§ Mr. Nigel Waterson (Eastbourne)
This debate is very timely, coming on the day after the county council's budget meeting, and also the day after publication of "Better Value for Money in Social Services", of which more later.
On any view, the budget in East Sussex has been a moving target again this year. Across the whole range of spending—including spending on social services—we have seen the Liberal Democrat administration indulge in its usual mixture of scaremongering, blatant party politicking, and plain ineptitude. The technique is to hype up a range of possible so-called cuts in spending in order to antagonise and worry the maximum number of interest groups and individuals. When they understandably react, an attempt is made to blame the wicked Government.
For education, for example, East Sussex was given a generous funding increase of £7 million this year, but we have seen the spectacle of local Liberal Democrat politicians and paid officers of the council warning schools of the possibility of a £1.2 million cut in their budgets. Indeed, at meetings of governors only just before half-term, head teachers were reporting on possible redundancies among teaching staff. Only during the half-term holiday did the Liberal Democrats choose to unveil their plans, and to accept that there would now be no cuts in schools budgets. What an appalling way to treat professional people, as well as governors and parents.
The story in social services is, if anything, even more dismal. In the past, I have often accused the Liberal Democrats of behaving as if they were in opposition, when they are actually running things, and this year is no exception. In the words of Councillor Michael Tunwell, leader of the Conservative group on the county council, we are in the realms of "virtual reality" budgets. I look forward to the restoration of a competent and sensible Conservative administration on 1 May.
Predictably, the Liberal Democrats try to blame inadequate central Government funding. What are the facts? The standard spending assessment for 1997–98, on which Government grants are based, is to increase by 3.5 per cent., which is a larger increase than has been received by any county. If we assume that the council will spend up to its capping limit, that means a total this year of £305.5 million.
The total resources available for personal social services will amount to £123,322,000 in the current year. That represents no less than an 81 per cent. rise in real terms since 1990–91, compared to an average of 68 per cent. for the whole of England. Even over last year, there was an 8 per cent. increase in cash terms. The total resources available for community care have risen by 100 per cent. in real terms since 199–91.
Some confusion has arisen because of the relationship between the special transitional grant and the SSA, and the switch from the one to the other. The STG was always intended to be temporary, as its name suggests. Also, we must see all those points against a background of dramatically increasing resources for personal social services.
Since 1994, all the new resources given to local authorities for their new community care responsibilities have been distributed according to the SSA formula. 891 It follows that there is no difference between the amount that authorities receive when the additional funds are paid via the STG, and the amount they receive when it is transferred into their baseline resources and paid according to the SSAs. It is possible to identify a small difference in resources for 1994–95, but it is essentially a presentational rather than a real difference. This is a complex issue, and I imagine that my hon. Friend the Minister will want to expand on it.
Actual spending in East Sussex has swung wildly back and forth in recent years. An underspend of £3 million on community care became a £4.22 million overspend in the current year, with the forecast of an overspend of £7.3 million next year.
§ Mr. Charles Wardle (Bexhill and Battle)
Is there not a disturbing contradiction between the misleading claim of the chairman of social services that the county is actively encouraging independent care bed provision by the private sector, and the legitimate complaint of the Registered Nursing Home Association that none of the Government-funded increase is being passed on to the private sector? Has not the director of social services admitted to my hon. Friend, and to other colleagues, that private care beds in East Sussex cost much less than beds in care homes run by the county council? He has not grasped the nettle, however.
May I point out to my hon. Friend, on behalf of my hon. Friend the Member for Hastings and Rye (Mrs. Lait)—who, being a Government Whip, is prevented from speaking by parliamentary rules—that the social services department in Lewes is refusing to meet the cost of referring patients to St Augustine's nursing home, thereby putting the management of St Michael's hospice in further jeopardy? Is that not a gross dereliction of responsibility?
§ Mr. Waterson
My hon. Friend is absolutely right. I intend to develop those points later in my speech, but let me say now that, even if the Government could be persuaded to give a few million extra pounds to East Sussex, there would be no guarantee that the money would find its way through the system to independent care home owners.
How wisely are these substantial sums being spent at present? East Sussex prides itself on hitting what it calls the Government's "target" for spending in the independent care sector. That, of course, is based on a false premise. The Government set a minimum figure of 85 per cent., but, as my right hon. Friend the Secretary of State has made clear:The local authority's primary role is as an enabler and commissioner of services.Is it really sensible for this or any other council to insist on keeping its own part III accommodation going, when it is often aging and unsatisfactory compared with provision in the private sector?
It is clear from correspondence I had last year with Mr. Holbrook, the director of social services, that, at long last, the council has begun to consider seriously whether to transfer provision from the public to the private sector. According to figures that I have seen, there is a disparity of at least £150 per bed per week between what the council spends on its own homes and the amount spent in 892 the private sector. Only last year, Mr. Holbrook accepted that there was a potential net saving of £2 million, which is almost certainly an underestimate.
In any event, that money could be immediately available to meet other pressing needs in my constituency and elsewhere. May we be told what plans the county council now has to transfer provision from one sector to the other? It is significant that there is no provision in the capital programme for upgrading the council's part III accommodation. Does that perhaps show a lack of commitment on the part of the current administration to keep the homes open for much longer? As recently as 11 February, Mr. Holbrook confirmed in a letter to me that the council was engaged ina reappraisal of the services which the County Council should continue to provide and a determination of those elements which are no longer needed.Another issue is the cost of domiciliary care. I am told that, in the private sector, that can be provided at a cost of about £7 an hour, whereas in the public sector the cost is roughly double, at £14 or so. No wonder councils such as Kent—by no means a beacon of Conservative administration—contract out all their home visits, thus making significant savings.
The private care sector is a vital part of the local economy in Sussex. It is said to involve 10,000 jobs. I am indebted to Mr. Terry Fribbens of the East Sussex independent care group and his colleagues for pointing out to me the seriousness of the problem.
In my constituency, a number of homes have already gone out of business. We are told that the social services department is now operating a "one in, one out" policy. One distraught residential home owner contacted me a few days ago to say that he had been told by the department that it was freezing new referrals for at least two months. Stop-start policies of that kind can spell ruin, especially for small operators.
§ Sir Timothy Sainsbury (Hove)
I think I am right in saying that the figures that my hon. Friend has just quoted are for East Sussex as now constituted. As he and my hon. Friend the Minister will know, the Labour-controlled unitary authority of Brighton and Hove will shortly be taken out of East Sussex. Is he aware that all the indications are that that local authority, if controlled by Labour as opposed to the Liberal Democrats—it is a matter of choice which is worse—is threatening to behave in exactly the same way as East Sussex in regard to care homes? That will have an equally damaging effect both on residents and on care home owners.
§ Mr. Waterson
I suspect that, in those circumstances, my right hon. Friend's worst fears will come to pass.
§ Sir Geoffrey Johnson Smith (Wealden)
I hope that my hon. Friend is also aware that Wealden contains the largest district authority in East Sussex, and that the value of residential homes—in terms of the employment they provide, as well as the services they give—are highly prized.
§ Mr. Waterson
My right hon. Friend is absolutely right.
893 In a recent letter, Councillor Tutt, the chairman of social services, had this to say:Crudely this will mean a new client will not be provided with a service until the service to an existing client is terminated (usually on death). Inevitably the impact on the quality of life of people needing services, and on their carers, will be significant indeed. Legal challenges will doubtless materialise, and the businesses of a number of independent providers will be under very real threat.On any view, those are pretty breathtaking admissions. Indeed, so lacking has financial discipline been under the present administration that, for the first time in living memory, officers of the council have had to take executive action, without prior reference to elected councillors, to try to bring the budget back under control. I hope that that point, among others, will not be lost on those who brought about a Liberal Democrat administration, either by voting for them, or more likely by simply staying at home on polling day.
Councillor Tutt goes on to say:Regrettably it will be impossible to avoid hospital bed blocking.In addition to a self-imposed crisis in social services, East Sussex seems resigned to causing longer waiting lists in our local NHS.
I have long argued that one of the problems with social services in East Sussex is the council's mind set, which can be best summarised as "public sector good—private sector bad". Care home proprietors are incensed that the council, while freezing the weekly rates it pays them, will be adding to its overhead costs by allowing for a 2.5 per cent. rise in pay. On the other hand, the private sector will not be able to afford pay rises for staff, and in some cases will be looking at redundancies. That is not only wholly unfair, but makes no economic sense when the private sector is in a position to provide care that is at least as good as—if not better than—the public sector, and at significantly lower cost.
There are any number of examples of the strange priorities adopted by East Sussex. I have a letter from the National Association of Citizens Advice Bureaux, which expressed considerable concern about the budget proposals in East Sussex.
I was recently visited at my advice surgery by Mrs. Ho, of Communicare, who runs a successful psychiatric day centre. She had been told that her funding from social services is likely to be cut. All that that would achieve is a reduction in the number of days when she should open, with a knock-on effect on hospital admissions.
My hon. Friend the Member for Hastings and Rye, who is in her place, has passed me a letter from Mrs. Longbottom, one of her constituents. Mrs. Longbottom relates, as did my hon. Friend the Member for Bexhill and Battle (Mr. Wardle), that St. Augustine's nursing home has had to advise 10 of its residents that their contracts are being terminated. How many other examples are there around the county?
The net result of all this is that, despite the very substantial sums being channelled into social services in East Sussex by central Government, the funds are not being spent in the most sensible and cost-effective fashion, and residents of East Sussex will end up with a council tax that has increased by 9 per cent. in one year, or three times the rate of inflation—in other words, poorer 894 services at greater cost. Perhaps that should be the Liberal Democrats' epitaph in East Sussex. Contrast that with the figure of £410, which was the equivalent band D tax level in the last year of a Conservative administration.
It is particularly timely, therefore, that, only yesterday, the Department of Health published "Better Value for Money in Social Services", which asks such pertinent questions as:Are we making deliberate, well informed decisions and priority choices about the development of our services?Have we in place the appropriate tests to demonstrate that resources are being used to maximum effect?What is the cost differential between placements in our own homes and residential care placements in private and voluntary homes? If our own homes' costs are higher, how do we justify the extra expense?With other colleagues, I eagerly await the forthcoming White Paper about the provision of social services. I do not know whether my hon. Friend the Minister is in a position to trail any of its likely proposals today. We already know that one issue that will be addressed is the relationship between social services departments' providing, commissioning and regulatory roles.
In East Sussex, the present administration at county hall is characterised by a lack of leadership, a sense of drift and an organisational nightmare. That means that, despite very substantial Government funding, there is a chronic inability to deliver the care that is needed when it is needed to the local people who need it.
§ The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns)
I congratulate my hon. Friend the Member for Eastbourne (Mr. Waterson) on his success in securing this timely debate on funding for social services in East Sussex. He performs a singularly important function on behalf of his constituents by raising this issue today.
The importance of the issue and the concerns that it is causing people in East Sussex can best be demonstrated by the fact that my right hon. Friends the Members for Hove (Sir T. Sainsbury), for Wealden (Sir G. Johnson Smith), and my hon. Friends the Members for Bexhill and Battle (Mr. Wardle), for Brighton, Kemptown (Sir A. Bowden) and for Hastings and Rye (Mrs. Lait) are present today.
I know, not only from their interventions during the debate but from the way in which they have raised issues in their constituencies, at ministerial level and through the avenues that are open to them in the House, that they are as concerned for their constituents as my hon. Friend the Member for Eastbourne at what is going on, and the way in which a political party in this country is playing grubby political games with the most frail, vulnerable and elderly people in society.
It gives me no pleasure to say that I also have the misfortune—although, fortunately, not on the same scale as my hon. Friend—of having to face the tactics, the cheap ploys and the rather unpleasant soundbites of Liberal Democrats in my constituency. We all know the tactics, some of which were so eloquently described by my hon. Friend.
We know that Liberal Democrats have a handbook that advises their parliamentary candidates what to do. If local councillors see an issue on the agenda for which a popular 895 decision will be taken, Liberal Democrats start a campaign calling for it, and, lo and behold, when the decision is taken, they claim the credit, even though they had little to do with it.
My hon. Friend highlighted what has become a despicable annual game for the Liberal Democrats in this country at this time of the year, in the run-up to the budget. They say, "Let's cause some scare stories. Of course, it won't be our fault—it's the Government's fault—so let's try to score some political points out of it." They then create stories of cuts here and cuts there. They say that there is a lack of funding, but that is not based on any reality or truth. They raise fears simply to try to win votes; then they place the blame for their own inadequacies and failings on someone else.
I should like to put that into perspective by setting the record straight. I make no apology for beginning my reply to my hon. Friend's speech by quoting some impressive statistics to underline the Government's commitment to funding social services fairly, so that the elderly, the frail and the vulnerable in our society get the best deal possible. That is what government is about: providing the funds for the best services, the best care, the best provision, so that the vulnerable and those who are often confused by the political rhetoric that is dredged out of the gutter by the Liberal Democrats, can have peace of mind and security, either in their own home through a domiciliary care package or in a residential or nursing home.
At the start of the 1970s, expenditure on social services in this country was just over £243 million per annum. That increased rapidly through the 1970s, 1980s and early 1990s, and spending is now more than four times more in real terms than it was in 1971–72. I think that all my hon. Friends will agree that that is an extraordinary record over such a sustained period.
East Sussex council alone has budgeted to spend more than £124 million on social services this year. That is £616 for every man, woman and child in that county. It is almost four times the level of net spending on personal social services by the county council 10 years ago, and more than double its net spending at the beginning of this decade. No area of the council's business has seen such a rapid expansion in its funding from central Government.
The Government have shown their commitment to people who need social care by the provision of almost £8 billion for personal social services in the forthcoming year nationwide. The amount provided for social services in East Sussex has increased from £56 million in 1990–91 to £123 million this year, which is an increase of 81 per cent. in real terms, and is noticeably above the national average increase of 69 per cent. in real terms.
The amount provided by Government for community care has grown from £41 million in 1990–91 to £101 million this year, which is an increase of 100 per cent. in real terms. In case the Liberal Democrats do not understand that, it is 100 per cent. over and above the rate 896 of inflation during that period. Anyone who does not accept that that is a substantial increase is, quite frankly, living in cloud cuckoo land.
§ Mr. Charles Wardle
Is it not entirely predictable that not one Liberal Democrat is present to hear my hon. Friend's indictment of the party's performance in East Sussex?
§ Mr. Burns
As usual, my hon. Friend is extraordinarily perspicacious. He will probably have noted that, seven minutes into the debate, the hon. Member for Bolton, North-East (Mr. Thurnham) ambled into the Chamber, sat down and listened to the searing indictment made by my hon. Friend the Member for Eastbourne. He did not like what he heard, because he was ashamed of it, and he scuttled out fairly quickly afterwards.
It is worth pointing out that, when the Government provide a local authority with funding for personal social services, it is based on its standard spending assessment. It is up to local authorities, within their overall capping limits, to prioritise the services on which they want to concentrate more spending. A local authority can, if it wants, spend more on personal social services, education or some of the airy-fairy policies that are more akin to the demands and desires of the Liberal Democrats, even though they bear little resemblance to the desires of real people in the real world.
§ Mr. Burns
My hon. Friend mentions cycle paths, and I can think of others.
In 1994–95, East Sussex county council underspent on its personal social services SSA by 1.2 per cent. In 1995–96, it spent over its SSA by just 1 per cent., and in 1996–97 it spent over its SSA by a mere 0.3 per cent. It is up to local councillors to take local decisions, but those figures seem small—there was even an underspend in 1994–95—given the crocodile tears they shed and the accusations, smears and scares they try to arouse in East Sussex.
The issue of special transitional grant is complicated, but let me try to put it into perspective. An SSA is set for personal social services, and above that there is the STG, which the Government introduced at the beginning of the community care programme. The STG provides additional money to fund the new community care programme and is ring-fenced, so that 85 per cent. must be spent in the thriving independent sector to protect it from the encroachment of a local authority. At the end of the year, that money goes into the baseline for the SSA, and the next year a further STG is ring-fenced.
That measure was introduced for four years, and I am sure that my hon. Friends will be delighted to know that our right hon. and learned Friend the Chancellor of the Exchequer has extended the provision for a further year from April 1997. That is important. In his speech to the Association of Directors of Social Services, my right hon. Friend the Secretary of State for Health said that we see the role of local authorities as enablers, and the private sector as the providers of the services that we need for our frail and elderly people.
§ Mr. Waterson
Is my hon. Friend aware that a great number of dedicated independent care providers in my 897 constituency are raring to go? They can provide residential care, respite care, domiciliary care packages, day care and the whole gamut of social services provision, but their ambitions are being blocked by the rather old-fashioned attitude of East Sussex social services.
§ Mr. Burns
My hon. Friend is right. I pay tribute to the successful, dedicated and thriving private sector, not only in his constituency but in the constituencies of my other hon. Friends. He makes an important point. I commend to East Sussex county council the paper published yesterday, "Better Value for Money in Social Services". The council should study it carefully: the questions in each chapter are not difficult, so it will be able to understand them. Let us hope that it will come up with some constructive answers to enhance its performance in that area.
I am afraid that I must disappoint my hon. Friend, because I shall not be tempted to trail or leak the White Paper that my right hon. Friend will publish shortly. However, as a titbit and an inducement, I will say that the document will be extremely interesting and important. I strongly recommend that my hon. Friends read it, and that they ensure that their constituents are familiar with its contents, because it will be a good read.
My hon. Friend referred to bed blocking. I suspect that East Sussex social services have not made much of the extra funds to be spent on priority services next year to help with bed blocking. East Sussex health authority will receive £428,000, most of which is available to meet pressures arising from delayed discharge from hospital. Those funds are intended to be used to alleviate the most serious pressures and to focus on underlying problems, and they should bring long-term benefits to my hon. Friends' constituents.
In April 1997, East Sussex is to be reorganised. As my right hon. Friend the Member for Hove (Sir T. Sainsbury) mentioned, the Brighton and Hove area will become a unitary authority. I should like to say in passing that the Government have increased the provision for personal social services next year nationwide by a further 5 per 898 cent., which brings the total resources up to £8 billion. Both East Sussex county council and the new authority of Brighton and Hove will benefit as a result of that increase.
I have a great deal of sympathy with my right hon. Friend and his constituents. I fear that his suspicions about the way in which the Labour local authority will run services may well prove correct.
I have sought to explain the vast amounts of money that have been made available for personal social services, but how that money is used to provide the best service is equally important. Social services departments are big business with large budgets. It is crucial that they obtain the best value for money to provide the best service.
It is telling that a local authority which complains that it does not have enough money to provide a service has advised me that the cost to a prospective elderly resident of an in-house placement in one of its homes is £355 a week, whereas the maximum cost of an independent residential sector place purchased by East Sussex is £203 a week. The difference is a staggering £152 a week, which has to be met by local council tax payers.
Last year, East Sussex had about 600 residents in its own homes. That represents a potential saving of almost £5 million, if my mathematics is correct. That high-cost difference is sadly not unique to East Sussex. When a local authority is complaining that it does not have enough money, I cannot understand how it can justify spending about £152 a person a week extra just by placing them in its own homes. There are similar problems with domiciliary care. By being competitive, the private sector can and will charge less, as well as incorporating its management costs into the overall charge.
I thank my hon. Friend the Member for Eastbourne once again for bringing this important debate to the House, and for representing the interests of his constituents against a local authority controlled by a party that has always been most comfortable when it is scrubbing around in the gutter with its scares and smears. I hope that all my right hon. and hon. Friends will use their undoubted talents to get the message across.