Care Bill [Lords]

Baroness Keeley Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

I am delighted to do so, Mr Speaker, and I know that you would think it was legitimate of me to hold the Labour party to account for its decision if it is voting against today’s Bill or declining to support it, as its amendment clearly states.

However, today is a day to rise above party political considerations, as Mr Speaker has just said, and recognise that putting these things right is overwhelmingly in the interests of patients. If the Labour party continues its stubborn refusal to support legislative underpinning for a new chief inspector of hospitals, which is in today’s Bill, how will it ever be able to look patients in the eye again? Perhaps the most shocking thing about Mid Staffs, which is one of the reasons we have so many provisions in the Bill, was not just the individual lapses in care but the fact that they went on for four long years without anything being done about them.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

When problems are uncovered, action must be swift. Robert Francis cited confusion over which part of the regulatory system is responsible for dealing with failing hospitals, so this Bill makes it clear where the buck stops. It is the CQC’s job to identify problems and instigate a new failure regime when it does so. Monitor and the Trust Development Authority will then be able to use powers to intervene in those hospitals, suspending foundation trusts’ freedoms where necessary to ensure that appropriate action is taken. If, after a limited period, a trust has failed significantly to improve, the Bill requires a decision to be taken on whether the trust needs to be put into special administration on quality grounds—and, yes, where necessary, a trust special administrator will be able to look beyond the boundaries of the trust and consider the wider health economy. As we know from Lewisham, that is not easy, but we will betray patients if we do not address failure wherever it happens.

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[Mr Hunt]

As the hon. Gentleman knows, we considered that matter carefully. We decided that the best way forward is to strengthen the professional duty of candour on individual doctors and nurses through their professional codes. After extensive consultation, which was supported by the medical profession, including the British Medical Association, we decided that that was a better way of ensuring that we had the right outcomes and did not create a legalistic culture that could lead to defensive medicine, which would not be in patients’ interests.

If supporting the Francis measures in the Bill is too awkward or embarrassing for Labour Members, can they not see the merits in the parts of the Bill that deal with out-of-hospital care? I am talking about not just vulnerable older people, but carers, for whom we need to do more. We need to do much more to remove the worry that people have about being forced to sell their own home to pay for their care.

[Barbara Keeley]

rose—

[Mr Hunt]

I want to make some progress.

At Committee stage, we intend to table amendments to enable the creation of a £3.8 billion better care fund in 2015-16. That represents the first significant step any Government have ever taken to integrate the health and social care systems.

[Hazel Blears (Salford and Eccles) (Lab)]

rose—

[Barbara Keeley]

rose—

[Mr Hunt]

I will give way in a moment, but let me make some progress first.

I commend the right hon. Member for Leigh (Andy Burnham) for championing integration, although he chose not to do anything about it when he was in office. How, then, when a Government take steps to do that for the first time, can he possibly justify not supporting it?

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[Julie Hilling (Bolton West) (Lab)]

rose—

[Barbara Keeley]

rose—

[Mr Hunt]

I am going to make some progress.

Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.

The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.

We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.

We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.

We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.

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[Andy Burnham]

I was about to explain that those charges are increasing quite quickly, but first I will give way to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has done so much to raise these issues.

[Barbara Keeley]

I thank my right hon. Friend for giving way and I am surprised and disappointed that the Secretary of State would not give way.

My local council, Salford local authority, is one of the many that are reluctantly having to cut their eligibility criteria this year. Salford tried to stick with the moderate level and this is the third year of cuts. The council has lost £100 million over the past three years and it will lose another £75 million before the Bill’s reforms are implemented. That is a 20% cut in adult social care. How can any of the Health Ministers, whose southern local authorities are not affected in the same way, think that our northern councils can afford this?

[Andy Burnham]

Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.

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[Andy Burnham]

I say again, with all respect to the Chair of the Health Committee, that I was proposing a fundamentally different scheme to that in the Bill. I was proposing a universal all-in scheme, and several steps were put forward to get us to that. The right hon. Gentleman knows that because the Conservative party and those on the Government Front Bench put posters up about that scheme before the last election. Does he remember that? [Interruption.] He nods, right—that was my proposal, but it is not the Government’s proposal, which is different. I proposed various steps to get to my scheme. Is it about time the Government started answering for their proposal, rather than for mine?

[Barbara Keeley]

My right hon. Friend is being generous in giving way, and I guess we ought to move on shortly. There is all this harking back to our policies, but I understand—I was here—that steps were taken towards Labour’s national care service, including the Personal Care at Home Act 2010 that would have helped 400,000 people, not the 100,000 who will be helped by this Bill—if, indeed, it ends up being 100,000. Is my right hon. Friend, like everybody else, totally disappointed with the Government’s lack of ambition to help people?

[Andy Burnham]

I completely agree, and it is unfair that older people have not been given a full picture. People need proper information to plan for the future, and they have not been getting that today. People need the facts. Spin is of absolutely no use to them whatsoever, but that is all that is on offer from this Secretary of State. The truth is that in the end, the Bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes. It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Care Bill already seems like a wasted opportunity. I worked for four months, alongside right hon. and hon. Members of this House and Members of the other place, on the Joint Committee that scrutinised the draft Care and Support Bill, and I pay tribute to its members for their work. We now have a Bill that contains some measures that are welcome but others that are seriously flawed.

I will talk first about the burdens the Bill places on local authorities and argue that they must be resourced by the Government. Some people—Ministers or Government Members whose southern local authorities are not being cut in the same way that ours are, for instance—might think that perhaps times are okay, but there could not be a worse time to place extra financial burdens on local authorities. Indeed, the situation for my local authority, Salford city council, will be even bleaker in 2016, the planned date for implementation of the Bill’s reforms. As I said earlier, Salford has already lost £100 million in funding since 2010, and it knows that it will lose another £75 million by 2016. I hope that the Minister is listening—he does not seem to be—because funding for adult social care in Salford has fallen by 20%, from £67 million in 2010 to £53 million this year.

[Robert Flello (Stoke-on-Trent South) (Lab)]

My hon. Friend has already alluded to the fact that that is the picture up and down the country. The Special Interest Group of Municipal Authorities has said that Stoke-on-Trent has been hit the hardest, but the impact is on constituents across the country.

[Barbara Keeley]

I agree with my hon. Friend.

Changing eligibility from “moderate” to “substantial” this year will mean that the number of people in Salford receiving council-funded care packages will fall by 1,000, to 7,500. To give credit to Salford city council—my right hon. Friend the Member for Salford and Eccles (Hazel Blears) has already done so—it held off making the eligibility cut until the third year of Government budget cuts, but now it must join the nine out of 10 local authorities setting eligibility at the higher level. I am afraid that the Secretary of State’s earlier claim that they do not have to set it at that level will have sounded very hollow indeed.

Talking of things that sound hollow, the new rights for carers set out in the Bill will sound very hollow to carers in my constituency at a time when many of them are losing the few hours of support they have that give them a break. I want to cite the example of an elderly couple in Salford who have cared for their adult son for over 30 years and who have relied upon respite care for a rest or a break. At the last review of their son’s care package, the respite care element was reduced, which has had a detrimental effect on their physical and mental well-being. They are now not even sure whether they can carry on caring for him. I fear that my right hon. Friend the Member for Salford and Eccles and I will hear many more such cases as 1,000 people in Salford lose their care packages over the next year.

Many organisations involved in social care have raised fears about the crisis in care and their view that the eligibility level should be set at “moderate”, rather than “substantial.” Over the past five years, the number of people over 65 receiving publicly funded care has fallen from 1.2 million to less than 1 million, and for people aged 18 to 64 it has fallen from £570,000 to £470,000. That is a serious fall in the number of people receiving care. Some of those who have lost publicly funded care have funded the care themselves, but in other cases the care workload will have fallen on unpaid family carers.

The number of unpaid carers caring for more than 50 hours a week has increased by over a quarter in the past 10 years. As my right hon. Friend said, Carers UK has told us that 1 million carers have given up work to care, which costs the Exchequer £1.3 billion a year in extra carer’s allowance and lost tax receipts. I believe that reliance on unpaid family care with those heavier carer workloads might also have an impact on the health of those carers, particularly those caring at the heavier end.

The Government plan to set the national eligibility threshold at “substantial”. The Care and Support Alliance says that this means that 105,000 working age disabled people will be left without the support they need to live independent lives. That issue was raised by my hon. Friend the Member for Stretford and Urmston (Kate Green), and she is right to do so. We focus an awful lot on adult social care and older people, but we need to think about working-age disabled people as well.

[Norman Lamb]

I absolutely respect and appreciate the hon. Lady’s concern for carers; she has campaigned vigorously on their behalf for a very long time. Does she accept, though, that when her party left office, 108 councils set “substantial” as the eligibility criterion for support from local authorities? Do we not all face the same incredibly difficult financial circumstances and have to examine the innovation that the right hon. Member for Salford and Eccles (Hazel Blears) talked about? There is not simply a pot of magic money that will appear if ever Labour returns to government.

[Barbara Keeley]

I do not agree at all. These cuts are far too swingeing, and there is nowhere else for my local authority, Salford, to go. After 20% cuts, the £100 million loss of funding that we have sustained cannot be found with any amount of innovative thinking. Ministers are now at the point of kidding themselves. I am sure that the Minister, like all his predecessors, goes round the country and is shown all kinds of examples of innovation, but innovation without funding will not work.

The eligibility issue interacts with the cap on care costs. The vast majority of older people will fail to benefit from the £72,000 cap on care costs; it will help only those with the most complex needs. As has been said—we need to keep repeating it—a cap set at £72,000 ignores Andrew Dilnot’s warning that it would work only if it were set at a much lower level and if the underfunding of social care were addressed. It is clear from the Government’s own impact assessments that the number of people whose costs will be capped are a tiny minority. It is estimated that just over one in 200 people aged over 65 will be helped in 2016 and that fewer than one in 200 will be by 2026. It is an incredibly sad reflection of this Government’s ambition that they will have spent the whole of a five-year Parliament—in fact, longer than a five-year Parliament—introducing measures on the long-term funding of social care that eventually help only one in 200 people. My right hon. Friend the Member for Salford and Eccles talked about being ambitious; this is not ambition.

On the support needs of carers, I will repeat some of the things that we heard from the right hon. Member for Banbury (Sir Tony Baldry). Full-time carers are more than twice as likely to be in poor health as people without caring responsibilities. I point out to the Minister that this Bill does not do enough to support those full-time carers. The Government have said that carers are the first line of prevention in that properly identifying and supporting them prevents the escalation of demand on statutory services. Given the A and E crisis, we need that prevention. However, identification of carers is not happening and the Bill does not do enough to change that. Macmillan Cancer Support, which has been carrying out surveys on this, tells us that 70% of carers of people with cancer come into contact with health professionals, who are the people who should be identifying them and signposting them for information and advice. Only 5% of that group of carers receive a carers assessment, and only one in three of those surveyed by Macmillan had even heard of a carers assessment. It is meaningless to suggest to people that they have a right to something they have never heard of and are not going to get.

In Salford, we have a project run by the Carers Trust centre to identify carers within the primary care system. I want to pay tribute to the work that the centre does and to mention its manager, Dawn O’Rooke, who is leaving this month after several years of work in this field. Over the years, the project has established a network of links within GP practices to identify carers. Last year, GPs made only 300 referrals to the carers centre, yet we have 23,000 carers in Salford, over 5,000 of whom will be caring at the heaviest levels. The Carers Trust tells us that, nationally, GP practices are identifying only about 3% of carers, but it should be 10% or more. Health bodies must be required—this Bill is the place to do it—to take on the task of identifying carers and referring them for advice and support, because carers are mainly seen in health settings and not by local authorities. The figures I gave about people losing packages mean that 1,000 fewer people in Salford will be seen by, or go anywhere near, the local authority because the person they care for is not getting a care package.

The Minister is aware of my private Member’s Bill, the Social Care (Local Sufficiency) and Identification of Carers Bill, which had clauses to tackle that issue. I am happy to show them to him again and explain how he could go about tackling the issue in his Bill. The clauses would ensure that NHS bodies have procedures in place to identify carers and ensure they receive information and advice. The Government’s own care and support White Paper stated that there is

“still an unacceptable variation in access to tailored support for carers”

and that NHS organisations should

“work with their local authority partners...to agree plans and budgets”.

The right hon. Member for Banbury made that point. Why are there not more robust measures in the Care Bill to make sure that this happens? As things stand, it will not happen. The NHS has been going through an agony of reorganisation and is now going through an agony of finding efficiency savings, and its staff do not have the time, unless they are directed to the right procedures, to take this task on.

As has rightly been said, clause 2, with its requirements for local authorities to provide preventive services, makes no explicit mention of the NHS, and the only duty on NHS bodies is one of co-operation. Anyone who has tried to work in local authorities on co-operation with health bodies, as I did years ago, knows that it does not go anywhere when there is no budget and no duty. Without effective procedures and systems within health bodies, the identification and signposting of carers will stay as it is now—patchy and inconsistent. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers alongside giving information and advice to self-funders and doing a lot more assessments. They will not be able to do that in any way that makes it a worthwhile exercise for carers, and carers will not bother with it if it is not doing anything for them. Indeed, the Joint Committee on the draft Bill received many comments via its web forum from people who said that local authority assessments are of little practical help in their caring role.

GPs and other health professionals are best placed to help carers when they start caring, which is when they most urgently need help and advice. During carers week here, I met carers who told me about a whole variety of things that they needed help with but nobody helped them. Nobody told them that there were schemes to help them with the cost of parking at the hospital. One mother had to buy a hospital bed and nobody told her where to find one; she was looking for one on eBay. She had no advice and support on that whatsoever. GPs deal with dementia patients, stroke patients and patients with cancer. The GP and primary health care team is best placed to establish whether there is an unpaid family carer or whether they live in another town or city. The GP can then refer them to sources of advice and support and, if they are local, give them regular health checks. A new duty on the NHS professionals is the only thing that would make it easier for social care and health services to work together to support carers. I believe that that is wanted by Members in all parts of the House.

Given everything that we are talking about, carers are clearly being placed under ever greater strains. It is essential that the Bill is used to ensure that carers are identified and signposted towards the support they need. It is clear from all the statistics that unpaid carers are the most vital providers of care in this country. I urge Ministers not to miss this chance to improve the support that we give them.

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[Paul Burstow (Sutton and Cheam) (LD)]

I want to echo the remarks made by the right hon. Member for Salford and Eccles (Hazel Blears): we must keep the dignity and well-being of those who need care and, indeed, their carers at the forefront of our thinking in this debate and as we seek to implement the Bill.

Like the right hon. Lady, the hon. Member for Worsley and Eccles South (Barbara Keeley) made a very interesting speech. I thank her for her service on the Joint Committee that scrutinised the draft Bill. I had the pleasure to chair that Committee, which had a very strong team from both Houses. It made some recommendations to which I will return in a minute.

What struck me during the speech from the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), is that if so much in the Bill appears to be wrong, surely he should have the courage of his convictions and go through the Lobby to oppose it. There is apparently so much awful stuff in it—so much of it is inadequate, does not reach far enough or does not do enough, or if it does enough, there will not be enough money—that the Opposition should perhaps have the courage of their convictions.

At the same time, we have heard really interesting examples of where social care should be celebrated. Too many speeches have suggested that the picture of what is being done on the ground is uniformly bleak, but examples have been given of dementia-friendly communities, Unlimited Potential and the “garden needs” scheme in Salford. Those are just a few examples, and I am sure that every hon. Member could go back to their constituency and find such initiatives. Many of the initiatives do not require substantial resources because, as the hon. Member for Sheffield, Heeley (Meg Munn) just said, they can lever in additional resources by enabling communities to respond to need. That is an essential part of the Bill.

[Barbara Keeley]

Will the right hon. Gentleman give way?

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Paul Burstow]

I give way to the hon. Lady because she tried to intervene first.

[Barbara Keeley]

It is about a year since the right hon. Gentleman and I started four months’ work on the Joint Committee, and I was prepared to commit that time although I still find some aspects of the Bill disappointing. The reality of our situation in Salford now and over the next year is that—week in, week out—I, as a local MP, will find that people and their carers have lost care packages. I invite him to think about the situation of the very many MPs who now see the heart-breaking decisions that families face when they suddenly find themselves without care, respite care or support.

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[Liz Kendall (Leicester West) (Lab)]

Today’s debate has been about one of the most important issues facing Britain today: how we care for the increasing number of older and disabled people. The Care Bill is the result of the Law Commission’s review of adult social care legislation, which was initiated by the previous Government. The Opposition welcome the Bill’s emphasis on prevention, promoting well-being and new rights for users and carers.

I want to pay tribute to the work that has already been done to improve the Bill by members of the Joint Committee on the draft Care and Support Bill and by Members of the other place. It now promotes the integration of care and support with health and housing, which is really important, and requires local councils and the NHS to work together in relation to the needs of young carers and, in that regard, I want to thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), in particular, for her tireless efforts.

The right hon. Member for Banbury (Sir Tony Baldry), my hon. Friend the Member for Blaenau Gwent (Nick Smith), my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), my hon. Friends the Members for Edinburgh East (Sheila Gilmore) and for Hayes and Harlington (John McDonnell), the hon. Members for Pudsey (Stuart Andrew), for Strangford (Jim Shannon) and for Totnes (Dr Wollaston), and my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Worsley and Eccles South all spoke about further changes that should be made to the Bill, for example to ensure that NHS staff identify carers, to support parent carers, to improve the safeguarding of people in social care, to improve the assessment process and advocacy, to ensure an effective transition of support from childhood to adulthood, to transform end-of-life care and to deal with portability, particularly of community care packages, in the devolved Administrations. I am sure that we will return to those issues in Committee.

The main concern, raised repeatedly by hon. Members today, is that the Bill does not address the fundamental issue facing elderly and disabled people and their families or put in place the really bold reforms we need to tackle the growing care crisis in England. It is true that council care budgets have been under pressure for many years, but this Government’s decision to impose the biggest reduction in any Department on local councils has the pushed care services that hundreds of thousands of people rely on to “the brink of collapse”—not my words, but those of Age UK.

Adult social care budgets have been cut by £2.7 billion under this Government. The result is that fewer people are getting the care they desperately need, particularly at home, which is the key issue for the future, as my hon. Friends the Members for Sheffield, Heeley (Meg Munn) and for South Shields (Mrs Lewell-Buck) pointed out. Frail, elderly people are receiving home visits that last barely 15 minutes, or in some cases only five or 10 minutes, as we have heard. Disabled people are being trapped in their homes, denied the basic opportunities to work, train, volunteer or have a social life that other people take for granted, a point powerfully made by my right hon. Friend the Member for Stirling (Mrs McGuire). Paid care staff on zero-hours contracts are not even earning the minimum wage, let alone a living wage, and unpaid family carers have been left struggling without the help they need to look after their loved ones, which means that their own health suffers, too. At the same time, more people are being charged more for vital services such as home visits and meals on wheels, which are up by £740 a year since the election.

Reducing care budgets by that scale hurts some of the most vulnerable people in society. It is also a false economy, because as more elderly people do not get the help they need to stay at home, they are ending up in hospital in increasing numbers, which costs the taxpayer far more. Delayed discharges from hospital have soared by 42% since the election, as my hon. Friend the Member for Easington (Grahame M. Morris) rightly said. Delayed discharges have costs taxpayers £225 million this year. That could have paid for almost 17 million hours of home care. It is spending money in the wrong place in a way that is not good for the people using the services and does not provide value for money.

Families are also paying the price. As my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said, one in three carers now has to give up work or reduce their hours because they cannot get the help they need to look after their loved ones, and this costs the Treasury £1 billion in lost tax revenues alone. The Bill will not solve these problems. The new rights it contains and the new focus that it places on prevention and well-being risk being meaningless as care budgets are reduced to the bone.

Nor are the Government being straight with people about their plans to reform long-term care funding in future. Any measures that protect people from catastrophic care costs are welcome, but Ministers have not spelled out the reality of their plans. They have repeatedly claimed that no one will have to pay more than £72,000 for their care, but this is not the case. People’s care costs will start to count towards the so-called cap only if they are assessed as having eligible care needs. Nine out of 10 councils provide care only for those with “substantial” or “critical” needs. If someone needs help to stay living at home but their council assesses their needs as “low” or “moderate”, what they pay for home visits will not count towards the cap.

With regard to residential care, the cap will not be based on what someone actually pays for their home care but on the standard rate paid by their local council. I see that the Secretary of State is being informed by the Minister about the reality of these plans, so I hope that he listens to more of my speech. The standard rate paid by local councils is currently, on average, about £470 a week. Government Members, as well as Labour Members, will know that many of their constituents pay far more than £470 a week for their care home, but these extra costs will not count towards the so-called cap. People will also, rightly, have to contribute towards their hotel and accommodation costs. The Government are setting this contribution at £230 a week—much higher than Andrew Dilnot recommended—and these costs will not count towards the cap either. Taking both those factors into account, it will take elderly people almost five years, on average, to hit the so-called cap, during which time they will have clocked up, on average, £150,000 for their care home bill, and much more in many cases. Because elderly people stay in a care home for about two and a half years, on average, six out of seven people will be dead before they hit the cap.

Ministers have repeatedly claimed that people will not have to sell their homes to pay for their care; again, this is not the case. The Bill puts a duty on councils to offer deferred payment schemes—care loans that will have to be paid back by selling the family home after the person has died. The loans will not be universally available, as Andrew Dilnot recommended, but means-tested. Interest will be charged on the loans, but that interest will not count towards the cap. Although the Government are raising the upper level of the means test, that will not help many pensioners on average incomes because of how the test works, whereby councils take a notional income from the remaining assets in a person’s house and add it to what they get from their pension and any savings or second pension. For many pensioners on average incomes, this combined total will take them over what their local council will pay for care, and they will therefore not qualify for any extra support.

Elderly people and their families deserve to be told the facts about the Government’s plans so that they can properly plan for the future rather than have Ministers attempt to pull the wool over their eyes. One of the main claims made by the Prime Minister about the Government’s reforms is that they are so clear and straightforward that lots of insurance products will emerge so that people can insure themselves to pay for their care in future. I would be very interested to hear from the Minister how many of these new insurance products have emerged so far.

[Barbara Keeley]

I chair the all-party group on social care and when the Dilnot recommendations were made we implored the Government to have a national debate so that all the issues my hon. Friend is raising so well could be explored. Judging by the look on the Secretary of State’s face, he needs to be given some of that information, too, so perhaps we need a national roadshow on what his Bill will actually do.

[Liz Kendall]

My hon. Friend makes her points diplomatically. It is only owing to the efforts of Members in the other place that the Bill includes a requirement for councils to provide people with clear information. These are huge issues for elderly people and their families. We are asking the Government to be straight and I hope that when the Minister responds he will confirm what I have been saying.

On top of everything—I hope the Minister will also address this—we learned in June that the Government will top-slice £335 million from existing council budgets to pay for the start-up costs of the new scheme in 2015-16. They propose to take money from existing users who are already desperately struggling to pay for reforms that will benefit a small number of future care users in five, six or seven years’ time. I think that many people will be astonished, particularly after the Government had claimed that all the additional costs for their proposals would come from elsewhere. I hope the Minister will explain whether I am correct in saying that that £335 million will be top-sliced from council budgets.

Labour Members will continue to focus on the reality of this Government’s actions, not on their rhetoric, and we will continue to expose their true record on the NHS and social care. Instead of making the real reforms needed to improve front-line services, they have wasted three years and £3 billion on a back-room NHS reorganisation that nobody wanted and that nobody voted for. Instead of working with clinicians and patients to make difficult decisions on the future of hospital services, they now want to give the Health Secretary unprecedented powers to impose changes without the consent of local people. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, the Government are taking away control from the very people to whom they pretend they want to give power. Indeed, National Voices—the voice of patients—says that the proposal is

“wrong in principle and counterproductive in practice”.

Instead of championing the full integration of health and social care to enable a powerful shift towards prevention and fully personalised care, as Labour proposes, the Government’s unambitious proposals bring together only 3% of the total NHS and social care spending. Instead of holding serious cross-party talks on long-term care funding reform, the Government chose to go it alone, water down Dilnot’s proposals and spin the results beyond recognition. That is why we have tabled our reasoned amendment and why I urge hon. Members to join us in the voting Lobby tonight.

[The Minister of State, Department of Health (Norman Lamb)]

I thank everyone who has taken part in what has been a lively and interesting debate on a subject of the utmost importance for the future and for many very vulnerable people in our country. I absolutely share the view of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), on that. Incidentally, I also share her view that it is not possible to get great care on the back of exploiting low-paid workers. We have been very clear about that.

I do not anticipate having time to be able to respond to every point that has been raised—there were many excellent contributions—but I will write to hon. Members who participated in the debate so that everyone will get a full and proper response, including on the cross-border issues raised by the hon. Members for Arfon (Hywel Williams), for Strangford (Jim Shannon) and for Edinburgh East (Sheila Gilmore) among others.

The effect of passing the reasoned amendment would be to defeat the Bill, which is why the Government are so dismayed by the decision taken by the Labour party on what we regard as a Bill that will be groundbreaking in its overall impact. It seeks to modernise the law on care and support, shifting the focus from a very paternalistic system to one that is acutely personal and focused on an individual’s well-being. The Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell) and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) both focused on the important principle of well-being, which will be new in legislation, but is absolutely central to what we seek to achieve. There is also a focus on preventing ill health and—

[Barbara Keeley]

Will the Minister give way?

[Norman Lamb]

I will just finish this point.

There is also a focus on protecting everyone from catastrophic care costs, ensuring that people will no longer have to sell their homes during their lifetimes to pay for care. The Bill reforms a fundamentally unfair system, drives up standards in GP surgeries, hospitals and care homes through the new chief inspectors, adds a new statutory duty of candour so that hospitals, care homes and other care providers are open with patients when mistakes are made, and introduces valuable new rights to carers. Of enormous significance is that it signals the first ever big step, as the Chair of the Select Committee said, towards joining up our health and care systems through the better care fund, which is worth £3.8 billion.

The best description of the Bill was in a letter forwarded to me by a Labour MP, which said that the Bill is a groundbreaking piece of legislation that has the potential to make a big difference for older people. Despite that, the Labour party is declining to give it its support.

[Hazel Blears]

rose—

[Barbara Keeley]

rose—

[Norman Lamb]

I give way to the right hon. Member for Salford and Eccles (Hazel Blears).

--- Later in debate ---

[Norman Lamb]

I note the challenge, but I have been passionate about integrating care for many years. I made the case for it on many occasions when I was my party’s spokesman in opposition, and I remember not getting much of a response from the right hon. Lady’s party when it was in government. The Bill is really ambitious and marks the potential for a fundamental change in how our system works.

The right hon. Member for Stirling (Mrs McGuire) welcomed the principles of the Bill and rightly said that it is the duty of the Opposition to challenge and to probe. However, to use her expression, I think that many Opposition Members have been “churlish” in their response, with a few honourable exceptions, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke). I say that because in 13 years, Labour had two manifesto commitments, one royal commission, another promised commission, a Select Committee report, a White Paper, a Green Paper and numerous independent reviews on the issue, and what was the net result of all that talk? Absolutely nothing. In 1997, Tony Blair told the Labour party conference:

“I don’t want our children brought up in a country where the only way pensioners can get long-term care is by selling their home.”

That is exactly what happened throughout Labour’s time in government. In contrast, the coalition Government are getting on with reform.

Even now, we have no idea what the Opposition’s policy is. The shadow Health Secretary has hinted that he prefers an all-in approach—everything free, paid for by new taxes on death and by cutting hospital beds—but he has clearly failed to persuade his own colleagues about the plan or to set out how he would pay for it. Opposition Members’ criticisms can only be of any real value if they can answer the question about how they would pay for anything that costs more. So it was good to hear the right hon. Member for Salford and Eccles, who seemed to be about the only Opposition Member who recognised the scale of the challenge that we face, whoever is in power, and the fact that we need to think afresh about where money can come from. Her ideas about innovation using social investment bonds are welcome, and I would like to talk further to her about them.

We want to reshape care and support so that it is focused on enabling people to live more independent lives and giving them a good life. The Bill provides a new framework that places people’s well-being right at the centre and empowers them to take control of their care and support. It consolidates 60 years of legislation and pulls a dozen Acts together into a single legal framework, and it has been roundly welcomed. The King’s Fund has said:

“The government’s proposals for funding reform are an important achievement against the odds in a daunting fiscal and economic climate.”

Baroness Pitkeathley of Carers UK has described the Bill as the “most significant development” in the history of the carers movement.

[Barbara Keeley]

rose—

[Norman Lamb]

I did not get much of an impression of that in the hon. Lady’s contribution, but I give way to her.

[Barbara Keeley]

I thank the Minister for eventually giving way. I am surprised and disappointed that he is repeating the same type of inaccurate information that we heard from the Secretary of State earlier. Will he think about the point that I made in my speech? How hollow is it to talk to carers in Salford, 1,000 of whom are involved in families who are losing their care packages, about new rights? What rights are there for someone whose family member has lost their care package? That is what people face this year.

The Minister has also just repeated the ridiculous notion of the £3.8 billion for the integration of health care. That is not new money. It includes care—

[Mr Speaker]

Order. I call the Minister.