Adult Social Care

Monday 16th July 2012 Commons Chamber

19:45

[Liz Kendall (Leicester West) (Lab)]

I beg to move,

That this House notes the growing crisis in adult social care; welcomes many of the proposals in the Care and Support White Paper including national minimum standards on eligibility, stronger legal rights for family carers, portability of care packages and improvements to end-of-life care; notes that many of these ideas were proposed by the previous administration, but believes they are now in danger of appearing meaningless without the ability to properly fund them; is concerned that the Government is considering a cap on individual costs as high as £100,000; is committed to the important Dilnot Commission principle that protection against the risks of high care costs should be provided for everyone; and calls on the Government to honour the commitment in its 2010 NHS White Paper to introduce legislation in the second session of this Parliament to establish a legal and financial framework for adult social care.

The issue of how we provide decent care for older and disabled people and their families is one of the biggest challenges facing Britain today. Ten million people in the United Kingdom are now over 65, and that figure will rise to more than 15 million by 2030. The number of over-80s is growing even faster, and is set to double to nearly 6 million in 20 years’ time. Medical advances also mean that people with disabilities are living longer than ever before.

The fact that we as a nation are living longer is something that we should celebrate. There have been many improvements in adult social care over the past 10 years, and I shall say more about that in a moment. However, too many people still face a daily struggle to get the care and support that they need if they are disabled or become frail and vulnerable in their old age. The ways in which we provide and fund care need major reform if we are to deliver a better, fairer and more sustainable system. That reform is vital for older and disabled people and their families who want and deserve a decent system of care and support, but it is also vital for our economy. The Office for Budget Responsibility’s fiscal sustainability report states that the primary pressure on the public finances is our ageing population. Without major changes to pensions and, crucially, to health and social care, the long-term growth of our economy and the sustainability of our public finances could be put at risk.

Last week, the Government had the chance to show that they were prepared to meet the challenge of fundamentally reforming care and support, and many of the promises in their White Paper and draft Bill on social care are welcome. They build on Labour’s achievements when we were in government. Indeed, many of the Government’s announcements were put forward by Labour in our White Paper, “Building the National Care Service”, more than two years ago. They included a shift in the focus of local council and NHS services towards prevention and early intervention to help more older and disabled people to stay living independently in their own homes, and more joined-up NHS and council care to stop families having to struggle with the different services to get the support that they need.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I am experiencing a sense of déjà vu. Those of us who take an interest in these matters pleaded with the previous Government in debate after debate to take action and to make some tough decisions to ensure that we looked after our ageing population, but, time and again, they failed to take any real action. We are not building on what they did; we are having to go into the space where they failed to act.

[Liz Kendall]

I always respect the hon. Gentleman’s interventions, but he seems to forget that we faced up to those difficult decisions and choices on adult social care in “Building the National Care Service”. We tried to get cross-party agreement on those proposals, but they became a political football at the last general election. The hon. Gentleman should be encouraging those in his Front-Bench team to engage seriously in cross-party talks and to take the difficult decisions that need to be taken.

[Margot James (Stourbridge) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

I want to make some progress, then I will give way.

Labour proposed better information and national minimum standards to tackle the postcode lottery in care. We also proposed that everyone should have the right to have a personal budget—which we introduced—that people should be able to take their care package with them if they moved to a different area, and that carers should have the right to have their own needs assessed and met independently of the person for whom they cared.

The difference between the Labour Government and the present Government is that we set out the difficult decisions about how those changes would be paid for. The absence of that information is the gaping hole at the heart of this Government’s plans. There is a risk that their promises of new rights and services will be meaningless without the ability to fund them properly. Indeed,

“this White Paper is not worth the paper it's written on.”

Those are not my words, but those of the Alzheimer’s Society, which has damned the White Paper as a massive failure. Similarly,

“the key test for this White Paper was to deliver an urgent timetable to reform social care funding. The Government has failed this test.”

Again, those are not my words. They are the words of the Care and Support Alliance, which consists of more than 65 organisations that represent and support older and disabled people.

[Kelvin Hopkins (Luton North) (Lab)]

I entirely support the principle of a national care service, but will my hon. Friend go slightly further and be as bold as Nye Bevan in suggesting that it should be free for all at the point of need?

[Liz Kendall]

I know that my hon. Friend is passionately committed to this issue, and he will know that we remain determined to ensure that there is a fair, affordable and sustainable system for care and support in future.

The Government have failed to take proper action to tackle the immediate care crisis, and they have failed to confront the difficult funding decisions that we need for the future. Last week we heard nothing but complacency from the Government about the desperate care crisis that faces people throughout the country. Ministers repeatedly claim that there is enough money in the system, but the truth is that the Government’s savage cuts in council budgets have pushed an already pressurised care system to breaking point.

Adult social care accounts for about 40% of council budgets—it is up to 60% in some areas—and for the largest elements of councils’ discretionary spending. When council budgets are slashed by a third, it is inevitable that care services will be cut. Figures from the Government’s own Department for Communities and Local Government show that more than £1.3 billion has been cut from older people’s social care provision since the coalition came to power. Fewer people are receiving the support that they desperately need as councils raise eligibility thresholds. Charges for vital services such as home help are soaring, with huge variations across the country. That is a stealth tax on the most vulnerable members of society. At the same time, the quality of care is being put at risk as councils are forced to pass on cuts in their budgets to care providers. [Interruption.] From a sedentary position, the hon. Member for Truro and Falmouth (Sarah Newton) asks what we did in 13 years. We increased spending on adult social care by 53%, we invested £1.2 billion in the carers’ grant, we provided new rights for carers to have their needs assessed and to request flexible working, we introduced the Supporting People programme, and we spent £227 million on extra care housing. I rest my case.

According to the United Kingdom Homecare Association, one in 10 home care visits now lasts for only 15 minutes. That is a completely inadequate amount of time if frail, vulnerable people are to be helped to get up and to be washed, dressed and fed. Residential care is under huge pressure too. Nine out of 10 home care providers say that low council fees are creating a two-tier system, with new investment being directed only towards wealthier parts of the country. Unpaid family carers are suffering as well as they are forced to give up work, and their own health suffers because they cannot obtain the help that they need to look after their loved ones. Yet the Government repeatedly deny the scale and urgency of the care crisis.

[Several hon. Members]

rose—

[Liz Kendall]

Last week, local councils throughout the country will have listened in disbelief as Ministers repeatedly insisted that there was enough money in the system and no need for councils to cut care provision. Sir Merrick Cockell, the Conservative chairman of the Local Government Association, has said that the current system does not have enough money to provide care for

“anyone other than the most needy, or those who can afford to pay for all of their own care.”

Without more funds, he says, we will

“see some of the most popular services councils provide, such as parks, leisure centres…winding down by the end of the decade.”

The Government are astonishingly complacent about the impact that cuts in social care are having on the NHS. Last week the Secretary of State for Health brushed aside concerns about delayed discharges from hospitals, saying that they were

“broadly the same as… last year”.—[Official Report, 11 July 2012; Vol. 548, c. 322.]

[Several hon. Members]

rose—

[Liz Kendall]

In reality, the number of days on which a hospital bed is occupied by someone who could have been discharged has risen by 18% since this time last year, and by a staggering 29% in the last 18 months. These delays now cost the NHS £18.5 million every single month, and more than a third are due to cuts in social care. The number of delayed discharges from social care has risen by 11% in the last month alone.

Instead of burying their heads in the sand, Ministers should be taking action. Labour has called for £700 million from last year’s NHS underspend to be ring-fenced for social care immediately, and I was delighted to learn that the all-party group on local government today called for those funds to be used for that purpose, rather than being absorbed back into the Treasury coffers. I hope that, when the Minister responds, he will tell us whether he agrees.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

I congratulate the hon. Lady on giving way at long last. It is nice of her to do so, and we are most grateful. Given that she began by saying that she wanted to see a consensual, non-partisan approach to the issue, can she explain why we have just heard a party political diatribe? I find that very disappointing.

[Liz Kendall]

I was stating the facts about the care crisis, which have been made clear not by me but by organisations representing older and disabled people, by local councils and by the NHS. It is the Government’s denial of the existence of the care crisis and their insistence that there is enough money in the system that I am seeking to correct.

As I have said, the Government have failed to recognise, let alone tackle, the care crisis, and they have failed to face up to the difficult decisions that we need for the future. Their progress report on funding merely says that the Government support the principles of Andrew Dilnot’s commission on the funding of long-term care and support. They now claim that it is only right for Dilnot’s proposals to be considered as part of the spending review. That was not their view two years ago, when they made a clear promise in their NHS White Paper to legislate on a new legal and financial framework in the current parliamentary Session. Now we have only a draft Bill to reform social care law alone. At best that means that there will be no change in funding before the next general election, and at worst it means no change at all if the Government return to power.

[Richard Fuller (Bedford) (Con)]

Will the hon. Lady give way?

[Liz Kendall]

I want to make a little more progress.

According to yesterday’s edition of The Sunday Telegraph, Andrew Dilnot has said that the delay has left older and disabled people in fear and misery. He expressed serious concern about the possibility that the Government will set the cap at a far higher level than that proposed by his commission—at £75,000 or even £100,000 rather than £35,000. He also said:

“if you go beyond £50,000 it is less effective in giving reassurance to the population and ceases to be a way of helping people with lower levels of assets.”

Instead of making real progress on funding reform, the Government trumpeted proposals for a national deferred payment scheme, providing loans to cover the costs of residential care.

[Sarah Newton (Truro and Falmouth) (Con)]

Does the hon. Lady recall what the Secretary of State actually said when he announced his proposals last week? He made it very plain that, if the hon. Lady’s party sat down seriously with Ministers and reached the consensus that the whole country is clearly crying out for, the necessary mechanisms could be introduced in the Bill and the funding could be found in the comprehensive spending review. We need less party politics and more consensual conversations.

[Liz Kendall]

It was Labour Members who proposed cross-party talks, and it was Government Members who decided unilaterally to publish the progress report on which we had been trying hard to agree. The hon. Lady accuses Opposition Members of not being serious about funding reform. We are, and I will set out what we would like to happen so that those talks can proceed.

The deferred payment schemes that were announced last week already exist in some parts of the country and are currently interest-free, but according to the Government’s plans interest will be charged, which will make loans more expensive than they are now. Many councils remain utterly unclear about how they will find the money to pay for those schemes. As the Local Government Association says,

“Councils are not banks and the implication of this level of debt in an already overstretched system needs urgent attention.”

The truth is that the Government have so far ducked the care challenge, and the reasons for that are clear. First, owing to their disastrous economic policy, they are now borrowing £150 billion more than they originally planned to borrow. The Treasury has pulled the plug, and has kicked long-term care funding into the long grass.

[Richard Fuller]

I thank the hon. Lady for giving way. As she recognises, cross-party consensus is required if we are to solve the social care problem. Care workers—the people who actually provide the care to people—do not get sufficient attention, however. One of the problems they have suffered from over many years is per-minute billing. Does she recognise that our changes to get rid of per-minute billing are worth while, and what impact does she envisage that will have on the provision of care over the long term?

[Liz Kendall]

The hon. Gentleman raises a serious point. I know from shadowing care home assistants in my constituency that commissioning by the minute can cause considerable problems. For instance, it does not allow the staff to meet the individual needs of those who are most desperate for help and support. As I have said, we welcome many of the proposals in the White Paper, but they need to be properly funded, and that is why I am so concerned that the issue of long-term care funding has been kicked into the long grass.

The second reason why the Government have failed on this issue is that the Health Secretary’s obsession with reorganising the NHS has been a disastrous distraction. Two years have been wasted on an unwanted and unnecessary reorganisation, when everyone should have been relentlessly focused on the key challenge of our ageing population: meeting rising demand for care at a time of unprecedented financial pressure.

The third reason is the most fundamental of all. Many Conservative Members have still not grasped the basic principle that we must collectively and universally pool the risks of facing catastrophic care costs, as we do in the NHS, in order to make things better and fairer for us all. A voluntary system that leaves it up to individuals and their families alone will not work. The only way forward is through an effective partnership between individuals and the state.

[Kelvin Hopkins]

I agree with what my hon. Friend is saying. The Government keep on talking about consensus, but the problem is that we say yes to Dilnot, but they do not. If they were to say yes to Dilnot, we might have a basis for consensus.

[Liz Kendall]

We remain serious about trying to achieve cross-party consensus. If one party comes forward on its own and proposes a controversial and difficult decision, that always leads to a political fight; we saw that only too clearly before the last general election. However, we need cross-party consensus because this is a long-term challenge. We have to try to get agreement so that, whichever party is in power, people know there is a system that they can understand and pay for in future.

Government Members have criticised Labour’s record in government, but we are proud of our achievements on social care. We increased spending by 53% when we were in government. We helped drive up quality through national performance assessment of local councils and independent inspection of care services. We championed integration, with new legal powers for the NHS and local councils to pool budgets, and new care trusts jointly to commission care. Those care trusts will be swept away under the Health and Social Care Act 2012. We supported carers through the carers grant and new rights for carers. We introduced the first ever national dementia strategy, and we backed improvements in housing through the Supporting People programme and extra care housing. [Interruption.] The hon. Member for Reading East (Mr Wilson) mutters from a sedentary position that that is not real action. He should try telling that to the carers we supported through breaks that are now under threat, and the people who have benefited from extra care housing and the Supporting People programme, which his Government have cut by 12%.

We understood that we had much further to go, however. That is why before the last general election we published plans for fundamental reform, including difficult decisions on how care should be funded. We tried to get cross-party agreement. We did not succeed, but we are determined to try again now.

A year ago, my right hon. Friend the Leader of the Opposition made an open and sincere offer of cross-party talks, and it is a matter of genuine regret that the Government unilaterally decided to publish their own progress report on funding, rather than the joint report we had wanted to agree. Labour remains committed to serious and meaningful cross-party talks.

I hope that the Minister will tell the House whether the Government will commit to addressing the current funding gap as well as future reform. Andrew Dilnot says that that is vital. Will they also set a clear timetable for reform, with legislation on funding reform in this Parliament, as Labour has called for? Will they agree to include their Treasury team in the talks, which Labour has offered from the start?

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

One of the authors of the Dilnot report was Lord Warner, who was a member of the previous Labour Government. He made the point that one of the reasons for the funding crisis is that the previous Government failed to invest adequately in social care; it received only 70% of the funding compared with the NHS. That was one of the major failings of the previous Government. They should have invested more in social care when the sun was shining and the country had the finances to do that.

[Liz Kendall]

I politely say to the hon. Gentleman that we did not cut local council budgets by a third. I have always said that social care budgets have been under increasing pressure for many years, which is why we desperately need funding reform. I know that he supports that reform and will work with us in the years ahead.

The Government’s decision to kick the issue of long-term care funding into the long grass is a bitter blow for older and disabled people and their families. It is a huge disappointment for local councils, which are desperate for a new social care settlement, and it is a disaster for our NHS, which will face intolerable pressure as our care system crumbles further still. This issue will not go away, because our population is ageing. Our care system needs fundamental reform—reform this Government have so far failed to deliver. I commend the motion to the House.

20:05

[The Minister of State, Department of Health (Paul Burstow)]

Let me begin by striking a note of agreement between Government and Opposition, before moving on to the areas where we disagree. I agree with the hon. Member for Leicester West (Liz Kendall) that our debates about our ageing society are too often couched in terms of burdens and impacts on public expenditure, when they should be a cause for celebration as we have more people living longer and living healthier for longer. That stands as a tribute to our national health service, our local authorities and many others besides.

I sat in the House for 13 years in opposition to a Labour Government, and it became very clear to me that, despite the wealth of the nation being much greater at that time than it is now, the Labour party was not willing to tackle the pressing need for serious systemic reform of social care. I shall talk in a moment about the Labour Government’s last-minute moves to address that agenda.

Social care is Bevan’s orphan. It was left over after the NHS was established in the 1940s, and it has suffered ever since. It has been hidden behind its favoured sibling, the national health service, out of sight until life takes a turn and tips people into crisis. Social care’s founding principles date back to the Poor Law; it was a poor relation to the NHS, ripe for reform, but neglected for decades.

Much of last week’s reporting about the Secretary of State’s statement in the House and the publication of the White Paper and draft Bill gave the impression that the only subject that was talked about was who pays for care—where the line is drawn between what an individual personally is responsible for in meeting their care costs and what costs the state would pick up. The Government do not dispute that that is an important issue, and we have made significant progress on that agenda, but it is not enough simply to redraw the boundary between personal responsibility and state support, because the system of social care in England is undoubtedly broken.

Given that there were 13 years of Labour inaction, the hon. Member for Leicester West must face up to some of the challenges in respect of social care. A White Paper finally emerged in the dying days of the last Labour Government; it was published on 30 March, just seven days before a general election was called. That is not good enough; it is too little too late. What did that White Paper say? It talked about national eligibility, but when? It was by 2015, so it was going to take Labour five years to introduce that change. On portability, it did not commit to ensuring that support would be provided immediately in the area to which the person was moving. In other words, there was still a risk of interruptions. In addition, that Labour White Paper said nothing about the rights of carers. The hon. Member for Leicester West was absolutely wrong when she told the House that Labour was responsible for introducing carers legislation. Back-Bench Members in this House, tirelessly arguing the case, were responsible—[Interruption.] Labour, Conservative and Liberal Democrat Members supported those many measures over a number of years, but none came from the Front-Bench and none came from the Labour Government.

[Hugh Bayley (York Central) (Lab)]

I would like to get back to the issue in hand and call a spade a spade. The only substantial asset that most families have to pass on to their children and grandchildren is the home they live in. If the Government want a new inheritance tax, would it not be fairer to levy it at the same percentage rate on rich and poor alike, and not simply target those people who have the misfortune to fall ill at the end of their life?

[Paul Burstow]

I will come in a moment to our response to the Dilnot commission recommendations, so I will deal with the hon. Gentleman’s point at the right time.

[Hugh Bayley]

Now would not be bad.

[Paul Burstow]

No, I am talking about the time at which in the sequence of my speech I will make the point about the Dilnot commission recommendations.

I wish to make one other observation on the national care service White Paper that the Labour Government published seven days before the last general election was called. Our White Paper addresses the end-of-life care issues, but Labour’s failed to address them.

[Mr David Anderson (Blaydon) (Lab)]

The Minister is rightly critical of the failure of the previous Government to bring in care for the people of England. Does he support what was done in Scotland by the previous Government?

[Paul Burstow]

I am not certain which thing the hon. Gentleman is inviting me to support. Many measures were introduced by the coalition Government in Scotland over a number of years to reform the social services system in Scotland, not least some relating to adult safeguarding which this Government are now making progress on.

[Andy Burnham (Leigh) (Lab)]

I think that the Minister has unfairly misrepresented the process we went through in the last Parliament. We did not just have a White Paper before the general election. We had a Green Paper in the summer of 2009, and the whole process was kicked off in the 2007 spending review. Upon a request from the then shadow Health Secretary, I agreed to cross-party talks. So the Minister is unfair in saying that nothing was done and then a rabbit was produced from the hat. May I say to him that the White Paper that I produced before the election addressed both service reform and funding? I am afraid that the same could not be said of the White Paper that emerged last week.

[Paul Burstow]

That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

[Mark Field (Cities of London and Westminster) (Con)]

Does the Minister not recognise that any cap, be it at £35,000 or £60,000, as was initially proposed by Dilnot, is likely within a very short time to be wholly inadequate, given the funding constraints that we are under? The harsh reality is that people who wish to preserve an inheritance for their children—that is an understandable desire—must recognise, as must their children, that those children will have to take on the burden of looking after aged parents, in both time and financial terms. It sounds like a hard truth, but it needs to be put on the record, because otherwise we are not going to get any further forward in dealing with this matter.

[Paul Burstow]

The hon. Gentleman expresses an opinion that is held by many people, but the Government’s position is not to take that view. We take the view that a cap on care costs is an important component in a redesigned system for funding in this country. What we have said clearly is that we have to address how that is paid for as part of a spending review. That is why we believe that both a cap and an increase in the means-test threshold provides the necessary assurance for a family to plan and prepare for care, and provides the mechanisms by which the financial services industry can grow and develop to offer appropriate products.

[Mark Field]

Is there not a problem with what the Minister has said? I understand that this is an incredibly difficult issue, which we all have to deal with. I have lost both my parents. One died at the age of 70, only 18 months ago, at a time when we were on the cusp of putting her into full-time care, which would have been ruinously expensive. Is not the problem with all this that if we put in place today any system with a fixed cap, it will almost certainly be superseded by events and will then be seen as unjust for future generations?

[Paul Burstow]

The hon. Gentleman identifies one of the issues associated with the design of the introduction of a cap. It is worth pointing out that the interaction between the cap and the means-test threshold means that every family would have a different level for which they would be liable to meet their care costs. The issues relating to design are real, as are those about how to meter the system from the point someone enters it, and they require detailed work as part of the design of an effective implementation alongside the costings of it.

[Hugh Bayley]

The hon. Member for Cities of London and Westminster (Mark Field) is right to identify that there is a link between inheritance and the high cost of end-of-life care for people. May I put it to the Minister that if there is a cap of £100,000, the entire inheritance could be wiped out for a family who have a modest home in the north of England, whereas somebody living in a home worth 10 times as much in southern England would still maintain a large proportion to pass on?

[Paul Burstow]

That is why we have to explain this clearly. By lifting the means-test threshold to £100,000, the interaction between the absolute cap and the means test means that the amount the individual will ultimately pay as their lifetime contribution towards their care costs is related to their wealth. I urge the hon. Gentleman again to look at both the tables and the graphs in the progress report, as he will see exactly how it protects the assets of a family, even in the scenario he has described.

It is also important to understand that redrawing the boundary between what the individual pays and what the state pays does not—things all too often were conflated in this way last week—add any new spending power to the system. That leads me to the question of getting funding into the system. Before the 2010 spending review, the Dilnot commission urged the Government to protect baseline funding for social care, and we did just that. In October 2010, we confirmed an extra £7.2 billion of support for adult social care, which, together with a programme of efficiency, was sufficient to protect access to support. That included an unprecedented £4.2 billion of NHS resources to support social care, to promote integration and innovation, and to support the expansion of reablement services. The Labour party wants to paint a picture of doom and gloom up and down England on these services, tarring every council with the same brush of being crude cutters of services, when that is not the case.

[Kate Green (Stretford and Urmston) (Lab)]

Perhaps I could describe to the Minister what is happening in Trafford, which has a Conservative council and is where my constituency is located. We are seeing a twin squeeze, despite the Minister’s apparent sanguinity about the funding. On the one hand, we are seeing thresholds for access to care being raised as a means of rationing the way in which the money is spent. On the other hand, as care providers are telling me, commissioners are reducing and reducing the price they are prepared to pay providers to the point where they can hardly sustain their business at all or meet minimum wage legislation.

[Paul Burstow]

We know from the surveys that although last year there was a cash freeze in the increases that local authorities paid to provider organisations, this year across the country the average was a 1.4% increase. Again, that does not quite tally with the picture that some hon. Members want to paint.

It is also worth saying that the picture of local authorities grappling with tough budget settlements is complex. Different councils are responding to the pressures on budgets in different ways. Some are acting in a very smart way, as the Demos report, “Coping with the Cuts”, revealed. Such councils are protecting access by focusing on reablement services, helping more people to get back on their feet without the need for long-term support, which is better for the individual and more cost-effective. Indeed, the latest figures from the Association of Directors of Adult Social Services reveal that councils are protecting front-line care.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Would the Minister agree to look closely at the report of the all-party local government group on social care, published today? It makes it very clear that a funding gap still exists and recommends that NHS money should be used to plug that gap. Will the Minister commit to continuing to do that and to considering the other recommendations in the report?

[Paul Burstow]

Obviously, I will happily look at the report and I look forward to meeting the all-party group to discuss its findings and recommendations later.

I want to report to the House the findings of the ADASS survey, which was published recently. Last year’s survey found that for every pound saved by local authorities in social care, 69p came through greater efficiency. This year, it found that that had risen to 77p in every pound. Yes, some councils are cutting services, and last year 23p in every pound that councils saved came from service reductions, but this year that figure is just 13p in every pound. Local authorities are getting smarter in organising their services, so I want to pay tribute to those councils and councillors who have worked hard with service users, carers and providers to protect services to make the best possible use of the extra money the Government have provided. As a result, between last year and this year, council budget spend on social services has gone down by just 1%.

[Sheila Gilmore (Edinburgh East) (Lab)]

On the question of efficiencies, would the Minister include councils that tendered a service and made a saving, but to the detriment of the end user of the service? That is how we got to the 15-minute, short-term care options. Is that an efficiency or a cut in service?

[Paul Burstow]

When there is a crude race to the bottom and contracting is by the minute simply to ration access to the service, resulting in a care home provider or home care provider delivering care on a very time-and-task oriented basis, that is totally unacceptable. We know that in places such as Wiltshire, where home care services are organised on an outcomes basis, that is delivering better results for the service users and releasing resources to reinvest in services.

[Richard Fuller]

When I intervened earlier, Mr Deputy Speaker, I forgot to refer hon. Members to my entry in the Register of Members’ Financial Interests as the director of two care companies.

The Minister is absolutely right to say that there is a patchwork of responses from local authorities. I absolutely welcome the end of per minute billing, which is a tremendous step forward, but I draw the Minister’s attention to the comments made by the hon. Member for Stretford and Urmston (Kate Green). She talked about the pressures of meeting the minimum wage and the pressures that local councils are putting providers through. The Government must consider that issue, because there is exploitation in some areas. As businesses and charities try to meet the requirements local councils are putting on them, workers are finding it difficult to achieve a sustainable wage in providing care services.

[Paul Burstow]

My hon. Friend is absolutely right to highlight that issue, which the Low Pay Commission has commented on over a number of years, including before this Government came into office. In our White Paper, we make it very clear that local authorities, as the commissioners of such services, must be mindful of their responsibilities in ensuring that the resources they provide to providers are sufficient to allow them to fulfil their legal obligations.

[Heidi Alexander (Lewisham East) (Lab)]

The Minister talks about the financial pressures faced by local authorities in providing care to elderly and disabled residents, but is he aware that the cost to local authorities of self-funders who have to fall back on the state is in the region of £1 billion a year? Does he agree that that is a very unpredictable thing for local authorities to deal with? What proposals does he have to help local authorities in that regard?

[Paul Burstow]

I am grateful to the hon. Lady for her question, because it allows me to talk about some of the points I think will directly address it. Reform of our care and support system is about more than just who pays for care; it is also about some other very important issues. A central proposition in the White Paper we published last week concerns the move from a service focused on managing crisis, and often not doing so very well, to one focused on supporting people’s well-being by concentrating on early intervention and prevention. That is why, alongside the White Paper, we published a draft Bill that will underpin the reforms we intend to make, consolidating, simplifying and modernising the legislation. The Bill sets out for the first time in statute some very clear governing principles about how decisions are made in social care, focusing on people’s well-being and living by the idea set out by our first White Paper in government of “No decision about me, without me”.

The Bill sets out a number of important changes that go to the heart of people being able to plan, prepare and have proper choice about the care available to them. First, it makes it a requirement for local authorities to ensure that there is a universal offer of information and advice so that people can plan and prepare. Secondly, it requires for the first time local authorities to focus on prevention. Thirdly, it requires a sufficiency of quality care so that choice is available to people locally. Fourthly, it requires integration and co-operation not just between the NHS and social care but between those agencies and housing.

The Bill will not only do that; it will simplify the point of entry into the state system. It will ensure consistent national eligibility and, for the first time in Government legislation, will ensure that there are rights for carers not just to an assessment of their needs but to support for those needs. It will also deal with the often mentioned issue of protection from disruption when people move from one part of the country to another or when a child moves from children’s services to adult services. It will guarantee continuity of services, which is not currently provided for.

Personal budgets, which were started by the Opposition but have not stuck well because of the legal framework, will for the first time be given a clear legal basis. I am delighted to say that whereas when this Government came to office in 2010 we inherited 168,000 people receiving personal budgets, by March of this year 432,000 people were benefiting from them. There will also be clear legal duties on the NHS, police and councils to safeguard people.

At the heart of our White Paper reforms is the notion that we need less variability on quality, to ensure that providers are responsible for driving up quality and accountable for doing just that, and to have more and open information about the quality of provision. That is why our provider quality profiles will provide that information in a way that will allow people to compare and rate providers for the first time and why we are putting an extra £32.5 million in to support those services.

[Andy Burnham]

The Minister is mentioning the things in the White Paper that he will ask councils to do. Can he give us a figure tonight for how much the Government have estimated that the cost to councils will be of providing all those things and tell us how councils will pay for it?

[Paul Burstow]

I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

[Andrew George (St Ives) (LD)]

I am grateful to my hon. Friend for his remarks. I hope I am not taking him back too far, but given that he is talking about the integration of services, particularly among authorities, and implying the portability of assessments for those with care packages, will he comment on the extent to which the Local Government Association has approved and supported the proposals in the Government’s White Paper?

[Paul Burstow]

On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

[Jim Shannon (Strangford) (DUP)]

The Minister has used the term “integration” several times. In Northern Ireland we have an integrated health and social care system, which is working extremely well. I am conscious that that is very different from the position on the mainland. Are there lessons from the integrated system in Northern Ireland that could be applied here? We have done it well in Northern Ireland. Perhaps the example could be used here.

[Paul Burstow]

From my own limited study of the system and from visits that I have made over the years, one of the conclusions that I would draw, which is at the heart of our reforms as well, relates to culture and collaborative behaviour across the various parts of the system. That has been essential to delivering genuinely integrated care in some parts of Northern Ireland. I believe it is essential to delivering genuinely integrated care in England as well.

I mentioned earlier that end-of-life care was an omission from the Labour Government’s last White Paper. It has not been omitted from ours. We are doubling the budget of the pilots that we have instituted to test the patient funding mechanisms and to make sure that we have the necessary data to understand the benefits of a free social care system at end of life. We want to make it clear that we see the merits of such a change, and it is why we want to make sure that we have the information on which we can base the final decision.

Our goal is to shift the focus of the system to prevention and early intervention, not to wait for the system to stutter into life when a crisis strikes. We want to make it easier for people to plan and prepare, both to avoid and reduce the need for care and to meet the need for care in the first place. Last week we laid out a reform agenda of universal information and advice, national eligibility, deferred payments, integration of health, housing and social care, better transition for children to adult services, and support for carers. Together those constitute the most comprehensive overhaul of adult social care in 60 years, and they are a contrast to the motion before us, which adds nothing, says nothing about how change will be paid for, and says all that it can to scare people about the current system.

Rather like 13 years of a Labour Government, today’s motion gets us nowhere. That is why we are investing an extra £300 million in the system to support change, and why I urge my right hon. and hon. Friends to vote against the motion.

[Several hon. Members]

rose—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. To accommodate as many Members as we can, a five-minute limit will be introduced, with the usual overtime for two interventions.

20:32

[Mr Michael Meacher (Oldham West and Royton) (Lab)]

The Minister, as always, sought to present a positive picture of his proposals, but I continue to be struck by the internal conflicts of the White Paper.

The whole thrust of this Government has been to shrink the state, but Dilnot will clearly expand it. The Chancellor, who torpedoed Labour’s social care proposals just before the last election by claiming that they represented a death tax, is now supporting his own death tax, only this time it will be £35,000 to £50,000, as opposed to Labour’s £20,000. Now the Chancellor has once again sabotaged a fair and reasonable inter-party settlement, which is plainly needed, by abruptly breaking off the talks and introducing a pretty vacuous White Paper with no costs in it—or, to use the words of Sir Alec Douglas-Home in 1964, a menu without the prices.

Furthermore, the Chancellor clearly wants the adult social scheme to be voluntary—I think this is what lies behind many of the difficulties—but the sums add up only if there is compulsory risk pooling. Yet the Chancellor—it is he, rather than the Secretary of State, whom we must deal with—still will not face up to the ineluctable logic of a mandatory adult social care system, and he is still trying to dodge it in two rather unscrupulous ways: first, he is kicking it into the long grass by postponing it to the uncertainties of the next spending review in 2014, even though gross neglect is endemic and reform is needed urgently; and secondly, he is evading today’s realities by ignoring any need for upgrading standards. The Minister referred to upgrading standards, and clearly he wants to, but the means with which to do so are incompatible with the White Paper. The Treasury’s £1.7 billion is purely a dead-weight cost to protect family inheritances. It takes no account of rising care costs or the imperative need to lift care standards, which in many cases shame a civilised society.

This is where we come to the crux of the matter. At present, many local authorities pay only for 15-minute or 30-minute visits, and many do not pay for the journey time, even though that is part of the contract, or the petrol costs, which care providers are obliged to provide themselves. Frankly, it is impossible in 15 or 30 minutes to get an elderly and often infirm person out of bed, to clean the sheets, which may well be soiled, to get him or her dressed, washed and fed, to clean and tidy up and, of course, to engage in some kind of conversation to generate some decent human relationship. Equally, it is impossible, as my hon. Friend the Member for Leicester West (Liz Kendall) pointed out, with the minimum wage rates paid by local authorities because of their squeezed budgets—a funding shortfall of at least £1 billion this year—for care providers to offer the higher standards the Minister talked about and which they want to provide and which the service users deserve.

How is the big black hole in the White Paper to be dealt with? The Local Government Association says that the gap between the money available this year and the predicted cost is about £1.4 billion, stretching to £16.5 billion by 2020, when spending on social care will exceed 45% of council budgets. Against that shortfall, the £300 million of extra funding announced by the Secretary of State in his statement last Wednesday looks derisory.

This dilemma is by no means insoluble. The long-term costs of Dilnot are estimated at about £3 billion a year. In his Budget four months ago, the Chancellor had a choice in the allocation of precisely such a sum, but he decided to spend it on the top 1% earning more than £3,000 a week by cutting the 50p rate of tax. For the same amount of money he could have funded Dilnot in full, but for this Chancellor the priority are the super-rich, not the elderly, infirm or disabled people in need of social care. The long-term answer to this problem is the introduction of a new social insurance scheme.

20:37

[Fiona Bruce (Congleton) (Con)]

I welcome the Government’s White Paper “Caring for our future: reforming care and support” and its priority of putting the well-being of the cared for and their carers at the heart of its approach. As the Member who represents the constituency with the highest proportion of elderly people in the north-west of England—there are 72,000 carers in Cheshire—I particularly welcome the proposals.

For the first time there will be a clear legal basis for the cared for and their carers having their own individual care and support plans, a tangible recognition of the utterly invaluable contribution that some 6 million carers make, many of whom often work more than 50 hours a week, at great personal cost. With 2 million people moving in and out of caring roles each year, the Government are right to recognise that giving carers a right to personal assessments and plans is a priority so that their own health and well-being are supported and recognition is given to the fact that they, too, have lives to live.

I am also pleased that the Government have already allocated £400 million for carers’ breaks over the current five-year period, but it is important that that is reviewed to ensure that the effectiveness of such payments is maximised. I welcome the new duties placed on local authorities, which will substantially help the cared for and their carers to access appropriate support, as the fragmented health, housing and care support services that have existed until now have caused at best frustration, and at worst despair.

Clearer dissemination, and the duty on local councils to provide advice and preventive services, should go a long way towards alleviating the problem described by one volunteer in the care sector, when she said that social workers just do not have time to help signpost carers to information, advice and support.

The Government are to be commended for their commitment to working towards the assurance of quality care standards through improved training provision for care workers, the introduction of a new code of conduct and of minimum standards for care workers and the appointment of a chief social worker, and for their aim of doubling the number of care apprenticeships to 100,000 by 2017. In that respect, I commend the excellent work of the apprentices on Cheshire East council’s A-Team, who are already blazing a trail through their apprenticeships as carers for the elderly in our community —soundly rebutting the myth that younger people do not care for our elderly or give them the dignity and respect they deserve.

I also welcome the Government’s proposals to fund adaptations to keep the homes of the elderly safe, because the NHS is estimated to spend £600 million a year treating injuries caused by hazards in inappropriate housing—the majority of cases associated with falls. The Government’s new care and support housing fund of £200 million over five years, to support the development of specialised housing and adaptations of homes, is particularly welcome.

I welcome also the Government’s commitment to abolish per-minute billing for care visits. That will be music to the ears of a distressed care worker who came to my surgery and said that she was seriously considering leaving the profession, because not only was she unable to provide within the time frame allocated the care needed for those she visited, but there was nothing like the necessary allocation of travel time between the homes that she needed to visit. In some cases, they were even in different towns. She showed me her timetable, and I can only say that I entirely agreed with her.

I welcome in particular in the White Paper the Government’s recognition that if we are to address this massive challenge and make a reality of good quality, comprehensive care provision for all, which I am sure is everyone’s aspiration across the House, we will do so only if we harness the energy, resource and skills of the whole community, including community groups, many of which are highly professional and which work very hard to support carers and the cared-for.

I am very pleased that the Government have committed to working closely with Age Action Alliance jointly to find practical approaches to improving the lives of older people; that they have decided to invest funds through Big Society Capital, so that social enterprises, charities and voluntary groups can access greater resources in order to make a difference in communities; and that they have decided to involve those communities in strategic decisions on health and care services through local health and wellbeing boards. That will be particularly welcomed by Crossroads Care Cheshire East, whose director told me, shortly after I was elected in 2010, that

“we could do so much more and add so much value if we were more involved in strategic discussions about care provision.”

The Government’s proposals in the White Paper are to be welcomed.

20:42

[Mr David Anderson (Blaydon) (Lab)]

In 1989 I became a care worker after losing my job as a coal miner. I did so almost by mistake, but it was one of the best decisions I ever made, and over the next 16 years, as a care worker and as a representative of people working in care, I came to realise that we can look at care in three ways: we can provide none, provide it on the cheap or provide quality. We cannot do a combination of the three, and I hope that in the Chamber tonight we all agree that, if we are going to do quality care, we need to look after the work force properly, train them properly, treat them like professionals, have them in numbers, respect them, treat them with dignity, have the resources in place and give them some responsibility. They respond to that if allowed to, and the best way they respond is by showing respect for, and treating with dignity, the people they are taking care of, building the trust and confidence not just of those they are caring for but of their carers—their family and their friends who look after them.

I believe that my Government did some good things over their 13 years in office, regardless of what the Minister says, but in truth we did not do enough. In 1999 we set up the Sutherland commission, but we backed down on it—we chickened out. We did the right thing in Scotland, and, yes, it was done under coalition government, but the commission was set up by a Labour Government.

We should have done more, and we have a chance today to do more. My view is clear: why is someone needing care because they cannot take care of themselves different from someone who needs care because they are ill? We never say to anyone who needs physical or mental care on the NHS that they cannot have it, but we do say that to people who cannot take themselves to the toilet, bath themselves or take their medication. We would never do that with children, so why should we do it with the elderly and disabled?

I am clear that there is a cost; of course there is. I want to ask the Minister about some of the things he was saying earlier, and I hope that I get a response. What resources are we going to put in? If there are to be 100,000 apprentices, what will that cost? If there is to be a new code of conduct, what is the implication of that? If there is to be extra training, what will that cost? All those things are welcome, but if we are just going to talk about them and not resource them, we might as well not bother to talk about them.

I would like to have clear in my mind the issue raised by my right hon. Friend the Member for Oldham West and Royton (Mr Meacher). What is the difference between what is now proposed and the death tax that the current Secretary of State so cleverly used during the last election to undermine the stuff that my Government were trying to do? He talked then about £8,000 a year and a saving of £40,000 for everyone. That has all disappeared—it is all under the carpet. Did he mean what he was saying back then and does he mean what he is saying now?

Yes, if we are going to do this properly, there will be a cost—but we always find the cost of going to war and of extending the nuclear deterrent. In the past week, we have found the cost of taking 3,500 troops off duty to save the embarrassment of the Home Secretary. If we can do all that for those reasons, why can we not do it to take care of the elderly, vulnerable and frail in this country?

We were attacked by the Minister, who said that Labour MPs were moaning and whining on. That is part of the game that we play in this place, but what about what other people are saying? The Care and Support Alliance says that

“the social care system faces collapse”,

while the Alzheimer’s Society says:

“Millions of vulnerable people had been promised vital reform but today they are being massively let down.”

Mencap says:

“this promising blue print will never get off the ground if it fails to address the chronic underfunding in social care.”

Finally, the UK Home Care Association says:

“The Coalition Government’s White Paper has failed the frail and disabled”.

Those are those organisations’ words—not mine, and not my party’s.

Like other Opposition Members, I believe that the only real answer is a care system funded from general taxation. We have a generational chance to make this a crusade, just as 60 years ago people in this House made a crusade for the NHS. I know that some Government Members will say that that has been anathema, because ultimately the NHS—when we get down to the bare bones—is socialism in action. It is socialism delivering for the people of this country. What I want would be exactly that—the strong providing for the weak, not the weak being let down by the strong. We have the chance to do that. It is a challenge for this generation. The question for all of us on both sides of the House is: are we up for it?

20:47

[John Pugh (Southport) (LD)]

I want to be constructive. I fear that this debate may take a different route from that taken in the recent consensual Back-Bench debate. We all recognise that the cost of adult social care is a problem not just for this country, but for every advanced society that we can think of. The outline is fairly familiar: funders, private and public, feel stretched and frightened by demographic change and the elderly are scared and anxious about mounting costs. Treasuries throughout the world are nervous whenever the issue crops up, and normally they vacillate. Last week, the Government were, in part, accused of that—of dragging their feet.

That is nothing new. Back in 2009, following the publication of the Green Paper, there was very much the same thing. The current Secretary of State, who was then the shadow Secretary of State, said:

“One debate always seems to roll into another with this Government. We need a decision, and we need serious, costed proposals to be the basis for that decision.”

The current shadow Secretary of State, then the Secretary of State, said:

“we are putting forward three broad options for the country to debate, and it would be wrong to force the pace of that debate.”

For the Liberal Democrats, my hon. Friend the Member for North Norfolk (Norman Lamb) said that the Green Paper

“comes 12 years too late. It is this Government’s shameful legacy that they will leave office having failed to reform a system that the Secretary of State”—

now the shadow Secretary of State—

“himself has described as a cruel lottery.”—[Official Report, 14 July 2009; Vol. 496, c. 160-62.]

When social care is viewed as a sustainable enterprise, Governments always see it as involving a big—and, worse still, an uncertain—sum, and that is why Treasuries usually baulk at it and we make very little progress. Governments are far happier in clarifying people’s rights and then passing the buck to local authorities. What paralyses Governments is the potential, not the identifiable, cost—what it is and how we are going to share it out —and that amounts to a huge political headache.

In order to resolve this, we need to do two things. First, obviously, we need to get a handle on the costs; but secondly, we need to work out a way of trying to defray them. Elderly people to whom I have spoken following our recent debates and last week’s statement have spoken in slightly different terms from how we speak here. They are sceptical about some of the Armageddon scenarios. They are resentful about their perceived lack of contribution to society—not in the past but currently. They do not see themselves, en bloc, as a drag on society.

We know that some people incur massive costs because they are frail, disabled, suffer with dementia and so on, and the social, personal and family costs are appreciable, but we also know of many pensioners who make a huge family and social commitment, and some who are even in employment. My predecessor, Lord Fearn, still has a delivery round of 500 copies of “Focus”, as does his wife, and they are both in their 80s. That shows the benefits of delivering “Focus”. We do not know enough, and need to know more, about how we get people into the category of the fit and keep them out of the category of the frail. We need to know why people end up in one category or the other and what the relative costs are of maintaining them there in terms of drugs, treatment and so on. We do not know whether by advocating an active, healthy old age we are deferring costs or eradicating them. The science of gerontology has an appreciable way to go. It is not clear to me, and probably not to many Members, how public health can move people into the better category of the fit and away from the category of the long-term frail.

My main point—to some extent it is not mine, as it was suggested to me by what the hon. Member for South Thanet (Laura Sandys) said in a previous debate—is that even if we accept that there is no way of avoiding the cost of the last years of life and the fact that as people get older their maintenance gets more expensive in terms of calls on the NHS, there is a case for considering whether we should do some serious number-crunching to re-engineer social care in order to sharpen up and prioritise interventions, as we have seen with dementia and arthritis. We do not know at this stage what the true benefits of that could be. I am not quite sure what I mean by re-engineering social care even as I say it, but we need to find out what it means and try to implement it in order to defray the costs.

20:52

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Thank you, Mr Deputy Speaker, for calling me to speak in this important debate.

I am often contacted by my elderly constituents and their families about social care and its funding, and I can tell the House that it is a massive worry to many of them. While I welcome many of the “in principle” recommendations in the Government’s White Paper, their lack of commitment to reforming the long-term funding of social care means, in effect, that they are kicking this urgent reform into the long grass. Dilnot recommended capping social care contributions at £35,000 and increasing the means-tested savings figure to £100,000. Supporting that in principle is all well and good, but the fact that the Government are not proposing anything specific until the 2013 comprehensive spending review and not implementing anything this side of the general election means that thousands of my constituents will continue to face anxiety about the potential cost of their social care and a substantial loss of their lifetime savings. One in 10 of them will face catastrophic social care costs of over £100,000. That is not acceptable and shows that the Government are out of touch and ducking the issue.

Social care funding is in crisis. Councils across the country have been forced to cut £1 billion from social care. In Ealing, the Labour council has had its overall budget cut by 30%. With a substantial proportion of its budget being spent on adult social care, it is struggling to protect the most vulnerable, who depend day in, day out on the social care that it provides. It has found 70% of the £85 million that it must cut over four years from efficiencies and has cut a smaller percentage from adult social care to try to protect the vulnerable.

The spend on social care is decreasing while the number of elderly people in need of social care is increasing. The Local Government Association recently released a report on local government financing that made it clear that with the elderly population and the cost of social care both increasing, unless the Government reform social care funding urgently, by the end of the decade, councils will be able to pay only for social care and all other council services, such as refuse collections, will have to stop. That is not a sustainable situation for social care or for other council services. The Government cannot afford to do what they have done in this White Paper. They have not grasped the financial nettle, but have kicked social care funding into the long grass.

One action that the Government could take immediately would be to use some of the £1.7 billion underspend from the NHS—£1.4 billion of which has been returned to the Treasury—to tackle the funding crisis in social care. Labour is sensibly calling for £700 million of that underspend to be given to councils immediately to tackle the crisis in social care funding. That would be a significant step that would help my constituents who have social care needs. The need for a long-term funding solution is critical. I hope that the Government will engage urgently in all-party talks so that a solution can be found without further delay. I therefore support the motion.

20:59

[Margot James (Stourbridge) (Con)]

I will start my contribution with some points that I wanted to make earlier in the debate about the origin of the problems. I accept that there are severe problems with adult social care. I do not know where the hon. Member for Leicester West (Liz Kendall) got her figures about the last Government’s record on adult social care spending, but according to local government figures, between 2004 and 2010, spending increased by 0.1%. Meanwhile, the population of over-65s grew by 7.7% and the number of over-80s by 11.6%.

[Liz Kendall]

I am grateful to the hon. Lady for being more generous with her time than perhaps I was. I got my figures from an independent assessment of Labour’s record in Government that was produced by the King’s Fund before the last general election.

[Margot James]

I am grateful to the hon. Lady for clarifying that. According to local government statistics, in the six years up to 2010, the spend was flat, and I have mentioned the demographic pressures. Interestingly, the same analysis states that over the same time, NHS expenditure rose by 27%, expenditure on the police rose by 20%, and even expenditure on schools rose by 12%.

A picture is emerging of the deprioritising of adult social care under the last Government. That is the origin of the problem that we are debating. That is what gave rise to the restrictions of the eligibility criteria for care. Long before this Government came to office, many local authorities started to restrict eligibility to those in moderate need of care and then to those in critical need of care.

[Mr Anderson]

Will the hon. Lady give way?

[Margot James]

I will give way one more time.

[Mr Anderson]

I appreciate it.

May I suggest that in criticising the last Government, the hon. Lady needs also to look at the record of the Government before that? Throughout the 1980s and 1990s, the social care and health service budgets were drastically reduced to a degree that was an embarrassment to this country.

[Margot James]

I welcome the hon. Gentleman’s intervention, but I will move on to the present day, relevant though the NHS and social care budgets of 20 or 30 years ago no doubt are.

We are beset by problems, although I was pleased to hear the Minister confirm that according to ADASS, social care spending has gone down by just 1% in the past year. Given the incredibly difficult economic situation that we are in, much of which we inherited from the previous Government, that is an achievement. However, we do have problems.

People value their independence, and most older people want to stay in their own home. With the right support, many can. To a large extent, the White Paper proposals will provide the support that is needed to enable more people to stay at home. Carers are a vital source of people’s ability to maintain their independence at home, and the 5 million carers who do an incredibly important job in our country do not get enough support at the moment. I welcome the extra money that is being put towards enabling them to have respite, because carers tell me that a break is what they need first and foremost. I am sure that no amount of money would ever be enough to give them the breaks and support that they need, but at least the White Paper proposals will provide some support.

Many people do not realise that social care is means-tested until they get to the point in their lives at which they need it. That means that we need more information to be available. We need to be honest with people about what is possible, what is available and what is not. All Governments are guilty of putting the best picture forward, which is sometimes misleading. I applaud the Government’s decision to commit £32.5 million to improving information, but perhaps I can make a plea on behalf of some of my older constituents: that investment should not all be online. Many older people do not communicate in that way, so we must allow for some leaflets in GPs’ surgeries, libraries and day centres, and for other traditional forms of communication. Otherwise, we will make older people who do not engage with new media even more dependent on other people to get information for them.

[Fiona Bruce]

Will my hon. Friend give way?

[Margot James]

No, I promised not to take any more interventions, because I know other Members want to speak.

Then there is the dreaded assessment. Older people often try hard at their assessment to suggest that they can do more than they really can, especially when their carers are present. At the moment, assessments are conducted inconsistently not just around the country but within communities—it depends on who conducts them. I applaud the initiative to make them far more universal and consistent. The Dilnot proposal of making them portable around the country is certainly a huge step in the right direction.

As Members of all parties have indicated, the quality of care needs to improve. I welcome the emphasis on dignity and respect that runs through the White Paper. It is important that we have better training for care workers and an end, if possible, to the terrible business of contracting by the minute, which flies in the face of dignity. I quite agree with other hon. Members that it is impossible to get an elderly person out of bed and dressed in the amount of time that is allocated these days.

Dignity and respect are at the heart of a good-quality care system, and I am pleased that that has been given the prominence that it deserves in the White Paper. Of course we would like to do more, but I applaud the Government for making a very good start and, if I may say so to Opposition Members, they have done so within two and a half years of coming to office, which is a great improvement on the previous Government, who took 12 years before they got round to the same point.

21:05

[Nic Dakin (Scunthorpe) (Lab)]

Adult social care is probably one of the biggest, if not the biggest, challenges that we as politicians and policy makers face. We have heard thoughtful contributions from Members on both sides of the House explaining why it is so difficult. If people are fortunate, they never need to access adult care. If they are unfortunate, they do need to do so, or members of their family do. As we heard from the hon. Member for Southport (John Pugh), it can be a cruel lottery. One of our purposes should be to minimise the extent of that lottery and maximise entitlement and support for all individuals.

One of the most humbling experiences I have had since becoming Member of Parliament for Scunthorpe was going to visit a constituent in his home last week on this very issue of care and support. He is a similar age to me. When he was younger, near the end of his training in the medical profession, he went out into the sea and suffered a terrible accident. As a result, he was paralysed from the neck down. Since then, he contributed to society in a number of different ways. He retrained in higher education until he was advised by his GP to retire because if he did not, in the GP’s words, “the wheels would come off” and he would no longer be able to contribute to society.

After going to see my constituent, he wrote to me—this is about individuals and real people’s lives—about the publication of the draft social care bill:

“I have just been reading the latest on social care funding on the BBC website—it would seem that meaningful cross-party dialogue re Andrew Dilnot’s recommendations has broken down and that the government wants to put decisions off until the spending review late next year.

My suspicions about kicking into the long grass appear justified!...I have already contributed over £60000 towards my care package and seem to be paying more and more each year—despite the fact that North Lincolnshire council reduce the value of my care package every time there is a review.

My condition has not improved. I am, in fact, starting to suffer more and more of the long term complications that inevitably hit ageing tetraplegics.”

The worry and concern are there. When visiting my constituent in his home, I observed that the people who were providing the care were brought in at his expense. Resources were not adequate, because that cost was being taken out of his small pension from working in higher education, which went up by 5% a couple of weeks ago, although the contribution to North Lincolnshire council went up by 25%. What is the incentive to do the right thing in difficult circumstances when those sort of things happen?

What I have described was additional care. The core care was provided by my constituent’s mother, who was in her mid 80s, and his sister, who travelled for two and a half hours to spend half the week helping to care for him. As politicians, we need to step up to the plate. It is about leadership—cross-party leadership—and being able to do the right thing for people, such as my constituent, who suffer misfortune. Had that misfortune occurred, as he said to me, in a car crash, he would have received insurance compensation, which would have paid for his care package. Because it took place in a situation of utmost tragedy—nobody was responsible for it, but it was a total misfortune—there is no underpinning support from the state, which should properly protect him and his family from having to pay more and more money. My plea is for us to show the leadership across the parties—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order.

21:10

[Sarah Newton (Truro and Falmouth) (Con)]

I am delighted to follow the hon. Member for Scunthorpe (Nic Dakin), as I completely agree that this issue is about leadership. Some of my hon. Friends alluded to a better-tempered debate, such as the Back-Bench business debate, to which all parties made thoughtful contributions, based on a great deal of expertise from different walks of life—whether from people in the medical profession, those who had spent their life in social services or those who had a personal point of view from being a carer. We heard some heartfelt contributions in that debate, so I think we are united in the desire to do something about this issue.

What I have found deeply disappointing about today is the fact that this debate was called in the first place. There was significant and genuine desire by this coalition Government to solve once and for all this problem that everyone agrees needs to be solved. Everyone agrees that it needs cross-party support—for reasons that are obvious to anyone sitting in the Gallery or watching this evening’s debate and to all the various voluntary organisations that have been very substantially misquoted or very selectively quoted this evening. There is a unity of purpose, but it is not being served by the Opposition who are tabling Opposition day debates, falsely dividing the House.

If the Opposition were to put their efforts into working closely with the two parties that form this coalition to come to a sensible solution, I believe that measures would be in the White Paper, but we are still seeing sledging and negative comments from Opposition Front-Bench Members as we have seen all day. It is deeply disappointing that the Opposition are so thoroughly letting down the people whom they claim they represent. I do not believe it is too late, and I really urge them to get back to the table and to be more positive about the steps that the Government are taking—[Interruption.] Here we go again; I cannot even finish a sentence without Opposition Members chuntering.

The fact is that I worked very closely with a number of Opposition colleagues. Various Members have talked about the very good work we did in the inquiry led by the all-party group on local government that looked at this issue. There was an all-party agreed proposal that identified many measures—which the Government have picked up in the draft White Paper—that we can achieve together. The effort should be focused on what we agree on, so that we can offer the reassurance that is needed by the desperately worried people all around the country that have been quietly identified this evening. People are worried not only about the social care system now, but the social care system in the future. We should be reassuring these people and giving them hope that this House has the necessary combined will and determination. I do not think any of us want to face the electorate at the next general election saying that this problem has not been solved.

As to the timetable, yes, I would love to be able to stand here today and congratulate the Government on finding every penny to fund a long-term solution. If we can get the cross-party talks into gear in September, we should be able to put in place the mechanism that, as confirmed by the Secretary of State, could be built into a Bill and put before Parliament. When all parties have agreed on how this is to be funded—as many people have rightly said, it will cost billions of pounds every year and we are in a very difficult financial situation, so all parties must agree on how those billions can be found—there is every possibility that such a Bill will get through Parliament and, when next year’s comprehensive spending review is developed, the money will be found.

Yes, it is frustrating if we have to wait another year or 18 months. Before I entered the House, I spent the best part of my adult life working for Age Concern England and for the International Longevity Centre in the UK, coming up with solutions that previous Governments certainly kicked into the long grass, so this is our best hope in a generation.

[Heidi Alexander]

I respect the hon. Lady’s work on this issue, but does she recognise that there is almost universal agreement outside the House that the big disappointment is that there were no proposals last week on how, in the longer term, we provide the funds that we all want for care for the elderly and those with disabilities?

[Sarah Newton]

I accept that there is genuine disappointment, but people equally understand that all parties in the House must be committed on where the billions of pounds each year will come from, so that the proposals are sustainable for the long term, and so that people can save and invest without fear of the rug being pulled from beneath them.

The proposals are a sticking plaster—there is no doubt about that—but if only people could hear the facts, they would appreciate that more money is being put into the system while the problem is being resolved for the long term. It is not true that all councils are cutting back. Cornwall council has not cut its adult social care. It is working in extremely innovative ways with the NHS and the voluntary sector to ensure that services are improved. I do not accept the shroud waving from Opposition Members, who say that every part of the country is in crisis.

[Richard Graham (Gloucester) (Con)]

My hon. Friend has a high interest in, and knowledge of, these matters. Does she agree that counties such as hers and mine—Cornwall and Gloucestershire—that prioritise adult social services precisely because of their ageing populations, are helping to find a solution to the problem, which is so badly needed by constituents all round the country?

[Sarah Newton]

I agree. I encourage people to read the good report published today by the all-party parliamentary group on local government, because it contains good examples from all over the country of how proper integration of social services with housing and the NHS is beginning. There is every possibility, as a result of HealthWatch and the health and wellbeing boards, that such integration innovation will deliver the joined-up services for families and carers that will lead to an agenda focused on public health and the prevention of the problems that lead people into acute settings such as A and E and hospitals. People currently end up in such settings far more than they need to.

I am confident that, in a years’ time, hon. Members on both sides of the House will come here to share best practice from those parts of the country that grasp the opportunities of the Health and Social Care Act 2012 and make the most of the changes. We can then encourage other parts of the country that do not prioritise those matters to do the best they can for older people and carers in their societies. All hon. Members want them to have higher-quality and better care so that they can live in dignity for the rest of their lives.

21:18

[Kelvin Hopkins (Luton North) (Lab)]

The hon. Member for Southport (John Pugh) was kind enough to say that people of a pensionable age can sometimes make useful contributions. He is very kind to me—I am the only Member of a pensionable age to speak in the debate. I am 37 in my mind, but with a son of 42, that is rather unlikely.

The Government have failed at the core of the White Paper on the question of funding. This is about money, not leadership or consensus or saying nice words in the Chamber. I am very pleased that Labour Front Benchers have accepted Dilnot. His proposals are not perfect, but he goes a long way to proposing a free national care service, which my hon. Friend the Member for Blaydon (Mr Anderson) and I want.

I know Andrew Dilnot well—he is a fine, highly intelligent and compassionate man. He went to great lengths to tailor a precise scheme that could be accepted by the Government, but at the last minute, they have buckled and not committed to it. The problem is the Treasury—the worst Government Department of all. It has failed the country over and over again with terrible mistakes. The European exchange rate mechanism destroyed the credibility of the Conservatives, but the Treasury has done lots of other bad things. It is a dreadful Department. I hope that Ministers now tell me how wonderful it is.

There has been almost no mention of the royal commission on long-term care from some 14 years ago—I think my hon. Friend the Member for Blaydon mentioned it—which recommended free long-term care, which is precisely what he and I want. However, the Government at the time—they happened to be a Government I supported—could see that the report was going to be unanimous, so they slotted in two people at the last minute to ensure that it was not unanimous, and from that point onwards they hung on to the minority report of those two members. It was a bit of a disgrace, and I made that point strongly. I tabled an early-day motion in the 1997 to 2001 Parliament calling for implementation of the royal commission’s recommendations, which was signed by more than 100 Members of the House at that time, and in the 2001 to 2005 Parliament I tabled another early-day motion saying the same thing, again with the same sort of support. I also have the support of the National Pensioners Convention—a body with which I am closely associated—which also wants free long-care on the same basis as in the NHS.

In Scandinavia they do it. Indeed, what I have always wanted my party to do—as well as the others, but particularly mine—is to move in the direction of Scandinavia, not the United States of America. If Members read the book “The Spirit Level”, they can see that the civilised societies—where people are happier and all sorts of social problems are lesser—are in the Scandinavian- style countries. The worst end of the spectrum is in America, and we have been steadily moving towards the American end, not the Scandinavian end.

In the end it is about cost and this word “affordability”. We choose what is affordable. It is not written in stone: we can choose to make things affordable, and we can choose to pay for them by progressive taxation—if we wish. It is a political choice. People say, “Oh, well it’s not affordable.” However—I have told this story many times—I remember that when my children were young, if they asked for a second ice cream, my wife would say to them, “Mummy can’t afford it,” when what she was really saying was: “You can’t have another ice cream.” Of course she could afford it. We can afford to pay for free long-term care too, but we choose not to—so far. I hope to persuade my side at least to commit to it in time.

The extra costs of Dilnot would initially be £2 billion a year. That is the equivalent of 0.5p on the standard rate of income tax. I have put this to many people in meetings and asked them, “What would you choose: the threat that your home would be taken away, with no equity to hand on to your grandchildren, or an extra 0.5p on the standard rate?” Without exception, they say 0.5p on the standard rate. Of course, we do not have to do it that way, because there is plenty of cash in the tax gap, which is estimated to be as much as £120 billion a year, or even more. If we collected a tiny fraction of that—one sixtieth—we could cover Dilnot’s proposals; and, if we have to have a bit more, let us squeeze the tax gap a bit further. However, since Margaret Thatcher’s time as Prime Minister, we have seen the standard rate cut by 5p, which is 10 times more than the cost of Dilnot, so do not let us pretend that it not affordable. We choose not pay for it, because we think—or some people think—that low taxes are better or that letting tax evaders and tax avoiders get away with it is better than looking after elderly people in great need.

We are also committed, apparently—I understand that this goes for both sides of the House—to the idea of owner occupation, but we are actually seeing the gradual erosion of owner occupation, particularly by poorer people having their houses taken away when—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order.

21:20

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a great pleasure to follow the hon. Member for Luton North (Kelvin Hopkins). I commend him for his ability to get Europe into almost every debate we have in this House. I am not sure whether his sums quite added up at the end of his speech, but it is commendable that we have seen a commitment across the House this evening to improving the dignity and quality of elderly care, which is something I am sure we would all like to see.

All previous Governments have taken steps in that direction, but I believe that the White Paper and the draft Bill that this Government have brought forward represent the most significant steps towards improving dignity in elderly care for a generation. The “in-principle” support for Dilnot and the Dilnot proposals is a good recommendation, and it needs to be considered in the context of whole-government spending at the next spending review. However, for the first time there has been an in-principle agreement by a Government that social care is one of the most important issues and challenges facing our country. How we are going to provide dignity in elderly care—high-quality care in the community—is a clear priority for this Government, and that should be commended.

I want to outline some of the real challenges that face people who are in receipt of social care, particularly the frail elderly. The hon. Member for Blaydon (Mr Anderson) pointed out that it can be difficult to distinguish between NHS care and social care, because they often involve exactly the same things. They include supporting the activities of daily life that we all take for granted, such as washing, dressing, getting in and out of bed or the bath and going up and down stairs. Those are the kinds of things that we mean when we talk about providing high-quality social care, and this Government have put forward strong measures that will make it much easier to provide such care for the people who most need it.

The White Paper and the draft Bill provide for support for carers, and for improving the personalisation of care, which is particularly important for younger people in receipt of social care, as the hon. Member for Scunthorpe (Nic Dakin) said. Respite care is also recognised as an important means of better supporting carers, giving them a break from the hard work of looking after people and ensuring that the role of carers is properly supported. The proposals also include a commitment to portability of care, and to a universal care assessment.

[Glyn Davies (Montgomeryshire) (Con)]

I raised the issue of portability with the Secretary of State last week. It is crucial that a debate should take place about what we are doing here and what is happening in Wales, as this is a devolved matter. There must be close liaison between us. I understand that the initiative must come from the Welsh Government but, without that liaison, people will fall between the two countries.

[Dr Poulter]

My hon. Friend makes an important point. Social care and NHS care do not recognise county borders, which is why portability is so important. They certainly do not recognise the boundaries between England and Wales or between any other parts of the United Kingdom. We have devolved responsibility for the NHS, and the fact that there are different funding priorities in the different parts of the UK, with the Government in England supporting investment in the NHS and the Labour Administration in Wales cutting NHS spending, highlights the importance of my hon. Friend’s point. I am sure that the Minister will be able to reassure us that the coalition Government are taking steps to ensure that portability can take place across those borders wherever possible.

The White Paper also contains a commendable commitment to improving integrated care and ensuring that more joined-up working takes place between the NHS and social care.

[Sarah Newton]

Would my hon. Friend like to comment on some of the Opposition’s assertions that the efficiency savings from reductions in management levels in NHS are not being put back into front-line services to enable integration, and that they are somehow being siphoned off to the Treasury? I do not believe that—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I must ask the hon. Lady to turn round so that the microphone can pick up what she is saying. I know that she is finding that difficult, but she should be heard by everyone in the Chamber.

[Dr Poulter]

I thank my hon. Friend for her intervention, and I agree with her. The Government are making a clear commitment to encouraging integrated care and to putting savings made in the back office back into the front line of NHS care. Many billions of pounds have already been committed, and there is more money in the draft Bill to encourage better integration between the NHS and social care services.

As the Minister of State said, it is important to shift the emphasis away from crisis management and towards preventive care. The focus on housing as part of the integrated care system is important. My hon. Friend the Member for Congleton (Fiona Bruce) made the point that, far too often, older people fall over and injure themselves as a result of poor lighting or a lack of handrails in their homes, ending up in the accident and emergency department, when better lighting and preventive care in the home would have provided a much more effective way of looking after them properly, as well as saving the NHS and social care a lot of money. That key commitment to more integration between the NHS, providers of housing and social services providers is a fundamental ingredient of the way in which we can improve the day-to-day quality of adult social care, while also saving a great deal of money, which can be spent on improving care for everyone else.

Finally, let me talk a little about funding. The Dilnot proposals have been agreed to in principle, and I hope that the Opposition will at least give the Government some credit for the fact that there has been a once-in-a-generation attempt to deal with this issue. It is not good enough to say, 13 years into an Administration, “Three weeks before the general election, we will publish a White Paper.” No one could consider that a serious commitment to tackling the challenges that we face.

The way forward now must be the cross-party working that we all believe is desirable. That means that all parties must work together and support the Government’s White Paper, support day-to-day improvements in care for older people, and support the agreement in principle to the Dilnot proposals that the Government have presented.

21:31

[Julie Hilling (Bolton West) (Lab)]

While we sit here discussing this issue, families will be sitting in their living rooms or around hospital beds trying to decide what to do for their loved ones. Can they stay in their own homes? Will someone be able to deliver 24-hour care? How long will the situation continue? What will happen when the money runs out? What should they do for the best? While we sit here listening to the Minister telling us that we will sort things out in the future, families—now—are making the most difficult decisions of their lives.

I want to talk about the reality for my constituents, and to plead with the Minister to work with all the political parties in this place to find a long-term solution to the growing crisis of adult social care. It has to be a long-term solution: it has to be a solution that will last for many years, whoever is in government, and we have to find it now, not after the next general election. Old age happens only once to each individual. It is not something that we can return to and do better next time.

We cannot just look at residential care; we must also look at the systems that keep people in their own homes, and allow them to lead fulfilling lives and live in dignity. The present situation is dire. Bolton council has had to cut £15 million from its budget for adult social care, which means that it can no longer give support to the 536 people aged between 18 and 64 and to the 1,312 people aged over 65 who have moderate needs.

[Roberta Blackman-Woods]

Does my hon. Friend agree that we have heard nothing from the Government this evening that demonstrates that they have any idea of the funding crisis that is hitting a number of local authorities throughout the country? There is no urgency at all in the Government’s actions.

[Julie Hilling]

Yes. The cuts faced by northern local authorities in particular are dire. Bolton will have to find £100 million worth of cuts during the current Parliament.

[Sheila Gilmore]

Does my hon. Friend agree that it simply is not good enough to express—as the White Paper does—concerns about matters such as short periods of care time, or the fact that some carers are not even earning the minimum wage, if there is no way of making things work financially? I do not believe that councils have chosen 15-minute slots deliberately; I believe that they have done it in order to save costs and make efficiencies. Similarly, there are carers who have to pay for their own travel.

[Julie Hilling]

We have to realise that we are facing a crisis now, not a crisis in the future. People in our constituencies are suffering daily. A young man in my constituency who has learning difficulties and has relied on carers to help him with his everyday life will now see his carer only once a week. Contact with a carer is the only contact that many such people ever have with another human being, and that contact is now going. It is truly a false economy. This low level of care for people with moderate needs is what keeps them in their homes, keeps them healthy, and stops them ending up in residential care prematurely. Bolton is managing to maintain substantial and critical care, but it will have to find £34 million in cuts over the next two years, and it is worried that it will have to join other councils in only providing critical care.

Paying for home care is a huge worry. The average cost is £13.61 an hour, but it can be a great deal more; in Brighton and Hove, carers cost £21.50. It is not unusual for people paying for care to have to find more than £10,000 a year to cover that cost. That spending needs to be taken into account if we are to have caps over the whole amount. Many Members will know that my mother has been in and out of care over the past 12 months. We have spent £20,000 since October on her care.

The cuts to local authority budgets are affecting other support services, and the consequent cuts to the voluntary sector are having dire consequences. The voluntary sector provides luncheon clubs, social activities and carers groups, all of which are under pressure or at risk.

Horwich visiting service in my constituency has lost funding and can no longer employ its part-time co-ordinator. That was the person who recruited volunteers, sorted out the police clearance, provided training, ascertained the needs of clients and supported the volunteers. The volunteers will continue to visit the elderly and disabled people with whom they are currently in contact, but it will not be possible to recruit new volunteers or take on new clients.

The fees local authorities pay to care homes is also an issue. There has been a significant real-terms cut over the last two years. That inevitably impacts on care. It also means self-funders are charged more in order to subsidise the costs of council-funded residents.

The choice of home is another huge concern. The other day, I was speaking to one of the police officers on the parliamentary estate. He told me his mother was in a care home. He and the family had chosen a home that suited her needs and they had sold her house to pay for the care, but now the money is running out and he does not know whether the local authority will pay the care home fees, whether his mum will have to move or whether the family will somehow have to pay the additional costs. If the cap is ever introduced, that will be too late for him, but he still needs to know that the care costs will be met in future.

The needs of the elderly and disabled do not move in a straight line. Some people may need to go into care for a period of time, such as when recovering from an illness or an accident, but, with support, they may be able to return home. However, we were told that after six months my mum would have to sell her flat to pay for her care. In fact, after eight months in a care home, she has returned to her own flat. That shows that people do not move in a straight line through the system. Decisions should not be taken on the basis of cost alone; they should be taken on the basis of needs, too.

Let me conclude by reading out a comment from a constituent of mine called Amy:

“Alongside the funding crisis there is also a huge injustice in the way we pay for care. This includes the dementia tax, where tens of thousands of families are left to pay all their care costs whilst other terminal conditions are paid for by the NHS.

The significant cost of care means many carers face financial hardship and are often forced to give up work.

We need reform to build a fair and sustainable care system which delivers dignity, independence and peace of mind.”

Amy is right. We need to get on with this. We need to find a solution where people’s needs are taken into account, and where people do not live in fear for both themselves and their families. We need to find a solution to this problem that all of us can live with, and that cares for people who are in need in our society.

[Several hon. Members]

rose—

[Mr Speaker]

Order. The Opposition Front-Bench speech must start at 9.40 pm, so the hon. Member for Blackpool North and Cleveleys (Paul Maynard) has a tiny window of time in which to make his contribution.

21:37

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

I shall be very brief then, Mr Speaker. I have just two minutes.

When we talk about social care, we tend to spend most of our time discussing the elderly. I want to say a few words about young disabled people, however, who benefit from social care, and who need to have a voice in this debate. I chair the all-party group on young disabled people, and we have been discussing many of the key issues. Last week, we discussed housing, for example. I welcome the money proposed in the White Paper for improving housing for the disabled, but may I sound a note of caution? At present, too many wheelchair-adapted houses are not going to those who need them—people in wheelchairs. It is all very well constructing these houses, but we must get the allocation policy right, too.

I welcome the transition funding, but I have a plea to make on that. There is a concern that there is a cliff-edge at the age of 18. For many families it is, as it were, a gradual cliff-edge. Things start to decline at 14, so the care package they get at 18 might not be the appropriate one they need as an adult. May I ask the Minister to look at that issue closely?

I welcome the introduction of portability, as that is crucial. I know that the Opposition brought similar measures in when in government, but we are taking this further. It is far more important for younger disabled people than it is for those who are elderly. We talk a lot in this Chamber about social mobility. One of the main hurdles for young disabled people who wish to go to university is the great fear that when they get there they will not have the same social care package as they had when they were at home with their parents. That is the main fear they face; it is what keeps them at home and means that they do not take full advantage of the educational opportunities on offer. I will stop there.

21:40

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

No family in the land is untouched by the challenges of social care. Families up and down the land who will watch this debate or read about it know that if social care is not an issue for them today, it may be an issue for them later. Labour Members therefore think it is important that it is spoken about not in policy wonk or accountancy terminology, but in terms of people. That is because it is an issue about people, be they the elderly, the disabled, the young disabled, about whom we heard eloquently just now, the carers within the family or the tens of thousands of men and women who work as professional care workers, about whom my hon. Friend the Member for Blaydon (Mr Anderson) talked so eloquently earlier.

Let me say from the outset that the Opposition accept that this is an issue about which we could have done more. Social care and the challenges it poses in the 21st century are unfinished business for Labour. However, it is not true to say, as some Government Members have unfortunately done, that Labour was wholly inactive on the issue of social care. We heard from my hon. Friend the Member for Leicester West (Liz Kendall) about all the steps we took and the innovations we made on issues associated with social care. To say that we were totally inactive is quite wrong and is merely party political point scoring, but it is true that we did not grasp sufficiently early the political nettle of how social care is to be paid for. That is why, from the very beginning, we offered talks and entered willingly into them, and why we remain willing to resume talks, so long as Ministers are acting in good faith.

Social care is an issue for families up and down the land. Government Members have said that people have to understand that they are going to sell off their homes, but the point about that is that homes are not mere bricks and mortar. These may be the homes that people came to as a young married couple and where they brought up their children; these are homes freighted with memory, emotion and family life. It is too easy to say that people have to be ready to sell off their homes. This is about people; it is not just about figures on a piece of paper.

Social care is also quintessentially an issue for the squeezed middle, to use the phrase of my right hon. Friend the Member for Doncaster North (Edward Miliband). The very poor will not have to meet their own costs, although there are still issues to address about standards of care, and the cost of care is not a problem for the extremely wealthy. This is an issue for the squeezed middle; it is an issue for people who, perhaps through years of struggle, have a home and assets and now see the frightening possibility—this is particularly the case for the elderly—of those assets being drained away because of a system that is not yet under control.

[Glyn Davies]

rose—

[Ms Abbott]

I am afraid that I will not be able to give way, because I want to leave sufficient time for the Minister to make her remarks.

We also have to address the issues of dementia and Alzheimer’s. They are largely dealt with as social care issues but in fact they are an increasing challenge for people as they grow older.

The Minister called social care Bevan’s orphan and I think that that is a little unfair. The world we face today is very different from the world of William Beveridge and the framers of the first national health service. People live much longer and do so with all sorts of long-term conditions, whereas changes in the role of women mean that there is no longer a vast, mute and hidden army of carers. There are also issues with dementia and Alzheimer’s.

The Opposition want to be collaborative rather than party political, but I would be failing in my responsibilities if I did not draw to the attention of Ministers the one message given to my colleagues and I as we have gone up and down the country talking to local authorities about the new public health arrangements and social care. Those in town halls, whether they are Labour or Conservative-led, have said that local authorities are under unprecedented financial pressure. Some of the things we heard from Ministers seemed to suggest a certain carelessness about or unwillingness to face up to the financial pressures that mean that local authorities are making real decisions that are affecting real people and real families. Ministers heard what local authorities are trying to do to make the money stretch. On the one hand, there are more stringent criteria, so people need to be in greater need to get social care at all, but on the other hand, they are squeezing the money and the standards. That is the only way it can happen.

If I could say only one thing to Ministers, it would be that they should listen not to the Opposition spokespeople or to Labour councillors but to their own Conservative councillors, who are trying to make them address the scale of the crisis that they face. They are very alarmed—we know that they are—that Ministers appear to be poised to place additional responsibilities on them without any ideas of how to provide funding.

I remember what the Prime Minister told this House in February 2010, speaking about social care. He said:

“What we want to know is: where is the money coming from?”—[Official Report, 10 February 2010; Vol. 505, c. 904.]

I have to say that councillors and families up and down the country, as well as Members of this House, want to know what is behind the fine words and what Ministers will do to fund the proposals outlined in their White Paper.

Precisely because I do not want to be party political, I will refrain from talking about the Conservative party’s party political broadcast on the death tax and the posters that said:

“Now Gordon wants £20,000 when you die. Don’t vote for Labour’s new death tax.”

I am not a party political person, so I shall leave that. I shall put it to one side.

We support Dilnot in principle, but we are a little concerned about the Secretary of State’s pick-and-mix approach to the recommendations. We are worried that although the White Paper reads well, it makes too many vague commitments. I would be grateful if the Minister could give me an answer on the question of loans, in particular. On that question, as she will be aware, the 1999 royal commission—sadly, we did not address the issues of funding that it raised—said that

“there would need to be an initial outlay of potentially between £1bn and £2.8bn…the scheme would be complex to establish, and to administer, probably very expensive initially and would leave the state with an uncertain liability. If Local Authorities administered it, they might be left with a complex burden of assets which would differ greatly from one part of the country to another. The Commission consider there little overall benefit to be gained from such a scheme.”

I would be grateful if the Minister could tell me —[Interruption.] It is a deferred payment scheme at the discretion of local authorities—[Interruption.] We want to know how the Government will fund the upfront costs and about the levels of interest. Members will appreciate that elderly people, in particular, are very concerned about issues of debt. On that and on a range of other issues, we are waiting for a little more detail from Ministers. They can sit on the Front Bench and make party political remarks, but that is no help to families throughout the country who are worried about how they can fund social care in the future. It is no help to local authorities, which say that in a very few years the cost of social care will have inflated so much that they will not be able to meet other needs from their budget.

There are many things in the White Paper that we welcome, not least because many of them were in the White Paper introduced by my right hon. Friend the Member for Leigh (Andy Burnham) on building a national care service. We say to Ministers that it is easy to score points. It is easy to talk about what could have been done in the past, but we need to meet the challenge of how we care for our elderly, our disabled and our young disabled. That is the challenge that the nation is facing now. The White Paper reads well, but Age Concern and all the stakeholders are asking how Ministers will fund it. We stand ready to enter talks. We stand ready to work with Ministers. All we ask from Ministers is that they act in good faith.

21:51

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I was heartened by some of what I read in the motion tabled by the Opposition. Welcoming the measures laid out in the care and support White Paper was a good start to a process that will be immensely easier with genuine co-operation and communication. However, the speeches from the Opposition Front Bench were partisan and contained no acknowledgement that for 13 years they did nothing. The hon. Member for Leicester West (Liz Kendall) seems to have amnesia. Cheap party political squabbling is not attractive. I remind the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that she was very political by trying not to be political. I remind her also that 40,000 people a year had to sell their homes to pay for their care. It reflects badly on her and on the House and does nothing to improve the lives of service users, carers and staff. A White Paper seven days before the general election announcement counts for little.

Care has to be funded in a way that is fair on service users and fair on the taxpayer. We agree with Dilnot that financial protection through capped costs and an extended means test are the right basis for any new funding system. Given the extra public spending that will be involved, we need to consider that alongside other priorities. An issue that has been raised throughout the debate is the funding for the means-tested system. The right place—the responsible place—to consider that is in the course of the spending review and I do not intend to pre-empt that tonight. I draw hon. Members’ attention to the progress report. Many of the answers to the questions that they raise are included in that. The hon. Member for Hackney North and Stoke Newington would do well to refer to figure 4 in the report.

We have allocated an extra £7.2 billion to improve care and support as part of the spending review. That comes as part of what we know is a tough settlement for local government. If spent well, it will go far and will help local authorities maintain people’s access to care and support. The recent report from Demos and Scope shows that this can be done, and that reduced funding does not have to mean a reduced service. By putting more into reablement services that help people regain their independence, for example, or by supporting people to live in the community instead of in expensive residential care, local authorities can provide the best standards of care while saving money.

My hon. Friend the Minister of State mentioned the £32.5 million for better online services and traditional communication methods to help people see what services are available, whether their care is paid for by them or by the state. Likewise, there is an additional £200 million for specialised housing. That additional money more than pays for the White Paper proposals leading up to the comprehensive spending review. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said, the issue was ducked repeatedly by the previous Government in far more favourable economic times. He also drew attention to the absurd distinctions between health and social care and the need for integration.

My hon. Friend the Member for Congleton (Fiona Bruce) spoke from the heart about the needs of carers, the £400 million we have provided for carers’ breaks and the end of permanent billing. My hon. Friend the Member for Southport (John Pugh) spoke of the contribution older people make and how to stop the fit becoming frail. My hon. Friend the Member for Stourbridge (Margot James) reiterated the ADASS figures and the desire for people to stay in their own homes. My hon. Friend the Member for Truro and Falmouth (Sarah Newton) spoke with passion and knowledge of the unity and commonality of purpose we need and the divisive nature of the Opposition’s motion. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) pointed out the huge need to address the needs of people with disabilities.

These are ambitious plans. As well as setting out a comprehensive package of reform for the longer term, the White Paper announces changes that will make a difference immediately: a national eligibility threshold; proper and meaningful portability; duties to share information to ensure that people can move without losing their care; a focus on housing; provider quality profiles so that people can finally have clear information on the quality of care providers; mandatory adult safeguarding boards; and a requirement to assess carers’ needs and actually meet them—much neglected help and support. It also announces a code of conduct and minimum training standards for care workers so that people know that their care is underpinned by high standards of training and ethics. We will train more care workers, with 50,000 more apprenticeships by 2017, double the current number.

[Mr Anderson]

rose—

[Anne Milton]

The hon. Gentleman should welcome that.

The White Paper opens for business the new national information website so that people can find out more about all parts of the care and support system. It sets out legal entitlements to personal budgets so that care users, their families and their carers can choose what services they get. There are improvements to the transition from children’s services to adult services. These are big changes, egalitarian changes and, most of all, they will be effective changes. We are also reforming the existing social care legislation through the draft Care and Support Bill. The White Paper is about keeping people well and helping them to take control, get independent and live the lives they deserve with the certainty and security they need to do so with dignity.

There are times when we, as politicians, need not only to open our eyes and ears to the world outside this House, but to stand in the shoes of those we represent. They do not want to see us argue, squabble and bicker over their lives. On this issue, perhaps more than any other, we need to work together. If we do that, we can improve the system for millions of people, whether they use the services or care for someone who uses them. The system is funded until the next spending review.

I urge Opposition Members and Front Benchers to put aside party political differences and work alongside us to ensure that we have a system that is sustainable not only for this year and next, until the next general election, but for the years ahead. Older people in this country, the carers who support them and people with disabilities deserve that. The White Paper gives us a foundation on which to work, a foundation that has been missing for far too long. In 13 years in government, in favourable economic times, those now on the Opposition Benches did nothing that was sustainable in the long term. We need a foundation that gives us a chance to build a care and support system that future generations will be proud of. I urge the House to reject the motion.

Question put,

21:59

Division 55

Ayes: 225

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Labour: 217
Plaid Cymru: 3
Democratic Unionist Party: 3
Social Democratic & Labour Party: 2
Independent: 1

Noes: 292

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Conservative: 246
Liberal Democrat: 45