Dr Peter Robespierre- audience member
In view of the impending cuts to local authority funding,
should now the funding for social care be given the same protection as health?
Dimbleby - chair
Since 2010 the social care budget for older people has dropped by 1.3b just over 15%, and there is a large shortfall still according to Age UK who gave us these figures.
Should there be the same protection as health for social care, Tessa Jowell?
Yes there should. (and)
If the crisis in our A&E departments this winter is going to be avoided , one of the main ways of doing that is for elderly people who become ill over the winter to be looked after at home and the services to be taken to them, and for them to be cared for there. (You know)
What you've got, actually, are two things.
The people who will be the victims of this will be the 95 year old ladies who are kept in a kind of limbo on a trolly in a corridor of a hospital ward, defying all the best intentions of the staff, and it is a real crisis, and you are absolutely right, that if there is any chance of elderly people being looked after at home which is where the vast majority of them want to be cared for, then there has to be protection of the social care budget, and proper organisation of integrated services for thier care
Dimbleby - So you are saying that whether it is integrated or not ...
Jowell who spent money on the Olympics Well it has to be combined
Dimbleby.It has to be ring-fenced?
Jowell who spent money on the Olympics I think it should be [ring-fenced], yes. [but she seems able to keep opposite points of view in her head at the same time - she stated an opposite view in her speech to the London School of Economics here http://election-richmond-park.blogspot.com/2014/12/democracy-decency-and-devolution-speech.html paragraph 29 quoted here and the theme of paragraphs 18-29: "The third element is the state, whether national or local government, which is steadily more efficient and more devolved, achieving more for less, [because it is] transferring more power down to more local tiers of government and promoting stronger collaboration between central and local government. In this collaboration will lie the solution to the large numbers of elderly people who against their own wishes have to stay in hospital because of a failure of imagination and collaboration to arrange for their care at home."]
Dimbleby
As a health minister, Norman Lamb, you have I think - as part of your responsibilities - you deal with local authorities as well? What's your view of this...
Norman Lamb MP [another speech here]
Well I think we have to get away from this idea of two separate systems. I agree with Tessa on this - I think it is rediculous. If you were setting-up a system now would you ever create a system that has a divide down the middle between health and care? You would create a single system. Particularly given that one of the challenges of this century is people living longer with chronic and long term conditions, and an aging society: we are all living longer.
Giles [a non-MP on the panel who refused to answer the question] incidentally makes a good point about how society treats older people . If we are going to ensure that we remain a civilised society, and that we sustain our health and social care system, we have got to all play a part in ensuring that we don't leave people icolated and stranded and lonely. In a way we have inadvertantly become quite a neglectful society as our extended families have moved far and wide, we've left elderly people often stranded on their own. Government can't do [this task] on their own. It has to be a collaboration between statutory services and the wider community and we all have a part to play in it.
Dimbleby
Very precisely minister, given the
Norman Lamb MP
My view is that we have to absolutely shift resources [away from health - see note at the bottom of the page] towards preventing ill-health, and that means supporting those very services that you are talking about...
Dimbleby
How are you going to do it this year and this coming year?
Norman Lamb MP
I'll explain exactly how we are doing it.
We have got something called the Better Care Fund.
Which for the first time ever pools money between health and social care.
One of the requirements [interupting himself] this transfers money from the NHS into those very services we're talking about. One of the requirements we have given to local areas [of the NHS to release funding] is that the local authority has to sign-up to say that they are "satisfied that their social care services will not be cut". That is a requirement of transferring the money into this pooled budget.
Dimbleby
Does that mean ring-fencing the budget?
Norman Lamb MP
In effect it amounts to ring-fencing because every local authority has to sign up to confirm that they are happy that social care services will not be cut. That's the start, for me, towards a transition towards creating a single budget for health and care, so that we focus much more on prevening ill-health and ending up with so many people un-necessarilly in hospital, which is the dys-functional nature of the current system.
Dimbleby
Should social care be given the same protection as health, John Redwood?
John Redwood MP whowants to spend money on a 5th UK parliament + Lords & Europe
[recently he has said something about committees in the commons as cheaper than an english parliament]
Well I believe that we need to be very generous on social care, and we need to be more generous than we are at the moment.
I think I welcome the initiative of the Better Care Fund, but for my own two local authorities in Wokingham and West Berkshire we've lost very heavily through it; we think we've got the numbers wrong and I hope the minister will look again at it because we don't want to be making cuts to services inadvertantly because of something that is intended to provide a better system.
I think you need a different kind of budgetary protection for social care than that provided for general health.
General health, people use, generally, as a service. You need to ring-fence it and protect it because of the costs of the technology and better medecine and the general costs of providing a service.
I think what you need in ring-fenced funding for social care is the amount of money you need to provide a generous service for the people requring it. So the way you do it is that you have a formula based on so-much-per-head. The amount per head has to be generous enough, and we need to have an accurate number of all those who need that care so that the local authority is not left short. I don't think they've got the numbers right yet.
But I think there are some very wild and exagerated numbers about overall local authority cuts which are very misleading. Net current spending (leaving aside education which has of course gone up under this government because that was also protected) was £74.7bn in the last labour year and is £78.9bn this year, so it is not down 40%, it is up in real...
Dimbleby So in real terms?
Redwood 5th UK parliament No, that's in cash,
Dimbleby So it isn't really "up" is it?
Redwood 5th UK parliament So it's been tight.
They've got to budget very carefully but it's not a 40% cut in the way that you read in the newspapers.
Dimbleby But is is important to note, given that you are a financial wizard, that when said that figures you were suggesting £4bn or so increase. It is actually a small cut. It is a lower reduction...
Redwood 5th UK parliament You have to take care of cost increases, but of course it has also been a time of public sector wage restraint and the main cost is wages
Dimbleby
Let me put this question: You asked the question Dr Robespierre. What are your thoughts about it?
Robespierre Well I'm a trustee of south London carer's trust, and we contract with local authorities in order to get, or in order to provide certain services into peoples' homes. We have found it increasingly difficult to get referrals in [to services] because local authorities quite simply can't afford it.
Dimbleby
Should - without getting into details about your local authority - but should, Norman Lamb, the local authority be able to? It doesn't matter what you said about the Better Care Fund, there shouldn't be any reason why the local authority shouldn't be able to provide the care that would save the doctor his problems?
Norman Lamb MP
They should be able to, and in fact when you look around the country the picture has been rather variable. The point you make about whether it is ring-fenced: the ring-fencing actually was removed under the previous government. I think ultimately you need a single ring fence around the health and social care budget so that we know exactly how much is available in any given area. It is really important that we provide that strong preventative care that stops people ending-up in hospital un-necessarilly. And the sort of services that you are involved with are absolutely essential.
Dimbleby
So Dr Robesparre should to back to his local authority, in his role, and say: "are you drawing down everything you should do from the better care fund in order to deliver the sort of service that you would seek to deliver?"
Norman Lamb MP
Absolutely
Tessa Jowell MP who spent tax money on the Olympics
But you see the problem with this is that nobody could disagree with most of what Norman Lamb, as the minister responsible for health and social care, has said, but it does not match what is happening on the ground, and Dr Robespierre is the person who is managing what is actually happening in the homes of elderly people being looked after by their carers.
The fact about this settlement is that nobody would pretent that Richmond - this borough we are in - is er more deprived than Lambeth, the borough that in part I represent. Lambeth has had a 5% cut. Richmond has had a 1.7% increase . That's what's not fair, and that's why people get so angry about the difference between what is said by the government and what is experienced on the ground.
Sound byte of the program:
http://downloads.bbc.co.uk/podcasts/radio4/bbcaq/bbcaq_20141220-1100a.mp
Gov.uk does back-up Norman Lamb a little. Under the title "giving local authorities more control over how they spend public money in their area", it says "the only exceptions are schools and the new public health grant", which probably could have said Better Care Fund as well. The Department of Health in Waterloo Road has asked council chief executives to sign that there will be no funny business.
Note about shifting money away from health. A google finds this from the National Audit Office:
In view of the impending cuts to local authority funding,
should now the funding for social care be given the same protection as health?
Dimbleby - chair
Since 2010 the social care budget for older people has dropped by 1.3b just over 15%, and there is a large shortfall still according to Age UK who gave us these figures.
Should there be the same protection as health for social care, Tessa Jowell?
Tessa Jowell MPTessa Jowell MP who spent money on the Olympics
As culture secretary under Tony Blair, Tessa Jowell did much to ensure the success [sic] of the Olympics. Now she is one of the many labour wannabe mayors of London, but not so shy as some of them about saying so in public.
Yes there should. (and)
If the crisis in our A&E departments this winter is going to be avoided , one of the main ways of doing that is for elderly people who become ill over the winter to be looked after at home and the services to be taken to them, and for them to be cared for there. (You know)
What you've got, actually, are two things.
- The government willing elderly people to not use A&E, to stay at home, and all the rest of it.
Yet the funds that are fundamental to support the people who can go in and care for them are being cut in this devastating way. - And the second point is that it's the
areas of greatest need, like the people I represent, that are suffering dis-proportionate cuts.
The people who will be the victims of this will be the 95 year old ladies who are kept in a kind of limbo on a trolly in a corridor of a hospital ward, defying all the best intentions of the staff, and it is a real crisis, and you are absolutely right, that if there is any chance of elderly people being looked after at home which is where the vast majority of them want to be cared for, then there has to be protection of the social care budget, and proper organisation of integrated services for thier care
Dimbleby - So you are saying that whether it is integrated or not ...
Jowell who spent money on the Olympics Well it has to be combined
Dimbleby.It has to be ring-fenced?
Jowell who spent money on the Olympics I think it should be [ring-fenced], yes. [but she seems able to keep opposite points of view in her head at the same time - she stated an opposite view in her speech to the London School of Economics here http://election-richmond-park.blogspot.com/2014/12/democracy-decency-and-devolution-speech.html paragraph 29 quoted here and the theme of paragraphs 18-29: "The third element is the state, whether national or local government, which is steadily more efficient and more devolved, achieving more for less, [because it is] transferring more power down to more local tiers of government and promoting stronger collaboration between central and local government. In this collaboration will lie the solution to the large numbers of elderly people who against their own wishes have to stay in hospital because of a failure of imagination and collaboration to arrange for their care at home."]
Norman Lamb MP
Norman Lamb is the Lib Dem health minister with a brief that among other things includes responsibility for older people and end of life care.
Added later: during the election Norman Lamb floated the idea of local NHS taxes, for liberal-voting "local people" I guess, who never move. I can't understand the logic; I don't see why people take him seriously.
♦ Firstly, a new tax lets government off the responsibility to cut submarines or embassies or whatever, which are over-provided compared to other similar countries. We have not decided what government is for so clearly as other countries and retain them at the cost of welfare state spending.
♦ Secondly, a local tax leads to the problem of someone who paid tax in Westminster with the lowest possible rate, and then uses services in Lambeth that has a higher rate. I prefer the idea of my taxes for all welfare state services being ring-fenced, kept in a fund, and available to me over as wide as possible a number of countries, not just in the UK or Wales or Lambeth.
Dimbleby
As a health minister, Norman Lamb, you have I think - as part of your responsibilities - you deal with local authorities as well? What's your view of this...
Norman Lamb MP [another speech here]
Well I think we have to get away from this idea of two separate systems. I agree with Tessa on this - I think it is rediculous. If you were setting-up a system now would you ever create a system that has a divide down the middle between health and care? You would create a single system. Particularly given that one of the challenges of this century is people living longer with chronic and long term conditions, and an aging society: we are all living longer.
Giles [a non-MP on the panel who refused to answer the question] incidentally makes a good point about how society treats older people . If we are going to ensure that we remain a civilised society, and that we sustain our health and social care system, we have got to all play a part in ensuring that we don't leave people icolated and stranded and lonely. In a way we have inadvertantly become quite a neglectful society as our extended families have moved far and wide, we've left elderly people often stranded on their own. Government can't do [this task] on their own. It has to be a collaboration between statutory services and the wider community and we all have a part to play in it.
Dimbleby
Very precisely minister, given the
- cuts that there have been - the actual loss of funding - within the framework of the general austerity cuts which were taken by the government of which you are a member. And the present
- impending cuts to local authorities which range from 1.8% overall - I think I'm right - up to to 6% in some cases.
Norman Lamb MP
My view is that we have to absolutely shift resources [away from health - see note at the bottom of the page] towards preventing ill-health, and that means supporting those very services that you are talking about...
Dimbleby
How are you going to do it this year and this coming year?
Norman Lamb MP
I'll explain exactly how we are doing it.
We have got something called the Better Care Fund.
Which for the first time ever pools money between health and social care.
One of the requirements [interupting himself] this transfers money from the NHS into those very services we're talking about. One of the requirements we have given to local areas [of the NHS to release funding] is that the local authority has to sign-up to say that they are "satisfied that their social care services will not be cut". That is a requirement of transferring the money into this pooled budget.
Dimbleby
Does that mean ring-fencing the budget?
Norman Lamb MP
In effect it amounts to ring-fencing because every local authority has to sign up to confirm that they are happy that social care services will not be cut. That's the start, for me, towards a transition towards creating a single budget for health and care, so that we focus much more on prevening ill-health and ending up with so many people un-necessarilly in hospital, which is the dys-functional nature of the current system.
John Redwood MP
John Redwood once ran Margaret Thatcher's policy unit. He's been a cabinet minister. Now as a leading Euro Sceptic he has the bit between his teeth in demanding not only English votes for English laws but an English Parliament as well.
Dimbleby
Should social care be given the same protection as health, John Redwood?
John Redwood MP who
[recently he has said something about committees in the commons as cheaper than an english parliament]
Well I believe that we need to be very generous on social care, and we need to be more generous than we are at the moment.
I think I welcome the initiative of the Better Care Fund, but for my own two local authorities in Wokingham and West Berkshire we've lost very heavily through it; we think we've got the numbers wrong and I hope the minister will look again at it because we don't want to be making cuts to services inadvertantly because of something that is intended to provide a better system.
I think you need a different kind of budgetary protection for social care than that provided for general health.
General health, people use, generally, as a service. You need to ring-fence it and protect it because of the costs of the technology and better medecine and the general costs of providing a service.
I think what you need in ring-fenced funding for social care is the amount of money you need to provide a generous service for the people requring it. So the way you do it is that you have a formula based on so-much-per-head. The amount per head has to be generous enough, and we need to have an accurate number of all those who need that care so that the local authority is not left short. I don't think they've got the numbers right yet.
But I think there are some very wild and exagerated numbers about overall local authority cuts which are very misleading. Net current spending (leaving aside education which has of course gone up under this government because that was also protected) was £74.7bn in the last labour year and is £78.9bn this year, so it is not down 40%, it is up in real...
Dimbleby So in real terms?
Redwood 5th UK parliament No, that's in cash,
Dimbleby So it isn't really "up" is it?
Redwood 5th UK parliament So it's been tight.
They've got to budget very carefully but it's not a 40% cut in the way that you read in the newspapers.
Dimbleby But is is important to note, given that you are a financial wizard, that when said that figures you were suggesting £4bn or so increase. It is actually a small cut. It is a lower reduction...
Redwood 5th UK parliament You have to take care of cost increases, but of course it has also been a time of public sector wage restraint and the main cost is wages
Dimbleby
Let me put this question: You asked the question Dr Robespierre. What are your thoughts about it?
Robespierre Well I'm a trustee of south London carer's trust, and we contract with local authorities in order to get, or in order to provide certain services into peoples' homes. We have found it increasingly difficult to get referrals in [to services] because local authorities quite simply can't afford it.
Dimbleby
Should - without getting into details about your local authority - but should, Norman Lamb, the local authority be able to? It doesn't matter what you said about the Better Care Fund, there shouldn't be any reason why the local authority shouldn't be able to provide the care that would save the doctor his problems?
Norman Lamb MP
They should be able to, and in fact when you look around the country the picture has been rather variable. The point you make about whether it is ring-fenced: the ring-fencing actually was removed under the previous government. I think ultimately you need a single ring fence around the health and social care budget so that we know exactly how much is available in any given area. It is really important that we provide that strong preventative care that stops people ending-up in hospital un-necessarilly. And the sort of services that you are involved with are absolutely essential.
Dimbleby
So Dr Robesparre should to back to his local authority, in his role, and say: "are you drawing down everything you should do from the better care fund in order to deliver the sort of service that you would seek to deliver?"
Norman Lamb MP
Absolutely
Tessa Jowell MP who spent tax money on the Olympics
But you see the problem with this is that nobody could disagree with most of what Norman Lamb, as the minister responsible for health and social care, has said, but it does not match what is happening on the ground, and Dr Robespierre is the person who is managing what is actually happening in the homes of elderly people being looked after by their carers.
The fact about this settlement is that nobody would pretent that Richmond - this borough we are in - is er more deprived than Lambeth, the borough that in part I represent. Lambeth has had a 5% cut. Richmond has had a 1.7% increase . That's what's not fair, and that's why people get so angry about the difference between what is said by the government and what is experienced on the ground.
Sound byte of the program:
http://downloads.bbc.co.uk/podcasts/radio4/bbcaq/bbcaq_20141220-1100a.mp
Gov.uk does back-up Norman Lamb a little. Under the title "giving local authorities more control over how they spend public money in their area", it says "the only exceptions are schools and the new public health grant", which probably could have said Better Care Fund as well. The Department of Health in Waterloo Road has asked council chief executives to sign that there will be no funny business.
Note about shifting money away from health. A google finds this from the National Audit Office:
2.24
Central government has begun further programmes to encourage integration and service transformation. From 2015-16, local areas will access the £3.8 billion Better Care Fund. This is a pooled budget for health and social care services, a joint initiative between the Department of Health and the Department for Communities and Local Government. Around £2 billion will come from NHS allocations to clinical commissioning groups. Health and wellbeing boards approve local plans for spending Better Care
Fund allocations. The King’s Fund has reported concerns about the consequences of removing £2 billion from acute care. In 2012, we reported that the NHS had made savings mainly through freezing pay, reducing the use of temporary staff and reducing back-office costs. More savings will need to be made by transforming services. This will be more difficult, will take time and may initially cost money. The Department of Health does not know what scale of savings it can expect nor how quickly the NHS can manage the funding reduction. The tight timescale for change set by the Better Care Fund increases the risk that new services or approaches will not be in place or embedded to meet the demand from reduced services elsewhere.
My impression is that ministers do want national social care funding, but not to say so because the agreed text is that councils are wonderful and everybody loves them as Tessa Jowell said about Lambeth Council for example. Their own job ads said that they were one of the "worst-managed local authorities in the UK" and that they were looking for better managers, but Tessa Jowell thinks that they are wonderful or whatever she says. I did social work jobs in Lambeth and could list details to talk about, just as I could in Richmond where I live.
My impression is that ministers do want national social care funding, but not to say so because the agreed text is that councils are wonderful and everybody loves them as Tessa Jowell said about Lambeth Council for example. Their own job ads said that they were one of the "worst-managed local authorities in the UK" and that they were looking for better managers, but Tessa Jowell thinks that they are wonderful or whatever she says. I did social work jobs in Lambeth and could list details to talk about, just as I could in Richmond where I live.
Commenting on the MPs...
ReplyDelete♦Tessa Jowell MP signed cheques to pay for the Olympics, and appears to believe that there is sufficient funding left after that fiasco for social care. She believes the system would be fine if councils like the ones in her constituency were given a bigger share of the money to use at their discretion, whether or not on social care, relative to previous budgets.
♦John Redwood MP appears to believe that there should be more money for social care but only from NHS budgets; he doesn't mention any other lower priorities in government spending. He's more coherent in suggesting a transparent formula for funding per head, rather than per council area.
♦Norman Lamb MP appears to believe that the system is about right. Like the other two he doesn't suggest that anything else could be a lower priority than social care nor that this is an insurance-like service that people have paid for all their lives. He also seems to believe what social service directors write to him in letters of assurance, making him probably the only person to believe what social services directors say.
I was surprised how well the speeches transcribe into text.
I was surprised how tactical the attempts to make everything sound alright were.
I disagreed with the replies but expected them to be worse.