Social Care

Dan Poulter Excerpts

Wednesday 16th November 2016 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—my good friend—on an excellent speech. She has no equal in this House as a champion for older people and their carers. Her speech, unlike the speech by the Secretary of State, was firmly rooted in the real world.

This is the century of the ageing society. Caring for people as they live longer lives is the greatest public policy challenge of our times, but for years Parliament has shown itself to be unequal to that challenge. I want to speak today to tell the story of the efforts to reform social care over the last decade, because I want the facts to be on the record, so that people can understand what happened and vow to do better. The story explains the mess we are in today. To be honest, it is quite a shocking story of partisan point-scoring and, worse, political cowardice, which have seriously failed millions of older and disabled people.

The story started nine years ago at the spending review in 2007. I was Chief Secretary to the Treasury at the time, and at the insistence of the Treasury I gave the Department of Health the condition on its spending review settlement that it would conduct a root and branch review of the funding of social care. There was a recognition, even in the Treasury, that if we allowed the situation to continue, it could, in the end, damage the national health service. Quite clearly, the funding was not sustainable, and if social care was left to collapse, it would drag down the NHS with it.

The urgency of such action had been recognised almost a decade earlier, in 1999, when a report by a royal commission on the matter recommended free personal care, paid for by general taxation. It did so for the reason that if we pay for free preventive care in people’s homes, those people do not end up in hospital and costing us all more. Nothing was done, and by 2007 the need for reform was urgent. So between 2007 and 2009, a huge amount of detailed modelling work was done and options were looked at.

When I arrived in the post of Health Secretary in 2009, the work had come to a head. The analysis supported a clear conclusion that radical reform, rather than patching up, was needed. Department of Health officials supported the Treasury analysis that there would be risks to the NHS if social care was allowed to decline. A Green Paper was published in July 2009, and the idea of a national care service was first put forward. The thinking was that only by bringing the systems together, with a system of clear national entitlement, would we be able properly to move towards integration. The maintenance of two entirely differently funded systems—one free at the point of use and the other means-tested and charged for—would mean that they would never be able to speak the same language and there would always be barriers to integration.

I was ready to grasp the nettle, because it was clear to me that the NHS was facing a decade of lower funding from 2010 and 2020, and that one of the ways it could cope with that was with the efficiencies we could unlock through properly and fully integrating health and social care and by moving from a hospital-based medical model to a person-centred social model of care starting in the home.

This is where things went wrong. Picking up that I was ready to up the momentum for reform, the then shadow Health Secretary, Andrew Lansley, approached me in Portcullis House just before Christmas 2009 and asked me for cross-party talks. I thought about it, but I agreed. I thought, as my hon. Friend the Member for Barrow and Furness (John Woodcock) has suggested, that we should take the issue out of party politics, which would be better for everybody. We had a couple of meetings, in which we went round the issues. I favoured the more ambitious, comprehensive reform of paying for social care on the NHS principle—that everybody contributes, but everybody is covered for their care needs and has peace of mind in later life. Andrew Lansley wanted a more voluntary system, in which the insurance market would come up with solutions. That was where we left it.

Then a bombshell was dropped in February 2010: the poster saying, “Now Gordon wants £20,000 when you die.” I very vividly remember the day when it landed. I was told that Andy Coulson had put pressure on Andrew Lansley to do it, and that he did not really want to, but felt he could not say no. I do not know whether that is true, but I know that the Conservatives, who asked me for cross-party talks, betrayed the confidence that I gave, and they have never seen fit to apologise for that. The point is not about the personal political damage that that did, but about the chilling effect the poster had on the social care debate. It instantly killed any talk of radical reform, and it actually had a deadening effect for the rest of the following Parliament—the last Parliament—during which no real progress was made.

That brings me to what happened after the election, when, as shadow Health Secretary, I challenged the Government from the Opposition Front Bench about the poster that they had put out during the election saying that they would cut the deficit, not the NHS. I made the point that if they did so, they would in effect cut social care: if they prioritised NHS spending within the reduced envelope, that would have devastating consequences for social care and would in the end come back to affect the NHS.

From the Dispatch Box at every Prime Minister’s Question Time, the then Prime Minister used to quote me as claiming that it would be irresponsible to give the NHS real-terms increases, but he never commented on the second part of what I had said, which was that it was irresponsible to do so if we were cutting social care. I did say that, and it was irresponsible to social care in the way they did to pay for their commitment to the NHS. Social care was cut by 9% during the last Parliament, with 400,000 vulnerable people losing support in their homes. Those people ended up in A&E or trapped in hospital beds, piling pressure on the hospital system.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I pay tribute to the right hon. Gentleman—this may be my last chance to do so—for the work he has done as a Member and wish him well in his future career if he is successful in his election. Does he agree that the chilling effect of the outcome of those conversations before the election and perhaps the betrayal of his confidence, as he puts it, is that there could no longer be a rational conversation about properly funding the health and care system through any form of taxation? That is the problem that has emerged, and perhaps the best way to fix it is through general taxation.

[Andy Burnham]

I am very grateful to the hon. Gentleman for his intervention and the spirit in which he made it. He is absolutely right: that set everything back and meant that there was no possibility of a cross-party approach. There will have to be such an approach if we are to fix social care and, indeed, to give the NHS what it needs, because they will both need more funding during this Parliament. That is the real shame. I did not make my point about Andrew Lansley for political reasons; I just want people to understand what happened, so that the current generations of politicians might do something different.

The answers we have since had from the Government are wholly inadequate. We have heard today that the precept does not raise enough money, particularly for poorer councils. It is no answer; in fact, it just cynically devolves the responsibility for the whole issue to local government, even though councils did not create the problem. I still favour an all-in system. I will say it: I favour a system in which we ask older people to pay a set contribution, so that they have peace of mind in later life, with all their care costs covered.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to follow the hon. Member for Halifax (Holly Lynch), who articulately outlined several of the human challenges facing some of her constituents due to problems in the social care system. We have heard many contributions from right hon. and hon. Members today, many of whom drew upon their own front-line experience of working in the health and care system and of the difficulty in getting the right care that people up and down the country are facing.

We must remember that we are debating issues that affect real people and real people’s lives, which we sometimes forget in the heat of political debate. We need to remember that social care and good social services are about providing basic dignity in the care of older people and disabled people with things such as dressing, eating and washing. No Member should forget the importance of personalised care that provides dignity. We need a system that is not only more integrated and joined up, but better funded than the current system, which is not adequately financed to meet the needs of the people it looks after.

I want to talk briefly about welcome initiatives such as vanguards, the better care fund and the STPs, which are moves in the right direction. I also want to discuss the future. The right hon. Member for Leigh (Andy Burnham) was right when he highlighted some of the missed opportunities over the past two or three decades to grip the issues of improving social care and properly funding a sustainable health and care service. Before I do all that, it is worth pointing out some of the fundamental challenges facing the health and care system today.

However one dresses up the figures, there is an undoubted trend towards increasing delays in transfers of care. That is the truth that the figures show us. Of course, there are areas of good and bad practice, but the national trend in delayed transfers of care shows increasing pressure on the system. Budget reductions in the social care sector are real and amount to about £4 billion over the past decade. It is welcome that more money is coming into the system through the local precept, but that barely touches the sides when we consider the challenge of also meeting the increased demands of paying the national living wage. The NLW is a welcome initiative that will raise the living standards and quality of life of many care workers by properly rewarding them for their work—or make a much better contribution towards doing so—but the change is nevertheless putting budgetary pressure on local authorities, which manifests itself in difficult decisions about how care is provided and rationed on the frontline.

One of the big trends of the past decade has been that many local authorities have tightened the eligibility assessment for social care. It is effectively now the case that someone has to be in severe need to receive social care, so we must recognise that the tightened criteria mean that those who receive social care are no longer those in moderate need. That is symptomatic of some of the budgetary pressures that the system faces.

The welcome initiatives—the vanguards, the better care fund and the STPs—are all about the better joining up of what health and social care do together, but we must remember that STPs have perhaps come about in spite of the Health and Social Care Act 2012 rather than because of it. Prior to the 2012 Act, we had strategic health authorities, which helped to co-ordinate care at a regional level. Those were abolished and disappeared. STPs are now a welcome return to the recognition that we need a degree of regional co-ordination of our health and social care system in order to deliver the right care. That co-ordination must be across primary care, secondary care and social care. Housing providers are equally important, because many delayed discharges from hospital are due to the lack of appropriate housing for people with mental health conditions and dementia who do not have the right houses or the right circumstances at home. That is an important part of delivering those local plans to make sure that the system works better for people.

The elephant in the room is of course funding. Yes, we need to transform services, and more money is needed to do that. There are transformation budgets available through STPs to support clinical commissioning groups in delivering improvements in the NHS, but that will barely touch the sides and will not make enough of a difference. The great tragedy is that if we really want to drive integration, we must put the money into the same place. We must properly fund the integration and joining up of care. The loss of opportunity before the 2010 election was highlighted by the right hon. Member for Leigh. I urge the Government to look again at having cross-party talks to consider a sustainable future for the health and care system in which we all believe.