Funding of Care and Support

Baroness Pitkeathley Excerpts

Thursday 24th November 2011 Lords Chamber

Moved by

[Baroness Pitkeathley]

That this House takes note of the report of the Commission on Funding of Care and Support and the future of social care.

[Baroness Pitkeathley]

My Lords, it is a pleasure and an honour to introduce this debate about the future of social care and to move the Motion that the House takes note of the Dilnot commission report. I am grateful to all noble Lords who have put their names down to speak and I hope they will not mind me calling them, in the context of discussing social care, “the usual suspects”. I mean that as a term of the greatest respect. However, it is a disappointment that there is no speaker from the Conservative Benches apart from the Minister.

Certain reports are so significant in the development of policy that they are known by a single name. Your Lordships will think of Beveridge or Wolfenden. In the field of social care, the names that spring to mind are perhaps Seebohm, Griffiths and Laming, and certainly many of us believe that Dilnot should join that illustrious number. I pay tribute to the Government for setting up the Commission on Funding of Care and Support and the future of social care, and to Andrew Dilnot for his extraordinarily important report. I include thanks, too, to his colleagues Dame Jo Williams and your Lordships’ very own Lord Warner—my noble friend—not only for their contribution to the report but for their continued work to have it accepted and implemented. Their diligence and sheer hard work are enormously appreciated.

The commission was set up to investigate the problems of the current system of adult social care in England and to develop ideas for reform. So what were the problems that the three musketeers, as some have called them, were to investigate? The current system of care and support is seen to be in crisis, severely stretched or broken, depending on where you sit. All agree that “something must be done”.

Of course, it is not the first time that such feelings have been expressed. Let us remember that social care has never been free at the point of delivery as healthcare has been, and the question of who pays—the individual, the family or the state—has occupied politicians for years. Twelve years ago, my own Government set up a royal commission on the subject and recommended that all care should be free. I am delighted that the noble Lord who chaired that commission is to speak in this debate—his second outing of the day—as is one of his dissenting members, and I look forward very much to hearing their views.

The problems in summary are as follows. The system is not fit for purpose. It was set up originally for a country in which men died at the age of 66, shortly after retirement, and women died before they were 70. The new statistics—for example, that 11 million people alive today will live to be 100—are of course a cause for celebration, as is the fact that so many more people are living longer, albeit with greater degrees of disability. This means that we are spending inadequate amounts on care and support, both publicly and privately.

Social care funding has failed to keep pace with demographic change. Since 2004, while spending on the NHS has risen by £25 billion, spending on social care has risen by just £43 million. To cope with rising demand and static resources, councils have increased charges for care services and rapidly raised eligibility criteria, with the percentage of councils providing support to those with moderate needs decreasing from 50 per cent in 2005 to 18 per cent in 2011, as eligibility criteria were raised to cover only those with substantial or critical needs. This has been compounded by recent local government spending reductions, with social services directors reporting £1 billion cuts to services this year and warning that the same level of cuts or even greater ones will have to be made next year. Our public provision is largely seen as providing poor services for poor people, and there have been several examples of this in recent months, most notably yesterday’s distressing report from the EHRC.

However, we should never forget that much good care is still provided to individuals within the system because of the dedication and skill of thousands of workers. Those workers and their agencies have had some success in recent years with the personalisation of services, promoting independence and early intervention. There are pockets of great service to be admired, and we should always remember that, but in general the care and support system is perceived to be starved of cash, failing to meet the volume of need, unfair and a lottery, especially for people with middle incomes, for the simple reason that if you die neatly without needing to use care services, you pay nothing, but if you become disabled through a long-term illness such as Alzheimer’s, you may need expensive services at full cost for many years, involving thousands, sometimes hundreds of thousands, of pounds. So people who own a home and have modest savings are hit very hard. The system is also extremely confusing. It is difficult to find your way around, different in different parts of the country, not portable when your location changes, and so on.

Moreover, caring families as well as the individual needing care suffer at the hands of the system, which for them is too complex, costly and unfair. Family members end up sacrificing their careers, finance and their own health in order to provide care to disabled or older loved ones, getting little or no help from a social care system and finding that services are of poor quality and expensive. However, if you have a carer you are luckier than the frail older person living alone whose total social care is a 15-minute visit once a day—twice if they are very lucky—which is not enough to keep them clean and comfortable, let alone cared for. These problems are only going to get worse if nothing is done. Within 20 years the number of over-85s will double and the number of people living with lifetime disabilities will grow too. Relatively fewer people will be working and paying taxes to help pay for support.

Apart from the practicalities of money and how it is all to be paid for, we have other changes in society that affect what we expect from social care. People want and demand greater choice and control than is often offered by our current system, and people’s expectations about standards of care are rising. The Dilnot proposals were published on 4 July and they aim to change the way that social care funding is raised and spent, extending entitlement to public funding for social care in a way that is acceptable and sustainable to taxpayers.

The key recommendations will be familiar to your Lordships. The contribution of an individual to their social care in their lifetime, which is currently unlimited, should be capped. After the cap is reached, individuals should be eligible for full state support. It is suggested that the cap should be between £25,000 and £50,000. The means-test threshold over which people are entitled to full costs should be raised from £23,000 to £100,000. Further, there should be national eligibility criteria, and portable assessments should be introduced. All those who enter adulthood with a care and support need should be immediately eligible for full state support without a means test. A new information and advice service should be set up to guide families through what they need to know.

The cost is estimated to be about £2 billion, although that figure is disputed. Of course, it is a large sum but not if you compare it with the £170 billion that social security costs or indeed the £119 billion which carers contribute to the coffers every year. In these difficult financial times there is of course a question of how money is to be found, but perhaps a better question is what will happen if that money is not found. We shall certainly see more reports of the kind which the noble Baroness, Lady Greengross, presented to us yesterday.

The unanimity of support for the Dilnot proposals is as great as I have ever seen. In my Second Reading speech on the Health and Social Care Bill, I reminded your Lordships that if you want to bring about change you have to build a consensus. There is no doubt that such a consensus now exists. That consensus is that it is inescapable that the future funding of social care has to be based on a combination of individual and state responsibility and contribution and that these proposals offer the prospect of a lasting settlement based on a partnership approach. That is not to assert that there is unanimity on every aspect of the Dilnot proposals. People are concerned about the level of the cap, about the fact that hotel costs are not included in the calculations, and about whether the life insurance product market will really be stimulated. I have no doubt that other noble Lords will speak about these concerns. Nor should we assume that the commission provides a total answer to the social care problems I have outlined, but these reservations do not detract from embracing its general thrust. The consensus that now is the time and that the general direction of the Dilnot report is right surely cannot be gainsaid. It would be sad and a failure of all of us involved in these important discussions if we allowed disagreement about details in the report and the valid arguments that are put forward to get in the way of action.

If you want to bring about change, another thing that you have to do is to make people, individuals, Governments, political parties and society itself see what they are going to gain as a result of the changes. What will they get out of it? That surely is clear. We will spend existing resources better. It will improve the integration of health and social care systems. When people’s need for social care is not met, they will turn to the NHS, resulting in increased numbers of emergency admissions or delayed discharges. The inconsistency between fully funded NHS care and means-tested social care the delivery of an integrated care system. Recent statistics from the Department of Health show an 11 per cent rise in the number of hospital bed days lost to bed blocking—I thought we had seen the last of those terms—so the costs have risen from £483,000 to £537,000 per day. In addition, if we adopted these proposals, the rights and responsibilities of individuals and agencies would be clear to the public. If people were clear about their future personal liability they could plan how they would meet care costs up to the level of the cap, wherever that was placed. We would also stimulate the care market to provide more choice for families and incentives for business.

The government consultation process on the report is under way and is to be commended. The engagement process is about to conclude. It has been helping people to put their views, and the leaders of the discussion streams will indicate the priorities for change. I hope that the Minister will be able to tell us more about the process of putting those priorities into action. I know that the Government are committed to a White Paper in the spring, but it cannot be stressed too strongly that action is needed, with the greatest possible dispatch, to take advantage of the near consensus around this issue at the moment. We hear rumours of the Treasury having misgivings about the cost of the proposals. Will the Treasury be involved in the decisions about putting the identified priorities into action? I hope the Minister will tell the House the answer.

Another cause for concern is how the Law Commission proposals on social care, which again have been widely welcomed, will be dealt with. I do not have time now to go into these in detail, but they would create a stronger legislative framework, are compatible with the Dilnot proposals and together would form the basis for a White Paper and subsequent legislation. Do the Government intend to combine their response to the Law Commission proposals with their response to the Dilnot report? The chance to do so has been called a once in a lifetime opportunity. It would be tragic if the opportunity were missed. Therefore, it is vital that we harness not only the consensus in the care sector clearly set out by the 52 organisations in the Care and Support Alliance but the willingness of political parties to cross party political divides in the interest of finding a solution to the social care dilemma. We must find political consensus. My own party has suggested ways of facilitating this. My noble friend on the Front Bench will say more about this and I hope that the Minister will respond to these suggestions.

In conclusion, the Minister for Social Care, in a debate on 10 November in another place, said that,

“when the decisions are made … I hope we will be in a position to legislate at the earliest opportunity. Social care has languished … in the ‘too-difficult-to-do’ box for far too long. We are the Government who are committed; we see the urgency and the need. I hope that together we can get the cross-party lead that results in the changes which are long, long overdue”.—[Official Report, 10/11/11; col. 181WH.]

Amen to that. I hope that the Minister today will give an equally strong commitment. We must not fail to grasp the opportunity that Andrew Dilnot and his colleagues have given us. I beg to move.

--- Later in debate ---

[Baroness Pitkeathley]

My Lords, we have seen great enthusiasm for the Dilnot Commission in the course of this excellent debate while acknowledging that it is not the whole answer, and while acknowledging its shortcomings. Even my noble friend Lord Desai admitted that it is the best chance we have. However, if the objective of the debate was to save Dilnot, as my noble friend Lord Lipsey proposed, I am not sure we can be confident that we have succeeded, judging by the Minister’s response. Even so, I know that as ever the House will be grateful to the noble Earl for the way in which he has responded and, indeed, confronted some of those inconvenient truths about which the noble Lord, Lord Sutherland, reminded us.

My noble friend Lord Warner robustly reminded us that doing nothing is not an option. As ever, the wisdom and expertise shown around the Chamber has been extraordinary, and there has been universal agreement that we need a lasting settlement based on a partnership between the individual and the state. We have also seen that we must have honesty and, above all, we must have political consensus, which will require a degree of bravery. I know that the usual suspects who have taken part in the debate—these guys, as we all are—will continue to apply pressure, as well as offer advice and consultation to stiffen the resolve of the Government and the Opposition to be brave, to bite the bullet and make this a watershed moment in the history of social care by responding to the call to arms. I thank all noble Lords who have taken part in this inspiring debate.

Motion agreed.