Health and Social Care Budgets

Adrian Bailey Excerpts

Tuesday 14th March 2017 Westminster Hall

[Several hon. Members rose—]

[Mr Adrian Bailey (in the Chair)]

Order. Before I call the next speaker, I will just make it clear that I am trying to shoehorn a three-hour debate into one and a half hours. I need to call the Chairs of the relevant Select Committees, and I am looking for five minutes each from them. There will be a hard and fast three-minute time limit for subsequent Back-Bench contributions. If anyone wishes to intervene, they are perfectly free to do so, but I might take it into consideration when I consider the order of speakers.

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[Mr Betts]

We will return to the proper training, long-term commitment and pay of staff in the care sector in our Committee’s further report, but we certainly had evidence to that effect.

We need another way of dealing with the funding gap for the rest of this Parliament. For the longer term, I very much welcome the announcement of the Green Paper, but I echo the comments of the two previous speakers. We need to get cross-party agreement on a sustainable, long-term settlement that will last not merely for the next Parliament, but for several Parliaments after that. There are major challenges. I agree that we should look at health and social care together, but there are fundamental differences in governance and accountability between the two systems, so how do we resolve that?

We should certainly look closely at what is happening in Manchester, to learn about the devolution deal there and how the two can work together within the same governance structure. Personally, I feel that losing the local accountability that the social care system currently has and simply centralising the whole system would be a mistake. That would take us in the wrong direction, so it is important to look at what is happening in Manchester. We have two very different funding systems. We have the health system, which is free at the point of use, but I do not think that anyone suggested in evidence that we could fund social care on exactly the same basis. We will have to consider something slightly different to fund social care, but how the two systems fit together will be a challenge.

If we are considering the future for social care funding, we should bear in mind that currently we have a mixture of funding. We have some central Government funding, local authority funding and the personal contributions that come through people paying for their care, particularly in residential homes, and what happens to their estate when they die. Will that mean a bit extra from those different elements—a bit more from central Government, local Government and personal contributions—so that the total whole grows? However, the Government have said that they will introduce the Dilnot proposals in the next Parliament—that is what the Minister said to us—which will cap and reduce the contributions that may come in from people’s private estates when they die, so does that mean more money from somewhere else?

I am sorry that the Chancellor did this, because everything should be on the table, but he ruled out a different way of taxing or receiving contributions from people’s personal estates when they die: taking a percentage of everyone’s estate. Currently, people contribute their estate if they end up with dementia and go into a care home, but if they have a heart attack, they tend to contribute nothing. Is that system fair? Is that a challenge we must look at? Even with Dilnot, the £72,000 limit would take most of the estate from a small house sold when someone in my constituency dies, but it would be only a fraction of the value of a property sold in the more expensive parts of London. Is that fair either? Do we simply scrap the whole thing and go on to a German system of social insurance?

The Communities and Local Government Committee went to Germany to have a look at its model. There are pros and cons to it, but we really need to put everything on the table and not rule out any possibilities. We need something that we can, in the end, reach cross-party agreement on, recognising that the social care system will probably be different in its funding from the health system. How they can fit together and be governed together will be absolutely crucial to the success of a long-term settlement, when we eventually reach one.

[Mr Adrian Bailey (in the Chair)]

I remind Back-Bench contributors that there is a three-minute time limit. I call Anne Marie Morris.

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[Margaret Greenwood (Wirral West) (Lab)]

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate.

On 4 March, just over a week ago, a quarter of a million people marched through central London to call on the Government to stop the cuts and the privatisation of the national health service. I pay tribute to each and every one of those people who came to London to make that protest to the Government. When a quarter of a million people assemble directly outside this Parliament, the Government should think about what they are asking for. People value the NHS highly and are prepared to fight for it.

Many of the problems that we are facing in the health service have their roots in the Health and Social Care Act 2012. I hope that in any cross-party discussion, where we say that everything will be on the table, repeal of the 2012 Act will be on the table for consideration. One of the very many changes it introduced was the removal of the requirement to provide a comprehensive health service in England. As a result, we are seeing increasing rationing, and patients are suffering.

My hon. Friend the Member for York Central (Rachael Maskell) made an excellent speech in the Adjournment debate she recently secured on the rationing of surgery. As a former physiotherapist, she is very well-placed to make those points. Earlier this year, three clinical commissioning groups in the west midlands produced proposals to reduce the number of people qualifying for hip replacements by 12% and for knee replacements by 19%. Clearly, that has nothing to do with addressing patient need; it is all about balancing the books on the part of a Government with an austerity agenda that they are wedded to. Thousands of elderly people in our country are losing their sight, due to the rationing of cataract operations. That kind of rationing has a real and painful cost to many people in our society.

We are seeing the emergence of a postcode lottery. People are being told that we cannot afford a comprehensive service any more, but that needs to be challenged. Ministers will cite the ageing population and the costs of technology. Well, technology can reduce the costs of care; treating somebody sooner for a cataract operation— a relatively cheap operation—is a much more efficient way of using money than letting somebody become blind and hence terribly dependent on social care.

The coalition cut £4.6 billion from social care. The £2 billion over three years that the Government are providing is nowhere near enough. We want an injection of £2 billion now to stabilise the social care system. The public will not stand for it, and they will not forgive or forget a Tory Government who take the national health service off them. Ministers might think that they can erode it by trimming a little bit here and a little bit there—[Interruption.] But the public know what is going on. Those who have hospitals that are going to close understand what I am talking about. People will not stand for it: they will march again, and it will not be—[Interruption.]

[Mr Adrian Bailey (in the Chair)]

Order. I ask Back Benchers in sedentary positions to allow the speaker to speak. She did not interrupt their contributions, and I wish they would offer the same courtesy to her.

[Margaret Greenwood]

When 250,000 people are so unhappy about what the Government are doing and we are seeing the closure of A&Es, hospitals and all sorts of services, and the rationing of services that people really need, the Government should listen, as should Conservative Members.

[Mr Adrian Bailey (in the Chair)]

We now come to the Opposition spokespersons’ contributions. I wish the Minister to have a minimum of 10 minutes to respond to the debate, because many points have been made. I can allow the Opposition spokespersons 10 minutes each, but it would be helpful if they kept their speeches a little shorter so that Meg Hillier may respond to the Minister’s comments.