Adult Social Care

Chris Skidmore Excerpts

Thursday 8th March 2012 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

I start, like others, by congratulating my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate, bringing out the urgent need to tackle the issue of the future of social care, and ensuring that we face up to the responsibilities of looking after the elderly of today and tomorrow. We have heard humble messages from the Minister and the shadow Secretary of State about their willingness to work together. The spirit of cross-party agreement is encouraging.

As the right hon. Member for Leigh (Andy Burnham) said, these issues go right back to Beveridge in 1942, when the average life expectancy was 69 and social care was not an issue to be considered within the realms of the state. The right hon. Gentleman mentioned the “sixth giant”, and he is right that we need to revisit Beveridge for the 21st century and perhaps to look again at what Beveridge considered to be most important—the contributory principle. The contributory principle for social care will be all-important when we look at how to deliver social care reform.

As we know, reform is desperately needed. The arguments over the funding of our social care system are well practised, but let us rehearse some of the statistics, which are becoming more familiar with every debate we hold. The number of those aged over 85 will double by 2030, and during the course of this Parliament alone, more than 1.4 million people will turn 65—one in 10 of whom will have a long-term care need that will cost more than £100,000. We should also make it clear that this problem is not unique to the UK. Germany and Japan have recently taken radical action to reform their systems. However, the UK has a specific problem that makes finding a solution to the ever-growing problem of social care particularly difficult: most people simply do not understand the system. They do not understand that social care and the associated costs of getting older are not free, as the Minister stated, and nor have they ever been.

That point was made in the Dilnot report, and it cannot be stressed enough. I wish to highlight two of Dilnot’s recommendations. First, he states:

“To encourage people to plan ahead for their later life we recommend that the Government invests in an awareness campaign.”

Secondly:

“The Government should develop a major new information and advice strategy to help when care needs arise.”

The acknowledgement that more needs to be done to inform the public is welcome. In reality, until one is forced to interact with the system, there is a serious lack of information compounded by an assessment procedure that is often unrealistically complicated. For many elderly people, part of the shock that comes from being forced to sell their house to pay for care is the unexpected nature of that situation. In some respects, we are facing a problem of responsibility and of planning ahead. Although people are now accustomed to the idea of preparing for their old age with regard to pension provision, there remains an aversion to preparing for the eventuality of future frailty and ill health. Few of us wish to admit that we will grow old and frail and need help and support, before it is too late.

The solution to the funding crisis brought on by an ageing population will inevitably require individuals to pay more, and from an earlier age. Whatever we do to change the current system, it is absolutely essential that a much clearer picture of the relationship between contribution and entitlement—precisely as Beveridge set out—is at the heart of that.

Reform requires realism. Even if the Dilnot proposals are implemented in their entirety, they will not provide the full solution. Whatever cap on care costs is set, domiciliary care costs and annual living costs are not taken into account. A new system that is able to lever more private funding into the system will ensure that we can provide the best deal for the elderly, but it will require an understanding that we need to grow an insurance market to maturity that is then sustainable in the longer term. That will not happen overnight. This is a process that will take between 10 and 20 years.

The current Government have taken the first important steps to reforming the system. As hundreds of billions of pounds are being talked about in respect of the current euro crisis, it is easy to forget that the Government’s decision to give an additional £2 billion a year to social care in the 2010 comprehensive spending review was the greatest ever increase in social care funding, and will lead to a vast increase in resources. We are investing more than ever before in carers and respite care, recognising the huge contribution that they make to our country, selfless in their service to their partners, parents, families and relatives.

In addition, a greater focus on personalisation and individual budgets, combined with an increased use of resources such as tele-health, will put more control over care into the hands of individuals, ultimately allowing new providers to provide more tailored services, thereby driving down costs at the same time as improving quality. Placing the person at the heart of their care has the potential to transform social care services, which for too long have been led by inefficient monopolies.

The Prime Minister’s recent call for greater integration of health and social care is equally welcome. I am a member of the Health Committee, and we called for that in our recent report. If we fail to address the social care problem, the NHS will end up picking up the tab. Every unplanned hospital bed admission for the elderly is a mark of the failure of social care to prevent that from happening in the first place. We know that if we can reduce demand for hospital beds by just 10%, that could free up £1 billion that could then be redirected into community-based care services. We must recognise that hospital is not always the best place for care to take place and redirect resources to reflect that.

In preparing for the Committee’s social care report, we visited Torbay, and I was particularly struck by the experience of integrated care there. Torbay’s primary care trust and adult social services have been combined into Torbay Care Trust, following which five integrated health and social care teams were established. They seek to be proactive in managing patients and to work in partnership with GPs. In Torbay, a team was also introduced that was specifically charged with monitoring patients in hospital and discharging patients where there is pressure on beds—again, the team is working closely with clinical professionals. That has helped to cut out unnecessary lengthy hospital stays and delayed transfers of care. As a result, Torbay now has the lowest use of hospital bed days in the south-west region, as well as the best performance on the length of stay. The chief executive of the NHS, Sir David Nicholson, has said:

“I have seen the future and the future is Torbay”.

He did so because it is the elderly who will benefit most from integrated care. Complex long-term conditions complicated by age can be properly managed only with a collaborative approach.

[John Pugh (Southport) (LD)]

Torbay has, for some time, been a model of good practice and the fact that this good practice has not spread much further than the confines of Torbay is something of an enigma. Would the hon. Gentleman care to comment on that?

[Chris Skidmore]

Torbay was one of the sites for the pilots set up in alliance with Kaiser Permanente, which came over in 2003. Interestingly, it is instructive that one of the problems the NHS faces as an institution is that, although it creates fantastic pilots and the NHS innovation centre is working hard on rolling them out across a wider area, that process encounters significant delays. Good models of care should be spread out far more widely and far faster.

What most elderly people want from their health care system is simplicity. They do not want to be moved around constantly from pillar to post, waiting for specialists to see them; they do not want to see a host of different medical professionals, each of whom is unfamiliar with their case; and they do not want to languish in hospital beds when they could be more comfortable at home. The most important change must be a cultural one. There may have been a tendency in the past for health care to be reactive, responding to medical crises as they arise, but the future must be very different. To paraphrase John F. Kennedy, we do these things not because they are easy but because they are hard. We know that we face a challenge that will define the landscape of health and care for the decades to come—it is a challenge that all in this House cannot be willing to postpone.