housing for older people in my
constituency and elsewhere in Southwark. All highlighted
to me the increasing numbers of referrals they receive
from older people who are being made homeless and
suffering problems in the private rented sector. This
problem is growing. The report highlights the importance
of housing for the delivery of a sustainable social care
system and I wonder whether my hon. Friend might just say
a little bit about that now.
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Absolutely. Most people receive care in their own home.
The Committee’s report into housing for older people
looked at the nature of the home. It showed the
importance of the warmth of the home and the ability to
get around the home—trip hazards and so on. Means-testing
for the disability facilities grant relates to
means-testing for care provision and other benefits, so
they need to be properly integrated. Another
recommendation in the report was that where means tests
exist, they need to be joined up together.
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The economics of the sector are fluid. Does my hon.
Friend agree that there has been a high turnover of
ownership of care provider organisations? The Government
need to monitor buyouts in the sector carefully, so that
those living in care do not worry about who owns their
home.
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Absolutely. The Committee did not discuss the ownership
of care homes, but we did discuss the number of homes
that had gone out of business or had been contracted back
to local authorities. This is an ongoing and very real
problem. We need not just a well-paid and well-trained
workforce but viable care providers, so the money needs
to be there for the providers as well as the workforce.
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I thank the Chairs, the members and the staff of both
Committees, and congratulate them on producing an
exceptional document. I also congratulate them on their
extremely collaborative approach to their work, which is
incredibly refreshing. For too long this issue has been
used as a political football to be kicked around, but I
am afraid it is too late for that now. We no longer have
that luxury; we must reach a sufficient settlement. As
other Members have pointed out, successive Governments
have failed to address this issue. The Committees’
consultative, collaborative and constructive approach has
been very positive and has been warmly welcomed, as,
indeed, has been their engagement with the Citizens’
Assembly.
As has been made clear by the Secretary of State for
Health and Social Care, we want to integrate plans for
social care with the new NHS plan that the Prime Minister
announced recently. It would not make sense to publish it
before the NHS plan has even been drafted, so our Green
Paper will be published at the same time as the plan. It
will cover the Government’s proposals on a wide range of
social care issues, including, but not limited to, the
need for the social care market to be sustainable for the
future. It will also build on policies such as our
“Carers action plan”: we will, for example, consult on
proposals to provide better support for unpaid
carers.
The report will be incredibly valuable to our work. It
will enhance our plans for the Green Paper, and will
ensure that it can offer people a sustainable future and
the knowledge that as they approach their later years,
they will do so in security and safety and with quality
provision.
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Again, I thank all the members and staff of the
Committees for their work. The challenge now lies with
the Government and with Ministers. There should not be
any more long grass out there to kick things into. We
want to see Government and Opposition working together
and starting to make the difficult decisions that need to
be made for the benefit of the people who need the care,
both the elderly and those of working age.
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