Select Committee on Health Minutes of Evidence

Examination of Witnesses(Questions 207-219)




  207. Colleagues, can I welcome you to this session of the Committee on the expenditure inquiry and particularly welcome the Secretary of State and Minister of State as our witnesses. We are very pleased to see you once again. Can I repeat my thanks that I gave to your officials for their co-operation in this inquiry. We do appreciate that there is a lot of work involved and we are grateful for the efforts made by the Department in responding to our questions. Could you briefly introduce yourselves before we start.

  (Mr Milburn) Alan Milburn, Secretary of State for Health.
  (Jacqui Smith) Jacqui Smith, Minister of State in the Department of Health.

  208. Thank you. I was conscious when we had the officials a couple of weeks ago that we did not perhaps do justice to the personal social services side of your responsibilities. I wondered whether we might start with some of the issues arising from this report and also some wider concerns within the Minister of State's responsibilities. I do not know who would want to answer these questions; I leave that to you. I wanted to ask a question, first of all, about the figures on looked after children which I found of interest because I think it is fair to say that in the early 1990s we reached a post-War all-time low of about 45,000 children in the care system, but from 1997, looking at the figures from the current Government, these appear to have increased. It is a trend that I find worrying and I am not quite clear of the reasons behind it. If you look at your figures from 1997, it was 51,400 gradually increasing until the 2001 figure of 58,900. I have not got the latest figure although you may have it. Bear in mind the steps that have been taken by the Government to very seriously address social exclusion, things like the Sure Start programme and other initiatives (which I certainly very strongly welcome) why do we apparently have more children coming into care?
  (Jacqui Smith) I think, Chairman, you have probably answered your own question. Certainly our view would be—and yes there has been an increase—our latest survey suggests that the numbers in care are about 61,000—

  209. So it is a significant increase then on 2001?
  (Jacqui Smith) It is a small increase. I know that one of the things you have been concerned about is the balance between the sort of preventative work that we can do and the spending that relates to children that are in care. There is a suggestion that, whilst you are right there has been a shift towards the number of children in care, the amount of spending on those for whom social services departments have responsibility but who are not in care has remained at the same sort of proportion, even though the numbers there have gone down slightly. So there does seem to be a slight shift of priority in terms of the overall spending patterns towards prevention. To go back to your original question, yes, the numbers of children who are in care is of concern. I think it relates to some of those broader issues, as you suggested, to which the Government has to pay attention, whether or not those are general issues around social exclusion like some aspects of child poverty (not that I am suggesting that children always get taken into care because of issues around poverty), wider action in relation to drugs, or broader issues with relation to social exclusion. That is why some of those cross-cutting initiatives, for example Sure Start, are likely to have an impact, I would expect, in the future in a preventative way on the numbers of children going into care. What is also important is what happens to those children when they are in care. That is why there has been quite a big emphasis of the Quality Protect programme and the investment there has been on how we provide stability for children when they are in care and what we need to do in some cases to get them back out of care again.

  210. In looking at what we can analyse from the figures that your Department provides, are you satisfied that the methodology of the SSIs on local authority performance in this area is carried out in a way that is meaningful in respect of comparisons that are actually made? We are working around averages without detailed analysis of performance. How are we in any way able to measure the preventative work to which we are referring? To me if we were taking steps with prevention then we would not have had a 10,000 increase in the number of children in care. I find this very worrying and inconsistent to me with the wider policy directions being taken by the Government. This is not a trend I would have expected to see.
  (Jacqui Smith) There are two questions there. Firstly, am I confident about the SSI approach to prevention—

  211. Not the approach but the measurements used in terms of performance.
  (Jacqui Smith) You are right, it is difficult to have hard performance indicator measures about prevention and what we need to have is some sort of proxies in terms of children's outcomes with relation to spending on prevention, but that is also, of course, why we need—and this really links into the second part of your question, Chairman—to take action across government on prevention, and I am sure the Committee will be aware of the work announced by John Denham in relation to how we get the different agencies—so social services and the other agencies who are working together at the local level—to bring their strategies for prevention together. And this is not about "let's have a new strategy"; this really is about much better joint working across the considerable areas where the Government is both investing money and has already seen benefits in terms of the way in which agencies work best together.

Siobhain McDonagh

  212. I know it is a very London-based point but I wonder how far the increase in numbers is related to the numbers of unaccompanied minors that come and claim asylum. I know that the most devastating impact on the numbers in care in my own borough of Merton normally happens between Christmas and New Year when they regularly get 10 or 12 children arriving at Heathrow and it falls on Merton to pick them up. On quite a small borough that has an enormous impact. I do not know whether that has something to do with the increase.
  (Jacqui Smith) That has a very big impact on particular social services departments. Kent, for example, we know has had particular problems. I will write to you if I am wrong but I suspect that the largest number of those unaccompanied asylum seeker children are generally supported by social services departments outside care. So they tend to be 16 and 17-year-olds and they are not taken into care. Some of the younger ones may be but on the whole there are other ways of supporting them. I know that in London there are some good projects that we are supporting as a department along with the Department of Health on how we can provide, for example, better housing support for unaccompanied 16- and 17-year-old asylum seekers, and link that into the other sort of support that they need as well, but that would not be included in the numbers of children in care.

Mr Burns

  213. Minister, as you will be aware, for a number of years local authorities have consistently on average overspent on their SSA on social services and some of them have diverted money from the care for the elderly to meet their statutory requirements for children's care, for example. All of them agree that there is not enough money, despite the funding settlement for this year and the next two years, and I was wondering, given that this has led a number of local authorities to use their, to put it crudely, bulk purchasing power to force down prices in the private sector, if you could elaborate more on your written answer about the impact that the Competition Commission Appeal Tribunal decision in Better Care will have on local authorities?
  (Jacqui Smith) There is a series of assumptions in that question, Chairman. Firstly, I have to say your interpretation of diverting of resources can also be interpreted by local authorities as making correct decisions about what their priorities are locally.

  214. I am not arguing that.
  (Jacqui Smith) Secondly, on the implication that bulk purchasing power has been used to force down fees, of course, evidence from this year—and that is not our evidence, that is (?) evidence—is that as we have increased investment into local authorities, and specifically, as local authorities have looked at the way in which they are using their Building Care Capacity Grants bringing £300 million in, there has been evidence of fees actually increasing to care homes, and we do consider that to be important. Alan made very clear when he announced details of the older people's package some of the details about how the additional investment over the next three years would be spent, but where it is necessary to maintain capacity in the care sector it is appropriate that some of that extra investment is used for fees. On the specific point about Better Care, our view of the Better Care judgment is that, if you like, it goes some way towards clarifying, although of course in a very different situation to the situation that most English social services are in, that there was justification in that particular case for defining the authority as an "undertaking" with relation to the Competition Act. If what you are trying to create is a case that has very wide implications in England, we do not subscribe to that view because we do not believe that that is a conclusion of that particular judgment.

  215. Why not?
  (Jacqui Smith) Because it was based on the very particular circumstances of that individual case. What it did was it made a particular judgment about whether or not, as I have suggested, the authority in that case was an undertaking; it did not make any judgment about whether or not they were correctly or incorrectly using their purchasing power in those particular cases. If what you want to say is that there is a broader issue about how local authorities should work in partnership with their private partners in order to commission care, that I would very much take on board. I think that that is a very important area in which in very many cases local authorities, in the terms of the way in which they act both now and with the extra resources that will be coming into their older people's services, need to improve on the way they are operating. That has been a focus, for example, of our Change agencies in working with specific local authorities on better commissioning, it has been a focus of the Strategic Commissioning Group that I chair and, of course, it was the subject of the ground-breaking agreement we published about good practice on commissioning.

  216. Would you be prepared, given that there is some confusion about the Better Care decision, to provide each one of us on this Committee as soon as conveniently possible with an explanation of exactly what the decision means and how you think it relates to the world of care for the elderly?
  (Jacqui Smith) I would certainly be willing to provide our view of what the implications of it are.

  217. That is great, but can I now move closer to home because you did mention that there was evidence that fees were rising in the long-term care sector from local authorities. That is an interesting point because, of course, as the Member of Parliament for Redditch you will be acutely aware of what is going on in Birmingham where I do not need to remind you (but I may need to remind the Committee) that there is, by any definition, a crisis in care in Birmingham because one is seeing a significant closure of homes, and loss of beds and capacity because of what Birmingham City Council social services department is prepared to spend on beds in the private sector. I know that you have had representations from the different organisations in Birmingham, as have Birmingham MPs and one of your colleagues Stephen McCabe, of course, has tabled an Early Day Motion calling on your Department to do something to help the problem that is continuing. Given your proximity to Birmingham and your knowledge of the problem, who do you think is in the wrong and how do you think the situation can be resolved to put an end to the loss of capacity and the driving out of business of badly needed homes in that city, because it seems that not the Department of Health but Birmingham City Council has got its head in the sand and will not recognise there is a problem.
  (Jacqui Smith) Firstly, Simon, can I say what a pleasure it was that you came to my constituency and took such a close interest in what is going on there.

John Austin

  218. I hope the rest is going to be more truthful!
  (Jacqui Smith) But with relation to Birmingham, I think I have to say once again that I would dispute with you the suggestion that there is a crisis in Birmingham.

Mr Burns

  219. Speak to Stephen McCabe, he is the Labour backbencher.
  (Jacqui Smith) I do not think he has called it a crisis. I would not disagree with you that there are considerable problems in the Birmingham social services department. That of course is why when we did our first star ratings of social services departments Birmingham had a zero star rating and therefore has been working with a performance action team that we have sent into the city since then on a variety of issues, some to do with their children's services, some to do with their older people's services. I also know that there is a lot of concern amongst members of the Birmingham Care Consortium about the relationship between Birmingham City Council and care home owners. I also know that there is a split in the Birmingham Care Consortium. What is quite interesting is that recently I had a meeting with representatives from Birmingham City Council who brought with them care home owners because I had specifically said publicly to Birmingham that I was concerned about the breakdown in the relationship between the City Council and those partners in the private sector that, you are quite right, they depend on to provide the quality of care. I was somewhat reassured by the fact that certainly the care home representatives that came with that particular delegation spoke about the efforts that the City Council was making to rebuild that relationship with private providers in the city, and I know that they have worked quite hard to negotiate a package not only of fee increases but also, for example, using some of the considerable extra resources that they got as a City Council from the Building Care Capacity Grant. Remember. Remember, we recognise that Birmingham did identify the fact that there were areas where there were particular problems with delayed discharge, for example, and that is why out of the £300 million, Birmingham has got somewhere around £9 million of that money. They have been able use that both to look at fee increases and to look at how they could support private providers in training their staff, so I think some progress has been made and, of course, the key determinant of the progress that is being made there is the fact that they have had some success—they still have a long way to go—in reducing levels of delayed discharge and I think the general consensus in the health and social care environment in Birmingham is that there is a better and more constructive working relationship than there was perhaps this time last year.

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