Queen’s Speech

Baroness Tyler of Enfield Excerpts

Tuesday 15th May 2012 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, the gracious Speech contained a welcome commitment to improve the lives of children and families, and who could disagree with that? There is much that I would like to say about adoption, and indeed other forms of permanency, including life chances for children in care, speeding up processes in the family courts and improving the assessment and support available for disabled children and those with special educational needs. However, I shall save those comments for another day because today I want to highlight the complexity of families by talking about a group who are all too often put in too difficult and unglamorous a box: older people who are unable to look after themselves any longer.

In my experience, family policy often overlooks older people, both as regards the invaluable contribution that they can make to their own families and the wider community and as regards their own care needs if they are to lead a dignified life in old age with the quality of life that we would all wish for ourselves. It is a stark fact that over the next two decades, the number of people aged over 80 is set to double in Britain. That presents major challenges for the way in which public services are delivered, the way our houses, towns and cities are designed and the way in which families organise their lives.

The major shortcomings with the adult social care system are well documented and cause people to be fearful. In brief, the current system is fragmented: there is a postcode lottery; it is extremely variable in quality, confusing and hard to understand; it focuses on crisis cases and high-end needs rather than on preventive action; and, of course, as we have already heard, the funding is unsustainable. Many carers and those needing care find themselves let down by a faltering service and others find themselves having to sell their homes in order to pay for the care that they need. Of the 2 million older people in England with care-related needs, nearly 800,000 receive no support of any kind from public or private sector agencies. As the Health Select Committee stated in its recent report on social care, it comes as a great shock to many people to find that while the care provided by the NHS is free, care services such as help with washing and preparing food at home are means tested, and many will have to pay for them.

Every family in the land is affected by the issue. It is no respecter of class, income, geography or ethnic group. That is why I consider it to be the biggest social policy challenge facing the country. Caring for older people affects everyone in the family—particularly women. Increasingly, families find themselves caring for the needs of three, four and even five generations. This can place a huge strain on those caught in the middle. They may find themselves simultaneously supporting teenage children, looking after young grandchildren and caring for elderly and frail parents or even grandparents—all of this at the same time as being at their most stretched in their working lives. No wonder they are increasingly called the squeezed or sandwiched generation. Of course, it makes the new legislative measures proposed on flexible parental leave and flexible working particularly important.

I welcome the draft Bill announced in the gracious Speech that is intended to modernise the legal framework for social care; it is much needed. I also welcome the commitment to pre-legislative scrutiny. There is huge expertise and passion in your Lordships’ House on the subject and I very much hope that both Houses will be involved in the process. However, the Bill is only one element of the radical overhaul that is needed for the system as a whole. Our goal should be to create a coherent, consistent and comprehensive system of care, with effective strategic planning and commissioning, improved quality of care, substantial workforce development, more choice and personalisation of care, proper information advice—and above all, fair and transparent funding as well as a greater focus on early preventive services.

The forthcoming White Paper, the funding progress report and the draft Bill should be seen and judged as an overall package that needs to add up to considerably more than the sum of its parts. We heard a lot today about the Dilnot report. It is well known to many in this House and widely regarded as an excellent report. It is not the whole answer to the problems I described because its remit was to recommend a new funding system. However, the potential funding framework that it offers is by far the best yet produced. In short, Dilnot provides a framework for a long-term settlement for funding social care—a partnership between the individual and the state. The funding model aims to eliminate the catastrophic care costs faced by some people by capping the maximum amount that individuals contribute over their lifetime, beyond which the state will meet all future costs. By limiting people’s liability in this way it is expected that a market will develop with new financial products so that people can insure themselves against the costs of their contributions.

There are many other very good recommendations in the report, such as national eligibility criteria for services and portable assessments between local authorities. However, I will focus on why it is so difficult to make progress. Some have argued that the Dilnot proposals are too much about protecting the wealth and property of the majority and not enough about targeting help on the most needy. I do not see it that way. I see the Dilnot proposals as being about sharing costs and risks rather than about protecting the wealthy. At the moment, individuals assume all the risks of becoming unwell or disabled or having care needs, especially in old age. People who work hard all their lives to provide for themselves and their families risk losing everything and being reduced to a threadbare existence through simple misfortune.

Of course there is a key concern about affordability. In the current economic climate that is understandable, but it does not preclude the Government committing to key principles governing the future funding framework, including a cost cap, and considering the phased introduction of the cap with its level perhaps recalibrated as economic conditions improve. While those details are being sorted, immediate steps could be taken at modest cost to help people start planning for the future. These include creating a deferred payment scheme and developing comprehensive information and advice services.

In conclusion, I agree with Andrew Dilnot that this is primarily a moral crusade. Future generations will not forgive us if we duck the issue simply because it is difficult—as indeed it is, particularly with the economic climate being so tough. I urge the Government to be courageous and to start embarking on the path now, particularly if a cross-party consensus can be found, and to start a national conversation about the political priority that should be given to this area, and the trade-offs that may be needed in other areas. We owe it to future generations and we must not let them down.