Health and Care Bill

Daisy Cooper Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Caroline Dinenage (Gosport) (Con)]

I rise to speak on new clause 49. For 40 years, successive Governments have tried desperately to address this issue, and successive Governments have put it in the “too difficult” pile. It is incredibly expensive, it is hellishly complicated and, to put it simply, there is no silver bullet to address all the concerns surrounding it. That is why I am so proud that this Government have made an attempt to grip this issue.

The fact is that what happens to us in old age is entirely random, and whether we incur catastrophic care costs that wipe out everything we have worked for in our lives is often down to luck. The current system is complex, it is unfair, many people simply do not understand it, and that has been compounded by the fact that successive Governments—nobody is blameless—have used unhelpful language such as “death tax” and “dementia tax”, which have made people terrified of the issue and blown any Government’s attempts to try to solve it out of the water.

Such language strikes fear into people’s hearts about what will happen to us when we are elderly, when we are vulnerable, when we cannot look after ourselves any more. As humans, this is something we do not want to talk about. We do not want to consider it or think about it happening to us; not for us the slow decay, the hellishly expensive degeneration, which affects perhaps four in 10, with the catastrophic amounts of money involved affecting perhaps one in seven. That is why insurance models have never really worked.

The new clause looks to amend the cap on care, basically, where the local authority costs should contribute to the metering towards the cap. I have to be honest: I thought really hard about whether I could support this. Many people, including the brilliant Andrew Dilnot, have pointed out the financial inequalities and some of the geographical inequalities of removing the local authority contribution. As local authority contributions differ by area already—they are much higher in better-off areas—there is already a postcode lottery of care depending on where someone lives. We have to address that. The key thing here is not the cap, but the floor. Those with lower property values will be protected by the floor, not the cap. The reforms increase the threshold above which people must meet the full cost of their care from £23,000 to £100,000—more than four times the limit. The daily living costs limit of £200 per week means that more people will keep more of their income and assets and the package includes domiciliary care, which many others have not done. It is not perfect—it is far from perfect—but everyone who is contributing towards their social care today, and those of us who face the uncertainty of this possible spectre in our future, will be better off than they are now. That is why we have to move forward in a way that is deliverable and that we can finally, for once, get over the finishing line, after 40 years of trying.

There are details that need to be fleshed out. The White Paper just cannot come soon enough and I wish to mention two burning issues in particular. The first is how we support working-age adults, who make up more than half of those who need adult social care. Some people need that care throughout their lives; for others it happens to them unexpectedly. How do we support the people of working age for whom care costs are not paid out of a nest egg, which they might have been able to build up over decades of work? Finally, the biggest issue facing adult social care is the workforce. This job is significantly undervalued. It is too often described as “unskilled”. That drives me mad. These people have unbelievable skills. They have experience and passion, and we entrust our most valuable and precious family members into their care and their hands. Frequently, they just make more money in hospitality or retail. How do the Government create a society that values these heroes for what they are? I look forward to reading the White Paper and seeing how the Government will tackle some of these thorny issues, the most intransigent challenges facing our adult social care system, because for those money alone will not be enough.

[Daisy Cooper (St Albans) (LD)]

I would like to start by talking about social care. The Liberal Democrats have long called for reform to properly integrate health and social care services, but this Bill does not do that. As others have mentioned, it seeks to reorganise parts of the NHS, but it pays lip service only to social care. That is why the Lib Dems think that the Bill should be put on hold until the proper social care reforms are brought forward.

As others have mentioned, it has been months since the Prime Minister announced his plan to fix social care. It is unforgivable that this new clause was sneaked out during the sleaze row last week, in a move that changed the goalposts. The Minister would do well to listen to the unease among his Back Benchers as well as among Opposition Members.

Struggling families now face being hammered by a double whammy of unfair tax rises and the prospect of losing their homes to fund care costs. The right hon. Member for West Suffolk (Matt Hancock) is no longer in his place, but I noted that he selectively quoted Andrew Dilnot. He did not quote Andrew Dilnot’s comments on new clause 49. Andrew Dilnot said that that proposal was not welcome. He said that he was very disappointed and that this represented “a big change” that

“finds savings exclusively from the less well-off”.

That is two promises from this Tory Government now broken.

There is also no mention in this Bill of the millions of people who are unpaid carers in the UK, even though we know that carers are twice as likely to experience ill health as a result of caring. That is why I have tabled new clause 63 for debate tomorrow. It is supported by Carers UK and it calls for the NHS to ensure that the health and wellbeing of unpaid carers is taken into account when decisions are made concerning the health and care of the person for whom they care. I hope the Government will support it. I know it is grouped for debate tomorrow, but I reference it now to highlight again the fact that the Bill does not present a comprehensive plan to reform social care.

The Bill also represents a massive and unnecessary power grab by the Secretary of State. It is simply wrong for the Government to have the power to abolish arm’s length bodies and approve or reject the chairs of integrated care systems. The public have been rightly outraged at political meddling in covid contracts, and the Government should learn their lesson. We should all be seeking to protect the independence of the NHS.

Vacancies in the NHS and social care are utterly staggering. We know the numbers: 100,000 vacancies in the NHS and more than 120,000 in social care; and 1.5 million people missing out on the care they need. We simply cannot go on like this, with the Government setting their own sporadic targets and constantly missing them. NHS waiting lists are at a record high. Ambulance services received a record number of calls in October. Major A&Es treated more than 1.4 million people in October—the third highest monthly figure on record.

The Bill will do nothing to get those waiting lists down, nothing to recruit the workforce we need, nothing to help people get seen faster and nothing for the millions of unpaid carers. The Government should delay the Bill for a few months and look properly at reforming social care, rather than doing a half-baked job now. But I do not think they will, and that is why the Lib Dems will vote against it.

[Mrs Maria Miller (Basingstoke) (Con)]

I listened carefully to my hon. Friend the Minister for Health earlier as he introduced new clause 49 because the funding of social care has been a huge concern for too many years. The people we represent deserve far more certainty about how their old age will be funded if they require social care.

We have a pension system and a system to support disabled people, but the funding of social care is a real uncertainty. I pay tribute to the Minister for bringing forward these costed proposals to provide some certainty for the future for more people. He is to be commended for being clear that no one will lose out under the proposals and that the majority will be better off because of the issues that we have already gone through—particularly because the means-test threshold is being significantly raised. He can say that with some force because of the more than £5 billion extra being put forward by the Government to fund social care in a sustainable way for the future.

However, there is still clearly some concern, as the Minister can hear from the debate. As my hon. Friend the Member for Gosport (Caroline Dinenage) said, no solution will be perfect, so I was particularly pleased to hear of the Minister’s plans to publish an impact assessment, which will clearly set out the impact of these measures across the board. That is important.

Finally, I want to speak in support of my amendment 102. We all know that the quality of support that we give victims of domestic and sexual abuse is a marker for the health of our society, and it is not just a matter for the NHS. However, the NHS plays a vital part in that support. Amendment 102 requires the joint forward plan for integrated care boards and their partners to properly set out the steps they propose to take to address the needs of victims of domestic abuse—whether domestic violence or sexual abuse, and whether it involves children or adults.

Amendment 102 does not limit the plan to addressing only the victims of domestic abuse; many other types of abuse are equally devastating, and it is permissive enough to allow innovation and improved ways of working to be developed in guidance. I hope that it can be used as a basis for guidance to integrated care boards as part of their general powers.

Amendment 102 is just part of the greater whole. The Police, Crime, Sentencing and Courts Bill in particular will require action across Government, but the amendment will help to ensure that every part of the state is pulling in the same direction when it comes to issues of domestic and sexual abuse. My amendment is similar to new clause 33, which my hon. Friend the Member for Newton Abbot (Anne Marie Morris) outlined earlier, but my amendment is more permissive and less prescriptive, so I hope the Government will find it acceptable.