§ Motion made, and Question proposed, That this House do now adjourn.—[Jim Fitzpatrick.]
10.28 pm§ Sue Doughty (Guildford)I have requested this debate because many of my constituents face problems in getting the care that they need in Surrey. First, however, I pay tribute to the enormous amount of work undertaken on behalf of the people of Surrey by those who work in adult social services, their colleagues in the national health service and those in the care sector.
We are indeed fortunate that, despite the enormously high cost of living in the area, those people work so effectively with the scarce resources that we have, not only to provide the services that they are required to perform, but to ensure that the money is spent as wisely as possible. Their work has already been assessed by the social services inspectorate as making significant progress against Government targets. However, from time to time their best efforts are not enough, and people are badly let down because the needs in Surrey are greater than the resources we have.
It is important that before I go into specific issues, I make the Minister aware of some of the good things that we have been doing in Surrey social services. We have not been allowing a problem to develop in the hope that the Government will bail us out. Far from it: in social services We have secured the country's first and largest private finance initiative contract, with the transfer of 17 former county council homes for older people to Anchor Trust, and seven other homes to Care UK to be developed as specialist centres dealing with mental frailty in older people. Joint developments with district and borough councils have supported developments for older people, and a learning disability partnership board. In my constituency, Guildford borough council provides day centres for older people to relieve Surrey of that load. Guildford has also implemented ground-breaking intermediate care schemes—"step up" and "step down"—to provide temporary sheltered accommodation while changes are made to people's homes, so that they can return after hospitalisation. Time forbids me to mention the many other initiatives on which great progress has been made.
The Minister will recall that I briefly raised this issue in an earlier debate. Although I was pleased with the "cash for change" funding that the county received to reduce the number of delayed discharges, I was concerned that we were not yet out of the wood. The large increase in Surrey county council's taxes had Liberal Democrat support, because we are all concerned about the major funding problems that Surrey faces. The people of Surrey have experienced a staggering 11.4 per cent. increase, 5.4 per cent. of which is for social services alone.
We have no difficulty with the provision of national funding for areas where need is greatest, but our social services funding has fallen below the acceptable level. Care costs are inevitably high in an area where property is expensive. Our unit cost of delivery is high, and we need nursing homes to stay in business. Housing costs are also a major issue, as they contribute to employment costs as well as job vacancies. The Government have allocated money for key worker housing, but demand is massive 777 and, understandably, we keep losing staff. Agencies and homes are unable to bring in people from abroad, because the qualification levels needed for many posts are below that for which work permits would be allocated. High land and property costs also contribute to the problem. To build care home capacity, we need business planning. Building new care homes is almost impossible at the moment however, as land owned by the health service is being sold off at commercial rates, out of reach of the care sector. Sadly, in Surrey it is a case of selling off the family silver.
Staff vacancy rates also give us cause for concern. For care managers, the rate is 15 per cent.; for occupational therapists, it is 16.5 per cent.; and for learning disability residential services care staff, it is 34 per cent. The average vacancy rate for residential care staff for older people is 31 per cent., but in some homes it is 51 per cent. In Surrey, domiciliary care assistants work long and hard to do as much for their clients as possible, often finishing off in their own time, rather than leaving someone in distress. However, the average age of those who do such work is rising, despite training efforts at local colleges.
The Minister will be aware that Surrey hospitals have some of the worst problems with delayed discharges in the country, leading, of course, to unacceptable waits in accident and emergency departments, and cancelled operations. The "cash for change" funding has helped with rebuilding capacity, and in the next year Surrey aims to support an additional 120 people who might otherwise have experienced delays in being discharged from hospital. There is much yet to be done, however. Fee levels must be raised if we are to purchase places for those who need nursing home care. Meeting Government targets to reduce delayed discharges is presenting us with a real challenge.
I hope that the Minister can tell me how patients currently funded through "cash for change" will be funded when the scheme ends.
§ Mr. Philip Hammond (Runnymede and Weybridge)I am most grateful to the hon. Lady for allowing me to intervene. The Government seem to be focusing on areas traditionally regarded as being in greater need than Surrey. However, does she agree that, if people in areas such as Surrey are unable to access good quality public services, the consensus that underpins provision of those services is in danger of breaking down?
§ Sue DoughtyI thank the hon. Gentleman for making that point. I agree. We have grave concerns about the future of some of those services.
We welcome the additional funding for Surrey that was announced after the Budget, but we are unclear about how much it will really be. The basis of the calculation is 6 per cent., but of which level of funding? Surrey's funding has fallen over the years and to enable wise planning with care providers and the health service, we need to know how much that money will be in real terms. The care business is in crisis in Surrey. We are in competition with London boroughs to get nursing home accommodation, and they have far more money at their disposal. The competition for places with self-funding people is also a constant problem for those who cannot fund themselves.
We share the Government's concern that no one should receive care that falls below acceptable levels, and providers are working hard to meet the new standards. 778 However, inevitably, prices will need to rise to cover costs and Surrey will need to increase the rates it pays. It is a fact that fees are between 20 per cent. and 100 per cent. more than Surrey can realistically afford to pay, and any increase in fees that the council agrees to pay leads to a reduction in the number of people whom it can support.
Finding places that are accessible for family visits and suitable for the individual is a tortuous process. Improvements have been made through the work done by the Surrey ambulance service, which has developed a website listing homes, vacancies and prices. It helps families through some of the process, but Surrey can only pay fees of £450 a week for residents admitted from 1 April this year and £380 a week for existing residents. On 16 April, the most recent date for which I have figures, there were only four beds in nursing homes at less than £450 a week, but the Royal Surrey county hospital alone has 56 delayed discharges, many of whom are waiting for those beds. We cannot reduce those numbers in this financial climate. We are getting one of the lowest SSA settlements in the country, but facing some of the highest costs.
In the meantime, our acute hospitals are regularly featured at the wrong end of lists of those with delayed discharges and delayed operations. We need to gain a greater understanding of what hospitals will charge social services for having people in beds. At the moment, there is the ludicrous possibility of the Royal Surrey county hospital seeking to recover its costs at £200 a night, when Surrey social services does not have resources to place people in the more expensive nursing homes that nevertheless cost less than the hospital beds. The money runs out, and if it is paid to hospitals it cannot be used for nursing homes. If, through no fault of the hospital, patients cannot be discharged from hospital, will the council be required to pay fines from money that it does not have?
Provision to fund places for those with learning disabilities is also a major issue. Several long-stay hospitals in Surrey have closed, resulting in many people—far more than the national average—living in residential care in the county.
§ Mr. Nick Hawkins (Surrey Heath)The hon. Lady mentioned facilities that have closed. Does she agree that throughout the county, private sector care homes are closing because the people who have run them successfully for many years have chosen, when faced with huge new additional bureaucracy from this Government, to close down completely rather than try to wrestle with it? Does she agree that the Government's policies have directly led to a substantial reduction in the number of care home beds, which is only making the delayed discharges problem—the bed-blocking—worse?
§ Sue DoughtyI thank the hon. Gentleman for making that point and I agree that that additional bureaucracy and work is driving people out of business. Indeed, only today, I spoke to the manager of Surrey Care Homes, the umbrella organisation, and he made that point to me. The owners do want to do a good job and to stay in business, but they are finding that the climate is against them.
We have many problems with the places for people with learning disabilities. For example, demand for those places does not follow social need in the same way as 779 other problems. We have a very large number of people who need places with high costs, but we have a smaller amount of money to pay for them. We have problems with older parents caring for sons and daughters who should have other accommodation, but it does not exist. I can tell the Minister that Mencap has asked me to raise those concerns.
Many people were on preserved rights which have now ceased, and Surrey has taken over the management of their funding. The Government revenue grant for Surrey is £14.429 million. That covers 1,200 people, of whom 700 are known to the council, and they are already having their fees topped up as Government funding is inadequate to cover the purpose stated, which included shortfall in fees and care assessment costs. A further 500 people are not currently known to social services.
The transfer fund is estimated to be £100 million short. Care providers are already demanding an increase as the rates are not high enough to cover costs. That fee pressure is likely to be a further £1.5 million, but Surrey social services has calculated that if the preserved rights rates were allowed to escalate to the current market level of fees, that figure of £1.5 million would rise to £4.6 million. Not all the information is available because the Department for Work and Pensions has not provided details of the rates paid to individuals, so social services are still hacking through the details.
We want to know how Surrey should deal with this problem. We want our people living in their own home for as long as possible, happy and healthy. To achieve that, and to avoid the problems that send people to hospital in the first place, more resources should be allocated to prevention. We need the total integration of health and social care, rather than costs shunting between providers, to nobody's benefit.
I hope that the Minister will tell us that she has recognised that Surrey is doing as much as it can out of its own resources but is prevented from reaching the minimum standards that are decent, let alone meeting its aspiration to be a top-performing local authority. I await her response.
§ The Minister of State, Department of Health (Jacqui Smith)I congratulate the hon. Member for Guildford (Sue Doughty) on raising the very important matter of social services provision in Surrey. Like the Government, she is clearly keen to see high-quality health and social care provided for her constituents.
The hon. Lady made much of her concern about social services funding in Surrey. The Government have already made a considerable investment in social services which has been growing substantially in real terms. Resources for personal social services have increased by 20.4 per cent. in real terms between 1996–97 and 2002–03—an average real-terms increase of 3.1 per cent. per year. That compares with an average real-terms growth of less than 0.5 per cent. per year between 1992–93 and 1996–97 under the previous Conservative Government.
Surrey has benefited from that investment. Last year, it received an increase of 6.4 per cent, in its total personal social services resources, compared with a national average increase of 4.7 per cent. This year, Surrey's 780 personal social services standard spending assessment will increase by a further 4.6 per cent., its carers grant by a further 21 per cent. and its children's grant by a further 12.8 per cent. Increases of that size demonstrate the Government's commitment to social care, throughout the country and in Surrey.
The hon. Lady suggested that when it comes to the standard spending assessment formula, Surrey is hard done by. I am sure that she is aware that the Government are reviewing the SSA formula. The Department of Health has already presented to representatives of local government some of the research that we have commissioned for this process. During the summer, consultation will take place on a range of options for possible changes to the formula, and I am sure that Surrey will want to make its views known. However, I note that Surrey's personal social services standard spending assessment per capita in 2000–01 was the same as that for comparator local authorities. So although I recognise the need for detailed consideration of the formula, we need to be clear about the basis on which that is being carried out.
The hon. Lady raised particular concerns about older people's services.
§ Mr. HammondFor all the Minister says about the SSA and personal social services spending, does she believe that the funding available to Surrey county council is adequate to provide satisfactory levels of personal social services to the elderly in particular?
§ Jacqui SmithThe Chancellor made the decisions that he did in the Budget last week because the Government believe that all local authorities, including Surrey, should get extra investment if they need it. Conservative Members voted against that Budget and it is a bit rich for them to turn up to an Adjournment debate to argue a case for which they were not willing to vote last week.
The hon. Lady raised particular concerns about older people's services, and delayed discharges in particular. She is right that delayed discharges are bad not only for system but, most importantly, for older people themselves. That is why, last October, the Government announced a further £300 million of new funding for social care over two years. That is closely linked to the work of a strategic commissioning group to give greater direction to the commissioning of care for adults. Incidentally, that covers good practice in commissioning residential care for people with learning disabilities as well as focusing on the commissioning of care for older people.
The group published the agreement on building capacity and partnership in care on 9 October, and we expect local social services and health authorities to adopt it. It will lead to real improvements in the planning and commissioning of services and ensure continuing good-quality care for those currently using such services.
The funding was targeted on the 55 councils that have the most severe problems with providing a sufficient range of services in the community to allow people to leave hospital. That recognises some of the concerns that the hon. Lady outlined with respect to Surrey, which is one of the authorities that was targeted for extra support. The money was also to be used to stabilise the care home market, and there is evidence nationally of its being used to increase fees and to buy more places.
§ Sue DoughtyI hope the Minister understands that Surrey has, with great reluctance, increased prices. 781 That was in response to the lack of beds and because care homes close when prices fall below a particular level. In addition, I hope the hon. Lady understands that the social services department has done much to work with care homes to ensure that there is ongoing provision. It has done that when the funding has allowed it, but the funding is finite.
§ Jacqui SmithObviously, but the Government have increased funding and will increase it in future. We also need to ensure that the long-term commissioning activity at a local level between the private independent sector and the commissioners allows us both to maintain and to improve capacity.
Of the £100 million available last year, Surrey county council's share was £2.4 million. This year, its allocation is £5.2 million. Those are significant sums, and the council's proposals aim to reduce the number of delayed transfers of care and to sustain the independent sector market. I understand that last year the council utilised its extra funds to provide more long-term residential and nursing home care packages. That allowed 163 people to be discharged from hospital whose discharge would otherwise have been delayed.
The increased investment resulted in decreases in delayed discharge of 15 per cent. in the East Surrey health authority and 18 per cent. in the West Surrey health authority between 2 September last year and the end of the financial year. So the increased investment and the way in which it is being used by local authorities throughout the country and in Surrey has helped to deliver lower levels of delayed discharge.
The hon. Lady also raised the issue of allowing people to remain independent in their own homes. I understand that the rate of households receiving intensive home care packages in Surrey is relatively low, although I am pleased that it increased by 8 per cent. between September 2000 and September 2001. That is an important trend throughout the country, because the people concerned and their families tell us that they want the choice of being independent in their own home. The fact that by September 2001 the number of people receiving intensive domiciliary care had increased by 6 per cent. compared with the previous year is an important sign of how the system is changing to provide the necessary capacity, particularly for older people.
There is also increased capacity in intermediate care. Those important services are key to the prevention of some avoidable hospital admissions and allow a faster discharge for those who are admitted. Further strategic planning is required to ensure that development is carried out effectively, but we have already seen progress in intermediate care in the south-east, including Surrey. In the region as a whole, an additional £21.5 million has been invested in intermediate care since 1999–2000. In Surrey, that means that there are plans for 1,500 extra people to receive intermediate care compared with the figure for 1999–2000. Investment is making a difference in the provision of services for older people.
The hon. Lady raised concerns about preserved rights. The changes that the Government have introduced from this month bring those residents within the existing community care arrangements. They will benefit from local council involvement in their care assessment, management and contract negotiations. The transfer 782 removes anxiety from those who were struggling to pay their fees under the old system, and it promotes independence, giving some people in residential care the opportunity to move to more suitable accommodation, such as sheltered housing.
In 2002–03, councils are receiving £614 million in a special grant to meet the costs of their new responsibilities for that group of residents. As the hon. Lady said, Surrey county council will receive £14.429 million this year to fulfil its responsibilities. Out of the £614 million total, £86 million is to meet the shortfall and assessment costs. That is generous. Councils were already meeting many of the shortfall costs from their existing resources. Consultants Laing and Buisson and the Joseph Rowntree Foundation suggested in a report that the cost to councils of assuming responsibility for the shortfalls would be less than the money that they were being given for that purpose.
The hon. Lady also raised the important issue of support for people with learning disabilities. I am sure that she is aware that the White Paper "Valuing People" set down for the first time the sorts of services that people with learning disabilities should receive and, importantly, how they should be involved in decision making. People with learning disabilities will clearly benefit from extra health and social care investment, but they will also benefit from much better use of the £3 billion that is already spent on learning disability services throughout the country.
The Government have recognised the need for development money to help to make the changes necessary to fulfil the aspirations set down in "Valuing People". That is why, this year, the learning disability development fund will be £20 million of capital and £22 million of revenue. Surrey has been allocated over £350,000 this year from revenue allocation alone to support priorities for service change. The hon. Lady made an important point about how we ensure that health and social care work together for the benefit of those who need the services, so I point out that that money needs to be spent as part of a pooled budget, emphasising the importance of partnership in ensuring good-quality services.
In his Budget, my right hon. Friend the Chancellor was able to put NHS finances on a sustained footing for the next five years and begin to reverse the decades of underfunding. For personal social services, the plans deliver annual average growth in real terms—the hon. Lady asked me whether this was a real-terms figure—of 6 per cent. from 2003–04 to 2005–06. That demonstrates the Government's firm commitment to social care. Details of the way in which the money will be allocated will be made available later this year, but the settlement puts health and social care on a much firmer footing. The people of Surrey will undoubtedly benefit, as will people throughout the country, from increased investment in social services. They will also benefit from other Government actions, including a recruitment campaign.
§ Sue DoughtyI have listened with great interest to the Minister's figures. While I naturally welcome the increases, does she believe that they are adequate to cover the shortfall and the problems that I described? An 783 increase of far more than 6 per cent. is required to deal with delayed discharges, the rise in their number and the problems that we in Surrey face.
§ Jacqui SmithI have a relatively short time left, but it is no surprise that a Liberal Democrat Member should argue that a doubling of the annual real-terms increase in social services spending is still not enough.
The new cash includes resources to cover the cost of hospital beds that are blocked needlessly as a result of delayed discharges. Councils will need to use the extra resources to expand care at home and ensure that all older 784 people are able to leave hospital once their treatment is completed and it is safe for them to do so. We will introduce stronger incentives to ensure that people do not have to wait so long to be discharged. Older people and other service users have the right to expect that local services work together as a coherent whole, as the hon. Lady outlined. We are moving in the right direction to a seamless service which, with the extra resources made available by the Government, ensures that people get the right care at the right time and in the right place.
§ Question put and agreed to.
§ Adjourned accordingly at four minutes to Eleven o'clock.