Social Care — House of Commons, 2018-04-25
Topic: Social Welfare
Katherine Anne Green (Labour, Centre-left): It is a great pleasure, as a Manchester MP, to follow a Yorkshire Member from the other side of the Pennines, my hon. Friend the Member for Keighley (John Grogan). I am pleased to have an opportunity to contribute to the debate and want to make a few points that have not come up very much in the debate and that particularly affect my constituents in Trafford We have a relatively elderly population in Trafford, compared with Greater Manchester as a whole, which creates a higher level of need in the borough. We also suffer from a high level of delayed transfers of care— in February we had 737 days of delays in the system because of a lack of places in nursing homes, residential care homes or domiciliary care. We also have a disproportionate number of self-funders, which makes it more difficult for the local authority to shape the market. It also means that many self-funders have no connection with the social worker, so they do not necessarily get good advocacy to ensure that their care needs are met In Stretford and Urmston we have relatively few large chains supplying residential or domiciliary care; the market is characterised by small businesses, often long-established and family-owned. Those businesses struggle with a lack of reserves, and they are often in buildings that they have occupied for decades and that were not purpose built as care homes. They are now unable to raise the funds to enable them to upgrade their facilities to meet modern standards, not least because of the relative inadequacy of funding from the local authority. Only the other day another small local business decided that it will have to close its doors. As we heard from my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), that is a cause of great anxiety and stress for residents and their families Many hon. Members have talked about the pressures on the workforce. That is a particular problem in Trafford, where there are many job alternatives—people can work in the Trafford Centre or in MediaCity, or they can travel into Manchester to work in the many businesses in the city centre. I am sorry to say that I think that position will become worse as a result of Brexit, because we rely heavily on European Union nationals to serve our care sector One thing that I think the Government could helpfully do is talk of care jobs as skilled jobs. They might be low-paid jobs and they might have relatively low qualification entry requirements, but they are skilled jobs. If we have to replace workers from the European Union with more workers from our domestic workforce, we will need to make social care jobs seem attractive to them with good pay and conditions, training and career paths, and by talking up the quality and importance of those jobs I am sorry to say that the pressures on Trafford put us in a very bad position. According to Independent Age, we have the seventh worst CQC inspection record in the country. The CQC has found that 43% of residential care homes and 45% of domiciliary care providers in Trafford are either inadequate or require improvement I turn to what I hope will be in the Green Paper. Let me say first how concerned I am that the CQC system, although it provides assessments, seems to lack real bite when it comes to bringing about improvements. It seems that providers are given poor assessments and have six months to try to raise their standards, during which time the local authority has some conversations with them but there is a lack of sustained external attention and pressure to ensure that they actually improve, and that by the time the CQC comes back they have not much improved. When a care home or care setting receives a poor assessment, the local authority rightly is no longer prepared to place residents there, which of course means that its income drops further, making it even harder to improve. I would be grateful if Ministers, in preparing the Green Paper, paid particular attention to how we could make that CQC process work better so that it drove improvement, rather than simply providing a picture of what is going wrong We have talked about family carers. I absolutely recognise and applaud the work they do. Age UK recently held a focus group in my constituency with family carers, who said they felt it was difficult to find co-ordinated information and support. Very few people plan or choose to be a family carer, and it is incumbent on us to think about ways we can get much better co-ordinated information to them about the support that is available and how they source it. We must also recognise that family care is not always appropriate. Some family members will not be able to provide family care—someone’s needs may be too high or the family member may have other commitments. In some cases, the person who requires care will not want a family member to provide intimate care to them I want to draw Ministers’ attention to a second phenomenon in my constituency that is putting further pressure on the system. The south Asian community in particular has relied heavily on family care, but traditional family patterns in that community are breaking down. We must look to the point in 10, 15 or 20 years’ time when we have raised the education and aspirations of women in those communities and they are no longer prepared to stay at home and care for auntie and granny, as previous generations have. We desperately need attention to be paid to building up the provision of culturally appropriate care Integration has been much talked about. We are finally making progress with the health and social care partnership in Greater Manchester. I welcome that, because we have talked about integration in Trafford without many visible results for many years. Members touched on working-age adults, for whom integration with just health is missing the point. Many of them are not unhealthy, but they do need integration with employment, education, transport, housing and so on. I hope the Green Paper picks up on that point Let me join other hon. Members in talking about funding. We need much greater clarity about what is means-tested and what is universal. We need to think that through in a strategic and rational way. We have all said that it is not right simply to expect those who need care to bear the whole cost of it. We must begin to set up a system that properly enables us to pool and share cost and risk. I am with my hon. Friend the Member for Leicester West (Liz Kendall) in thinking that that requires us to use a range of measures through progressive taxation. I am also with my hon. Friend the Member for Keighley (John Grogan) in saying that that means that inheritance tax, and taxes on assets, have to be part of the mix. That is necessary to ensure intergenerational fairness and fairness between my constituents in the north of England, where house prices are relatively lower and all someone’s assets will be used up paying for care, and those in London and the south-east with much more valuable properties, who may be left with more assets after they pay for their care Finally, I say to the hon. Member for Redditch (Rachel Maclean), who sadly is not in the Chamber, that council tax can be only a very small part of the answer, because it produces a very uneven pattern of funding given the very different council tax bases in constituencies around the country I would be grateful if the Green Paper picked up, in addition to all the other points that have been made this afternoon, on the specific points I have made. It would make a big difference to people in my constituency who need care today, to their families and to all of us in the future if, finally, this matter was properly and strategically addressed.