Adult Social Care

Andy Burnham Excerpts

Thursday 8th March 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I, too, congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on bringing this important debate to the House. They make an impressive and persuasive double act for this most important of causes, and are right to challenge both Front-Bench teams as this is without doubt the biggest unresolved public policy challenge facing the country. So far, between us, Parliament has failed to face up to it, and as others have said the result is a developing care crisis in England.

We must all bear our share of the responsibility for allowing that to happen, but the best response is to resolve to find lasting solutions. This century of the ageing society demands it, and the earlier we do it, the better. If we do not, to Beveridge’s five giants of the last century we might add a sixth for the 21st century: fear of old age. We cannot let that happen, and people are looking to us all to put point scoring aside and to work constructively to find a solution. In that spirit, I welcome much of what the Minister said.

I commit the Opposition to doing the same, and as a sign of our intent, the Leader of the Opposition has appointed a member of the shadow Cabinet with specific responsibility for these matters. I refer to my hon. Friend the Member for Leicester West (Liz Kendall). The House might have noticed that she is not here today. I send her apologies. [Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is absolutely right. She has a good excuse: she is in Leicester with Her Majesty the Queen at the commencement of the diamond jubilee celebrations; otherwise of course she would have been here. I hope that I am an acceptable substitute.

[The Minister of State, Department of Health (Mr Simon Burns)]

You are.

[Andy Burnham]

Thank you.

I wish to demonstrate today Labour’s commitment to this issue. The House might remember, as my hon. Friend the Member for Worsley and Eccles South said, that I made reforming social care my top priority as Health Secretary, and I did that for a very personal reason: I have never forgotten my grandmother’s dispiriting journey through England’s care system and the battles that my mum fought to preserve her dignity. The day I visited her in a nursing home near where I lived to find that her engagement ring had been wrenched off her finger and stolen was the day that I knew something was seriously amiss with how we looked after our older people.

We all have our own personal experiences, and we all know that we have to do much better. Looking after other people’s relatives, particularly the most vulnerable in our society, should be one of the most highly valued and respected callings there is, but sadly the reverse is the case. England’s care provision is too often low status and low wage, with about 70% of the work force having no qualifications and many earning at or around the national minimum wage.

With every year that passes and every year that we do not achieve a lasting and better solution to the funding of adult social care, the cruel unfairness in the system gets worse and the quality of service diminishes even further. People are paying higher charges, and the most vulnerable, as the Minister said, are losing everything. Families are being wiped out physically, emotionally and financially by the situation, carers are under intolerable pressure and councils are struggling to cope with the demographic pressures.

But there is hope. I did not think that the White Paper and cross-party talks that I led before the election achieved as much as they might, but perhaps I was wrong, because they might have prompted the Government to establish the Dilnot commission, on which we congratulate them. We also congratulate Andrew Dilnot and his commission on the intelligent way they addressed their brief and delivered a solution that politicians on all sides can work with. It provides a basis for progress, and we should take it.

Since then, we have also had the Health Select Committee’s excellent report on social care, which made a persuasive case for integration. At present, the social care debate is happening in isolation from the debate about NHS reform, which is unhelpful. We are looking at a Bill called the Health and Social Care Bill, but there is not much about social care in it. Indeed, it is slightly odd that a Bill of this name is going through Parliament, yet a social care White Paper is not due until May, as my hon. Friend the Member for Worsley and Eccles South said. It is essential that we start viewing reform of social care and the NHS as two sides of the same challenge—how to provide integrated, people-centred and preventive care in the century of the ageing society.

The Committee’s recommendation of a single commissioner for older people was an important one, and I was pleased to hear the hon. Member for Truro and Falmouth endorse it. I do, too, not least because it was precisely what I would have done had I returned to the Department of Health as Health Secretary had we secured a different result at the general election. However, I am worried that this vision, which we share, is made more difficult by the Health and Social Care Bill and the new landscape that is developing.

Those are the issues that the Government need to address in the White Paper. We are grateful for the opportunity that the Minister and the Secretary of State have extended to us to take part in cross-party talks and to influence that debate, as well as the crucial issue of how to fund the Dilnot proposals. Speaking for the Opposition, I can assure the House that we will play a constructive and responsible role in those talks. However, I would also like to take this opportunity to place three caveats on the table. First, we need to make it clear to people that although the Dilnot package is an important step forward, it is only that. It is not the whole answer to the challenges that the country faces. Its introduction would make the system fairer than it is today and would deal with the catastrophic costs of care that the most vulnerable people face. However, people would still be liable for high charges, with the vulnerable paying the most.

Secondly, there has to be a recognition from all parties in the House that progress will come only with difficult decisions and nettles being grasped. We need to have a mature discussion with the public about those difficult options, rather than using them for point-scoring purposes. What stands in the way of progress is not the complexity of the issues—they are not over-complex—but the political will to advance a difficult argument. That is what has prevented us from making more progress than we should have. To push things along and give our talks some impetus, it would help if the Government committed to introduce legislation in this Parliament to implement whatever has been agreed. That would bring a useful focus to the cross-party talks. Thirdly, we believe that there is a genuine danger that the debate might focus only on funding the Dilnot recommendations, and not on the existing pressures in the system. That must be avoided at all costs, as my hon. Friend the Member for Worsley and Eccles South said. As one care charity told me yesterday,

“We can’t have jam tomorrow if we have no bread today”.

I, too, was concerned by the comments that the Minister made before the Select Committee on Health, specifically when he said:

“We don’t accept the position that there is a gap. We have closed that gap in the spending review. On the issue of unmet need, I am yet to find any agreement among academics on a definition of unmet need.”

Many councils would struggle to reconcile that statement with the reality of what is happening on the ground. Council budgets are being cut by more than a third over the course of this Parliament, and as we know, adult social care makes up the largest part of those budgets, at around 40%.

The Prime Minister is fond of quoting me on health funding at Prime Minister’s questions, but he only ever uses the bits that suit his purpose. If I may, I would like to give the House the full version of that quotation today, because what I was warning of was the danger of taking an unbalanced approach to public spending. Before the election, the Conservatives were saying that they would give the health service real-terms increases, over and above inflation—which have not, in fact, materialised—within a much reduced overall public spending envelope. My worry was that taking such an unbalanced approach could damage other public services, including those that are intrinsically linked to the health service. What I actually said was:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting. The effect is that he is damaging, in a serious way, the ability of other public services to cope: he will visit real damage on other services that are intimately linked to the NHS,”

such as social care. I believe that this is what we are seeing right now.

[Paul Burstow]

The right hon. Gentleman made those remarks ahead of the spending review in 2010. The spending review also gave the Government the opportunity to make announcements about social care spending, and it is when we committed £7.2 billion extra for social care support. We have to challenge local authorities to use those resources wisely. Indeed, I hope that he will join me in challenging local authorities to commit to spend the resources that the Government have allocated for social care on social care.

[Andy Burnham]

Yes, I will. There is no difference between us on that, but there is a difference between us on the funding position that the Minister has set out. The King’s Fund and others have identified that there is a £1 billion funding gap in adult social care in England, not just because of the money but because of the demographic pressures, which we cannot get away from.

The Government’s commitment was to give more money to the health service, but we have produced figures showing a real-terms cut in outturn last year, and we also notice that transfers—indeed, recent transfers—have had to be made to the social care system, which implies that the Government have left it short, and that there is an emergency propping-up of the system, revealing the flaw in their position.

[Kelvin Hopkins]

To reinforce the point that my right hon. Friend makes, on a recent visit to my local hospital I was told by staff that they have more than 20 elderly patients who are perfectly well enough to live in a care home, but the care homes will not accept them and the funding cannot be found for them. Care is free in hospital, but it costs outside, so those people are forced to stay in hospital, and that places extra costs on the NHS.

[Andy Burnham]

The two systems do not work in such situations. The health service is intrinsically tied up with the social care system, and if it collapses the health service cannot discharge people from hospital. It is a false economy.

As for what is happening on the ground, the Minister commented on funding nationally, but in reality eight out of 10 councils now provide care only for those with substantial or critical needs: they are restricting their eligibility criteria. Age UK estimates that that leaves 800,000 people without any formal support, representing plenty of unmet need, and the situation also leads councils to increase charges for home care. The average cost for a disabled or older person paying for 10 hours a week of home care is now £7,015 a year. Never mind a death tax, that is a stealth tax—or a dementia tax, as people pay more and more for the costs of care while they are alive. It is not fair, it is not right, and we should do something about it.

That is why we say to the Government that we must address the question of the local government baseline alongside that of Dilnot. There cannot be a choice; we have to do both. If we do not and we fund only Dilnot, a larger number of people will pay increased charges but with a cap on what the charges might be, and that will not feel like the leap forward or the social progress that the Care and Support Alliance and others are looking for. It will not help us to drive up quality in the care system, either, but we desperately need to do so.

Councils are being forced to stretch inadequate budgets ever more thinly, and that is leading to corners being cut. I shall illustrate that directly with an example from my constituency. Several years ago, Wigan council contracted out home care services in our borough, and staff were transferred to a number of private providers, which have changed hands over the years. Just after Christmas, home care workers in Leigh came to my surgery and told me how things had broken down over the Christmas period, leaving vulnerable people, frankly, unsupported. They showed me the timesheets that they had been given by the company they were working for, and one of them included four simultaneous bookings for 12 o’clock—a point that I think my hon. Friend the Member for Worsley and Eccles South made—on different sides of town, with no travel time built in. Impossible. If we look at the whole day, we find appointments within 10 or 15 minutes of each other, which are meant to include travel time as well as time for looking after older people. That is fundamentally unacceptable.

I was told about staff working extra hours because of that situation, and then not being paid. They said that equipment such as aprons and gloves was not being provided, and that staff were funding them out of their own pockets, which again is absolutely wrong. They also raised concerns about rotas being issued only the night before, and care assistants not having keys to get in to meet the service-users they were visiting. Across the board, there were terrible problems and vulnerable people were being left without support.

Members might think that the company in question is a small, local one, but in fact it is Alpha Homecare Ltd, which is wholly owned by Carewatch Care Services Ltd, a national company with 154 offices nationwide. That is an example from Leigh, but I bet that other Members could cite similar ones.

[Lisa Nandy (Wigan) (Lab)]

I too have been visited by employees of Alpha Homecare in my neighbouring constituency. Does my right hon. Friend agree that one of the real concerns is that because those women are so dedicated to their work and often pick up work out of hours, without being paid to do so as they told me, it masks the fact that the situation is probably much worse than it appears on paper?

[Andy Burnham]

That is absolutely the point. This is not responsible capitalism; it is the worst kind of capitalism—making money by leaving vulnerable people unsupported and, as my hon. Friend says, taking advantage of the commitment and vocation of those on the front line, who will not walk away from the people they care for. It is unacceptable to not pay them and let them buy their own equipment, and to make profits off the back of that kind of behaviour.

[Sarah Newton]

I hesitate to intervene because it is important that the many Back Benchers who are here today are able to share their views. However, although none of us could support the appalling situation that the right hon. Gentleman described, he will be aware that the commissioner—the local authority—has a responsibility for the quality of the service. If he is concerned about it—I would be absolutely furious if I were the local Member of Parliament—he can take it up with the council so that the contract can be cancelled, and ultimately refer it to the Care Quality Commission.

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[Andy Burnham]

I am aware of the system for raising complaints. I have done that, and I will now be inviting the CQC to take a look at the situation. I mentioned it because it illustrates vividly the thrust of my remarks. It is not an isolated example; the quality is not there in the system.

The problem is that we are in danger of getting what we pay for, or what we do not pay for. As the pressure increases, councils are forced to make budgets go ever further, and they contract companies that do not provide the standard we are looking for. We would not accept it for our own families, and we should not accept it for any families—that is particularly so for us, with our responsibility to speak up for the most vulnerable in our society. Let us resolve in this Parliament to do something about it and to make overdue reform of the care system in England a reality.

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[Tony Baldry]

One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.

[Andy Burnham]

I agree with the hon. Member for Kingswood (Chris Skidmore), who talked about the contributory principle, because there has to be a partnership between the individual and the state. If the hon. Member for Banbury (Tony Baldry) is ruling out general taxation, which I agree with him on because it would not be fair to make the younger population pay yet another cost, does he not accept that one ultimately comes to some difficult options in raising the extra money to build a fairer care system? We all have to start being honest about that and put some difficult options on the table, so that the public can have a debate about them.

[Tony Baldry]

Of course, general taxation will continue to play a part because it will fund the national health service, including the services delivered in acute general hospitals and so forth. However, far too many elderly ladies who go into a general hospital with a stroke or a broken hip stay there for longer than they need to for their treatment and could go home. We all need to engage in a debate in our constituencies that breaks out of the secret garden and involves far more people, including elected representatives, voluntary organisations and others.

Finally, I want to talk about carers, because I do not believe that any debate on care for the elderly should take place without a discussion about carers. I am the co-chair of the all-party parliamentary group on carers, so the House would be surprised if I did not mention them. There are two things that carers want. The first is recognition, which is now becoming slightly better. We need GPs and others to help people to understand that they are carers and to ensure, wherever possible, that they apply for a carers assessment, so that we can give support to carers. That will be particularly important if we are asking people to spend more time living at home when they are suffering from dementia and other conditions.

There are simple things that can be done. One of the worries of people who care for someone with dementia is that they will wander off and get lost. Age UK in Oxfordshire is starting a new initiative that encourages people to text a number if they see Mr Smith wandering down the street. Most of us are a bit embarrassed or shy if we see a neighbour wandering off and do not think that we should apprehend him, even if we think that he might not know where he is going or that it is not in his best interests to wander off. The question is how to deal with that as a community. There are lots of complexities in these matters. The whole community has to get involved if we are going to have more people living at home.

The second thing that carers want—I have said this on occasions too numerous to particularise—is breaks. We must ensure that there is a decent system of respite care. If there is not, carers sooner or later break, and when they break, they break for ever. That means that people whom it had been possible to care for at home go into a nursing or care home, never to emerge. With judicious and supportive carers’ breaks and respite care, many carers can be supported to carry on caring for a long time. Carers need to be valued and deserve to be valued. At every opportunity, the House should say an enormous thank you to the hundreds of thousands of carers in this country.

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[Kelvin Hopkins]

I agree with the hon. Gentleman entirely. The Care Quality Commission was encouraged to have light-touch regulation and to do only occasional inspections, of which the homes were usually warned. The inspections were not adequate, and many homes fell below the standards anybody would expect. If every care home was rigorously inspected, with spot checks from time to time, we might ensure that they lived up to the standards that we expect. However, it could cost a bit more because they might have to employ more qualified staff and so on.

We should professionalise the system and ensure that it is properly regulated and checked, even if it stays in the private sector. I personally prefer public provision, with people who are motivated by what I call the public service ethos. I have seen that working and I have seen what has replaced it. People come to my surgery and complain about being forced to move out of care homes that are being closed. That is especially difficult for those with dementia. People are pressed to go into other homes, which the residents’ families often find inferior. Some are good, but not all, and people are unhappy that three care homes in my constituency have closed.

The first home closed 10 to 12 years ago and I remonstrated with the local authority officer concerned. After an hour, he finally said that it was about costs: that private care homes pay lower wages, and that the staff work longer hours and have shorter holidays. I said that at least that was honest, but it was not right.

I disagree with my right hon. Friend the Member for Leigh (Andy Burnham) about young people paying. Most taxation involves redistribution to ourselves at other stages of our lives. When we pay national insurance contributions for pensions, we are in a sense saving for ourselves later through a state system. With the health service, we pay in when we can and take out when we need. It is a redistribution to ourselves. The young paying in now for long-term care is a sensible approach, especially as it will be proportionate.

[Andy Burnham]

The young would not be paying for their own care; we would be asking them to pay for the care of people who are already at an age when they might need the care system. In a world where those old people have built up valuable housing assets but young people cannot get on the housing ladder, is it right for us to say, “Here’s another tax for you to pay—for care for older people”?

[Kelvin Hopkins]

We must start getting the system right somewhere. We can adjust taxation provision in other ways in the short term, but in the long term we must have a properly progressive taxation system to pay for adult social care. I have just been to Denmark. Many Government Members and others say that high-tax countries are weak economies, but the tax take in Denmark as a proportion of gross domestic product is 18% higher than in Britain. The Danish have free tuition at universities, and students are paid €5,000 a year to go there up to the age of 25. I am not saying that we should do that, but I am making the point that taxation at that level, provided it is fair and progressive, does not ruin economies.

It is matter of choice. I have told the story of my young children many times in the Chamber. When my son asked for a second ice cream, my wife would say, “Mummy can’t afford it.” She was saying not that we could not afford it—we could—but, “You’re not having another ice-cream.” When people talk about affordability, they are saying, “We choose not to pay.” Those who constantly campaign for a low-tax society are doing down people who are in need. We must accept that if we want to be looked after when we are in need, we must pay taxes.

When people on the doorstep ask me what my problem is, I say, “I don’t pay enough tax.” I am sure other hon. Members do not say that. My income is now more than sufficient for me to live a very comfortable life, but the income of many young people is not sufficient for them. There is nothing wrong with shifting the burden of taxation to those who are on higher incomes or those for whom most expenses are over. It is unfashionable to say such things, but I happen to believe they are right.

I mentioned the care homes in my constituency, but another issue is that of payment. Our tax gap was not so long ago estimated at £120 billion a year. If we collected just 5% of that, we could pay for free long-term care without a problem. To be fair to the Government, they are starting to wake up to the need to close that tax gap—not enough, but a bit. We have left it alone for too long, because they do not want to upset rich people who are investing in the Cayman Islands or wherever.

The Government are starting to put a little pressure on and are employing a few more tax collectors. I know from my local VAT office that every inspector collects many times their own salary, so why not employ many more to get the VAT in? People recently went to prison for a tax fraud whereby they used VAT for import and export. Such people make billions out of hon. Members and our constituents. Let us round up a few of them and stop that loophole, and ensure that people who are well off and who should pay taxes do so.

I have known Andrew Dilnot for many years—he is a civilised, highly intelligent and wholly admirable man. He did a good job in his report of trying to find the fulcrum point—the Treasury might just wear what he is proposing, but if he went further it would probably say no. There is a parallel with Adair Turner, another intelligent, civilised man. He tried to change the pension system a bit. He knew that if he pushed the Treasury too far, it would react and he would not get what he wanted. Indeed, he had a hard job persuading the previous Chancellor to accept his proposals.

The authors of those reports try to come up with recommendations that will be acceptable to the Government and the Treasury instead of coming up with what they believe to be a strong position. The problem is not the electorate, but the Government and hon. Members on both sides of the Chamber. Ministers and officials will not accept the approach I suggest for a more civilised society.

Like all hon. Members, I do a lot of public speaking. I say, “What would you choose? Would you take the risk that your family member’s house will be compulsorily sold, and all the money used to look after granny, or will you pay a tiny bit more tax over a lifetime to make sure that granny is properly looked after without being forced to sell the house?” For wealthy people, that does not matter, but it does matter for many working class people, including first-time owner-occupiers. In many cases, they have bought council houses, which I do not believe is a good idea. They have a bit of equity in their family for the first time ever and it can be used to help their children—or grandchildren usually—to stay in the owner-occupied sector, but it is being eaten away by their being forced to pay for care for elderly relatives. Indeed, owner-occupation is now falling as a proportion of housing tenure. Whatever one thinks about owner-occupation or renting, that is happening, and a factor in that might be that people are being forced to sell houses to pay for care, and the equity is in effect being lost in rich taxpayers’ pockets, because they are the ones who can get away with not paying enough to ensure that granny is looked after.

We have to accept that people are living longer. We have not found a solution yet to Alzheimer’s or dementia. I hope that we do—it will solve many problems—but while we have not, we have to ensure that elderly people are cared for, which means that we have to pay for it properly. We will all get old one day, and we all might need this care one day. Certainly, for me and my family, I want to ensure that, as and when any of us need that care, it will be there for us and provided properly in a civilised and caring way.