Social Care Reform (Disabled People)

David Ward Excerpts

Thursday 11th July 2013 Westminster Hall

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

I was pleased when I heard that you were chairing this debate, Ms Clark, as I know that you have strong views on this issue. Most of us ought to have strong views on it.

In everyday conversation, we tend to use the word “ability” to indicate that we believe that someone has a special talent. We mean that someone has the ability to play the piano or tennis or to speak in public rather well. That is an inaccurate way to use the word, but it can sometimes lead to the false view that a disabled person is seeking special attention. We have heard that for ourselves: “They’re always after something.” Such disparaging remarks are often made. The reality is that that is simply not true. What disabled people seek constantly is not special attention at all—as a good liberal, I would say this, wouldn’t I?—but the basic human right to a normal life.

Of course, that does not mean that people with disabilities cannot ascend the heights and cannot have unbelievable special abilities—we know that all too well, and history is full of countless examples—but the starting place must be the basic human right to access all life’s opportunities, such as work, leisure and family, things that non-disabled people far too often take for granted. As a good left-of-centre liberal, I believe that the state has an important role to play in supporting people, not necessarily through direct state provision but by helping them attain their rights.

I thank the Backbench Business Committee for granting me time for this debate, and I thank the hon. Member for South Derbyshire (Heather Wheeler) for her support, as this debate is co-sponsored. I also congratulate her on the work that she has done on the issue—I am sure that she will refer to it—as the chair of the all-party parliamentary group on local government.

I thank Scope for the great support that I have received so far on this campaign and for the partnership work that we are carrying out in Bradford, where we are preparing at this very moment for the launch of the “Bradford Cares” campaign, part of the wider national Scope campaign “Britain Cares”. The launch will take place next Monday in Bradford, and I am delighted to say that the former Care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow) will be speaking.

To add more power and force to our arguments when bidding to the Backbench Business Committee for this debate, we were rightly asked to justify the time devoted. We were given eligibility criteria, including topicality and importance. As for topicality, we know that social care is the largest remaining area of reform for the coalition Government in this Parliament, and the Care Bill is on its way through the legislative process. The crucial issue of eligibility, to which I will return, is extremely topical, not least for people in Bradford, where the council is one of the few remaining local authorities to use the moderate level of need when assessing support. However, the council is consulting as we speak with a view to moving to assessments of substantial need. That consultation will last until 4 August.

As for importance, we must acknowledge that much of the debate about meeting and funding care needs has focused on the elderly. We understand the reason perfectly, but we must also remember that one third of care users are working-age disabled adults. That one third equates to more than 500,000 people between the ages of 18 and 64. It is a big issue for us as a nation, and the numbers are projected to increase substantially. In addition, working-age adults have considerably different aspirations from the social care system. They are not more important, but they are different and must be clearly understood when developing social policy.

A report called “The other care crisis: Making social care funding work for disabled adults in England” was published in January this year by Scope, the National Autistic Society, Mencap, Leonard Cheshire Disability and Sense. The report highlights the fact that, since 2008, there has been a constant move from moderate to substantial needs as the basis for assessment in local authorities. Since 2008, the number of people using care, at a time when we know need is increasing, has fallen by at least 90,000, or one in six of all people using care. We also know that there is a shortfall of £1.2 billion in the funding required to support social care for working-age disabled adults.

The report states that if social care reforms go ahead as planned, a further 100,000 people or more risk losing vital care and support. I know the Minister, and I know that if that is true, it will not be acceptable him. I am willing to admit that all the organisations that I mentioned and I must be wrong in our fears, but the trouble is that I cannot see how, which is why I wanted to have this debate.

On the first page of the briefing prepared for this debate by the Library, there is an article by Baroness Grey-Thompson, who apparently can see that we are all wrong. She states:

“The Chancellor announced a £3.8 billion investment”—

I know that the Minister will refer to it—

“including £2 billion of new money, in social care—the support disabled and older people get from their council to get up, get washed and dressed and live independently.”

My understanding is that setting the national eligibility threshold at the substantial level of need would mean that that was simply untrue. People would not get that support. The needs that Baroness Grey-Thompson refers to would not be met.

I know that the Minister will say that local authorities can provide support at what levels they choose. They could provide it, as many did for many years, at the moderate level of need, but the trend is moving in the opposite direction and at a rapid rate of knots, hence the figures that I gave earlier, which are getting smaller and smaller, on the number of people receiving support.

We all understand the need to avoid the existing confusion with the so-called postcode lottery—the differing levels of support in different parts of the country—but I must ask a question. What is the value of having the certainty, wherever I live in the country, of being guaranteed a level of support that fails to provide me with my basic human right to live an independent life? That is not a freedom: to be told that I cannot have the life that I deserve. It is not an improvement to provide the certainty of not knowing what care I will get, which we have at present, with the certainty of getting almost no support at all. I know the Minister and that that is not his intention, so I am in the Chamber today not to bury Caesar—not to criticise my hon. Friend—but to understand better how the planned reforms will work. I cannot work them out; we cannot work them out; and we desperately need to know.

I read the discussion document on the draft national minimum eligibility threshold for adult care and support and I do not get it. To me, there seem to be four crucial elements to the provision of care and support, and there may be more. First, without sufficient funding, there will be a problem, no matter how effectively and efficiently we deploy the available resources. Funding will always be vital. The other three parts are integration, eligibility and the actual care services provided.

We are told that £3.8 billion—£2 billion of new money—is there to help with that crucial integration, but good integration will improve the efficiency and quality of care and support at any level of funding. If we were given 1p, through good integration we could spend that penny better than by being disorganised and chaotic. Eligibility, however, will determine the level at which a person can access the wonderfully improved care and support that we will achieve through integration. Eligibility is the gateway, and the integration can take place at any level of care. We could remove all the postcode lottery uncertainty by setting the eligibility level at critical and yet integrate wonderfully, but how would the improved integration help the hundreds of thousands of people whose needs fall below the threshold level? I do not get it.

[The Minister of State, Department of Health (Norman Lamb)]

If my hon. Friend were to go somewhere such as Torbay, where completely integrated teams of health and care workers have been created, he would see that those teams can together make rational judgments about the people who need care and support, by identifying the individuals most likely to end up in hospital and allocating a worker from an integrated team to support them. I absolutely recognise that the eligibility criteria play a role, but the joint team can assess the needs in the area and do whatever is necessary to maintain people’s health and to prevent the deterioration of health and people ending up in hospital. Integration seems to be essential to what he seeks to achieve.

[Mr Ward]

It is not an either/or, or a route from one to the other. We can integrate at any level of support, and greater integration would certainly improve the system with greater economies and, we hope, greater equality of provision. If the Government had planned to introduce a whole new system and remove all criteria—looking simply at people and their needs—I could possibly see, with a wonderfully well funded and integrated system, how that might work. What is planned, however, is not that but an eligibility threshold against which people will be assessed. At that point, even with the washing, the getting dressed and all the other things that Baroness Grey-Thompson was talking about, the decision might be made that the person is simply not at the required level—the threshold—to be given support.

In the foreword to the discussion document, the Minister stated:

“We are establishing a system that will place a greater focus on prevention, which will mean that the care and support needs of people will be considered earlier than is currently the case.”

That is good, and it must refer to the early identification of potential future needs through improved integration. From my own background—in particular, in the area of children with special needs—I am well aware that early identification, so that support can be given, even from mainstream provision, can stop those needs developing to a level at which additional funding and support are required.

I understand all that, but a working-age adult can, for example, have a stroke—something that we saw at the Stroke Association event yesterday—and move, within a day, from being perfectly healthy to having needs that might even be classed as critical. On the direction, however, this is not about progression for many working-age disabled people, because they may move from critical or substantial down to moderate, but about how someone who has had a stroke perhaps may never move back to a point at which support is not required and live a truly independent live. The danger is that such people might go down, in terms of the needs as assessed, and fall out of the system. Where will they then end up? Later, at greater cost, they will go back into the system. That is the concern.

The discussion document refers to the creation of a working group to take matters forward. My problem is that it also states that developing and evaluating the research carried out by the working group may take three to four years. Too many disabled people, however, may quite literally not have that long.

--- Later in debate ---

[Mrs McGuire]

Of course I welcome that. I think that the big challenge for the Minister, the Government and, indeed, any future Government that I hope will be there within 18 months or so is how that is delivered—how we break down those barriers. Although I can obviously speak about the silos within the UK Government, at Whitehall level, we must be realistic and recognise that there are tensions even between one local authority and another. The issue is how that policy is delivered, but of course I give the Minister due recognition for that comment.

I want to emphasise the issue of the eligibility threshold. I heard what the Minister said about that, but if the threshold is at the “substantial” level, many people will not qualify. I accept what he said—no one will lose out on what they have now, so if someone gets it at the “moderate” level, which I understand is the situation in Bradford, they will not lose out. But in the event that the provision is limited to those whose needs are at the “substantial” level, many people will still require that additional element of support, which would allow them to live independent lives.

[Mr Ward]

The point was made by the Minister that no one will lose out. As I pointed out in my speech, 90,000 people have already lost out. They may be being told that they will not lose any more, but they have nothing more to lose, because they have already lost it. That is the big concern. We already have this level in 84% of authorities, which means that people have lost the provision; it has gone from them for ever.

[Mrs McGuire]

I hope that the Minister has heard his hon. Friend’s comments.

The report clearly identifies the issue of preventive care. That issue has bedevilled the health service, probably ever since it was established. People think of the health service and the social care service as providing solutions at the point at which they need them, as opposed to being innovative and looking at how some of those situations can be prevented from arising. As the hon. Member for South Derbyshire said, there is a saving in the long term if we get that right.

It is perfectly true that many disabled people who fall out of the system have to re-enter it and probably at a higher level of support and therefore expense. Of course, the crucial element in all this is that closer integration of budgets is needed to ensure that “health and social care” actually means health and social care. I do not think that any of us can run away from the issue of financial austerity. It is about getting the best value for money and recognising the funding gap, but I hope that we can reach agreement across the political spectrum about how we deliver this. I would hope that hon. Members in this Chamber would share many of the frustrations that certainly we had in the last Parliament about the fact that we could not reach cross-party consensus on funding.

I want to address a couple of remarks to the Minister. One has to do with a gap in the Care Bill. There is no mention of the role of the DWP in any of this, yet the DWP holds the purse strings, in some respects, for many individual disabled people. Some of us were quite surprised in the debate yesterday in the main Chamber when we discovered that the Minister leading the debate on behalf of the Government, the Minister of State, Department for Work and Pensions, the hon. Member for Fareham (Mr Hoban), said that he had not read the Care Bill. That was quite a shock. We do not know whether his officials had read it, but there is a strong element that I think must be taken into account. I am referring to the role that the DWP can play in this. I would be interested if this Minister had any comments on what he believes will be the impact of the closure of the independent living fund in terms of the wider area of health and social care.

I want to finish my speech by offering very special thanks to Baroness Campbell—Jane Campbell. One of the idiosyncrasies of this place is that although we can share agendas with our colleagues in the House of Lords, we cannot share with them, even in the slightly less formal environment of Westminster Hall, some of the discussion and debates. Baroness Campbell was a pioneer of independent living and a driving force behind this agenda for many years. She has her own piece of legislation, a private Member’s Bill, and I understand that much of what was in that private Member’s Bill has probably been taken on board by the Government. Individuals such as Baroness Campbell, who depended themselves on the health and social care system, were not prepared to let that system drive them down. She has been a powerful advocate for this agenda over many years. I wanted to pay a particular and special tribute to her this afternoon as we have the opportunity to discuss the report.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I join others in saying that it is a pleasure to serve under your chairmanship, Ms Clark, and I apologise again for my rudeness earlier. I noted that the right hon. Member for Stirling (Mrs McGuire) said that it was a “genuine pleasure” to serve under you. I am not sure what it means when on other occasions she leaves out “genuine”; none the less, it was clearly a tribute to you, Ms Clark.

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate. This is the second time this week that the two of us have discussed and debated care issues, and I know that he cares passionately—and genuinely—about the subject.

I want to make a number of points at the start. I very much welcomed the fact that the hon. Member for South Derbyshire (Heather Wheeler) highlighted the absolutely central importance of the principle of well-being in the Care Bill. The Bill has the potential to be transformational in how it challenges culture—how the system works and how it treats people. In part, it is about a big shift from a paternalistic system in which people get done to, to a personal one in which their needs and priorities come first.

The right hon. Member for Stirling made the point, absolutely correctly, that there is more to life than getting up, being washed, eating and going back to bed. I am not sure who focused on the important issue of social isolation, but the truth is that many people in this day and age live miserable lives. If someone lives on their own and has substantial care needs, and the extent of their life is getting out of bed, getting washed, sitting in a chair and going back to bed, with no one to see during the day, that is a miserable life.

One point I want to make today is that this is not just about care services. If we are talking about a good society and about giving people a good life, there must be collaboration between statutory services and communities, families and the streets on which we live. I have floated the idea of neighbourhood watch groups applying to provide care. We have a national movement that looks out for whether our houses are being burgled, so should we not be thinking—all of us stepping up to the plate—about whether there are people on our streets who have care needs, or who might just be very lonely and could do with a bit of companionship?

If we are to have a civilised society, the focus has to be not just on statutory services but on collaboration within the community. That is all the more important given the extraordinary strains which the public finances are under now and will be under in future. All political sides in the debate must face up to the extraordinary financial challenge and how best to meet it.

Reference was made to setting the eligibility criteria. My hon. Friend the Member for Bradford East argued cogently for the level to be set at moderate, and the shadow Minister, the hon. Member for Leicester West (Liz Kendall), asked whether there had been a cost-benefit analysis. The problem faced by any Government is that the up-front cost for both working-age and older people is £2.7 billion. I absolutely buy into the case for preventing ill health and the deterioration of health and into making another fundamental shift from repair to prevention—the whole system must reflect that—but Governments should be very careful about committing themselves to that level of up-front cost. That would be exactly the same if Labour were in power.

The shadow Minister and the hon. Member for South Derbyshire asked whether the £3.8 billion pooled sum applied to working-age disabled people as well as older people. Absolutely, yes. My passion for integrated care and for preventing ill health and deterioration in health applies to people of whatever age. We have a particular challenge with frail elderly people, but we also have an understated challenge with people of working age who have disabilities, because often the focus is not enough on them.

[Mr Ward]

In relation to the impact on people, “The other care crisis” report states that we must look at not only what may happen but what has already happened over the past two years up and down the country, and the impact there has already been and no doubt will continue to be on people. I understand that the legislation is due to go through in 2015, and there is talk of having a working group over three to four years. That seems an awfully long period before we will have an assessment of what has happened and what may occur as a result of the legislation.

[Norman Lamb]

I will come on to the work that we intend to do on a more sophisticated way of assessing eligibility and responding to assessments. I absolutely accept the current danger that the system in effect says, “Go away, become more ill or more disabled, and when there is a real crisis, we might help you.” I want us to be more sophisticated and to intervene in ways that will help to build capacity and resilience and to stop the deterioration of health. I genuinely believe that the Care Bill will give us the foundations for a much more rational approach.