Oral Answers to Questions

Anne McGuire Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

I applaud the right hon. Gentleman’s work on this, and it is very important that we make it very clear to the public that all of us share the ambition to get people out of institutional care when they do not need to be there. Actually, it is not about the lack of resources. The scandal is that, as a system, we are spending a fortune on institutional care when people could very often be much better cared for in their own communities. The good thing is that Simon Stevens, the new chief executive of NHS England, has shown a personal interest in this. I have discussed it many times with him. We have asked NHS England to produce an action plan by the end of August, demonstrating exactly how it will speed up the progress of getting people out of institutional care.

[Mrs Anne McGuire (Stirling) (Lab)]

20. Promises come cheap, but results take sustained action. The fact is that a promise was made to the families of those with learning disabilities to move them out of assessment and treatment units by June 2014. What exactly is the situation now? The latest figures revealed that only 35% of that promise had been fulfilled.

[Norman Lamb]

The truth is that progress is far too slow. This has been a scandal that has dragged on for many years. It is not a new problem, and helping people who are capable of living independent lives with support in the community to get out of institutional care is long overdue. Changing the culture is complex and difficult, but we are absolutely determined to sustain the pressure to ensure that change is achieved.

Care Bill [Lords]

Anne McGuire Excerpts

Monday 16th December 2013 Commons Chamber

[Mrs Anne McGuire (Stirling) (Lab)]

For reasons that might become clear later, I am pleased to follow the hon. Member for Bradford East (Mr Ward). Before the hon. Member for Pudsey (Stuart Andrew) drifts away, let me say that his contribution helped to address some of the issues of transition, which can sometimes get lost in this debate.

We should recognise that this issue is not unique to the United Kingdom; it is a challenge that many countries face, and the hon. Member for Arfon (Hywel Williams) recognised that, even within the United Kingdom, the devolved Administrations are looking at how to develop their own social care policies in the context of their own nations.

I want to recognise, as some of my hon. Friends have done, that the Bill makes some progress, but I also want to assert our right to highlight the areas where we think it is failing. That is the justification for the reasoned amendment. We could get bogged down in parliamentary procedure here, but I think it is the right of the Opposition to highlight major issues that we think should have been addressed without undermining our support for the principle of the Bill. I hope that those who think that we are being churlish will think again. It is the right route for an Opposition. Talking about being churlish, let me put it on the record that I have rarely heard an opening statement from a Secretary of State, moving the Second Reading of one of his flagship Bills, that was so churlish, so partisan and, frankly, so disagreeable.

For understandable reasons, the debate on social care often focuses on older people, yet as we have heard—from the right hon. Member for Sutton and Cheam (Paul Burstow) as well as from the hon. Member for Bradford East—a third of those who receive social care are actually working age disabled people. We sometimes overlook their needs, rights and aspirations within the wider debate. Too often “social care” and “elderly” go together, and we need to get ourselves out of that mindset, because although they look the same, I think we would all agree that a younger person’s need for support can be quite different from the support needs of those who are older. The emphasis on older people means that the terms of the debate are often not as relevant as they might be to younger people who require social care. They often want to combine that social care with a life that includes work, education and so forth, and they potentially have a different pace and pattern of life from that of older people.

It was to highlight these issues that the all-party groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler) as chair of the all-party group on local government, and Baroness Campbell of Surbiton and myself as joint chairs of the all-party group on disability, were delighted when 10 parliamentarians of all parties from both Houses agreed to undertake an independent inquiry. The hon. Member for Bradford East was involved in that.

That report was lodged earlier this year and I trust that the Minister and my own Front-Bench colleagues have had the opportunity to consider its recommendations. What came out from all the evidence from disabled people, organisations and professionals was that the current system is not delivering on basic things such as washing, dressing and getting out of the house for many younger disabled people. If social care is to mean anything to the lives of the disabled working adult, it should be underpinned by a real recognition of the importance of an independent life. So the criteria of what is important should also include how the care dovetails into other important elements of daily life such as participation in work or education.

I acknowledge that in clause 1 the Government have recognised that promoting individual well-being is not just about care. They also recognise that it is about

“participation in work, education, training or recreation”

and

“social and economic well-being”

and

“domestic, family and personal relationships”.

However, those ambitions will not be realised unless the issue of eligibility is properly recognised and the substantial anticipated savings highlighted in clause 2 creating a preventive care system will not happen either. I fear that the national eligibility threshold in the Bill is currently set too high. In Committee in the other place, that was recognised by peers from all parties and none. It will shut out 105,000 disabled people from social care and prevent them from living independent lives with dignity.

Councils are now moving at a rate of knots towards providing social care only to those with critical or substantial needs. We cannot divorce what is happening in social care from some of the other changes the Government are introducing. We are moving towards substantial care in terms of social needs and we are withdrawing disability living allowance from people with less complex needs. We are perhaps moving to a situation where those with severe and complex needs will be taken care of and supported while those with fewer needs will not be, so there will be a double-whammy in terms of social care and the DLA transfer.

I recognise that the Government have transferred some £2 billion from the NHS into social care and into making the transition easier, but this cannot be seen outwith the context of a 33% cut in local councils’ budgets by 2014 and the chronic long-term underfunding of the social care system. Over the past three years, £2.68 billion has been cut from adult social care budgets, which is 20% of net spending, but the number of working-age disabled people needing care is projected to rise by 9.2% and the number of older people needing care will rise by 21% between 2010 and 2020.

[Sheila Gilmore]

On my right hon. Friend’s list of changes affecting people needing care, does she agree there is also the issue of the independent living fund which has helped working-age people? The Government have lost a court case in respect of their failure to consult properly on that. Does my hon. Friend agree that that should be looked at carefully?

[Mrs McGuire]

I agree with my hon. Friend and I raised that with the Minister in a Westminster Hall debate. The Care Bill does not address the role that the Department for Work and Pensions plays in supporting social care through the benefit system and the independent living fund is a classic example of that. At present, people who can pay for social care through access to the ILF do not know quite what is happening, because the Minister—as I think he said last week at the all-party group—is still considering his options.

I want to echo a comment by the hon. Member for Bradford East—I can assure him that he will not get so many mentions in any of my speeches again. He pointed to something that I think is often missed, which is that the debate often crystallises around the spend, which is not seen as an investment. I acknowledge the work done by Scope, and carried out by Deloitte, highlighting that for every £1 invested in care for disabled people with moderate needs a saving of £1.30 is generated. The figures are pretty staggering. There would be a £700 million saving to central Government through an increase in tax revenue and a reduction in welfare spending. This Government always tell us that they want to reduce welfare spending; well, there are opportunities to do so without doing some of the things that they are doing. There would be a £570 million saving to the NHS and local government, and £480 million would be saved by local government by avoiding the need for disabled people to enter expensive residential and crisis care.

The Minister knows that there is considerable political and organisational support for a lower eligibility threshold. The draft Care and Support Bill pre-legislative scrutiny Committee recommended that, when setting the national eligibility threshold, the Secretary of State should have regard to the duty of local authorities to promote individual well-being. The report of the joint inquiry I have mentioned also highlighted the issue of eligibility.

We in this House often talk as though we are somehow divorced from the beneficiaries of the legislation we pass, but I say to Members that we are talking about ourselves here. Any one of us could walk out of this Chamber tonight and be in need of social care tomorrow. If we want a good social care system, we should ask ourselves this question: what would we want for ourselves if we had a stroke or a car accident or fell down those marvellous marble stairs outside and cracked our head? That is the criteria that we should be using. This Bill makes small progress, but there is a lot more to be done.

Social Care Reform (Disabled People)

Anne McGuire Excerpts

Thursday 11th July 2013 Westminster Hall

[Mrs Anne McGuire (Stirling) (Lab)]

It is a genuine pleasure to serve under your chairmanship this afternoon, Ms Clark. I also want to congratulate the hon. Member for Bradford East (Mr Ward) and the hon. Member for South Derbyshire (Heather Wheeler) on promoting this afternoon’s debate. Protocol would not allow me to join them in sponsoring the debate, but I am delighted to be able to participate by making a short contribution.

For the record, I also want to identify colleagues from both Houses of Parliament who took part in what was a groundbreaking inquiry in terms of our Parliament. It was cross-party and cross-House, so I want to recognise the contributions of my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), Baroness Eaton of Cottingley, the hon. Member for Meon Valley (George Hollingbery), Baron Low of Dalston, the hon. Member for Truro and Falmouth (Sarah Newton), Baron Tope of Sutton, the hon. Member for Broxbourne (Mr Walker), and the hon. Member for Bradford East, who gave up their time to participate. I also want to thank the all-party parliamentary local government group, under the admirable chairmanship of the hon. Member for South Derbyshire, for joining with the all-party parliamentary disability group in promoting the inquiry.

It is also worth nothing that a distinguished group of people presented evidence to us, both as individuals—people who came from a variety of backgrounds—and as organisations, including the Joseph Rowntree Foundation, Sense, the Royal National Institute of Blind People, the NHS Confederation, Inclusion London, Mencap, Mind, the National Autistic Society, and the president of the Association of Directors of Social Work. I hope that the Minister and my hon. Friend the Member for Leicester West (Liz Kendall), the Opposition spokesperson, will recognise that the evidence brought together a significant spectrum of expertise from organisations, but more importantly, that it brought to the inquiry the particular experiences of disabled people themselves. It was not only about talking to the organisations that are out there, either representing or delivering services for disabled people; it was also about listening to disabled people. To echo the comments made by the hon. Member for South Derbyshire, I would like to thank Scope most sincerely, not only for servicing the inquiry, but for going beyond the bounds of what was expected to ensure that it happened—and happened professionally—and that our publication is both professional and challenging. I want to place that on record.

Disability can happen to anyone at any time. We could have an undiagnosed condition, a car accident, or we could develop a progressive illness. Last week, I attended a reception in the House of Lords for the management of bowel problems. I met a young man who became disabled in his early 20s when a rugby scrum collapsed on him. He never thought, in his wildest dreams, that he would be disabled in his 20s. He loved and played rugby, and one day, an accident happened. I hope that that would be the context in which we can discuss some of the issues that both my colleagues have identified today, because my benchmark for social care is what we would want to happen if it were us. If we start from that premise, we can build a picture of what we think should be the exemplar in terms of social care.

I want to identify why the inquiry took place, and why now. There is a momentum with the Care Bill, with both political parties—perhaps, in this company, I should say three political parties—coming together to recognise the importance of social care. As the hon. Members for Bradford East and for South Derbyshire highlighted, a third of those who rely on social care are, in fact, working-age adults. Sometimes, there is a great frustration among the disability community that working-age adults are not mentioned. We talk about care of older people—indeed, sometimes we use care of “the elderly”, which I think is somewhat disparaging, as we are talking about “older people”. That is only my particular pedantry, I suppose. However, working-age adults sometimes get forgotten, and I certainly welcome the focus that we are giving those younger people today.

As both my colleagues have identified, care cannot only be about basic survival. There is more to life than getting up, eating and drinking, getting into your pyjamas and then going to bed. Frankly, although the Minister mentioned Torbay, that, sadly, is exactly what social care means for many people around the country. For disabled people who want to live fulfilling lives, care is a facilitator for independent living, fairness and respect. It is an enabler to a social and family life and, thankfully, for an increasing number of disabled people, to participating in their own way in the wider life of their community through employment.

Frankly, social care for working-age adults cannot only be about fitting them into a pre-ordained system, nor can it be about a template that is pulled down, and then someone’s name is slotted into it. It is about ensuring that the individual disabled person has real independence, choice and control. Sometimes we talk glibly about independence, choice and control, without thinking about exactly what they mean; they can be different things for different people. There is no point in having someone come in to help a person dress at 11 o’ clock, when they need to get to their work at 10 o’clock. What is the point of that? That does not allow them to live a fulfilling life, and there is little dignity and respect in getting that person into their pyjamas at 6 o’clock when they might want to go out to the cinema, to visit their friends, or, indeed, to have their friends round to visit. Let us just imagine what that must be like. Their family, friends or neighbours are there, and the person is sitting there in their jimjams. That is not what we should mean by social care, but sadly it is what is happening in many parts of the country.

In addition, as the hon. Member for South Derbyshire highlighted, social care should not just be another arm of the emergency services. It should not be a response to a crisis. That is where some of the difficulties in terms of preventive measures come in, but I want to make two or three points to echo some of the recommendations in the report.

First, I think that the current Government, like previous Governments, believe in principle in the right to independent living. We believe, I hope, as a Parliament, in breaking down barriers for disabled people and breaking down some of the Government silos that create those barriers. Disabled people do not live their lives according to the Department for Transport, the Department of Health, the Department for Work and Pensions—we can add on whichever number of Departments we want. That is not how people live their lives and it certainly is not how disabled people live their lives, so it is important that we do not just talk about independent living, but look at how it can be delivered.

Both my colleagues identified the important issue of the portability of care, and I cannot emphasise enough how important that is to disabled adults of working age. I ask the Minister to think about this issue. Let us consider the case of a disabled person in the borough of Lambeth who has to move to Westminster but finds that they cannot take their care package—their support—with them. That is echoed across the country. If it is difficult within one city, just think how much more difficult it is if someone happens to live in Carlisle and wants to go and live in Bradford. Let us just think of the challenges that that poses for an individual disabled adult.

However, it is not just individual disabled adults who are affected. Let us consider the case of people who are the parents of a disabled child. The mum or dad gets a new job and moves from Bradford down to Birmingham. The disabled child has some sort of support mechanism. This starts in childhood and can develop into adulthood. I appreciate that we are talking specifically about working-age adults, but I think that we must recognise that the picture is even bigger than the focus that we have today. In many cases, this is an issue from the cradle to the grave.

[Norman Lamb]

I agree with the case that the right hon. Lady is making, but I want to ask her this. Presumably she is pleased that the Care Bill introduces the capacity to move from one part of the country to another without the care package collapsing and that it stays in place until the person has been reassessed in their new area. It may be that someone’s needs change if they are closer to a loved one, their home is different or whatever, but the care package stays in place until the reassessment happens.

--- Later in debate ---

[Mrs McGuire]

Of course I welcome that. I think that the big challenge for the Minister, the Government and, indeed, any future Government that I hope will be there within 18 months or so is how that is delivered—how we break down those barriers. Although I can obviously speak about the silos within the UK Government, at Whitehall level, we must be realistic and recognise that there are tensions even between one local authority and another. The issue is how that policy is delivered, but of course I give the Minister due recognition for that comment.

I want to emphasise the issue of the eligibility threshold. I heard what the Minister said about that, but if the threshold is at the “substantial” level, many people will not qualify. I accept what he said—no one will lose out on what they have now, so if someone gets it at the “moderate” level, which I understand is the situation in Bradford, they will not lose out. But in the event that the provision is limited to those whose needs are at the “substantial” level, many people will still require that additional element of support, which would allow them to live independent lives.

[Mr Ward]

The point was made by the Minister that no one will lose out. As I pointed out in my speech, 90,000 people have already lost out. They may be being told that they will not lose any more, but they have nothing more to lose, because they have already lost it. That is the big concern. We already have this level in 84% of authorities, which means that people have lost the provision; it has gone from them for ever.

[Mrs McGuire]

I hope that the Minister has heard his hon. Friend’s comments.

The report clearly identifies the issue of preventive care. That issue has bedevilled the health service, probably ever since it was established. People think of the health service and the social care service as providing solutions at the point at which they need them, as opposed to being innovative and looking at how some of those situations can be prevented from arising. As the hon. Member for South Derbyshire said, there is a saving in the long term if we get that right.

It is perfectly true that many disabled people who fall out of the system have to re-enter it and probably at a higher level of support and therefore expense. Of course, the crucial element in all this is that closer integration of budgets is needed to ensure that “health and social care” actually means health and social care. I do not think that any of us can run away from the issue of financial austerity. It is about getting the best value for money and recognising the funding gap, but I hope that we can reach agreement across the political spectrum about how we deliver this. I would hope that hon. Members in this Chamber would share many of the frustrations that certainly we had in the last Parliament about the fact that we could not reach cross-party consensus on funding.

I want to address a couple of remarks to the Minister. One has to do with a gap in the Care Bill. There is no mention of the role of the DWP in any of this, yet the DWP holds the purse strings, in some respects, for many individual disabled people. Some of us were quite surprised in the debate yesterday in the main Chamber when we discovered that the Minister leading the debate on behalf of the Government, the Minister of State, Department for Work and Pensions, the hon. Member for Fareham (Mr Hoban), said that he had not read the Care Bill. That was quite a shock. We do not know whether his officials had read it, but there is a strong element that I think must be taken into account. I am referring to the role that the DWP can play in this. I would be interested if this Minister had any comments on what he believes will be the impact of the closure of the independent living fund in terms of the wider area of health and social care.

I want to finish my speech by offering very special thanks to Baroness Campbell—Jane Campbell. One of the idiosyncrasies of this place is that although we can share agendas with our colleagues in the House of Lords, we cannot share with them, even in the slightly less formal environment of Westminster Hall, some of the discussion and debates. Baroness Campbell was a pioneer of independent living and a driving force behind this agenda for many years. She has her own piece of legislation, a private Member’s Bill, and I understand that much of what was in that private Member’s Bill has probably been taken on board by the Government. Individuals such as Baroness Campbell, who depended themselves on the health and social care system, were not prepared to let that system drive them down. She has been a powerful advocate for this agenda over many years. I wanted to pay a particular and special tribute to her this afternoon as we have the opportunity to discuss the report.

--- Later in debate ---

[Norman Lamb]

Well, it is. To bring health care and social care together structurally would be a massive re-organisation, and there is no way of avoiding that. The smart way is to focus on the care that an individual receives. The issue is not just about bringing health and social care together and integrating those two systems but about the health service itself and the fact that, institutionally, we have separated mental health from physical health and primary care from secondary care, which is crazy. The whole thing is fragmented, but we should shape services around the needs of patients. The Government’s approach, based on the duties to integrate in the Health and Social Care Act, is the smart, fast way of achieving much more joined-up care for the patient, whether individuals are elderly or of working age. I want to make some progress with my speech.

The Government are committed to improving the lives of disabled people and to supporting them in their independent lives. In very difficult financial circumstances, we have done much to achieve that through the disability strategy, welfare reform—it is incredibly controversial, but any Government would have to pay attention to the extraordinary growth in welfare spending—and a whole raft of condition-specific initiatives.

One outstanding issue still needs to be addressed—social care reform. The importance of care and support for disabled adults cannot be understated: it is the enabler of independent living. We hear much about the ageing population as the driver for care reform, but a third of all health and care users are working-age disabled people, so it is vital that the social care reforms address their needs. The fact that my hon. Friend the Member for Bradford East and his colleagues have secured this debate is valuable because it ensures that we focus on the needs of working-age disabled people. I repeat that there is a risk of their being forgotten, which must not happen.

Earlier this year, I read with interest the “Promoting Independence, Preventing Crisis” report into making social care reform work for disabled adults. It was a joint inquiry by the all-party groups on local government and on disability. I congratulate them on an important piece of work, and I will attempt to address some of the points raised in a moment. I first want to talk about some of the things we have done.

We know that disabled people face a number of challenges. They are far less likely to be in employment than non-disabled people. In fact, shockingly, only 46% of disabled people are in employment compared with 76% of their non-disabled counterparts. Some 19% of individuals living in a family with a disabled member are in income poverty, although I am pleased to say that that has been falling over time. Progress is being made, but much more needs to be done.

The first thing to say about all the Government’s reforms is that we are committed to the UN convention on the rights of disabled people, which includes the right of disabled people to independent living. The Department of Health has been working closely with the Office for Disability Issues on the new cross-Government disability strategy, “Fulfilling Potential”, which was published last September. It is about making the UN convention a living reality for disabled people in Britain. It describes the rights that disabled people—just like anyone else—have in all areas of life, and the duty on Government to ensure that those rights are met.

The shadow Minister made a point about co-ordination with the DWP. There is scope for much more joined-up working at a local level to bring disparate public services together and to achieve far more bang for our buck than we presently manage.

[Mrs McGuire]

Will the Minister give way?

[Norman Lamb]

I am conscious of time, but I will briefly give way.

[Mrs McGuire]

I do not wish to embarrass them, but I suggest that both the Minister and his officials look at the disability strategy report based on the “Fulfilling Potential” report that he mentioned. That update was published last week. I think the jury is out on what it says, but in the interests of joined-up government, he should have the most up-to-date picture.

[Norman Lamb]

I am grateful to the right hon. Lady for that intervention. What remarkable timing she shows. On 2 July, the follow-up document, “Fulfilling potential: making it happen” was published, which sets out the indicators that will show where we are making progress and where more work needs to be done.

In my Department, we have been working to ensure that we can hold the new health system to account for the quality of services and outcomes that they provide to disabled people. The NHS outcomes framework includes a number of measures that relate specifically to disability, including, critically from my point of view, mental health, which is an area that is sometimes forgotten. Talking about an outcomes framework sounds like horrible jargon, but it is actually about focusing on results for people—the impact on people of what we spend. If we can measure that and then measure the changes that happen over time, we can focus the whole system’s attention on the need to achieve outcomes for people rather than on process. Essentially, we will expect to see a reduction in premature death among people with a learning disability and people with serious mental illness. It is a scandal in this day and age that such people die so much younger than others. We will also expect to see an enhanced quality of life for people with mental illness and an improvement in their experience of health care.

This matter is not just about the NHS. We will also be holding to account the adult care and support system through the adult social care outcomes framework for ensuring that

“people are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation”.

We will be measuring that through the proportion of adults with a learning disability who are in contact with secondary mental health services, who are in paid employment and who live in their own home or with their family.

We have responded robustly to the challenges posed by the really dreadful events at Winterbourne View hospital and to the way in which people with learning disabilities, autism and behaviours described as challenging are viewed and treated. All too often, society has treated them as second-class citizens. I take a simple view that people with learning disabilities have exactly the same rights as anyone else, and we have to ensure that the whole system respects that basic position. By April 2014, every area will have a joint plan to ensure high-quality care and support services for this group of people in line with best practice. By June next year, everyone inappropriately in hospital will have moved to community-based support.

We are reviewing the national autism strategy to assess how it is addressing the barriers that people with autism face, and how care and support services are responding to their needs. However, that is not something that the care and support system can do on its own. As a Government, we are also aiming to make the benefit system fairer, more responsive and more affordable to help reduce poverty, worklessness and welfare dependency, and to reduce levels of fraud and error. For many, that will include support to work, which is the best route out of poverty and is very often beneficial for those with long-term health conditions. It is worth reiterating that severely disabled people who need support will always get it, and we will provide unequivocal support for those who cannot work.

I mentioned care reform. Many people have told us that today’s care and support system often fails to live up to the expectations of those who rely on it. Although many have good experiences, the system can be confusing, massively disempowering, paternalistic and not flexible enough to fit around their lives.

Our White Paper, “Caring for our future”, which was published last year set out a vision for a reformed care and support system. Yes, it was based on the Law Commission report, but it was implemented, I am proud to say, by this coalition Government. We need a modern system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives to pursue opportunities, including education and employment, to realise their potential.

The Care Bill, which we introduced in Parliament in May, is a crucial step in delivering that vision. It represents the most comprehensive reform of social care legislation in more than 60 years, creating for the first time a single, modern statute for adult care and support. The existing law that underpins care and support is outdated and confusing. It is rooted in the post-war period and must be overhauled, as the Law Commission concluded after its three-year review. Our new statute will be clearer, fairer, and will empower people to take control over their care and support. It has been done in the most collaborative way, with pre-legislative scrutiny and widespread consultation with the sector and the wider community.

The current legal framework is narrow and paternalistic; it is built around the idea of providing state-defined services, rather than of meeting and responding to the needs and goals of individuals. The other day, my hon. Friend the Member for Bradford East talked very movingly about the brilliant community work on dementia care that is under way in Bradford. That is where we see this collaboration between ordinary people who are good citizens and who care for one another and the supportive role that the state always has to play to back that up. The Care Bill will help to shift the focus of care and support from paternalism to a much more personal approach. It will place personal budgets on a legislative footing for the first time. I agree with the shadow Minister about the importance of personal budgets being real; they must empower people and not mask a cut in support or provision.

We want to extend the greater roll-out of personal budgets to give people who are assessed as needing care and support more choice and control over how their care is provided. Where personalisation has taken root it works—people get better results and it is popular with users and carers. That is particularly true for working-age adults; take-up is relatively high compared with that among older people. This great reform came about through working-age disabled people demanding that they have more control over their lives, and local government responding to them.

The current law fails to reflect the importance of supporting people in caring roles. The Bill, for the first time, puts carers on the same legal footing as those for whom they care, with expanded rights to assessment and new rights to support.

The Care Bill also implements historic reforms to the way in which the care system is funded, by introducing a cap on the care costs that people incur. Of course, as I said in an intervention on the shadow Minister, people can choose to spend more than that if they wish, but if we were to do what I think she was implying it would mean giving enormous financial support to wealthier people, which cannot be justified in times of real financial constraints.

The current care and support system offers little financial protection for the cost of care. As the Commission on the Funding of Care and Support said, because care needs are unpredictable, individuals and families are unable to know what care costs they might face in the future. We recognise that some working-age adults may face having to pay for care earlier than most elderly people do, so we have therefore said in our funding reform proposals that people who need care before they reach retirement age will pay less. In addition, the changes we are proposing will mean that people who are assessed as having care needs before they turn 18 will have their cap set at zero. We will be consulting on those changes very shortly.

We have made it clear from the consultation and publication of the White Paper through to the publication of the Care Bill that the same principles apply to all who need care and support. That applies equally to an adult with a physical disability, someone with a learning disability, an adult with mental health issues or an elderly person needing care. I know that my hon. Friend the Member for Bradford East is particularly concerned about eligibility criteria. We have published draft regulations setting out national eligibility criteria for discussion. They are set at a level that will allow local authorities to maintain the same level of services for service users when they move from the current framework.

Let me end by saying that I would prefer to have a more sophisticated system. Work is under way on developing that. I invite Scope to participate in that and work with the Government to achieve a much more rational system in which we can intervene earlier, provide some support and help to build capacity and resilience so that people get help when they need it rather than when they reach a crisis.

Health and Social Care

Anne McGuire Excerpts

Monday 13th May 2013 Commons Chamber

[Mrs Anne McGuire (Stirling) (Lab)]

It is a pleasure to speak in this debate and to follow the hon. Member for Aldershot (Sir Gerald Howarth), although obviously I would not necessarily agree with all his comments.

I was not going to say anything about immigration, but sometimes we need to look to ourselves when we talk about that subject. I suspect that there is not one individual here who has not had at one point in their background an immigrant who came to the United Kingdom. Those who talk about the “native British” need to reflect on the fact that Britain has always had immigrants—from the Vikings to the Huguenots and from the Dutch to the Irish. My father told me that our family were descended from members of the Spanish armada who were shipwrecked off the north coast of Ireland when they were trying to avoid the English fleet. We need to reflect and have a rational debate about immigration, not the hysteria that there sometimes is in this House.

[Mrs Moon]

Will my right hon. Friend give way?

[Mrs McGuire]

Very quickly, because I want to get on to the main substance of my speech.

[Mrs Moon]

Should we not get some of the figures clear in our heads? According to the Department of Health website, the actual cost to the NHS budget of the amount spent on foreign nationals is a mere 0.06%. This is not something that we cannot afford.

[Mrs McGuire]

As I have said, I do not want to go down that track but, having been nursed in a UK hospital by non-indigenous British staff, I think we ought to be more balanced in our comments on immigration.

The main focus of this debate—health and social care—is a vital issue for many people; even if they do not think so at present, it certainly will be in the future. As we are all aware, the changing demography and advances in modern medicine and technology have thrown up challenges to our society in how to develop the capacity for social care and, indeed, how to pay for it. The issue is not unique to the United Kingdom; it is a challenge in many countries across the world. As has already been said, the Administrations in Wales and Scotland are developing their own policies in the realm of social care.

Although the legislation under discussion relates to England specifically, I want to discuss some general issues that cut across the debate in the whole of the UK. Like my colleagues on the Opposition Front Bench, I welcome some aspects of the Care Bill, which builds on the work undertaken by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, when he was in government. I hope that the Bill will simplify the existing regulations, provide some confidence that lifetime assets will not be swept away by care costs, and—I stress that I hope that this will happen—eradicate the postcode lottery of care, introducing an element of consistency to the system. The Bill should also give stronger legal rights to carers—I echo the words of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—who are often the forgotten players when we debate social care.

Having said that, there are still some major areas of concern and I want to concentrate on them. Frankly, they throw up challenges for everyone in this House, regardless of which political party we belong to. I am not convinced that the Government have thought through where young carers fit into the big picture painted by the new Bill. It is, of course, a welcome development that, for the first time, councils will have to meet the eligible needs of carers for support. I also welcome the aim for a family assessment, which in some areas should pick up the pressures on young carers.

Many organisations representing young carers, however, feel that many concerns have not been covered adequately. The well-being of young carers very much depends on the level of support that the person they care for—more often than not their parent—receives. If that support is not adequate, an unacceptable pressure remains on young people who should, to be frank, be doing other things. Council budgets are being stretched and care and support is being restricted in many instances to those who have critical or severe needs, so an unacceptable burden is still being placed on young carers who support family needs but who will not meet the new exacting standards.

I do not want to reiterate some of the points that other hon. Members have made about the need to move from the current random method of identifying young carers to a more systematic approach. I want to spend a few moments on the issue of working-age people who need support from our social services. Too often the debate on social care concentrates on older people, but it should not focus on them alone, because the reality is that about a third of people who rely on support are of working age and they are often forgotten. I am sure we will all agree that a younger person’s need for support from the care system is not necessarily the same as that of an older person. To that end, the all-party parliamentary groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler), as chair of the local government all-party parliamentary group, and Baroness Campbell of Surbiton and myself, as joint chairs of the disability all-pary paliamentary group, were delighted that 10 parliamentarians of all parties and from the Cross Benches in the Lords agreed to undertake an independent inquiry.

The report will be launched officially on Wednesday, so I will not pre-empt its findings. I hope that colleagues will take time out of their schedules to come along and hear what the disabled people, organisations and experts that appeared before the inquiry committee said. The evidence is powerful and I hope that people will read it. When we debate health and social care over the next few weeks, I hope that we will listen to the voices of the people who matter: the people on the receiving end of the system. What they say gives us food for thought and food for action.

It is well documented that more than a third of the people who receive social care are of working age. We must also recognise that most of the pressure and innovation will be at a local level. It is important that we encourage local organisations and local government to ensure that there is innovation in the system. As my right hon. Friend the Member for Leigh said in his opening remarks, there is a funding crisis in local government that no amount of innovation can mitigate. There is only so much innovation that any system can support without the recognition of financial instability. It is not just Labour councils that are saying that to the Government; councils of all political persuasions are trying to persuade the Government that they cannot continue to support the pressure that is being placed on their social services.

Finally, we have spoken a lot about the cap and the protection of assets. The Government have not been clear about what will happen to people who do not have the capacity to build up assets, and I am talking about working-age adults who are disabled who have not had that opportunity. The overwhelming majority of people with learning disabilities will not be affected by a cap because they do not have an asset base to protect.

I hope that there will be a robust, challenging and honest debate about the future of social care.

Winterbourne View

Anne McGuire Excerpts

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question. He is absolutely right that an extraordinarily high sum was being paid to put people at risk of abuse —and to be abused, as it turned out in Winterbourne View. Pay rates are not ultimately the responsibility of Government, but one would hope that responsible organisations look to train their staff to a high standard—that is absolutely a prerequisite and they will be held to account by the Care Quality Commission for proper training—and, wherever possible, to provide better pay rates so as to ensure that people are rewarded for the incredibly important work in our care sector.

[Mrs Anne McGuire (Stirling) (Lab)]

Before I became an MP, I worked with parents of learning disabled adults to establish supported community care homes, as those parents would have done anything rather than allow their adult children to go into institutional care. I welcome the Minister’s comments today. There is an emphasis on process, which is important, but does he agree that there is a challenge in the wider cultural sense? As long as we do not give those with learning disabilities the respect to which they are entitled as equal members of society, we almost create an environment in which people think they can with impunity do the sort of things they did in Winterbourne. Will the Minister work with the Minister for Disabled People, the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey) and look at how we can challenge those attitudes, which are sadly still around in the 21st century?

[Norman Lamb]

I thank the right hon. Lady for that. She is absolutely right in what she says about institutional care. I keep mentioning Tower Hamlets, as it was rather inspirational to visit and see how things are done there. I was told that Tower Hamlets has one of the lowest rates of children going into care because of the support for families that it provides, preventing that from ever being necessary.

As for the right hon. Lady’s second point, she is absolutely right: this is moment that demands a change of culture, not just in the health and care system but in society as a whole. There must be a change in all our attitudes. We will make progress only if we understand the fundamental point that someone with learning disabilities has exactly the same rights as anyone else, and should be treated with dignity and respect.