The difficulties we have faced over the past year have brought into focus the challenges that the social care sector faces. Social care is a huge cost for local authorities, with around 70% of budgets being spent on providing this care, and so it is crucial that we find a sustainable long-term solution.
This week, it was very helpful to share these challenges and press the Government to find a stable and consistent funding model. In particular, I drew on the work of Sir Paul Carter, who has done a great deal of work to look at international best practices. You can read my full contribution below:
It is a pleasure to serve under your chairmanship, Mr Twigg.
I commend the hon. Member for Dulwich and West Norwood (Helen Hayes) and my right hon. Friend the Member for Ashford (Damian Green) for securing this debate, and I particularly commend my right hon. Friend for his work to develop long-term policy solutions for many of the challenges that we see, which are not new but which have been brought into sharp focus by the experience of covid and its impact across the social care sector. We have all seen large numbers of constituents, for example, who have been enormously distressed by the restrictions on care home visits, which has had a hugely significant impact, and it is welcome that we are able to see a lifting of restrictions, so that families can get together at long last.
However, when we look across the whole of the UK, we recognise that even in places where there is a relatively high level of demand being placed on the care sector, less than one in five of the population will make use of it during their lifetimes, including children’s social care, adult social care and social care for older people. It is a sector that is often not well understood. In fact, because most people do not engage with it during their lifetime, unlike the NHS, the police and other emergency services, people often do not appreciate how it works or indeed recognise that for most top-tier local authorities—those with social care responsibilities—social care will consume around 70% of their budget. It is far and away the biggest area of local authority expenditure in England.
I would like to draw the Minister’s attention to the work of Sir Paul Carter, formerly the chairman of the County Councils Network and the leader of Kent County Council, who has been looking internationally at models of care, particularly for older people, and ways of funding care that represent a move towards sustainable and long-term funding. This is a topic that I will come back to my closing remarks, but when 70% of the typical local authority budget is being spent on care, there is clearly a serious risk that unless we find a long-term solution, it will consume the rest of the budget.
Many of those other services, such as libraries, parks and leisure services, which support the wellbeing of the wider community and in many cases represent the infrastructure that our communities need, will genuinely be in financial peril unless we find a long-term financial solution. Indeed, the only area of local authority expenditure to have increased in the last decade is expenditure on children’s social care, which has been achieved largely at the expense of other areas of local authority expenditure, rather than through tax rises.
A number of ideas have been put forward. I know that many in the local government sector—I speak as a vice-president of the Local Government Association—have welcomed the opportunity to raise a council tax precept specifically for social care. However, even when I consider my own two local authorities, which are London boroughs, there is enormous variation within the same type of council and within the same type of city in what that precept can contribute to boosting social care budgets. It ranges from the maximum precept being implemented —in the City of London, an additional 0.02% on the budget—to the other end of the scale, in the London Borough of Richmond, where much more expenditure is raised directly through council tax and where there is an additional 1.8% net. When we take into account the variations across the country, it is clear that precepts are not a long-term solution to social care funding. We need to find a different way of looking at this issue.
The second issue, which seems to me absolutely critical, is that we need to consider the success or otherwise of the joint working arrangements put in place under schemes such as the better care fund, whereby the NHS and local authorities come together to manage local services. When we look at those ventures, it is very clear that it is the local authority-led elements of them that have consistently delivered against the targets that they have been set and the outcomes that we are all seeking to achieve. The NHS has found it considerably more challenging.
That demonstrates that we need to look at a local authority-led model for social care, because it is already clear and established that it is more efficient, more focused on delivery for our residents, and more likely to achieve the outcomes that we want to see. Because the vast majority of social care for children and adults of working age is well outside both the remit and the capacity of the NHS—indeed, it is not something that would normally be a priority for the NHS—it is clear that that bigger picture needs to remain firmly in view as we look at a long-term solution. A key element of likely success in social care reform will be in ensuring that it is managed and controlled by local authorities, who are in the best position to deliver against that.
Moving to conclusions, it is clear that in order to be effective and to address the issue around the discharge of patients from hospital, which causes such concern, a new model of care needs to have a very direct form of input, particularly from acute NHS services when it comes to the discharge of patients from hospital and rehabilitation services, which are a big part of this. We also need to ensure that general practitioners are able to work closely with the system so that the needs that they see emerging among patients in their surgeries can be taken into account. What we need most is a stable and consistent funding model, and there have been different attempts at developing that.
In his recent work, Sir Paul Carter looked at how the German operation is funded and structured through a form of social insurance. To an extent, what matters is not that we try to find a perfect solution. We need a solution that providers of social care and local authorities can rely on to ensure stability in the system and to avoid either the large-scale collapse of parts of the social care system, as we have seen with some providers, or a continued shortfall between what people need and expect, and what local authorities and their partners in the NHS can provide.
It seems clear from everyone who has spoken today—I am sure the Minister has grasped this message—that stability and consistency of funding are critical to provide a long-term solution for social care in England and the wider United Kingdom.