(12 years, 9 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Sarah Newton (Truro and Falmouth) (Con)
I beg to move,
That this House believes there is an urgent need to reform the current system of providing and paying for the care of adults in England and Wales; recognises that social care, unlike the NHS, has never been free at the point of need irrespective of income; notes the central role of informal carers in the provision of care; welcomes the Coalition Agreement pledge of reform and legislation; further welcomes the plans for better integration between adult social care services and the NHS; welcomes the extension of personal budgets; urges the Government to ensure that fairness is central to reform, including access to advice, advocacy, assessment of need, care services as well as funding options; recognises the need to break down the barriers to portability; and further urges the Government to publish its White Paper as soon as possible, and to bring forward legislation.
I am pleased that both the care Minister, the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the shadow Health Secretary will be joining us today, and that they have entered into talks to agree a way forward on the reform of our social care system. It is vital that today we show our Front-Bench teams just how much support there is in all parts of this House for their important work. Both teams need to know how important this Parliament feels it is to continue and conclude the talks, so that a White Paper and Bill can be produced as soon as possible.
Today’s debate should also be about our vision: our vision to enable adults living with disability or a chronic illness, or those people who are frail in their later life, to have the support they need to live as full a life in their community as possible. That is something that concerns us all, as it strikes at the heart of the values of our society. There are Members here today who have a lifetime of experience, inside and outside Parliament, tackling the issues we will be discussing today, so I will keep my remarks short to allow their valuable contributions to be made.
Central to this debate is the person who needs care and the people around them supporting them, principally their family members, close friends and neighbours, and the wider community. Of course, care provided by nurses, care workers and other professionals is vital, too. In the few minutes available, I shall focus on the care of the elderly, as colleagues with greater knowledge than I will talk about the care of younger adults, those with chronic illnesses and those living with disabilities. Too often in debates about social care we delve straight into the design details of the services provided by local and national Government. Often, such services were designed many years ago, in response to a very different society, when people died of illnesses and conditions that are now lived with; a society where people lived shorter lives. One of the greatest achievements of the 20th century was a significant increase in life expectancy and the challenge of the 21st century is to respond and to redesign care and support services so that they are fit for this century and the next. That is important not only for the people who need them now but for the young people who have already been born who will make it into the 22nd century.
Let us be honest: if we were designing services to support families who care for their elderly and disabled family members, would we have designed the system we have today? Despite the undoubted good intentions of previous Parliaments, our system has developed in fits and starts since the 1920s. It is disjointed and does not deliver joined-up help for the cared for or for carers and it can be utterly frustrating for care and health professionals.
It has been estimated that a total of £145 billion a year of public money is spent on the elderly in social care, NHS and welfare payments. That is £3,000 for every man, woman and child in this country. It does not appear to me that elderly people and their carers are receiving the quality of services and care that such a sum could provide if it were spent differently and more efficiently.
Harriett Baldwin (West Worcestershire) (Con)
Is my hon. Friend going to make the point that this problem will keep on increasing? We are all living longer and one in three girls born today can expect to live to the age of 100.
Sarah Newton
Yes. As I mentioned, it is a great achievement that people are living longer, but that will obviously present huge challenges in adapting our society as people live for so much longer.
Unfortunately, growing old or living with an illness or disability is frightening to too many in our country today—frightening both to the people involved and to their loved ones who support them. There is fear about physical and mental frailty, about the quality of care they will receive from the NHS and social services and about whether they will have to pay and how they will afford to do so. We need to alleviate as much of that fear as possible by creating services and a way of paying for them that are fair and easily understood by people of all ages, that deliver high-quality care and support to carers and in which those who are employed feel respected and appreciated.
To achieve that aim requires a vision and a plan that everyone understands. That plan should be fair and should offer a route from where we are today to where we want to be. It will then require all political parties, over a period of time, to implement it. That will deliver the lasting, consistent and sustainable reform that despite many good intentions has eluded all Governments for many years.
I believe that the Government have recognised the challenge and taken a number of steps forward. There is a pledge in the coalition agreement to reform care services and funding and, following the excellent work of the Law Commission and the commission led by Andrew Dilnot, we have been promised a White Paper this spring and a Bill soon after. That process will very much depend on the determination of the Opposition to work constructively with the Government.
The Government have also ensured that while a longer- term solution is found to the current funding issues more money is being given to councils, and they have committed £2 billion. The Health and Social Care Bill will enable the integration of social and health care and, through the health and wellbeing boards, local commissioning of new care pathways will be made possible. I have seen some highly effective piloting work in Cornwall through the “Changing Lives” approach to joined-up services, which is based around the person and their carers.
The Government have launched a carers strategy and a dementia strategy with funding attached, but it is very frustrating that the money provided for those services is not always finding its way to the people who need it most. I am a passionate supporter of localism and returning power from Westminster to people and their communities. I believe that services for people in Cornwall should be designed and delivered in Cornwall, but we must recognise that this is a revolution. Although some professionals in the NHS and councils are relishing the new opportunities, some are not, as many of them have served in these important public services for years and are used to the command and control management of the past. It is difficult for some people to change and these are big cultural changes.
At a time when large-scale efficiency savings are needed in the services that support older people, reform is more important than ever. The nurses, social workers and carers I know are all motivated to deliver a high-quality service but I think Ministers will need to give clear direction about the commissioning of new pathways—new pathways that explicitly deliver integrated and joined-up care and new pathways developed on the evidence from the innovative work being provided not only by doctors, nurses and social workers but in partnership with other organisations such as Age UK, Macmillan and a host of other not-for-profit organisations. Within the new framework of outcomes, new outcomes should enable better integration.
Those new outcomes and pathways will need funding. We know that for every £1 spent on social care, £2.65 is saved from the NHS budget, so not addressing the inefficient split of funding between the NHS and social care will mean that we continue to waste more and more money.
Mary Macleod (Brentford and Isleworth) (Con)
On funding, does my hon. Friend agree that we should look at having more respite care for carers, especially elderly carers, some of whom do a 24/7 job and need extra support?
Sarah Newton
My hon. Friend makes a very good point, which has been addressed in the carers strategy.
Each year we should aim to use more NHS money on social care, and more money from the NHS budget could be given to councils for the integration of services led by health and wellbeing boards. Eventually, I would like to see the pooling of budgets. Social care has never been free at the point of need, and we know that the NHS will always be free at the point of need irrespective of anybody’s ability to pay. That is enshrined in the Health and Social Care Bill. Despite that, however, most people do not think they will have to pay for care and it can come as a dreadful shock, especially to the one in 10 people aged over 65 who end up paying more than £100,000 for care. Dilnot came up with a framework of shared and capped costs for individuals needing social care—shared costs between the individual and the state. I am sure that framework is receiving a great deal of attention from the Front-Bench teams, but I expect that however well the cross-party talks are going, it will take several years to introduce such a system if agreement can be reached. In the mean time, there is an urgent need to design a fairer system based on shared responsibility to pay.
There are uncontroversial steps that would not require substantial new resources and that could be taken now as part of a longer term plan. The legal framework and assessment processes that are used to decide who is entitled to what help could be sorted. We also need to fix the means test that we use to decide what we expect people to pay. That would help families to understand what help will be available and who needs to pay for what. Families would then be able to plan accordingly. The Government could ensure that people had access to independent advice on the best way of planning and paying for care and they could bring in a universal deferred payment scheme that would tackle the issue that so many people dread—selling their home to pay for residential care during their lifetime.
Margot James (Stourbridge) (Con)
I congratulate my hon. Friend on securing this debate and on all the work she does on this issue. Under the present system, people do have to sell their homes sometimes; does she agree that in such cases it would be far better if some of the accommodation were available to purchase on a leasehold basis so that the individual would still have an asset to pass on?
Sarah Newton
That is an extremely interesting idea, and I would expect no less from someone with such knowledge in this area. I am sure the Minister will want to take that point on board.
Going back to means-testing, we really need to face up to one of the biggest problems facing families—the meanest of means tests in this country: the test for residential care. Making the simple change of raising the upper threshold of the means test to £100,000 would benefit those on modest incomes who are heavily penalised under the current system. It would enable families who have worked hard all their lives and accumulated relatively modest assets—often the first generation of their family to do so—to have something to pass on to their children and grandchildren. It is an understandable and human desire to want to help the next generation. That change would cost £100 million. In this economic climate, such a figure might be too much all at once, but a staged increase in the upper limit would be a step in the right direction.
We are taking this approach to delivering the excellent policy of increasing the personal allowance for taxpayers to £10,000. Apart from spending NHS money more efficiently, there are other sound economic reasons for redirecting public money into social care. While the vast majority of care is given freely, more than 1.5 million people are employed in providing care. We need to recognise better the valuable and challenging work they do. I know that the Minister is doing good work on training and quality standards. Many care workers are paid low wages, so investment in this sector would have the direct impact of putting more money into the pockets of some of the poorest paid workers.
We also need to enable more working age informal carers to combine their caring responsibilities with paid employment. This is even more important as the pension age rises. Much emphasis is put on enabling working age parents to care for their children and remain in paid employment—with flexible working, help with child care costs and financial support through the tax system. We need to put as much emphasis on enabling working age people with other caring responsibilities to remain in employment. Otherwise, we are going to have ever-increasing out-of-work benefit costs to pay.
While I do believe that the Government are starting to develop the processes that could deliver better and fairer access to services and higher quality care, bolder and more determined action is needed to enable more rapid change. I hope that the Minister and the shadow Secretary of State for Health will listen carefully today and bring back to Parliament a shared vision and a clear plan on how together we as a country and as a society are going to create a good place for us all to grow old in.
Barbara Keeley (Worsley and Eccles South) (Lab)
May I start by congratulating the hon. Member for Truro and Falmouth (Sarah Newton) on leading the debate and on the way in which she has just opened it? It is good to work with her on the all-party group on social care. In debates such as this we work together to ensure that social care receives the focus that it needs to have in the House.
I want to discuss two aspects of the future of social care. The first is the current crisis in care and the need to bring in extra resources to close the funding gap. The second is the recommendations of the Dilnot report, which the hon. Lady has already touched on, which mainly focused on dealing with the catastrophic cost of sustained high-level care and support.
On the funding gap, the Minister told me and the Health Select Committee recently:
“We don’t accept the position that there is a gap. We have closed that gap in the spending review.”
However, Age UK’s “Care in Crisis” report says:
“This year spending on older people’s social care in England has fallen by £500 million and the funding gap is growing. … We project that by 2011-13 the Government would need to spend £1 billion more than this year to stop the situation getting any worse. … The current system is at breaking point.”
Research by Age UK showed that 82% of local authorities now provides care only to those with substantial or critical needs. Fewer than one in five local councils still provide care for those with moderate needs. I have to say I am happy that that includes my own local authority of Salford.
The Economic and Social Research Council centre for population change has looked at the issue of unmet need for social care. It concludes that, regardless of the data source used,
“there is significant unmet need for care among older people.”
For example, 66% of people aged over 65 who need help with bathing were not receiving any support. That figure was based on data from 2008 and since then we have had front-loaded cuts to local authority budgets. I am sure that, although there is no up-to-date estimate, there are greater levels of unmet need than the figure I have given.
The Association of Directors of Adult Social Services has reported £1 billion of cuts to adult social care budgets in 2010-11, with further cuts predicted for next year.
This week many of us were involved when about 1,000 campaigners and 60 organisations lobbied Parliament for the urgent reform of social care and an end to the care crisis. For the first time, thousands more who could not attend Parliament joined the lobby online. A statement from those care and support organisations to MPs and Ministers said:
“Our social care system is broken. It cannot cope with a rapidly ageing population and positive impact of people living longer with illness and disability. Those who use our social care system can no longer tolerate a social care system which leaves many with no support and others with poor quality services. The public are angry that they can face huge care charges and end up losing all their savings or being forced to sell their home.”
One of the 1,000 people who came to Parliament to lobby MPs was a deaf-blind woman from Manchester who got up at 5 am to travel down because she said she was so worried about the future of social care. The Care and Support Alliance said that MPs heard personal experiences from people who need care but are receiving none, disabled people unable to access the support needed to live independently, families paying huge bills for care and carers pushed to breaking point.
I wanted to test the situation in my local area before the debate. Over the past few days I checked with three organisations that support older people and carers in Salford and the neighbouring area in Greater Manchester. This drew a depressing but familiar picture of services worsening, mainly due to budget cuts, but also due to cuts and organisational changes brought about by the NHS reforms. A staff member at Parkinson’s UK in Greater Manchester told me about her clients, people who have worked hard all their lives but are now struggling to pay for services that are essential to them. In some cases she had to apply for grants to help people with Parkinson’s buy a profiling bed or even pay off debts.
The staff member told me about a couple struggling to pay for the care needed by the husband, who has Parkinson’s. To help get him out of bed and dressed costs £22 an hour, and having someone sit with him while his wife does the shopping costs £11 an hour. Another carer of someone with Parkinson’s and dementia had her respite care cut from two weeks a year to one week. She feels that she cannot cope without those two weeks of respite. The staff member also told me that budget cuts mean that people with Parkinson’s can wait for a year for a stair lift, and she knows one man who has to go to bed at 7 pm because later in the evening his mobility gets worse and he cannot manage the stairs.
The staff member also told me that NHS efficiency targets mean that GPs are switching to cheaper brands of drugs for patients with Parkinson’s, but many of these are less effective. One person she told me about was admitted to hospital after becoming ill following a switch to a cheaper, less-effective medicine. The hospital staff had told her to “be firm with her GP” and insist on the more expensive brand. We have to be realistic that that is a difficult thing to do. NHS budget cuts in the local area have meant the loss of the community matron service, a service that was used by Parkinson’s UK staff for many of their clients but has now ended. In Salford—I have raised this point before—the primary care trust ended the pilot of active case management for people with long-term conditions, which was proving popular and effective.
Locally, Age Concern has told me that it has now lost the funding for a “Friends for Life” pilot scheme, which was part of the national dementia strategy. Its dementia support service has a planned income reduction of 40% over three years. It has had to make seven staff redundant and reduce its dementia support. Funding for day centres is being reduced by one fifth and will then be ended owing to the switch to direct payments from individual budgets. We all support personalisation and individual budgets, but not if it is a cover for cuts. I was disturbed to hear of a couple of cases where that is happening. In one case I was told about, a carer who had previously had two hours of respite care was given a budget of £9 and told, “Do what you want with the money.”
Our carers’ centre manager in Salford told me of her own experience of such cuts, this time to the personal budget of a family member she cares for with a learning disability who lives in Sheffield. Following what she described as a “fairly perfunctory” re-assessment that was done solely with the person with the learning disability, with no input from a carer or guardian—that is an important point—the personal budget was cut by £10,000. In that case, the carers’ centre manager was able to lodge a complaint and get legal help from a community care lawyer, but she knows that such an intervention would not be possible for other carers. These examples are what we mean when we talk about a care system in crisis.
However, those are not the worst examples. As I mentioned earlier, we know that some 800,000 older people are left without basic care. They have been described as
“lonely, isolated and at risk”.
Those are the words of 60 experts in social care in their recent letter asking the Government to make social care reform a top priority. We therefore know that the problem of unmet need is getting worse. Much of the additional burden will fall on unpaid family carers, many of whom are already overburdened. Statistics from the NHS Information Centre show that the proportion of carers providing more than 50 hours a week has doubled in the past 10 years. I think that that is the level at which it can be counted as a 24/7 caring job, as was discussed by the hon. Member for Brentford and Isleworth (Mary Macleod).
Many organisations have sent us briefings for this debate. There is a consistent call for a solution to the care crisis. Carers UK calls for the capped costs model that the hon. Member for Truro and Falmouth talked about. It sees a cap on costs as essential. It favours the cap being set at £35,000, which it feels would give carers and families the ability to plan for care arrangements and costs, and provide an opportunity for the development of care insurance products. I agree with that assessment and would caution against setting the cap at a higher level, such as £60,000, which has been discussed in the media. That is the value of some properties in Salford, so it could mean a family losing the entire value of their home, which would be wrong.
Carers UK believes that if families know that costs will be capped, they might be more willing to buy care and support earlier. That would help to promote independence and reduce the pressure on carers, which can result in ill health, giving up work or reducing working hours. It is thought that it will be harder to produce that shift in behaviour and move towards a new market in insurance products without a capped costs model.
Care and Support Alliance members argue for an additional £5 billion to be put aside over the next three years to meet the growing demand for social care. The cases that I have mentioned show that there is a clear need for additional resources to meet the growing demand, address the unmet need and tackle the shortfall in resources that has been growing for some years.
The Dilnot commission was given the task of making recommendations on how to achieve an affordable and sustainable funding system for care and support. Its report confirmed what has been said repeatedly for years: the current system is unfair and unsustainable, and without reform it will deliver ever-poorer outcomes for individuals and families. That includes the 1,000 people we saw here this week. The report also said that the funding of social care is inadequate and that people are not receiving the care and support that they need.
Although we may not have time to discuss this today—I certainly will not—the provision of advice and information is poor and very limited. People struggle to find financial information and advice, and there is little information and advice for carers. Worst of all—perhaps we can understand this—because the system is complex and difficult to understand, most people do not plan for, or even think about, the future care provision that they may need.
There is much consensus around the capped costs model. There is support for setting a cap at £35,000 and, as the hon. Member for Truro and Falmouth mentioned, for setting an asset threshold for means-tested support at £100,000. There are other important aspects, such as the need for national eligibility criteria and the need for local authorities to meet the eligible needs of carers. I think that those points are equally important. What still needs to be discussed, and I am not sure whether we will get into it today, is how to pay for the capped costs model and the additional resources that are needed to close the funding gap.
Care and Support Alliance members believe that there is a public appetite for reform. I think that we must take the debate across the country and ensure that the issues and solutions that I have talked about start to be debated. I have spoken about social care issues for the past seven years and I believe that they are now well understood. The 60 organisations that have lobbied Parliament this week have been lobbying on these issues for many years. The people in those organisations and the people they represent are tired of being consulted on the future of social care. What they want is action.
Andrew George (St Ives) (LD)
I congratulate my colleague on the Health Committee on her contribution to the report on social care. Does she agree that underlying the issue of care in crisis is an issue with the work force, who often work on the minimum income, are poorly regarded and are subjected to a lot of unfavourable reporting in the press? Does she think that we take them for granted when we look at the overall sector?
Barbara Keeley
Indeed, the work force issues are very important. I will not have time to discuss them today, but perhaps other Members will. The things that we hear about, such as tasks being reduced to one-minute periods and visits being cut down to very short periods, must make it a distressing and difficult job. We also have to recognise that personalisation leads to people working in an isolated way. Whereas before they might have been part of a local authority work force, they are now individually employed by care agencies and may not see anyone else. There are some new issues for us to consider, including the one that the hon. Gentleman mentions.
In 2009, after much consultation, my party brought forward plans to establish a national care service. As my right hon. Friend the shadow Secretary of State knows, Labour’s proposals for funding social care were treated as a political football, and there were some regrettable political attacks on them during the general election. That was unfortunate, and we cannot allow it to continue. I congratulate him on going back into the cross-party talks with great willingness, which must have been difficult knowing what happened to him during the election. We must work to achieve consensus across parties and across the country, because the issues that I have mentioned are becoming more pressing than ever before.
I believe I have found a unique way to link two speeches today, both of which you have heard, Madam Deputy Speaker. I talked earlier about women in sport, and this Sunday I will be running in a 10 km race to raise funds for Age UK’s “Spread the Warmth” campaign, which is aimed at making life better for older people in winter and avoiding needless deaths from the cold.
The Minister of State, Department of Health (Paul Burstow)
I am very grateful for the opportunity to speak in this debate. I start by thanking the Backbench Business Committee for granting it and my hon. Friends the Members for Truro and Falmouth (Sarah Newton) and for Stourbridge (Margot James) for securing it and leading it so well.
I have chosen to speak early in the debate because I want to spend the majority of it listening to colleagues. I undertake to respond to their questions in writing if necessary to ensure that we have a clear record of the Government’s position on these issues.
I pay tribute to the Care and Support Alliance. The lobby that it organised this week was a truly powerful event, because of the testimony of individuals who made the journey to Westminster to lobby their MPs. I had the pleasure of spending an hour being cross-examined by a large number of people on that lobby, and I found it a really useful opportunity to talk about social care.
I have been a Member of Parliament for more than 15 years and raised the issue of social care reform throughout that time. For far too long, it has been left in the “too difficult to do” drawer, and it is now due attention from the House and the Government. We must not make the mistake of putting it back in that drawer, which would be dangerously short-sighted.
What does high-quality social care mean? It means helping people to stay healthy, independent and out of hospital. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, it means reducing pressure on the NHS, but above all it means helping people to live the lives that they want—long, safe and comfortable lives with the maximum possible independence. That is why the coalition Government are determined to tackle social care, and we have already set to work on doing just that. We established the Commission on the Funding of Care and Support, chaired by Andrew Dilnot, to make recommendations on how we could develop an affordable and sustainable funding system for social care. My hon. Friend the Member for Truro and Falmouth outlined those recommendations.
Kelvin Hopkins (Luton North) (Lab)
There is constant emphasis on the importance of independence and of people living their own lives, but many people who depend on care want company. Some would prefer to live in decent, appropriate care than to be left on their own in their home and not cared for appropriately. Is the Minister not aware of that?
Paul Burstow
I am most certainly aware of that. Social isolation is a huge burden on the individuals affected by it and has huge consequences for health care. That is why, when I talk about independence, I also mean interdependence—the recognition of the value of family support and carers, and of the fact that people need to be active in their community throughout their life. Social care has a role to play in enabling people to do just that, rather than become institutionalised in their own home or a care home. I absolutely agree with the hon. Gentleman about that.
The Dilnot commission made a number of recommendations on the development of a system such as I mentioned, and my hon. Friend the Member for Truro and Falmouth described them well. In the spending review, we allocated an additional £2 billion by 2014-15 —£7.2 billion over the spending review period as a whole. In November 2010, we also set out our vision for social care reform, including the roll-out of personal budgets and greater personalisation. I agree that we need to ensure that that is genuinely about how we enrich people’s lives, not just an opportunity to reduce the available resources to individuals. We are also investing £400 million over four years to help to give carers much needed breaks. We are ensuring that the NHS is held firmly to account for delivering the money in the coming year by making sure that it has to account directly to carers’ organisations locally, and agree with local authorities the plans to provide breaks, spell out how many there will be and the size of the budget for that purpose.
It is also important to dispel a myth about social care, which has been hanging around for far too long—that, in some way, it is just like the NHS and free. As my hon. Friend the Member for Truro and Falmouth said, it is not free and never has been. If people assume that the state will pick up the bill, they are unlikely to prepare themselves. If they do not prepare and they need help, the impact can be truly devastating for them and their families: life savings wiped out, family homes full of memories sold off, and thoughts of a comfortable retirement turned to dust.
We therefore recognise the problem, which is getting worse. Our population is ageing, and that should be a cause for celebration. Too often, debates about ageing in our media are couched in terms of demographic time bombs and the like. However, the current care and support system is not fit for purpose. I agree with the Care and Support Alliance about that. It is broken, and patching and mending it is no longer acceptable.
However, reforming social care will not be easy. As has been said, it will require bold thinking and difficult decisions. The Dilnot commission shed much needed light on the reality of social care funding. Soon, we will publish a White Paper and a progress report setting out our response to the recommendations.
Barbara Keeley
Perhaps the Minister will enlighten us on what is meant by “spring”. There is speculation that spring might extend to May, June or July. When I was in government, I spent a lot of time answering questions about what spring meant in relation to Government reports. Will he tell us what it means now?
Paul Burstow
On that basis, the hon. Lady knows the answer that I would give and I shall therefore not tire her by saying what she would have said if she were in my place. We are anxious to publish a White Paper as soon as we can in a way that ensures that we have successful dialogue with the Opposition on funding. Those two matters are interdependent.
We are considering not just funding reform, but the legal structure that governs social care, which must be updated. The Law Commission has done a sterling job of making recommendations for replacing the patchwork that has built up in the past 60 years with a legal framework fit for the 21st century. A new social care law will bring clarity where today there is a complicated and confusing system, facilitate personalisation and support staff, service users and carers.
Beyond that, we need high-quality, integrated care, which focuses on early intervention, prevention and the needs of the individual. Better care is about not just spending more money, but spending it much more wisely. The Health Committee made that point powerfully to us. Some councils do that well; others could do it better. That is why the Government are jointly funding with the Local Government Association work to support councils to release savings while improving the care and support they provide.
The Health and Social Care Bill will foster far greater integration between the NHS, social care and, importantly, other public services. Health and wellbeing boards will bring together democratically elected local councillors, directors of children’s services, adult social services and public health services, clinical commissioning groups, and, importantly, the public through Healthwatch, to improve services in our communities. They will identify local needs now and for the future and, importantly, be accountable for setting the strategy to meet those needs. The unprecedented transfer of money from the NHS to social care is creating new opportunities for joint working.
However, we have a long way to go to improve the quality of social care, especially for older people. Clinical audits on fractures or continence care; the parliamentary inquiry into the human rights of older people in health and social care; and damning reports by charities such as the Alzheimer’s Society and Age UK all point to the fact that health and social care in England is far from universally excellent. In too many cases, it is very far indeed from being excellent. There can be no excuses and no mitigating circumstances. Yes, there are excellent staff working in our services, but some staff need to be challenged, and some need to leave the profession because they do not do the right thing. We need to be honest. We need to applaud the good, but to shine a light where there is no good.
It is not a matter of not having enough staff. In some places—
Paul Burstow
I will in a moment, because I made a point in direct response to my hon. Friend.
In some places, full staffing complements perform badly, while places under considerable staffing pressure perform exceptionally well.
Paul Burstow
I will give way to my hon. Friend, who I know works hard on these matters.
Andrew George
I am very grateful to the Minister, whom I respect. Poor standards need to be rooted out wherever they exist, whether among the lowest-paid care workers or the highest-paid managers, but does he accept that the care system is based on workers who work antisocial hours, who are often untrained and unsupported, and whose salaries are appallingly low?
Paul Burstow
I accept that we have a largely untrained work force—or they are not as trained as they should be. This is the first Government to set down the need for training standards for health care assistants and care assistants. We have signed off the funding to allow Skills for Care and Skills for Health to do that essential work for the first time.
On transparency, we need to know what is happening within caring organisations. Transparency is vital to improving the quality of services on offer and to holding providers and commissioners to account. As is happening already in the NHS, we need more information and data to improve the quality of social care. Without those, how can local authorities, individuals or their families hold providers to account?
That is why we published the adult social care outcomes framework last April, which was developed in partnership with the Association of Directors of Adult Social Services, the Local Government Association and others. I thank all those involved in developing that new tool, which has the potential radically to improve the quality of social care in England. The outcomes framework will enable local authorities to hold providers to account, and in turn enable local people to compare and contrast performance on social care in one part of the country with performance in another, and to hold their councils to account.
In the past, the emphasis has been on patients and people who use services bending to the convenience of service organisations. That must change, and it must do so faster than ever before. By focusing on the individual and integrating services around them, we can begin to break down institutional barriers that for too long have held back the improvements in care that the country needs.
Many people’s lives could be so much better. We are right to celebrate the fact that our population is living longer, and often living longer better, but we can do much more to ensure that we add quality to the extra years that the success of our health and other systems have delivered. That is why the best social care means the difference between a life of dependency and life lived with independence and dignity—the difference between a life endured and a life enjoyed, or a life in which potential is not realised or unlocked and a life in which it is.
Social care is among the most pressing issues facing us today—I believed that when I first came into the House. I hope that, during this Parliament, this Government, working in partnership with others and the Opposition on funding, can reach a consensus that can be delivered, and that we can translate that into sustained action. That is how we can do something that has not been done for 60 years.
We have inherited laws that are out of date, which make it impossible for some people to navigate their way around our social care system. It is time to change. That is why the Government will publish our White Paper and set out our plans for legislation. I look forward to more debates on adult social care as time goes by, but today I look forward to listening to colleagues, and will respond to further questions.
Andy Burnham (Leigh) (Lab)
I, too, congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on bringing this important debate to the House. They make an impressive and persuasive double act for this most important of causes, and are right to challenge both Front-Bench teams as this is without doubt the biggest unresolved public policy challenge facing the country. So far, between us, Parliament has failed to face up to it, and as others have said the result is a developing care crisis in England.
We must all bear our share of the responsibility for allowing that to happen, but the best response is to resolve to find lasting solutions. This century of the ageing society demands it, and the earlier we do it, the better. If we do not, to Beveridge’s five giants of the last century we might add a sixth for the 21st century: fear of old age. We cannot let that happen, and people are looking to us all to put point scoring aside and to work constructively to find a solution. In that spirit, I welcome much of what the Minister said.
I commit the Opposition to doing the same, and as a sign of our intent, the Leader of the Opposition has appointed a member of the shadow Cabinet with specific responsibility for these matters. I refer to my hon. Friend the Member for Leicester West (Liz Kendall). The House might have noticed that she is not here today. I send her apologies. [Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is absolutely right. She has a good excuse: she is in Leicester with Her Majesty the Queen at the commencement of the diamond jubilee celebrations; otherwise of course she would have been here. I hope that I am an acceptable substitute.
Andy Burnham
Thank you.
I wish to demonstrate today Labour’s commitment to this issue. The House might remember, as my hon. Friend the Member for Worsley and Eccles South said, that I made reforming social care my top priority as Health Secretary, and I did that for a very personal reason: I have never forgotten my grandmother’s dispiriting journey through England’s care system and the battles that my mum fought to preserve her dignity. The day I visited her in a nursing home near where I lived to find that her engagement ring had been wrenched off her finger and stolen was the day that I knew something was seriously amiss with how we looked after our older people.
We all have our own personal experiences, and we all know that we have to do much better. Looking after other people’s relatives, particularly the most vulnerable in our society, should be one of the most highly valued and respected callings there is, but sadly the reverse is the case. England’s care provision is too often low status and low wage, with about 70% of the work force having no qualifications and many earning at or around the national minimum wage.
With every year that passes and every year that we do not achieve a lasting and better solution to the funding of adult social care, the cruel unfairness in the system gets worse and the quality of service diminishes even further. People are paying higher charges, and the most vulnerable, as the Minister said, are losing everything. Families are being wiped out physically, emotionally and financially by the situation, carers are under intolerable pressure and councils are struggling to cope with the demographic pressures.
But there is hope. I did not think that the White Paper and cross-party talks that I led before the election achieved as much as they might, but perhaps I was wrong, because they might have prompted the Government to establish the Dilnot commission, on which we congratulate them. We also congratulate Andrew Dilnot and his commission on the intelligent way they addressed their brief and delivered a solution that politicians on all sides can work with. It provides a basis for progress, and we should take it.
Since then, we have also had the Health Select Committee’s excellent report on social care, which made a persuasive case for integration. At present, the social care debate is happening in isolation from the debate about NHS reform, which is unhelpful. We are looking at a Bill called the Health and Social Care Bill, but there is not much about social care in it. Indeed, it is slightly odd that a Bill of this name is going through Parliament, yet a social care White Paper is not due until May, as my hon. Friend the Member for Worsley and Eccles South said. It is essential that we start viewing reform of social care and the NHS as two sides of the same challenge—how to provide integrated, people-centred and preventive care in the century of the ageing society.
The Committee’s recommendation of a single commissioner for older people was an important one, and I was pleased to hear the hon. Member for Truro and Falmouth endorse it. I do, too, not least because it was precisely what I would have done had I returned to the Department of Health as Health Secretary had we secured a different result at the general election. However, I am worried that this vision, which we share, is made more difficult by the Health and Social Care Bill and the new landscape that is developing.
Those are the issues that the Government need to address in the White Paper. We are grateful for the opportunity that the Minister and the Secretary of State have extended to us to take part in cross-party talks and to influence that debate, as well as the crucial issue of how to fund the Dilnot proposals. Speaking for the Opposition, I can assure the House that we will play a constructive and responsible role in those talks. However, I would also like to take this opportunity to place three caveats on the table. First, we need to make it clear to people that although the Dilnot package is an important step forward, it is only that. It is not the whole answer to the challenges that the country faces. Its introduction would make the system fairer than it is today and would deal with the catastrophic costs of care that the most vulnerable people face. However, people would still be liable for high charges, with the vulnerable paying the most.
Secondly, there has to be a recognition from all parties in the House that progress will come only with difficult decisions and nettles being grasped. We need to have a mature discussion with the public about those difficult options, rather than using them for point-scoring purposes. What stands in the way of progress is not the complexity of the issues—they are not over-complex—but the political will to advance a difficult argument. That is what has prevented us from making more progress than we should have. To push things along and give our talks some impetus, it would help if the Government committed to introduce legislation in this Parliament to implement whatever has been agreed. That would bring a useful focus to the cross-party talks. Thirdly, we believe that there is a genuine danger that the debate might focus only on funding the Dilnot recommendations, and not on the existing pressures in the system. That must be avoided at all costs, as my hon. Friend the Member for Worsley and Eccles South said. As one care charity told me yesterday,
“We can’t have jam tomorrow if we have no bread today”.
I, too, was concerned by the comments that the Minister made before the Select Committee on Health, specifically when he said:
“We don’t accept the position that there is a gap. We have closed that gap in the spending review. On the issue of unmet need, I am yet to find any agreement among academics on a definition of unmet need.”
Many councils would struggle to reconcile that statement with the reality of what is happening on the ground. Council budgets are being cut by more than a third over the course of this Parliament, and as we know, adult social care makes up the largest part of those budgets, at around 40%.
The Prime Minister is fond of quoting me on health funding at Prime Minister’s questions, but he only ever uses the bits that suit his purpose. If I may, I would like to give the House the full version of that quotation today, because what I was warning of was the danger of taking an unbalanced approach to public spending. Before the election, the Conservatives were saying that they would give the health service real-terms increases, over and above inflation—which have not, in fact, materialised—within a much reduced overall public spending envelope. My worry was that taking such an unbalanced approach could damage other public services, including those that are intrinsically linked to the health service. What I actually said was:
“It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting. The effect is that he is damaging, in a serious way, the ability of other public services to cope: he will visit real damage on other services that are intimately linked to the NHS,”
such as social care. I believe that this is what we are seeing right now.
Paul Burstow
The right hon. Gentleman made those remarks ahead of the spending review in 2010. The spending review also gave the Government the opportunity to make announcements about social care spending, and it is when we committed £7.2 billion extra for social care support. We have to challenge local authorities to use those resources wisely. Indeed, I hope that he will join me in challenging local authorities to commit to spend the resources that the Government have allocated for social care on social care.
Andy Burnham
Yes, I will. There is no difference between us on that, but there is a difference between us on the funding position that the Minister has set out. The King’s Fund and others have identified that there is a £1 billion funding gap in adult social care in England, not just because of the money but because of the demographic pressures, which we cannot get away from.
The Government’s commitment was to give more money to the health service, but we have produced figures showing a real-terms cut in outturn last year, and we also notice that transfers—indeed, recent transfers—have had to be made to the social care system, which implies that the Government have left it short, and that there is an emergency propping-up of the system, revealing the flaw in their position.
Kelvin Hopkins
To reinforce the point that my right hon. Friend makes, on a recent visit to my local hospital I was told by staff that they have more than 20 elderly patients who are perfectly well enough to live in a care home, but the care homes will not accept them and the funding cannot be found for them. Care is free in hospital, but it costs outside, so those people are forced to stay in hospital, and that places extra costs on the NHS.
Andy Burnham
The two systems do not work in such situations. The health service is intrinsically tied up with the social care system, and if it collapses the health service cannot discharge people from hospital. It is a false economy.
As for what is happening on the ground, the Minister commented on funding nationally, but in reality eight out of 10 councils now provide care only for those with substantial or critical needs: they are restricting their eligibility criteria. Age UK estimates that that leaves 800,000 people without any formal support, representing plenty of unmet need, and the situation also leads councils to increase charges for home care. The average cost for a disabled or older person paying for 10 hours a week of home care is now £7,015 a year. Never mind a death tax, that is a stealth tax—or a dementia tax, as people pay more and more for the costs of care while they are alive. It is not fair, it is not right, and we should do something about it.
That is why we say to the Government that we must address the question of the local government baseline alongside that of Dilnot. There cannot be a choice; we have to do both. If we do not and we fund only Dilnot, a larger number of people will pay increased charges but with a cap on what the charges might be, and that will not feel like the leap forward or the social progress that the Care and Support Alliance and others are looking for. It will not help us to drive up quality in the care system, either, but we desperately need to do so.
Councils are being forced to stretch inadequate budgets ever more thinly, and that is leading to corners being cut. I shall illustrate that directly with an example from my constituency. Several years ago, Wigan council contracted out home care services in our borough, and staff were transferred to a number of private providers, which have changed hands over the years. Just after Christmas, home care workers in Leigh came to my surgery and told me how things had broken down over the Christmas period, leaving vulnerable people, frankly, unsupported. They showed me the timesheets that they had been given by the company they were working for, and one of them included four simultaneous bookings for 12 o’clock—a point that I think my hon. Friend the Member for Worsley and Eccles South made—on different sides of town, with no travel time built in. Impossible. If we look at the whole day, we find appointments within 10 or 15 minutes of each other, which are meant to include travel time as well as time for looking after older people. That is fundamentally unacceptable.
I was told about staff working extra hours because of that situation, and then not being paid. They said that equipment such as aprons and gloves was not being provided, and that staff were funding them out of their own pockets, which again is absolutely wrong. They also raised concerns about rotas being issued only the night before, and care assistants not having keys to get in to meet the service-users they were visiting. Across the board, there were terrible problems and vulnerable people were being left without support.
Members might think that the company in question is a small, local one, but in fact it is Alpha Homecare Ltd, which is wholly owned by Carewatch Care Services Ltd, a national company with 154 offices nationwide. That is an example from Leigh, but I bet that other Members could cite similar ones.
Lisa Nandy (Wigan) (Lab)
I too have been visited by employees of Alpha Homecare in my neighbouring constituency. Does my right hon. Friend agree that one of the real concerns is that because those women are so dedicated to their work and often pick up work out of hours, without being paid to do so as they told me, it masks the fact that the situation is probably much worse than it appears on paper?
Andy Burnham
That is absolutely the point. This is not responsible capitalism; it is the worst kind of capitalism—making money by leaving vulnerable people unsupported and, as my hon. Friend says, taking advantage of the commitment and vocation of those on the front line, who will not walk away from the people they care for. It is unacceptable to not pay them and let them buy their own equipment, and to make profits off the back of that kind of behaviour.
Sarah Newton
I hesitate to intervene because it is important that the many Back Benchers who are here today are able to share their views. However, although none of us could support the appalling situation that the right hon. Gentleman described, he will be aware that the commissioner—the local authority—has a responsibility for the quality of the service. If he is concerned about it—I would be absolutely furious if I were the local Member of Parliament—he can take it up with the council so that the contract can be cancelled, and ultimately refer it to the Care Quality Commission.
Andy Burnham
I am aware of the system for raising complaints. I have done that, and I will now be inviting the CQC to take a look at the situation. I mentioned it because it illustrates vividly the thrust of my remarks. It is not an isolated example; the quality is not there in the system.
The problem is that we are in danger of getting what we pay for, or what we do not pay for. As the pressure increases, councils are forced to make budgets go ever further, and they contract companies that do not provide the standard we are looking for. We would not accept it for our own families, and we should not accept it for any families—that is particularly so for us, with our responsibility to speak up for the most vulnerable in our society. Let us resolve in this Parliament to do something about it and to make overdue reform of the care system in England a reality.
Heather Wheeler (South Derbyshire) (Con)
I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) and the hon. Member for Worsley and Eccles South (Barbara Keeley) on bringing this debate to the House.
In South Derbyshire, social care is a very big issue, and I praise Derbyshire county council for grasping it with both hands. For the first time, an older people’s village is being built in my constituency, in Swadlincote. It will take anybody over the age of 55 when they do not need any care, until they need intermediate care, and then right until the end when they need dementia care. It is an absolutely brilliant new way of coping with care for the elderly, and I congratulate the council. Interestingly, there is now a strong debate about the typical old people’s homes that councils have run over the years, and people are concerned that the new style of looking after people will have to bed in a bit.
What is important about the older people’s village is not only that people will choose to buy or rent flats in it, or be put there by the state if they cannot afford it, but that respite beds will be available so that carers can have a break. People can have step-down or step-up beds, get themselves well again, and be able to look after themselves with total 24-hour care.
George Hollingbery (Meon Valley) (Con)
I want to develop my hon. Friend’s point a little more generally. As many colleagues will know, I am something of a bore on planning, but I think that the planning system has an important role to play in this in future. Does she agree that neighbourhood plans—the new local plans that are coming forward—are an essential part of catering for the needs of the elderly on an ongoing, 20 to 25-year basis?
Heather Wheeler
I am grateful to my hon. Friend for widening out the possibilities of my speech. I agree with him. As leaders in our areas, we need to direct people, as part of the consultations with their local development frameworks, to say, “This area could be zoned for bungalows”, or “That area could be zoned for an older people’s village”, or “That area, particularly if it has a section 106 agreement, could have some money allocated not only for the police, for education, or for a children’s play area, but for areas for older people.” We have recently had a planning application approved for a village for 2,500 people on a brownfield site, which included a zoned area for older people. The person who had the brilliant idea of building the village was inspired to do so by what he had seen his older relatives go through in their later years. He wanted to take a completely —dare I say it—holistic approach so that such people could in future grow old gracefully.
As well as championing what Derbyshire county council is doing on my patch, in connection with Trident Housing Association and South Derbyshire district council, I am also chairman of the all-party parliamentary group on local government. We will be conducting a new inquiry into social care, which will dovetail with the findings of the Dilnot report. We hope that, as an all-party group, we will be able to examine the issue a bit more widely and think outside the box, in order to be helpful to Ministers and give them as many ideas as possible. I know that a number of Members who are in the Chamber today will be sitting on that inquiry with me, and I am grateful for the all-party support.
When the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) came to speak to the all-party group, the room was packed. There were 70 people there, which is pretty good going for 2.30 on a Monday afternoon. People came from all over the country to hear him. It was a very uplifting afternoon, and I am grateful to him for giving us so much of his time.
This is an important issue for all of us, but it has been kicked around like a political football. The deficit is horrendous, and we all know that there really is not enough money in the world to deal with the problem, but the mood in the House leads me to hope that we will have some answers before the next general election in 2015. We need to put those answers on the table and get this done, for everyone.
Nick Smith (Blaenau Gwent) (Lab)
I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), and the Backbench Business Committee, on securing this debate. Adult social care is one of the most important social issues of our time.
The announcement by Ministers that the social care White Paper is coming soon—or soonish—is well timed. Given that there are an estimated 400,000 older people resident in UK care homes, I wish to concentrate my remarks today on residential care. The Dilnot report of last summer was well received. It struck the right balance between what an elderly person, their family and the state should pay and contribute to long-term care. Equally important for many were the report’s key premises that the current system of social care was underfunded and that additional funding and better targeting were urgently required. As Dilnot said, this is a price worth paying.
We all want to see a UK in which old people are respected and valued and can make the most of their final years. Alfred Morris, who became a Minister in the 1970s, said that
“if years cannot be added to the lives of the chronically sick, at least life can be added to their years”.—[Official Report, 5 December 1969; Vol. 792, c. 1863.]
People might want to move nearer to relatives or downsize as they grow older, so a national system makes sense. Dilnot was right to recommend the delivery of that objective. It would be unfair to call it a weakness of Dilnot, in that it was arguably beyond his remit, but he concentrates on the demand side of social care and how it is to be paid for. He does not consider the supply side and how it is commissioned and, importantly, how it is delivered.
We have recently seen too many examples of care for the elderly in residential care homes and hospitals that have been shameful. As many have said, we have to ensure that care is compassionate and respects the dignity of elderly residents. The care home business—and it is a business for many providers—has been a target for the quick-buck strategies of venture capitalists. Following the collapse of Southern Cross, another massive care provider, Four Seasons, has expanded. It now operates two homes in my constituency, but residents and staff are still worried about the outstanding debt liability of its parent company, Four Seasons Health Care. The Association of Directors of Adult Social Services has said:
“Care wouldn't have got the level of investment it has had without the use of private money…But in these very complex business structures, good governance is key.”
So, measures to ensure the effective oversight of the social care market to ensure stability and continuity are important for residents and relatives.
I would also like to emphasise the issue of NHS support for care homes. The British Geriatrics Society has published “Quest for Quality”, which identified
“unmet need, unacceptable variation and often poor quality of care provided by the NHS to older people resident in care homes.”
While some homes are well served by the NHS and “Quest for Quality” gives examples of good practice, it records:
“No model of coordinated health care has been developed to meet the needs of care home residents.”
Some residents in residential care have no access to key clinicians such as geriatricians or to community health services such as physiotherapy, podiatry and continence services for their long-term conditions. We have to ask how such expertise can be inaccessible to care home residents? This cannot be tolerated.
The solutions that have been proposed are familiar, and I have heard them several times this afternoon. They include co-ordinated teams of health professionals working together, patient and relative involvement and a partnership approach between health and social care workers. We know what works, but have failed to deliver the best care nationwide. We know, too, that early interventions cost less and emergency treatment costs more. Experts say that £40 million could be saved by a reduction in emergency admissions on hip fractures alone. Some care homes report that out-of-hours GPs tend to say, “Send to hospital”. In 2012, we should be doing much better than that. The report recommends that statutory regulators should scrutinise the provision of NHS support to care homes and the achievement of quality standards.
The Care Quality Commission currently has responsibility for regulating and monitoring care homes in England, with NHS health services providing support to such homes. The Care Quality Commission conducted its special review of the health needs of care home residents, which was published last week, although it was originally expected in 2010. When the CQC came to the Public Accounts Committee in January, I asked it when the report would see the light of day and why it was so far behind schedule. The chief executive told me:
“I suspect because of the complexity of the data collection and, to be honest, the fact that we have been focusing on trying to get the basic inspection processes up and running and right.”
Basic inspection processes are crucial but so, too, is the promotion of residents’ basic health care. This is not good enough.
Finally, in January I was co-signatory to a letter calling for doctors to record whether an injury from a fall, a pressure sore or an infection was present when a patient was admitted to hospital or developed while they were there. This is a simple and cheap mechanism for identifying in hospital a sub-standard quality of care.
Dilnot says that the care system is confusing, unfair and unsustainable, and that reform is urgently needed. I hope that the social care White Paper will build on good practice and deliver the reforms and the investment we need. Worry over the funding of residential care or over poor health care in the place they call home should be a thing of the past for our pensioners.
Chris Skidmore (Kingswood) (Con)
I start, like others, by congratulating my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate, bringing out the urgent need to tackle the issue of the future of social care, and ensuring that we face up to the responsibilities of looking after the elderly of today and tomorrow. We have heard humble messages from the Minister and the shadow Secretary of State about their willingness to work together. The spirit of cross-party agreement is encouraging.
As the right hon. Member for Leigh (Andy Burnham) said, these issues go right back to Beveridge in 1942, when the average life expectancy was 69 and social care was not an issue to be considered within the realms of the state. The right hon. Gentleman mentioned the “sixth giant”, and he is right that we need to revisit Beveridge for the 21st century and perhaps to look again at what Beveridge considered to be most important—the contributory principle. The contributory principle for social care will be all-important when we look at how to deliver social care reform.
As we know, reform is desperately needed. The arguments over the funding of our social care system are well practised, but let us rehearse some of the statistics, which are becoming more familiar with every debate we hold. The number of those aged over 85 will double by 2030, and during the course of this Parliament alone, more than 1.4 million people will turn 65—one in 10 of whom will have a long-term care need that will cost more than £100,000. We should also make it clear that this problem is not unique to the UK. Germany and Japan have recently taken radical action to reform their systems. However, the UK has a specific problem that makes finding a solution to the ever-growing problem of social care particularly difficult: most people simply do not understand the system. They do not understand that social care and the associated costs of getting older are not free, as the Minister stated, and nor have they ever been.
That point was made in the Dilnot report, and it cannot be stressed enough. I wish to highlight two of Dilnot’s recommendations. First, he states:
“To encourage people to plan ahead for their later life we recommend that the Government invests in an awareness campaign.”
Secondly:
“The Government should develop a major new information and advice strategy to help when care needs arise.”
The acknowledgement that more needs to be done to inform the public is welcome. In reality, until one is forced to interact with the system, there is a serious lack of information compounded by an assessment procedure that is often unrealistically complicated. For many elderly people, part of the shock that comes from being forced to sell their house to pay for care is the unexpected nature of that situation. In some respects, we are facing a problem of responsibility and of planning ahead. Although people are now accustomed to the idea of preparing for their old age with regard to pension provision, there remains an aversion to preparing for the eventuality of future frailty and ill health. Few of us wish to admit that we will grow old and frail and need help and support, before it is too late.
The solution to the funding crisis brought on by an ageing population will inevitably require individuals to pay more, and from an earlier age. Whatever we do to change the current system, it is absolutely essential that a much clearer picture of the relationship between contribution and entitlement—precisely as Beveridge set out—is at the heart of that.
Reform requires realism. Even if the Dilnot proposals are implemented in their entirety, they will not provide the full solution. Whatever cap on care costs is set, domiciliary care costs and annual living costs are not taken into account. A new system that is able to lever more private funding into the system will ensure that we can provide the best deal for the elderly, but it will require an understanding that we need to grow an insurance market to maturity that is then sustainable in the longer term. That will not happen overnight. This is a process that will take between 10 and 20 years.
The current Government have taken the first important steps to reforming the system. As hundreds of billions of pounds are being talked about in respect of the current euro crisis, it is easy to forget that the Government’s decision to give an additional £2 billion a year to social care in the 2010 comprehensive spending review was the greatest ever increase in social care funding, and will lead to a vast increase in resources. We are investing more than ever before in carers and respite care, recognising the huge contribution that they make to our country, selfless in their service to their partners, parents, families and relatives.
In addition, a greater focus on personalisation and individual budgets, combined with an increased use of resources such as tele-health, will put more control over care into the hands of individuals, ultimately allowing new providers to provide more tailored services, thereby driving down costs at the same time as improving quality. Placing the person at the heart of their care has the potential to transform social care services, which for too long have been led by inefficient monopolies.
The Prime Minister’s recent call for greater integration of health and social care is equally welcome. I am a member of the Health Committee, and we called for that in our recent report. If we fail to address the social care problem, the NHS will end up picking up the tab. Every unplanned hospital bed admission for the elderly is a mark of the failure of social care to prevent that from happening in the first place. We know that if we can reduce demand for hospital beds by just 10%, that could free up £1 billion that could then be redirected into community-based care services. We must recognise that hospital is not always the best place for care to take place and redirect resources to reflect that.
In preparing for the Committee’s social care report, we visited Torbay, and I was particularly struck by the experience of integrated care there. Torbay’s primary care trust and adult social services have been combined into Torbay Care Trust, following which five integrated health and social care teams were established. They seek to be proactive in managing patients and to work in partnership with GPs. In Torbay, a team was also introduced that was specifically charged with monitoring patients in hospital and discharging patients where there is pressure on beds—again, the team is working closely with clinical professionals. That has helped to cut out unnecessary lengthy hospital stays and delayed transfers of care. As a result, Torbay now has the lowest use of hospital bed days in the south-west region, as well as the best performance on the length of stay. The chief executive of the NHS, Sir David Nicholson, has said:
“I have seen the future and the future is Torbay”.
He did so because it is the elderly who will benefit most from integrated care. Complex long-term conditions complicated by age can be properly managed only with a collaborative approach.
John Pugh (Southport) (LD)
Torbay has, for some time, been a model of good practice and the fact that this good practice has not spread much further than the confines of Torbay is something of an enigma. Would the hon. Gentleman care to comment on that?
Chris Skidmore
Torbay was one of the sites for the pilots set up in alliance with Kaiser Permanente, which came over in 2003. Interestingly, it is instructive that one of the problems the NHS faces as an institution is that, although it creates fantastic pilots and the NHS innovation centre is working hard on rolling them out across a wider area, that process encounters significant delays. Good models of care should be spread out far more widely and far faster.
What most elderly people want from their health care system is simplicity. They do not want to be moved around constantly from pillar to post, waiting for specialists to see them; they do not want to see a host of different medical professionals, each of whom is unfamiliar with their case; and they do not want to languish in hospital beds when they could be more comfortable at home. The most important change must be a cultural one. There may have been a tendency in the past for health care to be reactive, responding to medical crises as they arise, but the future must be very different. To paraphrase John F. Kennedy, we do these things not because they are easy but because they are hard. We know that we face a challenge that will define the landscape of health and care for the decades to come—it is a challenge that all in this House cannot be willing to postpone.
Sir Alan Meale (Mansfield) (Lab)
I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on their tenacity in securing this debate. Hon. Members from all parts of this House should give them credit for their hard work and effort.
In this important debate, I wish briefly to raise the issue of people suffering from autism and Asperger’s syndrome. As hon. Members will be fully aware, those conditions are extremely serious. Both are lifelong disabilities and they affect sufferers in a number of different ways. I fully accept that some people who have either of those conditions are able to live semi-independent lives, with only partial support, but others—indeed most—need a range of specialist support throughout their lives. Although they do not represent everybody who needs adult social care, I am not talking about a small number of people. Approximately 1% of people in the UK have autism, and they and their families account for at least 2 million involved citizens in the UK, which represents, on average, approximately 3,000 people in every constituency in Britain.
Yet, even given those numbers, the National Autistic Society says that sufferers routinely struggle to access the services they need and that when they do access them the outcomes are largely poor. NAS research also shows: two thirds of all adults with autism say that they do not have enough support to meet their needs; more than 60% of these adults rely absolutely on their families for financial support, with approximately 40% of them having to live at home with their parents; and only 15% of people with autism are able to find full-time work.
Failures to provide such support are also very expensive to the ordinary taxpayer. According to the National Audit Office, if local services supported only 4% of adults with high-functioning autism, that would be cost-neutral, and if they supported only 8%, that would save the Government at least £67 million a year. As a number of hon. Members have said, the Dilnot commission on funding of care and support stated a number of good things, in particular that the present system was both unfair and underfunded. It called on the Government to increase spending on social care and to limit the cost and charges for those who need it.
The report’s key recommendations included the need for national eligibility criteria, with all those who enter adulthood with health and social need being eligible for free state support immediately rather than being expected to pay themselves. This is where I have a slight difference with the Minister, who said that it is not only about money. For many people who come to my surgery at their wits’ end, it is about money. Indeed, even those who had money do not have very much left in their late adulthood to spend either on themselves or on their loved ones, so money is very important.
In conclusion, I believe that the adoption of the Dilnot recommendations would lead to an entirely fresh approach that would deliver greater awareness of autism, and in particular of the sufferers’ needs, care and, of course, support. It would also put in place measures to relieve the short-term crisis in funding in social care.
Mr Robert Buckland (South Swindon) (Con)
The hon. Gentleman is quite right to raise important statistics about people with autism, but may I urge him, when he speaks passionately about it, not to refer to people as suffering from the condition but rather to acknowledge that they have the condition and have great potential and that what we should all be doing through the care system is ensuring that they realise that potential? Does he accept that?
Sir Alan Meale
I fully understand the direction that the hon. Gentleman is coming from, but let me just say that I am the son of a permanently and seriously disabled person and he was that way all of my life. I also served as a board member of the Portland training college for the disabled in Nottinghamshire and have been deeply engaged in matters connected with the seriously disabled for years. Believe me, when I use the terms “suffering” and “sufferers”, I mean them not in a derogatory sense but to highlight the plight of the people who I am talking about.
In conclusion, I believe that adopting Dilnot would put in place measures to relieve the short-term crisis in social care funding and, most importantly, establish sustainability for care and support in the longer term.
John Pugh (Southport) (LD)
I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on starting this debate. I shall be relatively brief because I sense that this is just the beginning of a debate that we will have throughout this Parliament and probably beyond. The whole issue represents a huge financial challenge to Government and a demographic challenge to the country and it will not go away. I suspect that many of the bad stories we have heard about poor care will, if anything, multiply over the years to come as finances are stretched further.
There are obvious things that the Government can do and that they mean to do, such as developing the public health agenda as well as ensuring that healthy old age is a possibility and that more healthy ageing takes place. I think that the Government are serious in their intent. Obviously, as has been suggested by many hon. Members, they can also join up health and social care a little better than they are at the moment. We want care to be integrated more and costs—and people—to be shunted around rather less. I cannot always follow how the Health and Social Care Bill advances that aim, because, after all, we will have a new set of commissioners with limited experience in interacting with local authorities and we will necessarily lose some established commissioners and some established arrangements will collapse. That will create a difficulty, albeit a temporary one; we will have it for a little while yet.
As I tried to point out in my intervention on the hon. Member for Kingswood (Chris Skidmore), there is no obvious mechanism for spreading good practice. How many times have we said that Torbay is an exemplar but then pointed to very few places that have followed that example? There is a real issue with how we spread good practice. I accept that the Bill gives the commissioners the right mandate to integrate social care and health care, but I question whether they will have the right capacity. I listened to the Minister, who put faith in the health and wellbeing boards being able to join things together or to force people to act together who might otherwise not do so, but the big issue staring us all in the face is the cost of care, followed by the quality of care.
In some respects, quality of care is the easier fix. We could have effective regulation and the Care Quality Commission could do a lot better and be less overloaded, but I suspect that it will not be short of work given some of the things it is asked to do by the Bill. Let me take this opportunity to pay tribute to the Minister, who has done a great deal in his time in Parliament to emphasise the need to treat people in care properly. In particular, he has campaigned for people to be respected in old age and for the elders—I think that is the word he used; it is a very nice word—to be defended. In terms of improving the quality of care, he is alive to the need to ensure there is portability so that, when someone goes from one place to another, the care does not decline but remains at a constant and expected standard. There is also a need, which we all recognise—again, the Minister has this well within his remit—to provide a proper legal framework in which people can understand their entitlements and secure them.
Then we come to funding, which is the big issue. I am relatively familiar with this issue because I have experience of being in a local authority with a large demographic bulge towards the top end that has had some difficulty with past Governments over this. Local authorities usually argue that they can provide only what they can—that provision is subject to whatever resources they have—and they try to ration what they deliver according to what they have in the kitty. They cannot always do what people feel they should, so they prefer to do what they can, but Governments are often quite explicit in telling them that regardless of what they have they need to deliver on the entitlements that people expect. I am very familiar with this because when I was the leader of a local authority, when Lord Boateng was in Richmond house, I was once summoned to be roundly told off because my local authority had just lost a celebrated case against Help the Aged. In that case, this problem was precisely the issue: we knew what we could justifiably afford but it was far less than what we needed to deliver what people expected. The previous Labour Government laid down in no uncertain terms that regardless of what we had got, we had to provide the service that was expected.
That tension between local authorities and central Government has always been there and is not going to go away. I accept the point that the Minister made—if we have an outcomes framework and greater transparency, it will be more obvious to people than it is now exactly what is going on and what quality of service is being delivered by individual local authorities—but at the heart of this issue is the local authority settlement. One can say many things about the local authority settlement, but one thing it is not is transparent. It is something that people argue over time and again. My borough has always found its resources severely stretched because we have a high percentage of elderly people and we have never felt that any Government have given us a fair deal in that respect. So the debate goes on, and in some ways it is going to become more critical because at some of the local authorities that have had to make quite severe cuts, including mine, the costs of adult care are going to swamp their budget completely. They are going to have to give up delivering other services in order to fund adult care. That is despite Government top-ups, which are welcome.
There is also the phenomenon of some sheltered housing providers, which have been affected by the refocusing of Supporting People budgets, giving up providing services that people expect as part and parcel of sheltered housing. There are also the local authorities being driven to be more efficient and switching providers but in the process completely hacking off the people who want continuous provision and do not see the case for doing that.
We need a solution to what is a huge financial problem. The solution needs to be affordable, sustainable, fair and, obviously, cross-party. I think we all regret what happened at the last general election, when the cross-party consensus broke down for political reasons. That is where Dilnot comes in. The Dilnot solution seems to be viable: it allows for individual responsibility but also caps costs. That deals with the two big problems I have always come across with this issue. From time to time, I get constituents saying to me how unfairly they are being treated when other people, who have blown all their money before retirement on cruises or whatever, seem to get provision—the free-rider problem. Dilnot recognised that and endeavoured to deal with it. The report also deals with the other, probably larger, problem that people fear that the cost of care will run away with their entire income and they will end up destitute. I personally know people who genuinely hope to die before the money runs out, and that is an unfortunate end to one’s time on this earth.
If Dilnot or something like it is to work, insurance companies will have to develop the right products, as other hon. Members have emphasised. If one has discussions with insurance companies, one will find that they are of varied minds and that some of the products that Dilnot expects that they will offer are not the ones that they would ideally wish to provide or that they think they should provide, so there will be quite a debate there.
Another problem with Dilnot, which I think we can all see, is that in so far as it caps the overall costs, it presumably represents some sort of bail-out for the fabulously wealthy. People might see fairness in that, but they do not see that it should necessarily be the Government’s first priority in the current circumstances.
Then, lingering behind everything, the Treasury is simply worrying what it is all going to cost at the end of the day and wants some financial certainty, for quite good reasons. It is difficult for anyone to provide that, so all this is going to provide a rich menu for a future debate, and we are grateful to the hon. Member for Truro and Falmouth for initiating it.
Tony Baldry (Banbury) (Con)
I am grateful for the opportunity to contribute to this debate, not least as co-chair with Baroness Pitkeathley of the all-party group on carers. The first point I want to make is about the phrase “adult social care”. One of the difficulties in this area is that if we are not careful we develop a secret garden of policy and we all start to descend into shorthand—referring to Dilnot as though everyone understands the five paragraphs that follow from that. I thought that the shadow Secretary of State for Health made a good point when he said that, for many people, this is all about being afraid of getting old. I think that this should be about not adult social care but care of the elderly.
When the Law Commission was asked to define social care, the best that it could come up with was the phrase
“promote or contribute to the well-being of the individual.”
That was pretty otiose. We should focus on care for the elderly because we will need to enlist in our constituencies many more people to get involved in this, not least local councillors, with the introduction of health and wellbeing boards. I do not know about other hon. Members but, although I think that the provisions in the Health and Social Care Bill on integration are really good news—I will come on to that in a second—I do not sense that county councillors and others have yet woken up to the fact that shortly they will be part of the boards and will be involved in delivering integrated care. Part of the reason for that is that this has been a bit of a secret garden of policy. One of the things that Ministers will have to do in the near future is go out and talk to, in two-tier authorities such as mine, county councillors, but in others those councillors who are responsible for running social services, to get across the fact that the whole way in which services are delivered will fundamentally change.
About half the speeches this afternoon have been what I would describe as old-fashioned speeches to Ministers, saying, “Please can we have some more money?” The truth of the matter, as we all know, is that there is no more money. It is actually more challenging than that. We have the Nicholson challenge of 4% efficiency savings in the NHS over four years. We will make this work only if we completely rethink the way in which we deliver services. We all know of far too many people who are in hospital but could be moved elsewhere if intermediate beds were available. That would mean they could be moved out of acute beds, such as those at the John Radcliffe hospital or the Horton general hospital in Banbury, but that would require someone working out how to provide more community facilities and intermediate beds and how they would be paid for, and that will require a lot of rethinking by county councillors and GP commissioning bodies working together.
We have to start to put this in a language that everyone understands. When the White Paper is published in the “spring”—that leaves only April—there is a danger that we will all get fixated on Dilnot and the cap. It seems to me that that is just one part of the whole equation for improving care for the elderly and, increasingly, elderly people suffering from dementia. The figures on dementia are really pretty scary. Among the many organisations that produced briefings for today’s debate is the Alzheimer’s Society, which reports—I had forgotten this—that there are now nearly 750,000 people in the UK with dementia, and that figure is set to rise to over 1 million by 2021, when many of us expect still to be in the House.
Dementia costs the UK economy £20 billion a year. When I was first elected to the House, most Christmases I would visit the homes for the elderly in my constituency. The residents then were mostly spry widows in their 70s, but now all the homes are almost totally full of people suffering from dementia or age-related dementia. This is about how we care for the elderly and, increasingly, elderly people with dementia, many of whom are having to stay at home longer. Indeed, the Alzheimer’s Society says that more than half of the people suffering from dementia have not yet been diagnosed as such because their families or those are caring for them are probably disguising the fact.
Barbara Keeley
I do not know whether the hon. Gentleman thought that my speech was one of the old-fashioned ones asking for more resources, but he probably did. However, I gave three examples of cuts to services for people with long-term conditions: the support services for people with dementia that Age Concern was running; a community matron service; and active case management for people with long-term conditions. It is inexcusable for those to be cut. If the Nicholson efficiency reforms are causing those services to be cut there is no way forward, because those are the supports in the community that will keep people out of hospital. It seems crazy. I now have three examples, whereas at Christmas I had only one. I am distressed to think that those services are being cut, because they are the way to support those people in the community.
Tony Baldry
One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.
Andy Burnham
I agree with the hon. Member for Kingswood (Chris Skidmore), who talked about the contributory principle, because there has to be a partnership between the individual and the state. If the hon. Member for Banbury (Tony Baldry) is ruling out general taxation, which I agree with him on because it would not be fair to make the younger population pay yet another cost, does he not accept that one ultimately comes to some difficult options in raising the extra money to build a fairer care system? We all have to start being honest about that and put some difficult options on the table, so that the public can have a debate about them.
Tony Baldry
Of course, general taxation will continue to play a part because it will fund the national health service, including the services delivered in acute general hospitals and so forth. However, far too many elderly ladies who go into a general hospital with a stroke or a broken hip stay there for longer than they need to for their treatment and could go home. We all need to engage in a debate in our constituencies that breaks out of the secret garden and involves far more people, including elected representatives, voluntary organisations and others.
Finally, I want to talk about carers, because I do not believe that any debate on care for the elderly should take place without a discussion about carers. I am the co-chair of the all-party parliamentary group on carers, so the House would be surprised if I did not mention them. There are two things that carers want. The first is recognition, which is now becoming slightly better. We need GPs and others to help people to understand that they are carers and to ensure, wherever possible, that they apply for a carers assessment, so that we can give support to carers. That will be particularly important if we are asking people to spend more time living at home when they are suffering from dementia and other conditions.
There are simple things that can be done. One of the worries of people who care for someone with dementia is that they will wander off and get lost. Age UK in Oxfordshire is starting a new initiative that encourages people to text a number if they see Mr Smith wandering down the street. Most of us are a bit embarrassed or shy if we see a neighbour wandering off and do not think that we should apprehend him, even if we think that he might not know where he is going or that it is not in his best interests to wander off. The question is how to deal with that as a community. There are lots of complexities in these matters. The whole community has to get involved if we are going to have more people living at home.
The second thing that carers want—I have said this on occasions too numerous to particularise—is breaks. We must ensure that there is a decent system of respite care. If there is not, carers sooner or later break, and when they break, they break for ever. That means that people whom it had been possible to care for at home go into a nursing or care home, never to emerge. With judicious and supportive carers’ breaks and respite care, many carers can be supported to carry on caring for a long time. Carers need to be valued and deserve to be valued. At every opportunity, the House should say an enormous thank you to the hundreds of thousands of carers in this country.
Kelvin Hopkins (Luton North) (Lab)
I apologise for being away from the debate for a short time, Mr Deputy Speaker. I was speaking in Westminster Hall on another subject. Being in two places at once, even for a Member of Parliament, is rather difficult.
I have long had an interest in this subject. I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on securing this important debate and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on her excellent speech. I also give full credit to the two Front-Bench spokesmen because I believe that they genuinely care about this matter and are not just speaking warm words. I appreciate that.
I will focus on residential care, but I believe that domiciliary care is also in a poor state. I know of many cases in my constituency of people not being looked after well under the new privatised, personalised approach to care. The contrast between that type of care and what people get from an NHS district nurse who goes around to tend to people is extreme. I have spent a day with one of my local district nurses—they are not called that any more, but Members know who I am talking about—and seen how a true professional, a public employee motivated by the public service ethos, treats their patients at home. That is how all sorts of care ought to be provided, rather than by private companies or private individuals who often have heavy work loads, are impatient and do not provide the care and sympathy that they should when they visit people in their homes.
The royal commission on long-term care for the elderly, which recommended that care ought to be free at the point of need on the same basis as the national health service, was absolutely right. The Government of the time rejected its recommendation, and went so far as to ensure that a couple of members of the commission voted against it so that it was a majority view, not a unanimous one. I personally think that was a terrible thing to do. I have raised it before in the Chamber and probably will again, because I think it was so wrong. Nevertheless, the royal commission recommended free long-term care for all, and I absolutely agreed.
I tabled an early-day motion in the 1997 to 2001 Parliament calling for the Government to adopt the royal commission’s recommendations. More than 120 Members signed it, most of them Labour Members, but other parties were represented as well. No notice was taken of it. The current Minister was one of the signatories. I tabled another early-day motion in the 2001-05 Parliament saying the same thing, and it got similar support. I hope I am not embarrassing him, but he tabled a similar motion when he was in opposition, which I supported. We were on the same side at that time, and I like to think that he is doing his best to push that agenda forward within the constraints of the coalition.
My position is absolutely clear: I believe that there should be free long-term care for all, provided by a professional care service of directly employed public service workers. That is how people would be served best, and it would be properly publicly accountable.
Paul Burstow
The hon. Gentleman is absolutely right that I signed early-day motions supportive of the royal commission, but I need to correct the record ever so slightly. He is giving the impression that the royal commission recommended that all aspects of long-term care should be free. I am sure he will want to acknowledge that accommodation and hotel costs were not intended to be covered by its proposal.
Kelvin Hopkins
I thank the Minister for his correction, and I think the situation is possibly similar in the health service.
I come to the problem of affordability. I remember that in the early days after 1997, the Government were trying to keep down public spending, and there was a crisis in the NHS because of under-spending. That crisis was inherited from the previous Government, but for the first two or three years after 1997 nothing happened. We got well behind in what we needed to do to fund the NHS.
During that Parliament, the standard rate of income tax was reduced by 1p, and nobody even noticed. I believe that at that time, 1p on income tax was the equivalent of about £3 billion, and that income was just lost. It could have been spent on long-term care or the health service, but the decision was taken to reduce tax. Later on, in the last Parliament, the then Chancellor decided to reduce the standard rate of tax by 2p. I am not suggesting that the standard rate of income tax is necessarily the way to pay for care, but it is not right to say that things are unaffordable when big tax cuts are being made. I believe that 1p on the rate would now raise about £4 billion or 2p about £8 billion—plenty to pay for free long-term care for all who need it.
Laura Sandys (South Thanet) (Con)
Of course money is important, but is this really just about money? Is it not really about how we believe the service needs to be delivered? We need to ensure that people are kept out of care, not in care. Until we re-engineer what we are delivering, we will not be able to consider the funding mechanisms. If we just fund what we currently have, we will be funding something that is broken.
Kelvin Hopkins
I thank the hon. Lady for her intervention, but I think that the system is broken because it is underfunded and we have forged ahead with privatisation. In my constituency, we had a wonderful care home, which I knew well because my mother-in-law lived there in the last few years of her life. She and the other residents loved being there. They had permanent, dedicated staff, all from the local community, who loved working there. All the health advisers and professionals who came into the home thought that it was wonderful. It was closed. The pretext for that was that it did not meet care home standards because it did not have en-suite facilities. It was a trick—a pretext for closing homes and forcing them into the private sector. That home was closed, the land was sold and all the residents went into private care, some of which was not very good.
Glyn Davies (Montgomeryshire) (Con)
I thank the hon. Gentleman for allowing me to intervene because it gives me an opportunity to contribute to the debate, a lot of which I missed because of the debate on the common agricultural policy in Westminster Hall that I had to attend.
The hon. Gentleman’s speech is about residential care homes. With the best will in the world, no matter how successful we are in developing domiciliary care, private sector residential care homes will play a big part in care for the elderly. Does the hon. Gentleman agree that, after the stories about the lack of regulation, including financial regulation, in private care homes in the past couple of years, we in Parliament will have to ensure that all residential care homes meet a certain standard for long-term sustainability so that people are not moved around without any real control?
Kelvin Hopkins
I agree with the hon. Gentleman entirely. The Care Quality Commission was encouraged to have light-touch regulation and to do only occasional inspections, of which the homes were usually warned. The inspections were not adequate, and many homes fell below the standards anybody would expect. If every care home was rigorously inspected, with spot checks from time to time, we might ensure that they lived up to the standards that we expect. However, it could cost a bit more because they might have to employ more qualified staff and so on.
We should professionalise the system and ensure that it is properly regulated and checked, even if it stays in the private sector. I personally prefer public provision, with people who are motivated by what I call the public service ethos. I have seen that working and I have seen what has replaced it. People come to my surgery and complain about being forced to move out of care homes that are being closed. That is especially difficult for those with dementia. People are pressed to go into other homes, which the residents’ families often find inferior. Some are good, but not all, and people are unhappy that three care homes in my constituency have closed.
The first home closed 10 to 12 years ago and I remonstrated with the local authority officer concerned. After an hour, he finally said that it was about costs: that private care homes pay lower wages, and that the staff work longer hours and have shorter holidays. I said that at least that was honest, but it was not right.
I disagree with my right hon. Friend the Member for Leigh (Andy Burnham) about young people paying. Most taxation involves redistribution to ourselves at other stages of our lives. When we pay national insurance contributions for pensions, we are in a sense saving for ourselves later through a state system. With the health service, we pay in when we can and take out when we need. It is a redistribution to ourselves. The young paying in now for long-term care is a sensible approach, especially as it will be proportionate.
Andy Burnham
The young would not be paying for their own care; we would be asking them to pay for the care of people who are already at an age when they might need the care system. In a world where those old people have built up valuable housing assets but young people cannot get on the housing ladder, is it right for us to say, “Here’s another tax for you to pay—for care for older people”?
Kelvin Hopkins
We must start getting the system right somewhere. We can adjust taxation provision in other ways in the short term, but in the long term we must have a properly progressive taxation system to pay for adult social care. I have just been to Denmark. Many Government Members and others say that high-tax countries are weak economies, but the tax take in Denmark as a proportion of gross domestic product is 18% higher than in Britain. The Danish have free tuition at universities, and students are paid €5,000 a year to go there up to the age of 25. I am not saying that we should do that, but I am making the point that taxation at that level, provided it is fair and progressive, does not ruin economies.
It is matter of choice. I have told the story of my young children many times in the Chamber. When my son asked for a second ice cream, my wife would say, “Mummy can’t afford it.” She was saying not that we could not afford it—we could—but, “You’re not having another ice-cream.” When people talk about affordability, they are saying, “We choose not to pay.” Those who constantly campaign for a low-tax society are doing down people who are in need. We must accept that if we want to be looked after when we are in need, we must pay taxes.
When people on the doorstep ask me what my problem is, I say, “I don’t pay enough tax.” I am sure other hon. Members do not say that. My income is now more than sufficient for me to live a very comfortable life, but the income of many young people is not sufficient for them. There is nothing wrong with shifting the burden of taxation to those who are on higher incomes or those for whom most expenses are over. It is unfashionable to say such things, but I happen to believe they are right.
I mentioned the care homes in my constituency, but another issue is that of payment. Our tax gap was not so long ago estimated at £120 billion a year. If we collected just 5% of that, we could pay for free long-term care without a problem. To be fair to the Government, they are starting to wake up to the need to close that tax gap—not enough, but a bit. We have left it alone for too long, because they do not want to upset rich people who are investing in the Cayman Islands or wherever.
The Government are starting to put a little pressure on and are employing a few more tax collectors. I know from my local VAT office that every inspector collects many times their own salary, so why not employ many more to get the VAT in? People recently went to prison for a tax fraud whereby they used VAT for import and export. Such people make billions out of hon. Members and our constituents. Let us round up a few of them and stop that loophole, and ensure that people who are well off and who should pay taxes do so.
I have known Andrew Dilnot for many years—he is a civilised, highly intelligent and wholly admirable man. He did a good job in his report of trying to find the fulcrum point—the Treasury might just wear what he is proposing, but if he went further it would probably say no. There is a parallel with Adair Turner, another intelligent, civilised man. He tried to change the pension system a bit. He knew that if he pushed the Treasury too far, it would react and he would not get what he wanted. Indeed, he had a hard job persuading the previous Chancellor to accept his proposals.
The authors of those reports try to come up with recommendations that will be acceptable to the Government and the Treasury instead of coming up with what they believe to be a strong position. The problem is not the electorate, but the Government and hon. Members on both sides of the Chamber. Ministers and officials will not accept the approach I suggest for a more civilised society.
Like all hon. Members, I do a lot of public speaking. I say, “What would you choose? Would you take the risk that your family member’s house will be compulsorily sold, and all the money used to look after granny, or will you pay a tiny bit more tax over a lifetime to make sure that granny is properly looked after without being forced to sell the house?” For wealthy people, that does not matter, but it does matter for many working class people, including first-time owner-occupiers. In many cases, they have bought council houses, which I do not believe is a good idea. They have a bit of equity in their family for the first time ever and it can be used to help their children—or grandchildren usually—to stay in the owner-occupied sector, but it is being eaten away by their being forced to pay for care for elderly relatives. Indeed, owner-occupation is now falling as a proportion of housing tenure. Whatever one thinks about owner-occupation or renting, that is happening, and a factor in that might be that people are being forced to sell houses to pay for care, and the equity is in effect being lost in rich taxpayers’ pockets, because they are the ones who can get away with not paying enough to ensure that granny is looked after.
We have to accept that people are living longer. We have not found a solution yet to Alzheimer’s or dementia. I hope that we do—it will solve many problems—but while we have not, we have to ensure that elderly people are cared for, which means that we have to pay for it properly. We will all get old one day, and we all might need this care one day. Certainly, for me and my family, I want to ensure that, as and when any of us need that care, it will be there for us and provided properly in a civilised and caring way.
Fiona Bruce (Congleton) (Con)
I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on the sensitive and caring way in which she brought this debate to the House. I also pay tribute to the 6 million unpaid carers in the UK. Unsung and often unseen, they are heroes and heroines who daily and sacrificially dedicate their lives to caring for others, often for 24 hours a day, seven days a week, 52 weeks a year. They deserve our utmost respect and appreciation, and I wish to record mine here.
I therefore wish to focus on the need to support carers in this era of an increasingly elderly population and greater longevity and with the exponential Treasury challenges that it will undoubtedly bring. Two million people currently move in and out of a caring role each year, but an ageing population and people living longer with chronic conditions mean that this figure is likely to rise significantly, so we must give serious consideration to how such carers, caring charities and community organisations can be better supported.
It is essential that we encourage a major cultural shift to consider how more support can be provided to carers, especially those who care for their families, and to charitable organisations that support carers. Caring charities, such as Crossroads Care Cheshire East, of which I am privileged to be patron, and the Prince’s Royal Trust for Carers, provide disproportionately greater value for money in the support they give than purely publicly funded social care services would ordinarily provide. As one former employee of the Prince’s Royal Trust for Carers told me, they supplement that work with volunteer support and the ability to act flexibly and go the extra mile, while all the time operating to high professional standards.
A significant caring role can affect a carer’s emotional, physical and financial health, but by supporting carers more positively, we can not only help them and those they care for but save the public purse considerable expense, which, as my hon. Friend the Member for Banbury (Tony Baldry) so eloquently said, will be increasingly important in the coming decades—to a degree that we have only just begun to glimpse. Crossroads Care Cheshire East writes:
“A clear agenda to support carers is an essential component of adult social care strategic planning.”
Caroline Hebblethwaite, who has been a volunteer worker with a caring charity in Cheshire, then an employee and now a full-time carer, speaks with unchallengeable authority and has told me of the many ways in which she believes we could support charities that in turn support carers more effectively. She says that longer-term funding commitments would help—beyond, say, two years—because shorter-term commitments make it difficult for organisations to plan and result in unhelpful churning, loss of experienced staff and disruption to well-established, cost-effective services. As Crossroads Care Cheshire East writes:
“Constantly having to reinvent well developed and user led services simply to fit another funding criterion is not a good use of time and money. Innovation is essential but experience should not be ignored.”
Both Caroline Hebblethwaite and Crossroads Care refer to the essential need for carer breaks. Crossroads says that carer breaks
“should not be paid for out of any benefits received by the person with care needs but should be a carer’s service for the benefit and health and wellbeing of the carer. It is not appropriate to assume that service users will use their own personal budgets to allow their carer a break—we know that often this does not happen. Without practical support carers and families will break down—this can be avoided by low level investment at an earlier stage.”
I will give examples of some of the many ways in which relatively low-level investment can be made.
Local authority funding could make a huge difference if a little more was channelled through carers charities, to be paid out at the discretion of the charities’ trustees. Caroline Hebblethwaite tells me that when she worked for the Princess Royal Trust, small grants paid directly to carers—not means-tested—made a disproportionate difference. She tells me, for example, of an elderly man caring full time for his wife for whom that small grant paid for a shed, in which he could pursue his hobby. It gave him that little bit of extra space and helped him to keep going. For another carer, there was a one-off spring clean, while yet another received computer literacy training, and another the occasional massage.
Provision to enable carers who work to remain in work—by having someone call in, just two or three times a day, to check that their loved one is all right—can make such a difference. A sitting service is also helpful, so that carers can go out. One way that local authorities can offer support—at a very modest cost, but making a real difference for those who care—is by funding befriending groups. Such groups enable carers to share experiences, but they need to be local, because carers do not have the time to travel far. Those that have helped in Cheshire include befriending groups that have provided talks on such matters as how to redecorate on a budget or how to make a hanging basket, and have even given advice on healthy eating. That might seem mundane, but it can make a real difference to carers, who often feel run down or a little bit depressed. Such small amounts of support can have a disproportionate benefit, and we need more of this.
Carers, often low on energy and self-esteem, find it hard to get information, advice and support, and I am advised that social workers often do not have much time to signpost them. However, local charities for carers can perform an important function in offering a great source of advice. Another function that they perform is by acting as a counselling service, providing counselling time—again, something that social workers cannot provide. There is a real need to recognise and support carers—for example, by giving them help in adapting to change, or to loss, or grief for a life once lived, or a life that might have been.
Caroline Hebblethwaite also told me about how much carers days have meant to those whom she has supported. Carers days in Cheshire have been held at local hotels, or even at a golf club. Carers are invited to come for special “feel good” days, where they are affirmed and told how much they are valued, and where high-level speakers talk to them, acknowledging the vital role that carers play. More of this is what we need as we move forward.
Local authorities could also ask professional advisers in carers charities to carry out more assessments of carers. This would not only be a valuable source of additional funding for carers’ charities, but also a likely cost-saver for local authorities. Incidentally, I am informed that assessments of carers’ needs are not made as frequently as they should be in many circumstances.
I would like now to deal with one or two other points. First, my constituent Barry Smith has written to me about higher attendance allowance:
“My parents-in-law are both 89, my father in law has advanced Alzheimer’s and my mother in law, in poor health herself, and lacking easy mobility after having broke both hips, is his primary care…We have spent the last few days trying to fill out the forms for…Higher Attendance Allowance and have come to the conclusion that the application itself constitutes a form of discrimination against the elderly. We had been warned…that the form is extremely difficult to fill in…and that the rate of success is only 60%,”
but it seems that
“for most elderly people it is simply impossible to complete…It is as though it has been carefully designed to ensure that the minimum number of applicants receive their entitlement”.
Hopefully that is something the Minister will look at.
I commend the proactive work of Cheshire East council, the local authority area in which my constituency lies, to support older people, as illustrated in its innovative “Ageing Well in Cheshire East” programme, 2012-17, which has just been launched. It focuses on how to support people from as early as 50 upwards—a little depressing for some of us at that age!—on the basis that the earlier we plan, the better those plans will be for later life, given that we all want to live well for as long as possible.
The aim of the programme is to ensure that older people live well and have access to the right levels of different services and support, including crisis support, at appropriate times in their lives. The programme aims to ensure also that they have a strong voice in influencing local policy and services; remain healthy, active and independent; receive help to plan their finances long-term; live in a safe environment, with appropriate housing; access appropriately constructed public transport; benefit from and contribute through employment, volunteering and learning; keep their links with family and friends; are actively involved in their communities; and maintain their roles as partners, carers and grandparents.
I commend in particular the wide-ranging network of relevant public, private and voluntary sector bodies which the Ageing Well programme has fostered, garnering a commitment to the programme that will be essential if we are to maximise our support and provide the effectively integrated care that has been talked about today. The programme has secured a commitment from agencies as wide-ranging as Cheshire fire and rescue, the police, clinical commissioning groups, local councils, the faith sector, housing providers, care charities and even the chambers of commerce.
The programme is already tackling older people’s concerns, such as those about disjointed services, the variable quality of care and social and economic isolation, and it is also improving volunteering opportunities. Such forward-thinking work is an essential component of our successfully rising to the challenge of caring for the elderly in the years ahead, and it is particularly important in an area such as Cheshire East, which has a rapidly ageing population and, in fact, the largest elderly population of any area, per head of population, in the north-west of England. The number of over-65s in the area will grow by 50%, and the number of over-85s is set to double, by 2025.
Cheshire East has funding challenges, however. The Government funding for the area is among the lowest of any in the country, despite the challenges that we are going to face and, indeed, already face in caring for such a large elderly population. We are given £191.62 per head, while Tower Hamlets, by way of comparison, is given £968.18, meaning that we can afford to spend per head £753.42, while Tower Hamlets has almost double, £1,428.16.
The funding context of each local authority area is an important influence on the services that can be provided, and in an area such as Cheshire East, with low funding but an increasingly elderly population, that is going to be a challenge, so I ask the Minister to consider it as we move forward.
I commend the Minister’s commitment to build on community capacity as the way forward, helping people to stay independent, healthy and well for as long as possible. Indeed, perhaps a better term for independent living would be inter-dependent living, recognising the importance of, and the need for, all of us to give and receive care at various stages of our lives. The more we can encourage caring within families, by friends and in communities, the healthier our society will be. We need to do all that we can to foster support and to encourage the sharing of caring, and we need to treat with gratitude and respect those who do care.
The words of the chief executive of Carers UK are apt:
“Our health and social care services could not function without the contribution of the unpaid care provided by families—which we estimate to be the equivalent of £119 billion a year.”
The basic building blocks of a healthy society are found in relationships—the networks of reciprocal responsibility that are found in the family, in friendships, in church, in community life, in work, and in schools. Through these basic building blocks, individuals meet the needs of their community. It is as much, if not more, the role of Government to help society to meet its needs through those relationships rather than seeking to take control and trying to meet those needs itself. As human beings, one of the ways we grow is through the challenge of meeting the needs of others in our relationships within our communities. Our national mindset needs to be increasingly directed towards that goal. Looking to the selfless example of our country’s 6 million carers would be a very good place to start.
Laura Sandys (South Thanet) (Con)
It is a great pleasure to follow my hon. Friend the Member for Congleton (Fiona Bruce).
My hon. Friend the Member for Truro and Falmouth (Sarah Newton) has been very important in instigating this debate about future policy on long-term care and ensuring that other such discussions are going on around the House. If it is the case that we come into Parliament because of certain issues, then reviewing and reforming long-term care would be one of the reasons that I find myself in this place. I am not sure that anything is more important for Government, Opposition and this House to resolve, and I give a huge amount of support to the cross-party debate that is going on.
However, we must realise that, unlike in other parts of NHS reform, there is not one person in the country who does not have a view on this subject and does not understand what long-term care means to them. They will look at it, and present it, through the prism of their parents or elderly relatives, and in their heart they will be thinking, “That is what my future will look like.” The shadow Secretary of State said that this debate needs to go beyond this House and to engage the public. I welcome that comment. As my hon. Friend the Member for Kingswood (Chris Skidmore) said, this is about a contract. We are entering into a discussion that will end up as a settlement between the country—the hon. Member for Luton North (Kelvin Hopkins) thinks that a little more funding might be needed—and the public, whose responsibility meets that of the state halfway, or perhaps more.
The public know that the system is broken. Its funding has been squeezed and there has been very little reform or innovation—other than in Torbay, which as we all know is the place to move to as one gets older. When people talk about care packages, it sometimes seems as though the patient is the package and it is hard to understand where the care kicks in. I believe that Dilnot has produced something useful and important, but perhaps it is a little pre-emptive. Until we can be explicit about what this care looks like and feels like, and what people’s experiences of it will be, it is difficult to talk to people about how we expect them to pay for it. I do not believe that the public are prepared to fund the current system, so we must first look at changing it.
I have been a carer myself. I cared for my father when he had a stroke when I was 17, and I saw my mother age by 15 years over a five-year period of caring for him. I have seen it first hand, and I understand some of the key issues that people face. I have also worked professionally in the areas of incontinence—not a charming subject, but one that is exceptionally important in this respect— epilepsy and motor neurone disease, so I have seen this from the end user’s perspective.
What could the new system look like? I believe that the system should be re-engineered around the principle of early intervention. The deceleration of the impact of ageing could be achieved by co-ordinating non-clinical services to keep people fitter and out of the care system. The things that social care delivers must change; it needs a total refit. I believe that that could be guided by four key principles. The first is about keeping the new old young. The second is about keeping people out of care, rather than talking about funding them in care. The third is about caring for carers; we need a whole stream of wraparound policy to support those people who are making that ultimate sacrifice—well, not the ultimate sacrifice, but a significant one. The fourth is about the need for top-quality care for those who do end up in residential care.
I hope that we will be able to keep the new old young. Members will be thrilled to hear that most of us have already started the process of ageing. Everything that we do now will have an impact on us in our 60s and 70s, and beyond. Why are we not introducing, through our GPs, human MOTs to look at any challenges to mobility? Owing to distributing far too many leaflets, both my arches have collapsed and I now have insoles in my shoes. That could have become a major problem as I got older. Why are we not looking at people in their 40s and 50s and taking steps to intervene and decelerate the ageing process?
Laura Sandys
I totally agree.
The acceleration of ageing starts to happen before we get old, and we must look at the public health opportunities to engage with and pre-empt some of the issues that we might face as we get older. That leads me on to keeping people out of care. The three biggest reasons for people going into care are dementia, incontinence and accidents, such as falls. Are we looking at those three factors in enough detail? This morning, on the radio, we heard about a drug that could help people to stay more able despite their dementia, and I hope that it will become more widely available.
I said earlier that I had worked in the area of incontinence. It is one of the most easily managed conditions, so why is it not properly supported? Why are so many people referring their family members to residential care for that reason, when the condition can be addressed easily and extremely cheaply? We are not addressing the condition, and we need to look at it in a lot more detail to ensure that more people can keep their relatives at home. I also mentioned falls. Why do we wait until someone breaks their pelvis before going into their house to see whether they have a handrail, whether their lights are working or whether the ramp is in the right place? None of this is rocket science, folks. It is perfectly straightforward, and I do not understand why such interventions are not being made much earlier.
We have a system that is broken, but we are not doing the necessary pre-emptive work. Instead, the system rewards acute services. It finds installing handrails or wet-rooms less thrilling than ambulances and broken hips. That makes no financial sense, and no human sense. The public know where the system is going wrong, and they can see that earlier intervention would make a difference to their loved ones. Many people have spoken about carers today, and we need to do as much as possible for them. They are at the heart of keeping people out of the care sector.
If we re-engineer our care system, making prevention and pre-emption the gold standard, we must look at a re-engineered funding mechanism, too. I believe that there is a policy framework that is a little like the green deal: for those who support people out of care, there is a bonus and an incentive, rather than the current financial model that rewards hospitalisation and pays far too little for those in home support.
I welcome the comments of hon. Members about how little care workers in homes are paid. My word, if we look at the value we get from that particular care intervention in comparison with extreme nurses in hospitals, we should start to understand that we have a very unbalanced system.
In conclusion, if we have a vision for decent and dignified care, the public will enter into a contract with the Government. They might even do so more than the Government think; they might even pay more than we are currently asking them to contribute. However, they will do that only if they see a re-engineered system that places the foremost priority on delivering care—quality care—that they can trust, rely on and understand.
Andrea Leadsom (South Northamptonshire) (Con)
My hon. Friends the Members for South Thanet (Laura Sandys) and for Congleton (Fiona Bruce) made interesting points specifically about caring for carers, which is the issue I want to address, too. I have one specific policy suggestion for the Minister, on which I would be interested to hear his thoughts: we should seriously consider introducing a post-retirement carer’s allowance.
It has always been the case in our society that no more than about a fifth of all the caring that goes on has been achieved by the state. In recent years, that fifth has expanded slightly to about a quarter, but if we were to try to pay via the state and taxation for all the caring in our society—whether it be for children, disabled relatives or the elderly—we would never raise enough in tax to be able to achieve it. For me, it has always seemed nonsense simply to look at the budgets and try to spend a bit more and a bit more. That will not be the solution in the longer term, particularly in an ageing society where the issue will crop up time and again.
I applaud my hon. Friends the Members for Congleton and for South Thanet for focusing instead on the carers—the people who carry out the caring. There are currently about 1 million people in England alone who are aged over 65 yet are caring for a relative. A constituent wrote to tell me that he was disabled, that his wife was his carer and that they also had a disabled adult child for whom his wife had been the carer since the child was born. He told me that his wife, who had retired at 62, was not eligible for any carer’s allowance because she was drawing a state pension. She is trying to care 24/7 for a disabled husband and travelling at her own expense to care for an adult disabled child. That is simply impossible, and he told me that it was inevitable that the family would have to go to the local council and call for help. His wife will give up that caring role because she will not be able to cope—financially, let alone physically—with the stress of having to care for two people in her own family.
If we turn that on its head and think about what happens with a carer’s allowance, we find that the carer gets £55.55 for 35 hours of care a week—£1.58 an hour in comparison with the national minimum wage of £5.59 an hour for an adult. Carers thus get an incredibly small sum of money. Looked at from the state’s perspective, it is an absolute bargain. If the person was not doing that caring for that kind of money, the state would be the default and have to pick up the pieces, as that is how things work in this country.
What we should be looking at is how we can continue to benefit from the love and cherishing of family members in order to give the people being cared for a quality of life that is so much better. We all know that £1 spent in the home saves £4 in the NHS. How much more is £1 spent on a carer who knows and loves the person they are caring for worth than £1 spent on a carer who, perhaps, comes in periodically through the day and who may frequently be replaced by another carer? The outcomes for the person being cared for are so much better if they are cared for by someone who genuinely loves them.
We should therefore seriously consider introducing a post-retirement carer's allowance that is available only to retired carers who continue to be the only carer for their loved one. That carer's allowance would cease on the day that they call on social care from social services or the local council. There will therefore be an incentive for people to continue to care for their loved ones, which is better for everybody. I absolutely take on board what my hon. Friend the Member for Congleton said about the need to provide a care package for the carers themselves, but the principle of enabling carers to continue to provide that support for as long as possible should not be overruled by the need to care for the carers.
The Department for Work and Pensions has estimated that this year the cost of simply retaining the carer's allowance alongside the state pension would be about £950 million. What it did not take into account was the fact that there would be a commensurate reduction in the pension credit, and also the enormous potential reduction in the cost of providing social care. We might be paying a family loved one £1.53 or £1.58 an hour, but we would be paying an official carer £10 or £20 an hour, perhaps, to go in and look after that person—and in a far less assiduous way.
The taxpayer, through Government aid, is simply not going to be able to foot the bill for all the care that will be needed in the future. We must find a way to support society, communities and carers, so that loved ones can continue to care for their own family members. I would be interested to hear the Minister’s thoughts on this idea.
Dr Sarah Wollaston (Totnes) (Con)
I have good news: people in their 40s and 50s are at the pinnacle of evolution, according to Dr Bainbridge writing in the New Scientist. I do not think my children would agree with that assessment, but they would agree that they feel rather outnumbered. This is a cause for celebration, however, and we should note it in this House: it is a good thing that we are all living longer—after all, the alternative is very unattractive indeed. A man who reaches the age of 65 can now expect on average to live a further 18 years, and a woman at 65 can expect to live even longer—to 85 and a half. We should welcome that on international women’s day. This is good news all round, therefore, but these extra years must be lived well. We should add to people’s years of life while also helping them live with independence and dignity.
I have the privilege of serving on the Health Committee, and I have also had the privilege of working for 24 years on the front line in the NHS. I have therefore met many carers, and also many people who, sadly, are suffering from dementia. Many Members have commented on that topic however, so I will not discuss it further now.
I want to focus on the Select Committee’s recommendations following our inquiry into social care. I acknowledge that, by 2014, an extra £2 billion a year will be spent on social care, and I welcome that investment. There is still an issue that needs to be addressed, however, and it transcends party politics.
As the King’s Fund and the Dilnot commission have made clear, demand is outstripping supply—by 9% over the past four years—and the Local Government Association and the Association of Directors of Adult Social Services have stated that this underfunding is a long-term problem. According to the King’s Fund, the funding gap could be as high as £1.2 billion by 2014. Also, about 890,000 older people in social care may have a need that is not being met. As the Select Committee heard, some councils are tightening their eligibility criteria, so that people who perhaps would have been classed as having “substantial” needs are now being classed as having “moderate” needs. Other councils are setting a different benchmark, so they are funding only “substantial” needs, rather than both, as they might have done in the past. Obviously, the problem goes beyond the total spend. Government Members are taking a realistic attitude to our national debt, knowing that there are no blank cheques. However, we need to continue to increase our social care funding slightly, so that we can achieve what we want to achieve for our older people: dignity and independence.
It will not matter how much we spend unless we change how we spend it. One thing the Dilnot commission examined well was how we divide our spending. We know that we spend £145 billion a year on older people in England, about half of which goes on benefits, such as pensions, housing-related benefits and pension credits. Some £50 billion is spent on the NHS but only £8 billion goes towards social care. That balance is not right. If we were designing the system from scratch, we would not set the funding in that way. That structural problem has been recognised for decades, but the White Paper and the changes in the Health and Social Care Bill give us an opportunity to address it. I therefore ask the Minister to rebalance things by examining the Select Committee’s key recommendation, which was to deliver integrated health and social care, with a single commissioner or a commissioning body, and to drive this joint working by also looking at pooling budgets.
Some wonderful examples of that approach are available, as we found when the Select Committee visited Blackburn with Darwen PCT and Torbay Care Trust. I am fortunate that the Torbay Care Trust covers much of my constituency, because it achieves real results: low average lengths of stay; rapid access to equipment, thus avoiding hospital admissions; and getting people out of hospital much quicker. The key to all that is recognising that keeping people independent in their own homes, rather than admitting them to expensive hospitals, saves money. As has been said, for every £1 we spend on integration, we save £2.65 for the health service—as is so often the case, the best care turns out to be the cheapest care.
I was disappointed to hear the Minister describe the care trust model as an experiment that never really got “out of the lab”. I urge him to get back into the laboratory with care trusts, because this is good practice. They bring a positive culture on joint working, pooled budgets and putting patients first. In Torbay, they have considered an imaginary patient, “Mrs Smith”, who has complex care needs and at every stage in the system they have designed everything around her, putting her needs first. That sometimes means sweeping away the silo working that we so often see. In many parts of the country, six different phone calls have to be made when dealing with a patient with complex care needs, and there are endless delays and frustrations, and repeated assessments, but Torbay has a care co-ordinator with a single number. We need to adopt that kind of working.
Paul Burstow
The hon. Lady is making an important set of contributions to this debate. That comment I made during the Health Committee’s evidence session was very much born out of frustration—it is frustration that my hon. Friend the Member for Southport (John Pugh) has echoed. How we spread best practice and get it adopted is one of the key challenges in delivering more integrated health and social care, and it is one of the things we are going to address in the White Paper. The Select Committee’s contribution to that process has been very helpful.
Dr Wollaston
I thank the Minister for that encouraging response. I am glad to hear him say that rolling out good practice is key to this. I ask him to consider the Select Committee’s recommendation that the way that we can best drive that is by having a single outcomes framework. We are currently going to have outcomes frameworks for housing, for social care and for elderly people in health. Bringing those together would drive proper integration. Having a single commissioner for all these services would bring people together. If we do not have that, we risk carrying on as we are. When budgets are stretched, as we all accept they are, there is more of a tendency for organisations to say, “This money is for social care”; where spending the money would perhaps improve only health outcomes, there is less of an incentive to spend it. We should consider pooling the budgets, and having a single commissioner and a single outcomes framework. I am not saying that we should be too rigid in imposing how that is done, but we should set out what we expect. In addition, we should recognise how important housing is in this area. We should not leave it out of the equation when we consider how we help older people to continue to live independently.
Damian Collins (Folkestone and Hythe) (Con)
Would my hon. Friend include more informal forms of care, such as referring patients who are socially excluded to local walking or singing groups where they can participate and be with other people? There are some good models of that in my constituency.
Dr Wollaston
I thank my hon. Friend for that intervention and agree with him absolutely. In the past couple of weeks, I have visited an organisation called Brixham Does Care in my constituency as well as another, Saltstone Caring, and I am sure that we all have wonderful examples in our constituencies, sometimes involving social enterprises and sometimes charities.
I feel that one of the most encouraging things about the Health and Social Care Bill is that it will give commissioners the flexibility to draw in partners, because there is sometimes an assumption that only the NHS can deliver good care. The NHS remains at the core of good care and I trust that GPs will have the sense to commission integrated care pathways that do not fragment local services. I do not know a single GP who wants to privatise the health service or social care; GPs want the flexibility to bring all these elements together while having the good sense to protect their much valued local NHS services. I am very encouraged to see that there will now be a focus on integration, but I ask the Minister specifically to consider integrated care with a single commissioner, because the Committee felt that that would be the most encouraging way forward.
In conclusion, let me return to Dr Bainbridge in the New Scientist, who describes middle-aged people as
“the most impressive things yet produced by natural selection.”
The Minister fits that bill perfectly and has a fantastic opportunity to achieve what we have been trying to achieve for 50 years: an integrated health and social care model. It can be done and I hope that he will look at the Health Committee’s report and make it a reality.
Guy Opperman (Hexham) (Con)
Well, they make them out of strong stuff in the west country. It is a joy to follow my hon. Friend the Member for Totnes (Dr Wollaston), who brings great medical and intellectual wisdom to the debate, and I am honoured to be speaking in a debate introduced by my hon. Friend the Member for Truro and Falmouth (Sarah Newton).
I would be humble in my approach to this matter, but I would like to think we are united in the sense that Members from all parties have a common desire to tackle what is probably the most intractable problem we face. There is in effect no dispute about what we want from social care: we want independence, dignity and privacy for those who are being cared for, and the people who provide the care need patience and humour and to know their individual clients and their family members. The question is how we develop a social care network that treats people as people within the confines of a budget that is ever changing and ever more difficult to reconcile.
How a society treats the vulnerable is surely the best definition of that society. I came into this House in my 40s, I am delighted to say, and I thought I was in the prime of my life, until last year when I became unwell. I am probably the only person in the Chamber at this moment who has needed social care. It was a great effort to become better researched in preparing for this debate, obviously, but becoming ill last April gave me a great deal of knowledge and insight from a personal standpoint about the degree to which such care is necessary and about the great service that is provided. Today’s debate is a wonderful opportunity to celebrate the great work done by individual carers in the public and private sectors and, not least, the work done by families.
I speak as an MP for the north-east, and there are shining examples of how the north-east leads the way in the provision of care to individuals. There is outstanding palliative care in my constituency through the Charlotte Straker palliative care teams in Corbridge. If I need to make a declaration it is that last summer I raised in excess of £3,000 for the charity Tynedale Hospice at Home, which provides care in Hexham. All of us as MPs will go around individual care homes in our constituency. The Helen McArdle organisation does an amazing job across the north-east, including at its Acomb Court service in Hexham. I was lucky enough to be asked to present some prizes at Wentworth Grange in Riding Mill and it was noticeable that more than 35 awards were made to individual staff members because there was a great deal of ongoing training to improve the quality of individuals’ care. I could name many others throughout the constituency, including Wellburn House in Ovingham, but I will move on, given all the support there has been across the House, to talk about the White Paper.
The White Paper on social care is coming this spring. I know that spring is drifting on, that there are pressures and that people are calculating what kind of spring it is going to be, but let me reassure the Minister. Last year, we all celebrated the Arab spring across the near and far east, which changed things. That Arab spring lasted quite a long time—virtually the entirety of last year—so we will not necessarily be critical of the Minister if the White Paper does not come within the technical confines of spring. Surely—I make a serious point—it is more important to get this right than to rush it. I accept that there have been a plethora of consultations and assessments over the past few years, but there is no doubt that the way we have approached this issue, on a cross-party basis with constructive attention to detail, is much more important than rushing something out that is not the right way forward. I welcome the fact that the White Paper is coming and I urge that we get it right and work on a cross-party basis.
This issue, I regret to say, is not about funding. There will always be small issues about the way that individual local schemes and individual approaches are funded, but the issue we will decide in the House this year is not about funding from the state: it is far more about outcomes. How do we reform the system such that we have an outcomes framework that integrates all the services for particular individuals? I endorse entirely what my hon. Friends the Members for Truro and Falmouth and for Totnes said about this. I hope that health and wellbeing boards can deliver a single commissioning process with a single outcomes framework whereby older people’s health, care and housing services in a particular area are integrated. That has never happened in the entire existence of the NHS or previously; it is a genuine aspiration. Less important than funding is attention to that detail because at the moment we have a patchwork of care.
I am conscious of the time and eager for my hon. Friend the Member for South Swindon (Mr Buckland) to get in. We speak so much in the House that we are now the rear gunners of every debate—of democracy. It is a shame because we feel that we have much to contribute but we contribute so much that we are always the last to speak. I must not dispel any chance for the House to hear from the great man from South Swindon so I shall try to abbreviate my comments.
I agree that the Dilnot proposals are correct but there has to be genuine understanding and we all need the ability to sell to our constituents what Dilnot means. The idea that Dilnot will not—I will not try that again—cost us in any way whatever is hard to grasp and hard to convey to our constituents. There are nettles that need grasping. Funding will be an issue, and a contribution from individuals will be unavoidable. If we do not accept that, there will be grave difficulties ahead.
I welcome the fact the NHS budget is protected at present. Given all the difficulties, we should celebrate the choices that are being made and that extra money is being spent on social care. It concerns me, for example, that the Government spend eight times as much on cancer research as on dementia research. I welcome the extra money going to dementia patients, but more needs to be done, as many groups have made clear.
I want to put one point to the Minister that I hope will assist. I tabled a question to the Department of Health and received the answer on 7 February. It was:
“To ask the Secretary of State for Health if he will make it his policy that the influenza vaccine should be compulsory for all public and private sector care workers.”—[Official Report, 7 February 2012; Vol. 540, c. 199W.]
I accept that certain people will want to retain the choice not to have the vaccination, which would be given only on the basis of informed consent, but it would be of great assistance to the vast majority of care workers. Vaccination would clearly cut the prevalence of infection and other problems, and the Government should lead the way. Some, for religious or other reasons, would not to want be vaccinated, and they should be exempted, but it would be a good move for the Department of Health in addressing what is clearly a problem of infection and of staffing when staff become ill themselves.
I support public sector carers, who need to be valued just as much as any other public sector workers. They do a difficult, messy and not always entertaining job. They are the unsung heroes. We also need to support our family carers and recognise the services that they provide. We must ensure, as many have said, that there is a decent system of respite care because if the family carer cannot care there will be huge problems for the Department of Health and the NHS.
With that, and allowing sufficient time for the sage of Swindon, I will sit down.
Mr Robert Buckland (South Swindon) (Con)
I do not know whether I should thank my hon. Friend the Member for Hexham (Guy Opperman) for that warm-up act. I know my place, and I am more than happy to take part in this interesting and varied debate.
There is no doubt that the facts that face us all as parliamentarians are pretty stark. We know that 11 million people alive today will live to be 100 and that the population who are over 65 is projected to grow by 50% over the next 20 years. The expected number of working age adults with a learning disability will rise by about 30% over the same period. My hon. Friend the Member for Totnes (Dr Wollaston) reminded us that we should celebrate the fact that we are all living longer rather than being a permanent Jeremiah figure when it comes to these statistics. However, they do pose us quite a stark challenge.
Much has rightly been said today about the army of carers. I add my voice to that chorus of opinion about the invaluable work they do. My hon. Friend the Member for Congleton (Fiona Bruce) estimated that their work saves our economy £119 billion a year. I support the arguments made by my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) in respect of carer’s allowance for people post retirement. It is a sensible and thoroughly appropriate point to make in this debate, bearing in mind the need to create an incentive to care for people at home.
Many hon. Members have mentioned local carers centres. I pray in aid my local centre, the Swindon carers centre, which provides an excellent support service for carers, many of whom are young people still at school caring for an adult relative. It provides a focus and brings people together in the way that has been described and organises carers days in my constituency in which I and others take part. The messages we get from those events are messages not just of emotion, but of hard facts about the reality of life for carers on the ground. Frankly, they are the greatest experts on the people they care for, which is why they must be involved as service users in developing the services on which they rely. Carers are a huge resource, as we have heard, and must be an important part of the service.
Two key principles underlie the reform of social care: first, transparency—I have already mentioned the need for carers to have knowledge of and access to local services—and the way we track national funding and how it is spent locally; and secondly, predictability and reliability for those who need care and their families. They need to know that they can work within the system and rely upon it in the long term.
We have heard a lot today about care for the elderly, and I support the observations made by hon. Friends and Opposition Members. Rather like the hon. Member for Mansfield (Sir Alan Meale), I want to focus on those with learning disabilities. I am grateful to him for raising the issue of autism, which is rather close to my heart, as I think most Members will know, as I chair the all-party group on autism. Before dealing with the issue, it is right that I emphasise the importance of advocacy for people with learning disabilities.
There are many independent charities and voluntary organisations across the country that provide a voice for adults with learning disabilities. In my constituency the Swindon Advocacy Movement, which receives sustainable funding from the local authority, works hard on that philosophy. It draws in people in with learning disabilities so that they can be part of the planning for the service, which enables them to speak for themselves, because advocacy is not just about people like us talking for people like them; it is about enabling those people to do it themselves. I know that the hon. Member for Mansfield and I agree on that point, because I raised it when I intervened on him earlier. What we want to see is a service that enables people with learning disabilities to stand on their own two feet as much as possible and to play a full and active part in our society. That is why I believe passionately in local advocacy, which will help us see an end to the Winterbourne Views of our society and the betrayal of all the principles we believe in become very much a thing of the past.
We also heard about overarching frameworks within which care services should be developed, and I want to thank my hon. Friend the Minister publicly for following my advice, and that of many others, by referring the quality standard for care of adults with autism to the National Institute for Health and Clinical Excellence. He knows that I and others have been working on that issue for some time. It was the subject of a 10-minute rule Bill I introduced last year. As an aside, I urge him to look at a quality standard for care for children with autism, because I strongly believe that it is the transition from childhood to adulthood that we are still getting so badly wrong in this country.
I will pause for a moment and deal with the threshold into adult social care and how we need to plan adequately for that while the person is still young so that adult social services are working hand in glove with children’s services. In particular, when we develop our policy on special educational needs—I know that this is not the responsibility of the Minister’s Department, but it is a point that should be made—we must ensure that the new care, health and education plans go up to the age of 25. It is absolutely vital that we stick to that proposal, which was set out so helpfully in the special educational needs Green Paper, so that the threshold issue can be dealt with properly and there can be proper and adequate further education provision for young adults. There is a dearth of provision for young adults between the ages of 18 and 25, particularly those with autism and related conditions. It is in those seven key years of life that adult social care often fails and when we do not address issues of education for young adults with autism. Ambitious about Autism’s “Finished at School” campaign, which I had the privilege of launching in Parliament a few months ago, calls for that extension of provision.
I have referred to the key principles that underlie the Law Commission’s report on adult social care that was published last year, which we all know about. There needs to be a single duty on authorities to meet eligible needs, a duty for carers assessments to be undertaken and—something that we have perhaps not touched on in this debate—a duty for adult protection cases to be investigated by local authorities or other agencies. We are getting child protection largely right, but let us not forget vulnerable adults, whether they be elderly people or people with learning disabilities. To return to the Winterbourne View scenario, there needs to be a proper mechanism by which we investigate cases in which the welfare and safety of vulnerable adults has been called into question.
It has been a pleasure to take part in this debate. It was particularly reassuring to receive a clean bill of health from my hon. Friend the Member for Totnes. Dare I say that I am in the same age group as her? I will leave the Chamber thoroughly reassured. Finally, if we do not address these issues, we will fail not only current generations, but the generations to come.
Sarah Newton
This has been an excellent debate in the breadth and depth of its contributions. We have seen the experience, passion and commitment of Members from all parts of the House.
In particular, I thank the hon. Member for Worsley and Eccles South (Barbara Keeley), with whom I work in the all-party parliamentary group on social care. The contributions have been wide-ranging. We have heard from my hon. Friend the Member for South Derbyshire (Heather Wheeler), the hon. Member for Blaenau Gwent (Nick Smith), my hon. Friend the Member for Kingswood (Chris Skidmore), the hon. Member for Mansfield (Sir Alan Meale), my hon. Friends the Members for Southport (John Pugh) and for Banbury (Tony Baldry), the hon. Member for Luton North (Kelvin Hopkins), my hon. Friends the Members for Congleton (Fiona Bruce), for South Thanet (Laura Sandys), for South Northamptonshire (Andrea Leadsom) and for Totnes (Dr Wollaston), and our famous rear gunners, my hon. Friends the Members for Hexham (Guy Opperman) and for South Swindon (Mr Buckland).
There can be no doubt from this debate about the cross-party support for delivering a re-engineered care system for the people who need care and for our vital carers. The system needs to be shaped around the person who needs care and their carers. I wish the Government and Opposition teams good fortune in their vital work to negotiate a new system for providing and funding care, so that we can all be proud to have created a society that we all want to grow old in.
Question put and agreed to.
Resolved,
That this House believes there is an urgent need to reform the current system of providing and paying for the care of adults in England and Wales; recognises that social care, unlike the NHS, has never been free at the point of need irrespective of income; notes the central role of informal carers in the provision of care; welcomes the Coalition Agreement pledge of reform and legislation; further welcomes the plans for better integration between adult social care services and the NHS; welcomes the extension of personal budgets; urges the Government to ensure that fairness is central to reform, including access to advice, advocacy, assessment of need, care services as well as funding options; recognises the need to break down the barriers to portability; and further urges the Government to publish its White Paper as soon as possible, and to bring forward legislation.