Asked by
To ask His Majesty’s Government what assessment they have made of
reports that some care charities have been forced to evict
severely disabled people from their care homes because of
disputes with local authorities about fees.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
The disruption of care where it negatively impacts vulnerable
service users is unacceptable. Under the Care Act, local
authorities have a duty to shape their markets and provide
services to those with eligible needs. The Government are
providing up to £7.5 billion over the next two years to support
adult social care and discharge. This historic funding boost will
help local authorities to start addressing waiting lists, low fee
rates and work- force pressures in the sector.
(Lab)
I thank the Minister for that Answer, but I cannot say that any
of it was a surprise to me. Will he acknowledge that this is just
the latest manifestation of a long-standing problem? For years,
the social care system for adults with complex disabilities has
been held together by charities and not-for-profits that have
poured literally millions from their reserves into subsidising
the services they provide for the NHS and local authorities. Now
these organisations are in financial trouble and can no longer
afford to do so. Those who are suffering are those in greatest
need. Does the Minister agree that the whole system of funding
for social care is broken and that the only solution is complete
root-and-branch reform, not the piecemeal solutions offered by
the Government?
(Con)
I thank the noble Baroness and echo the sentiment of thanks to
the charitable sector for the work it is doing in this vital
space. We have shown that we have listened in this area through
the £7.5 billion—a 22% increase over two years, which I think
everyone would agree is substantial. At the same time, we are in
touch with these bodies; we reached out to the charity Leonard
Cheshire, which is involved in this, to try to understand the
issues. If there are ways in which we can directly help, we will
do so.
(CB)
My Lords, does the Minister agree that there was a time when, if
the local authority asked to see the parents, they assumed that
this was for a review of what progress had been made by their
offspring in residential care? More recently, parents are saying
that they fear any approach by a local authority, because it may
say that it will have to move their child to a different
arrangement because it cannot afford to pay the fees now being
set.
(Con)
As I say, we are working on this. The CQC has a vital role to
play and we had a discussion recently with the Association of
Directors of Adult Social Services, which welcomed the relief the
Autumn Statement brings in this area. I can only reiterate that
we have listened and acted.
(PC)
My Lords, I draw attention to my registered interests. Do not
these cases underline the need to ensure that the additional
costs of severe disability, whether incurred in charitable
establishments, commercially run accommodation or at home with
families, should be met consistently from central sources rather
than falling on local authorities, which may have neither the
expertise in the degree of disability nor the resources to meet
them?
(Con)
As ever in these areas, there is a debate to be had on centralism
versus localism. I happen to believe that local authorities and
healthcare systems are best placed to understand the needs of the
people in their area, and I will continue to support that.
Clearly, where help is needed, we are there. I reiterate that we
have funds to support them from the centre, including a £2.3
billion increase for mental health, to give one example.
Generally, I would keep to the principle that it is best that
local people and authorities identify and meet local needs.
(LD)
My Lords, the Minister just referred to mental health funding and
referred earlier to the increased funding to cover delayed
discharges and get more people coming out of hospital into social
care. Neither of those affects severely disabled adults; funding
for them from central government to local government has not been
increased. I repeat the question of the noble Baroness, Lady
Pitkeathley: does the Minister think that the provision and
arrangements for this particular group of people are broken?
(Con)
No—it is for local authorities to decide how best to use the
funding we have put in place, as I said. That means looking at
the needs of local people and how best they will put this in
place. The 22% increase in funding can be channelled to exactly
these types of places and people if a local authority believes
that that is in the best interest.
(Con)
Does my noble friend accept that many disabled people in
residential and nursing care are of an age such that there are no
parents or close relatives left and there is no one with a
lasting power of attorney? How can that vulnerability be coped
with by the state in a way we would all approve of?
(Con)
My noble friend identifies an ageing demographic, the challenges
that brings to all of us and the pressure on adult social care
and the centres. As I have said, this is a challenge, but there
are high levels of satisfaction in the sector: 89% of people are
satisfied and 64% are very satisfied. So, although we have not
got this right in every case, we are broadly on the right track
and getting good results.
(CB)
My Lords, eight out of 10 of the largest providers of care for
the disabled and children are at least in part private equity
owned and, in many cases, wholly so. Their interest rates are
already their major concern, and these are going up. Is the
Minister concerned that these private equity-owned homes will be
forced either to cut what they do and serve their customers less
well, or close? If he is concerned, what is he doing about it?
(Con)
The financial health of this sector is an area of interest; we
all of course recall some of the problems and failures about 10
years ago. I had a meeting on this subject just this week,
identifying the health of the providers to see if that is of
concern. The margins made in this space are fairly typical of
other industries, so they are not indicative of an area under
particular stress. But I have my mind on this issue and will keep
an eye on it.
(Lab)
My Lords, ADASS reports that in the past four months,
“64% of councils … reported that providers in their area had
closed, ceased trading or handed back council contracts”
either through an inability to recruit staff or escalating care
home running costs. We all know that the extra funding to
councils, which the Minister repeats in almost every response,
just about props up existing services and does not provide the
sustainable and long-term funding that was promised to commence
with the again delayed social care cap. When will the Government
fulfil their pledge to fix social care?
(Con)
My Lords, the 200,000 extra care places that this funding
provides is a solid example of an expansion of supply, and I hope
all noble Lords agree that that is a substantial number. I hope
they also agree with the work we are doing to recruit from
overseas to increase the workforce in this sector, which is
indeed increasing. Areas such as these show that we are committed
to expanding the supply, and we are seeing that rewarded in the
increase in the last few months.
(Con)
My Lords, has my noble friend yet had an opportunity to read the
Economic Affairs Committee report on social care, a “national
scandal”, which points out that in care homes in both the private
and the charity sectors, people who pay their own costs subsidise
others to the tune of 40%? The local authority rates are simply
unsustainable, and this issue is therefore urgent and needs to be
addressed. Simply talking about inputs all of the time is no
good; we need to see what is happening to the outputs, which is a
tragedy.
(Con)
Funnily enough, the meeting on the sector’s financial health that
I mentioned was precisely in response to the Question last week,
so that I can make sure that proper work is being done in this
space. I will not pretend to have the answers to that yet
because, as my noble friend mentioned, a long-term review needs
to be done. But rest assured that I am working on this.
