Health and Social Care

David Ward Excerpts

Monday 13th May 2013 Commons Chamber

[Paul Burstow]

I welcome that comment from the Minister and look forward to seeing more detail.

My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

[Mr David Ward (Bradford East) (LD)]

Can I tempt my right hon. Friend to comment on his proposals on the use of universal benefits for wealthy pensioners? I know that he has produced a pamphlet.

[Paul Burstow]

I will try to do that in the one minute and 14 seconds left to me.

The ADASS survey paints a quite disturbing picture of the next two years. More providers will face financial difficulties and there will be increasing pressures on the NHS as social services shunt people into health care services.

The spending review that is under way is for just 12 months. It needs to fund the successful implementation of this legislation, and not least the introduction of the Dilnot proposals. More than 450,000 people will need assessments to get into the new system. The spending review also needs to sustain the transfers of money from the NHS to social care. Beyond that, the spade work needs to be done now to make the case for the critical interdependencies between social care and health that will sustain our social care system and make our health system deliverable and affordable.

The Queen’s Speech, with its specific commitment to this legislation, contains a landmark reform that will do a great deal to improve the quality of life of our constituents.

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[Sarah Newton (Truro and Falmouth) (Con)]

The inclusion in the Queen’s Speech last week of a Care Bill in this new Session of Parliament is nothing short of a landmark occasion. Those of us who have been concerned with the reform of our social care system for decades know that those desperately needed reforms, which are well summarised in the Bill, have repeatedly been kicked into the long grass or filed under “Too difficult to do”. Finally, however, we are making progress.

I have been disappointed by the response to the Bill from Labour Members, who know as well as I do how welcome the proposals are, and what a step forward they will represent for the quality of life of many thousands of people in this country. It was a courageous decision by the Government to introduce the Bill at this time, given that public finances are under enormous pressure as we try to clear up the mess of the financial legacy bequeathed to us by the Labour Government, because the reforms will require additional public finances.

In the last Session of Parliament, excellent work was done by the group of Members of both Houses in undertaking pre-legislative scrutiny of the draft Bill. That was a good example of how people can bring the experience they have gained outside Parliament into their work as legislators. I am grateful for their consideration of my contribution and the subsequent inclusion in their report of my recommendations. The recommendations resulted from work undertaken with a number of Members across the political parties who worked with the charity Macmillan, looking at what could be done to improve the quality of care of people who want to stay at home at the end of their lives. Ensuring people have a genuine choice over where they die is of particular importance to me.

Last year, I chaired a round table event in Parliament, organised by Macmillan Cancer Support, which brought together carers, health and social care professionals and policy makers to discuss how to enable more people to be cared for at home until they die, if that is what they choose. The expert attendees were clear that access to basic social care support can make the difference between somebody dying at home surrounded by their families or dying in an expensive hospital ward. All too often, however, patients and families cannot access the support because of a lack of integration of health and social care systems or because they cannot afford to pay for it.

I believe that removing the social care means test for people on the end-of-life care register would lift a significant barrier to the integration of care, allowing many more people to access the support they need and to exercise choice, which could also save the considerable costs of people being in hospital. The Government’s commitment, made in the care and support White Paper, to assess free social care at the end of life through the palliative care funding review pilots represents very good progress. However, with the Care Bill likely to become an Act before the pilots finish in 2014-15, it is also crucial that the Bill allows for the delivery of free social care at the end of life. This would enable the Government to implement the policy without delay, once the pilots report.

I understand from the responses I have received to written questions that the Minister is undertaking a review of the pilots this year. I very much hope that clauses will be added to the Bill to enable free social care for those at the end of life. Such a step forward would be welcomed by professionals and families alike. It would make such a difference to families at such a difficult time of their lives.

Another specific aspect of the Bill I would like the Minister to consider—together with the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey), who has responsibility for disabilities—is social care for working-aged adults with disabilities. The debate about the future of our adult care system has very much focused on the elderly and their family and carers. I am as guilty as anyone else of focusing on the injustices in the current system for elderly people and the need for a fairer and better system, but the care system has another group of people who need support: adults who acquire a disability through an accident or an illness. They might not have been working long enough to have savings that they can spend on their care needs and they might have a degenerative condition that has prevented them from working full time. For them, reform of the current system is less to do with how they can protect their assets or how they can pay for care without selling their homes than with how they can get the help they so desperately need.

The definition of eligibility for care within the Bill is of greater importance than the means-tested threshold and the caps on personal expenditure. We must have a realistic threshold of eligibility, so that people can participate in society as a whole—in education, as volunteers or as employees.

As the Minister will be aware, some local authorities have, sadly, chosen not to spend the money provided by central Government on the adult social care budgets and have been increasing the eligibility criteria. The Dilnot commission highlighted this concerning trend, and I know that Ministers listened. I understand that the Department of Health is working on amendments to the fair access to care criteria currently used by local authorities. The amendments are reflected in the Bill, which includes new interim eligibility criteria. Concerns have been raised, however, that the interim criteria will not address the continuing shift of social care provision away from those with moderate needs. Research undertaken by the London School of Economics indicates that 105,000 people could lose eligibility if the Government move ahead as proposed.

[Mr Ward]

Is the hon. Lady aware that in 2005, 50% of local authorities were setting the level at a substantial 84% for the move from “moderate” to “substantial” needs?

[Sarah Newton]

The hon. Gentleman makes a very good point, which illustrates the findings of the Dilnot commission.

I urge the Minister to consider this further and to ensure that the final interim criteria agreed upon, which will be in the Bill, recognise the very real care needs of those who fall into the moderate care category within the current fair access to care system. We found from the report we received on Friday on the Government’s consideration of what improvements might be put into the Bill that they have agreed to look at the eligibility criteria and to fund the proposals under the June comprehensive spending review. All that is very welcome. I hope that, once the criteria and the funding to support it have been agreed, the money passed over to local authorities will be ring-fenced for a period, perhaps up to three years. The Government have done that for public health, and doing it in this instance would enable the estimated 105,000 people who have moderate care needs to receive the funding and to continue with their working and volunteering lives, playing their full part in society.

I am sure that the Minister of State has been listening closely to the organisations that represent people with disabilities. I am also sure he supports the excellent vision and work of the Minister with responsibility for disabilities that aims to enable people living with disabilities to play as full a part in society as possible. I very much hope that, as this Bill passes through the House and is further scrutinised and consulted on, we will address the concerns of these groups of people who all too often fail to have their voices heard.

The Government have listened hard to the needs of elderly people and have produced a good way forward. These straightforward and common-sense improvements will make a hugely positive contribution to the lives of people at the end of life and those of working age who are living with disabilities. Those people are often living out of sight; we must show them that they are not living out of our minds.

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[Mr David Ward (Bradford East) (LD)]

I want to congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on her contribution, and I hope to add to her comments.

A quiet revolution is taking place. Slowly—although probably not very slowly—but surely, the life chances of thousands of vulnerable people are being changed. We in Bradford did a huge amount of survey work following the publication of the health and social care White Paper, the Bill and the progress report on funding reform, and we received a huge response with more than 500 direct responses from within the constituency. I want to pay tribute to Bradford council, which was very much involved, as well as the Bradford and District Age UK, the Bradford Alzheimer’s Society, Ideal Care Homes, Bradford disabled people’s forum, the Consortia of Ethnic Minority Organisations and also the area manager of Specialist Autism Services, who submitted a response last week.

The report was published after a Westminster Hall debate on this subject, and many of the Government’s proposals were generally welcomed. Some areas caused concern, however, including on hospital discharges, specialist housing, and waiting times for adaptations. Much of the concern is less about legislation and more about local delivery—about what is actually in place in the locality.

The backdrop to everything we are doing in all policy areas is the austerity programme and the deficit, and many local authorities are facing severe funding cuts as a consequence of the measures being taken. Their effects are being exacerbated by the increasing demand for social care. In my area, there will be an additional 5,000 over-65s in the next 10 years and a 38% increase in the number of over-85s. There will also be a large increase in those with learning disabilities. This will add an extra £10 million to local costs. A lot of complex cases are arising, and all of this must be seen against the backdrop of the cuts and changes.

The Government say that local authorities must decide on priorities. That is true, but it is also a bit dishonest. The national health service budget, for which the Government are seen as responsible, is protected, but the social care budget, which is predominantly picked up by local authorities, is under attack and being cut. If many of the preventive measures we are seeking to introduce enable people to go home sooner and have a better experience on their return from hospital, that will reduce the pressures on the NHS budget but increase the costs facing local authorities, as they will have to pick up the costs arising from those successful preventive measures. Things will be difficult for many local authorities, therefore.

The report we in Bradford produced following the publication of the Bill focused on residential care, and since then we have done a lot more work on another crucial, and topical, area: Bradford council has, through a consultation process, been addressing the fair access to care services—FACS—criteria, and I will focus on the criteria for the provision of social care. I mentioned discharge from hospital and adaptations, but the level at which the FACS criteria are set is crucial in determining the services many people will receive in their homes and the life chances and experience they will have.

The “critical” criteria include when “vital social support systems” and

“vital involvement in work, education or learning cannot or will not be sustained”.

A person’s care and support needs are deemed as “substantial” when

“many aspects of work, education or learning cannot or will not be sustained.”

We understand all that, but the bit I am not comfortable with is the description of anything lower than that as being “moderate.” That is a terminological inexactitude or misnomer. Listed under “moderate” are

“an inability to carry out several personal care or domestic routines and/or...several aspects of work, education or learning”.

I do not regard that as being “moderate.” The ability to do such things is often essential if people are to live a satisfactory life in their own homes and as part of their local community.

In plain and simple terms, and without trying to be funny, if someone cannot get their knickers or underpants on in the morning, they will not go to the day centre, however good it is, and if someone does not get the help to get the right tablets in the morning, they will not be going to the day centre in a minibus; they will go to hospital in an ambulance. We must not call this level of need “moderate.” For many people, it is essential if they are to have a full life in their community and in their home.

We must look less at what can be funded and more at what levels of need we need to fund. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) pointed out that much of the proposed legislation is about intervention and prevention, on the basis that prevention is better than cure, but the danger is that today’s moderate needs will become tomorrow’s substantial or critical needs if they are not met at the correct time. This is not about cutting our cloth or making do in times of austerity. It is about, foolishly, making short-term savings to the detriment of future taxpayers who will have to bear the costs of what should, and could, be regarded as avoidable needs.