Health and Social Care

Debate between Grahame Morris and Madeleine Moon

Monday 13th May 2013 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I thought that, rather than speaking about Europe or votes for prisoners, I might make a couple of points about health and social care.

There are many provisions that I should have liked the Government to include in their legislative programme. For instance, I should have liked to see a commitment to extending freedom of information requests to private health care companies. I should also have liked to see a commitment to excluding health care from the scope of trade agreements as part of a broader exclusion of public services. I understand that the Prime Minister is involved in negotiations at this moment, and I hope that the trade agreement issue is on his agenda, because there is an increasing fear among Opposition Members that—in that context, and also as a result of the Health and Social Care Act 2012—our health care system is being prepared for privatisation, and the way is being cleared for the mass entry of United States health care multinationals to the UK market.

I am pleased that the Care Bill is to be introduced in the current Session. It will go some way towards helping those who are most in need of social care, as well as their carers, providing as it does the first ever legislative framework for social care. It is a much-needed first step in the right direction, which has been a long time coming. However, it raises a great many issues. As usual with this Government, we need to look beneath the veneer and establish whether an opportunity is being taken or missed, and whether we are taking one step forward and several steps back. It would certainly be a retrograde step to raise expectations only for them to be dashed as people discover that the proposals are really quite limited. We need to be honest about what is on offer.

Members often receive some shocking and surprising statistics in their mailbags, but some of the most surprising pieces of information that I have seen relate to social care. I must thank a range of organisations—including Scope, Age UK, the Alzheimer’s Society, the TUC, the British Medical Association, Barnardo’s and the European Federation of Public Service Unions—for supplying briefings to me and to other Members. It shames me, and I am sure it shames Members in all parts of the House, that in Britain in the 21st century four out of 10 disabled people who receive social care support say that it does not meet their needs. That was established recently by research on social care conducted by the disability charity Scope following the publication of a report by the Joint Committee on the draft Care and Support Bill, on which I served. It is feared that the current provisions, and some of those that are proposed, will not be sufficient.

Other Members have welcomed the Bill. However, it is hugely worrying that local government finance has been hollowed out. That will have major consequences. It has been said that local government allocations for social care are protected, but they are certainly not protected when it comes to provision for transport and other supplementary services that are of value to members of the group involved. Many organisations have pointed out that setting eligibility criteria for care at “moderate” is essential if this framework is to be effective. As the hon. Member for Bradford East (Mr Ward) pointed out, according to the findings of a survey by Scope, by 2012 84% of councils had set their eligibility criteria at the “substantial” threshold. That represents an increase of nearly a third since 2005. As a result, only 14% of people with “moderate” needs are now receiving care, and the findings of recent surveys suggest that the position will only get worse.

According to Marc Bush, head of research and public policy at Scope,

“if we take moderate level needs, there are 36,000 people within the system of working age who, if the reforms go through as they are currently set, would fall out of the care system…if you do not meet need early, people's needs escalate and the costs escalate.”

Mr Bush’s evidence is in paragraph 186 of the Joint Committee’s report. Indeed, the Local Government Association has estimated that by 2019-20, 45% of council budgets will be spent on social care. Unless we increase substantially the amount of resources available—

[Mrs Moon]

There is pressure on people with illnesses and with disabilities if they do not get access to that social care, but should we not acknowledge the wider pressures on their families, who have to fill that gap all too often? That means taking time off from work and reducing the time spent on their leisure pursuits, thereby adding to family tensions.

[Grahame M. Morris]

That is an excellent point. The role of carers and families is absolutely critical; they are an army of unsung heroes.

We cannot build a quality care service based on driving down the terms and conditions of the people who deliver it. I am very concerned about the increase in the number of zero-hour contracts, through which staff are paid the bare minimum. Such contracts are increasingly being used by private care companies seeking flexibility when meeting short-term staffing needs, and they often lead to job insecurity and a lack of appreciation of workers. We are seeing the fragmentation of social care, driven by the pressure to cut costs, which only places obstacles in the way of quality and of integrating services. Contracting out and privatisation also make it more difficult to have joined-up services, and there is a real risk that local authorities will find it impossible to comply with their new duties.

We should be honest about what the Bill can achieve. It is a framework. It is paving legislation. It will not stop people having to sell their homes to pay for care. Under the existing deferred payment scheme, councils can loan money to people to cover their care costs, which has to be paid back by selling the family home after the elderly person has died. The Government propose something similar, but unlike the current system, interest is charged on the loan. The care Bill will not necessarily cap at £72,000 the costs elderly people actually pay for residential care. As has been said, hotel and other accommodation charges are not covered. Many elderly people in care homes will die long before they reach the cap that is being trumpeted as such a success. It certainly will not mean that pensioners get their care for free if they have income or assets worth up to £123,000. Elderly people will get free care only if they have income or assets under the lower means-tested threshold, which is not being increased and will be £17,000 in 2016.

More widely, the care Bill does nothing to address the funding crisis in social care or to help those who face a daily struggle to get the support they need right now. Elderly and disabled people are facing huge increases in home care charges, which are a stealth tax on the most vulnerable people in society. Few older people are getting their care for free, and more older and disabled people are being forced to pay for more vital services that help them to get up in the morning and get washed, dressed and fed.

We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people to stay healthy and live independently in their own homes for as long as possible. That would truly reinstate the idea of people being looked after from cradle to grave—a worthy extension of Aneurin Bevan’s legacy. Labour’s alternative is integrated, whole-person care, incorporating health, mental health and social care in a truly national health and social care service.