Adult Social Care

David Ward Excerpts

Wednesday 21st January 2015 Westminster Hall

[Mr George Mudie (Leeds East) (Lab)]

It is a pleasure to see the Minister here for this debate as well as you, Mr Robertson. I thank the Speaker for this opportunity to discuss the present and future state of the adult social care sector. This area of local government covers a vital service for the most vulnerable people in the country, with the elderly, the disabled and those with mental health difficulties being among its most prominent users. In the past four years, its future has become more of a concern.

We are weeks away from a general election and the Government are anxious that their fiscal plans are seen to be successful. Central to those plans is the fact that cuts to public services are unavoidable and necessary and that they must continue for the next four years. Before we blindly accept that doctrine, the debate gives me an opportunity to spell out briefly the extent of the damage those cuts are having on the lives of hundreds of thousands of vulnerable people who use the adult care service.

The Government have ring-fenced the health and education budgets, so, with those two huge Departments free from cuts, money has to be found from other Departments. In local government, adult social care services is the next largest budget. The Government have claimed to understand the sensitivity of that work, but nevertheless the 40% cuts in local government spending have made it impossible for the service to escape unscathed.

Age UK, the leading charity in this sphere, states that the sector has lost more than £1 billion since 2010—and that is at a time when, because of demographic changes, with people living longer, the services requires more money, not less. It is good that people are living longer, but when they eventually ask for help, because they are older, their needs are more complex and expensive.

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

Does the hon. Gentleman accept that cutting that spending is a false economy? If quality care is not provided at the right time—in particular in the home environment—more expensive care will often need to be provided later in hospitals and other care support centres.

[Mr Mudie]

The hon. Gentleman is quite right. I will touch on the sheer lack of connected thinking in the Treasury—I do not think that the Department of Health has much to do with that.

The National Audit Office, which is usually pragmatic and non-political and accepted as objective, pointed out in its review of the service that total spending on adult social care—covering the whole gamut of, I suppose, 18 to death—fell 8% in real terms between 2010-11 and 2012-13. Older adults experienced the greatest spending reduction at 12% in real terms. Interestingly, the NAO stated:

“Rising needs, reducing local authority spending, and reductions in benefits may be putting unsustainable pressure on informal carers and acute health services.”

Chillingly, it went on to say:

“National and local government do not know whether the care and health systems can continue to absorb these cumulative pressures, and how long they can carry on doing so.”

That is from its review last year, yet the cuts have continued.

--- Later in debate ---

[Mr Mudie]

It is clear that my hon. Friend has read my speech; I was just coming on to the privatisation of adult care services.

I hope that I have highlighted in my remarks the important role of local authorities in the sector. As an ex-councillor, I instinctively have much sympathy with the difficulty they face in having to take some very difficult decisions about priorities in the face of the Government onslaught on their budgets. Leeds, my home authority, has faced a tremendous task in running a city when it has had to find £250 million in cuts during the period of the first spending review. Having achieved that, it is now dismayed to hear the Chancellor threaten—indeed, promise—further cuts until 2018, if he gets back in office. In fact, Leeds has been told that it will face a budget cut of £46 million in 2015-16. Other councils face similar problems, and I simply do not know how the Chancellor feels he can order those huge cuts and still have our major cities being run and our elderly and disadvantaged being properly cared for.

I was alarmed when I was informed that a dementia residential and daycare home in my constituency, The Green, was being closed, and that many hundreds of home care workers were also losing their jobs. When I looked into things, I discovered that, chiefly as a measure to keep the city intact financially, the council had had to act in line with other big cities and had taken two unfortunate steps.

The first, which has been mentioned in passing, was to raise the criteria level at which help should be given. This meant that new applicants would have to meet higher eligibility thresholds than before. Parkinson’s UK and the National Autistic Society are two organisations that have pointed out how the new criteria put their members at a disadvantage when it comes to receiving help. The Government have legislated on that point in the Care Act 2014, and although that meets the Government objective of ending postcode unfairness, it also legitimises local authorities, or rather strengthens them, when they have to turn people down because they have needs that are lower than the criteria require. Those organisations have given evidence on how the quality of life of individuals with either Parkinson’s or autism has been diminished. I hope that the Government’s decisions will be reviewed in happier times.

What is more difficult to review is the point that my hon. Friend the Member for Coventry South (Mr Cunningham) touched upon—the decision to outsource adult care services. That has been done to help meet the shortfall in Government grant. Perhaps I am paranoiac—I probably am, because I think paranoia keeps us safe—but I wonder whether that is what the Government intended. Many people have been outraged by the Government’s propensity to privatise much of the NHS, but thanks to the love that the British public quite rightly have for that unique and wonderful organisation, the Government have backed off from adopting a full-frontal approach and are now taking a more subtle, if not devious, approach.

So quiet has the handing over of care homes and home care staff been that it has rarely been picked up by the general public, except by the clients of those homes and the ex-local government staff themselves. There is a growing awareness of 10-minute visits and the failure to provide elderly people with the same carer; providing the same carer is an important part of home care, so that people can build a relationship with them and trust can develop. The former staff are aware of the loss of local government wages, the use of zero-hours contracts and the loss of payment for travelling time, which accounts for those 10-minute visits.

I will just depart from my script to say that that situation is not surprising. If a council outsources contracts and there is a duty to save money, given that those contracts primarily involve labour, the only way in which money can be saved is to hand them over to a private company. That company would have no compunction in offering lower wages, no travelling time, worse holidays and worse sickness schemes. That is what has happened in the majority of cases.

[Mr Ward]

Does the hon. Gentleman accept that, in many cases, the private sector businesses are effectively offering wages that are below the national minimum wage, as a result of the commissioning process? In some cases, they are being given only enough money to offer no more than £12.50 or £13 an hour, which cannot cover all the costs of travel, transport, uniforms and training. That means that the private sector businesses are often almost being forced out of business.

[Mr Mudie]

I totally agree with that. Now that the local authorities have pocketed the money, it is clear that they are pressing down on the private firms, and we are a step away from the disaster of the private firms just going, “There—that’s it.” What happens when we have closed all our residential homes? There is a real problem building up.

I am sad that financial pressures have forced councils to do that. The care of the vulnerable elderly is a service that, just like hospitals, should remain in the public sector. The various scandals in care services have underlined the temptation—indeed, often the necessity—of people in business to do more than cut corners when looking after people who are helpless. I am less than convinced that the Care Quality Commission, with its proposed risk-based regulation, is any better than its predecessor, which turned out to be disastrous.

In Leeds, thanks to the protests by staff and unions, the public unhappiness over the closures and the sagacity of the council leader, Councillor Keith Wakefield, the decision on care is under review. I understand the pressures that the council faces, but I hope that it makes the right decision.

I will end my remarks by asking the Minister three questions, which, if past debates in this place are anything to go by, I will not receive answers to; I am referring not to this Minister but to his disreputable colleagues. I know that this Minister is a man of honour.

First, is any discussion taking place about putting adult social care, which is closely affected by and connected to hospital care, inside the ring fence? Secondly, are councils under any instruction about privatising or outsourcing adult services? Thirdly, is any Government legislation preventing councils, in commissioning work, from inserting provisions stating that wage and working conditions should be at a specific level?

I know I am crowding the Minister’s time, but I shall take just half a minute more. I was once in a group of people in sheltered housing discussing some problems, and I met an old lady of 90. She said, “I’m 90 and I haven’t had a bath for two years.” I started back. She said, “No, I do my best to wash myself standing up, but every time the door opened and the home care worker came in to bath me, I was getting a stranger. I may be 90, but I have my self-respect and my dignity, and I want to keep it.” That is happening to too many of our older people. They are vulnerable, they are being treated badly and they are neglected. It is about time that not the Minister, but the Chancellor woke up to this.

NHS Services (Access)

David Ward Excerpts

Wednesday 15th October 2014 Commons Chamber

[David Morris]

I thank my hon. Friend and namesake for making that point.

I am passionate about the NHS and I know that the Opposition and the right hon. Member for Leigh are also passionate about it, but we should get a grip on reality. Campaigns are saying that £25 million is being cut from the local trust when £150 million has been invested in it, so the maths do not stack up. As my hon. Friend the Member for St Ives (Andrew George) has said, we have been horse-trading figures, but we have to look at the reality of the situation. Scaremongering is not the way forward, because all it does is alienate the electorate, my constituents and the people we all live with across the nation and put fear into the services that we are trying to protect.

I am facing a third erroneous campaign on health cuts in my constituency, and my mail box is always full every time there is such a campaign. All it seeks to do is frighten the electorate, but it does not frighten me, because the electorate know the truth.

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

I was not going to intervene on the hon. Gentleman, but I sympathise with him, because Labour activists in my area have been campaigning against the closure of a treatment centre when all that happened, in fact, was that the contract came to an end. Hard work is now going on to make sure that the provision continues in another form. The big campaign was that this was about cuts and closing a treatment centre, but it was never going to close.

[David Morris]

I share my hon. Friend’s sentiments.

My hospital in Lancaster, in my neighbouring constituency, is not going to close. Like everyone else in the Chamber, I care about the NHS, but I appeal not just to the Opposition, but to all political parties that have the honour to serve here and speak: let us get a grip on reality, stop scaremongering and work towards making a better NHS. It has been an absolute pleasure to speak in this debate.

Care Home Top-up Fees

David Ward Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Paul Burstow]

That is a very good point and one that I am sure Care England and other organisations representing care homes would want to take on board.

It is important to understand the scale of the problem. Research carried out last year by the charity Independent Age highlighted the fact that 72% of local authorities—there was a very high response rate to this freedom of information request—were unable to demonstrate that they met their legal obligations with an overview of top-up payments in their area. In other words, they were not routinely monitoring and reviewing whether third parties remained “able and willing” to make top-up payments. That is a core requirement of the existing guidance. The onus is on councils to check that families are not unwittingly making top-up payments for care that should be paid for and met by the council as part of its duties to meet assessed, eligible needs. Those payments can range anywhere from £31 a week to perhaps £131 a week. In some cases, it is probably even higher than that.

The research also found that just under 30% of councils said that they did not hold or collect information about top-up fees in their area. This was a typical quote from a council:

“As a Council we’ve never had any involvement in top-up care home fees...The Council does not know how many top-ups are in place, in any financial year”.

Perhaps most disturbing was that so few councils knew what was taking place in terms of top-up fees arranged between care homes and families in their area. Almost 80% of councils did not routinely check up on the health of top-up payments as part of their annual reviews, and 75% of councils did not signpost families of care home residents to independent advice before entering into third party top-up agreements.

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

Will the right hon. Gentleman give way, just for two seconds?

[Paul Burstow]

It will have to be two seconds.

[Mr Ward]

Very few Members are present at the debate. What we are discussing is an enormous problem. Why do so many people not know about it? It is such a serious problem, yet that is not reflected in the number of Members here today. Why do people not know about it?

[Paul Burstow]

I hope that this debate will help with that. The hon. Member for Huddersfield (Mr Sheerman) and my hon. Friend the Member for Bradford East (Mr Ward) are here and will, I am sure, help to spread the news about the debate. My hon. Friend makes a good point. I attempted to get a 90-minute debate. We have a half-hour debate, and I am very grateful that other hon. Members are here, supporting me on this very important issue.

What is driving an increase in top-up payments is the key question. I think that an issue of funding is at the heart of this. More specifically, personal budgets are being set at a rate that simply does not reflect the actual costs of purchasing large numbers of care home places. My right hon. Friend the Minister will know that, in the three years from 2010, local authority baseline fees fell by almost 5% in real terms and rose by 1.8% in 2013-14. It is hard to imagine that that has not had some impact in terms of the numbers of requests for top-up payments during this period.

The problem affects large numbers of people across a wide range of local authorities. The local government ombudsman has said as much. She found Southampton guilty of maladministration causing injustice in the situation of an older woman. The council had sought, wrongly, additional fees beyond the assessed contribution, because no care home places were available within the council’s usual rate. The ombudsman published her report. She considered that that was in the public interest, because

“councils across the country are faced with similar situations”.

The LGO also carried out an investigation into a council near me, the London borough of Merton, in which a contracted private home asked a family to pay a top-up fee that the LGO says it had no right to demand. The report from the LGO serves as a stark reminder to councils that they cannot contract out their legal responsibilities. It was hoped that these reports by the LGO would stop councils turning a blind eye to care providers taking payments from relatives, on the basis that that is outside the agreed care contract. However, the practice continues to affect families up and down the country, which makes the need for today’s debate all the more urgent.

In her report on complaints in relation to adult social care, the LGO revealed that she receives complaints that

“providers have sought to charge…‘top-up fees’ in circumstances where the person’s care needs should be fully covered by public funding.”

The investigations have shown that 17% of all complaints received last year included concerns about the financial elements of care provision; that more than half of those complaints in 2013 raised issues about fees being charged where they should not be; that in 50% of these cases the LGO is upholding complaints; and, specifically in relation to top-ups, that people are

“not being given clear and comprehensive information about their financial liabilities.”

Let us not forget that we are talking about an increasingly frail care home population. The Alzheimer’s Society estimates that eight in 10 residents live with dementia or significant cognitive impairment. Given that, what is the Minister’s assessment of the LGO’s most recent report on all complaints made in 2013, which concluded that complaints about local authority social care increased by 16% and that the LGO often finds fault with top-ups being charged when they should not be? Does the Minister agree that the problem seems to be getting worse?

Soon-to-be-published research by Independent Age based on in-depth interviews with 13 councils reveals a wide variation in local authorities’ practices for arranging top-up fees, in terms of who the contract is with, the terms of the third-party agreement, what and how much information and advice is provided, and how the affordability of a top-up payment is assessed. It is essential that the regulations and the statutory guidance that are being developed in the Department address each of those issues. Perhaps the most striking aspect of that research, which I believe will be presented to the Department later this week, is that none of the councils that participated in the research had any openly agreed or consistent approach to reviewing whether third parties remained willing and able to pay top-up fees. That is a serious problem, which risks becoming bigger still when own-resource or first-party top-ups are permitted much more widely from April 2016.

There are many stories about the subject, and I suspect that other hon. Members who are present have stories from their constituencies. I want to refer briefly to two stories, one from the Alzheimer’s Society and one from Independent Age. The Alzheimer’s Society has told me that it was recently contacted by the daughter of an 84-year-old mother who has dementia and is virtually bed-bound. The mother lives in a nursing home, and the daughter agreed to pay a top-up payment of £35, but that payment keeps being increased and now stands at £75. The daughter feels that the payment is becoming unsustainable, but she is worried about the consequences of not paying and the impact of moving her mother to another care home. Families have to make such hard, emotional and often distressing choices every day.

The example from Independent Age is no less typical. The organisation was contacted by a daughter whose 87-year-old mother has only £7,000 in savings. The mother has Alzheimer’s and has been in a hospital for a month, and she has now been assessed as needing residential care for her own safety. She wants to live near her daughter in Gloucestershire, because her daughter is the only child. The council in London, where the mother lives, has explained that it will pay £441 towards the mother’s care but it has only found one placement at that rate, which is nowhere near where she wants to live. The local authority is trying to achieve a quick outcome, because it wants her to be moved out of hospital as soon as possible, and it is asking for a top-up payment as part of the process. The 87-year-old mother is being informed that she will be moved to the local home at the local authority rate, regardless of her wishes.

Clearly, the guidance on that point needs to be strengthened. Let me offer the Minister some suggestions on what might be done to strengthen the guidance on which the Department is consulting. I hope that my contribution to the debate will be treated as a formal contribution to that consultation. Local authorities must meet their legal obligations, so third-party top-ups are only ever a matter of choice, not a necessity. The best way to ensure that that happens is to make sure that all top-up agreements are agreed in the open between residents and their relatives, the local authority and the care home provider in a genuine three-way written agreement. It is good to see that that is set out in the draft regulations.

Will the Minister ensure that the guidance underpinning those regulations, to which people will refer to find out what scope, discretion and flexibility there is, states that residents should be offered more than one care home place within the amount of their personal budget? At the moment, the draft guidance simply states that at least one setting should be offered that could meet the person’s needs within their personal budget. If that were interpreted in a mean way—not all councils will do this, but I am certain that some will—the council would offer one home at the rate at which it will pay, and that would be that. In the worst case, an individual might be offered a place in a home rated by the Care Quality Commission as poor or inadequate. Provisions should be put in place to ensure that a person has a genuine choice, particularly if the home that they are offered has been rated as failing some of its fundamental standards.

Will the Minister ensure that the new framework actively enables residents to access independent information and advice, so that they can make a decision about whether to pay a top-up and what level of top-up they can afford? How will the new framework actively support residents to understand their entitlements? Does the Minister share my concern that simply calling on councils to consider

“when it is in residents’ best interests”

to signpost them to information and advice is not sufficient? Three quarters of councils do not signpost residents to independent information and advice now, so what will change unless the guidance signals that there should be a change? That is how the draft guidance is currently framed, but surely it would be better if councils routinely signposted people to information. That could be achieved by including a generic statement or section in a model agreement developed by the Department that checks with the local authority, the care home and the third party whether there has been a signpost to independent information and advice. That is a simple, honest check that could be built into the contractual arrangements. I emphasise that information and advice should be independent.

Should it not be incumbent on local authorities to review annually whether top-up arrangements remain affordable and whether people remain willing and able to pay them? Surely that should happen at the same time as the annual review of care needs and an adult’s finances. The draft guidance is too vague on that point; it states that local authorities should review top-ups “from time to time”. It should be made clear that at a minimum, the arrangements should be reviewed annually.

We have to consider the rates that local authorities pay care providers, and whether those rates really keep pace with the real market costs of care. The guidance should make it clear and unambiguous that, where a personal budget needs to be adjusted to meet an adult’s assessed eligible needs and top-up arrangements are not possible, a local authority must always adjust the amount of the personal budget and not seek a top-up to cover the shortfall in local authority funding. That point is absolutely fundamental, but the relevant section of the draft guidance merely states that the local authority should consider adjusting the amount of the personal budget. If a local authority chooses not to do so, it is breaking the law, but it is invited to consider doing something that would be unlawful. There should be no discretion.

Families are being separated. Vulnerable older and disabled people, together with their families, are not being informed of their rights. People who can ill afford hundreds of pounds in top-up fees are unwittingly paying out extra money for essential residential care that is really the council’s responsibility. That is why the guidance should be strengthened.

Care Bill [Lords]

David Ward Excerpts

Monday 10th March 2014 Commons Chamber

For working-age disabled people—

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

Will the hon. Lady give way?

[Liz Kendall]

Perhaps the hon. Gentleman will let me finish this point.

For working-age disabled people, the level at which the eligibility criteria are set is crucial and could mean the difference between being able not just to get access to training and a job but to spend time with their family or go out into their community—things that we take for granted. As hon. Members know, Scope and other organisations have warned that the Bill could risk shutting more than 100,000 disabled people out of the system, with all the human and economic costs that that entails.

The Minister will know that in Committee many hon. Members cited the economic modelling that has been done by organisations such as Deloitte, which shows that shifting the focus of investment and resources up front can save more money further down the line. The Deloitte modelling predicts that for every £1 invested in care for disabled people with moderate needs, savings of £1.30 per person are created. It predicts £700 million of savings for central Government from helping disabled people and their family carers to get work, and £570 million of savings to local NHS and local council services by avoiding the use of more expensive residential and crisis care and by reducing the need for more expensive medical care.

Such a long-term approach, whereby we assess the true costs and benefits over a longer term, is a good framework for making decisions about where priorities lie—

[Mr Ward]

Will the hon. Lady give way?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before the shadow Minister considers taking further interventions, she may not have realised that although the House appreciates that she is making some important points on a complex matter, she has spoken for some 24 minutes. She will not be aware, but I am, that a very large number of colleagues wish to speak in this debate and there is a limited time, so she might consider bringing her remarks to a close.

--- Later in debate ---

The Minister said in Committee that the Government would produce indicative time scales for support plans and reviews. Although that is helpful and shows that the Government recognise the problem, I do not think that indicators will provide enough motivation for local authorities to get on top of the issue. As I have explained, a measure already exists to show how quickly initial assessments are conducted. A measure also exists for reviews to be proportionate, but neither has stopped the gradual slide in performance of recent years. Informal measures simply do not carry much weight.

[Mr Ward]

I will try to hit my five-minute target by excluding a lot of other comments, including on the eligibility criteria, which I have spoken about at length on other occasions.

The shadow Minister, the hon. Member for Leicester West (Liz Kendall) effectively made the case about the false economy, whereby the criteria are at the wrong level and people’s conditions deteriorate, so they and the state face a greater cost. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) referred to the provision to identify patients who are or may become carers. I am concerned about carers who end up becoming patients or needing care because of a lack of support. We need to consider that, too.

I will confine my comments to new clauses 7 and 9. Without those, the rest is almost irrelevant. My right hon. Friend referred to the elephant in the room. An elephant in the room is something we are vaguely aware of; we know it is there but we are not prepared to talk about it. Out there, people are talking about the crucial issue of whether these services can be afforded. So much in the Bill is so good, but we are in danger of casting doubt on the deliverability of what we know is good and on whether it can be implemented.

As is often the case, it is no use relying on the good old principle of localism and local authorities making the decision to pick up these things. There is a difference between localism that is freedom and localism that is an abrogation of responsibility by Government to fund services during a national crisis. If we get that wrong, we will simply give local authorities the freedom to fail. We need to ensure that that does not happen.

The sad thing is that, although there is so much good will out there for the Bill— we are in grave danger of not responding to the comments of the voluntary and community sector and the public sector generally on the principles of the Bill and many of its provisions—there is a suspicion that, at the end of the day, we cannot deliver on it. The question is why would we not support new clauses 7 and 9. We are asking for assurances, not for additional money, because the truth is we do not really know. We are asking for assurances through a review. We are asking not for additional funding but for a commitment to a review.

I was going to give a grand finale about the voyage into the unknown, but it is not unknown, is it? We know that huge demands will be placed on the system and that that will have grave implications for many people who are receiving and providing care. We know that that is on the way. We think we have a system in place through the Bill that will enable us to deliver on that. The big question is not an elephant in the room. The groups that I am working with on the Bradford Cares projects, Age Concern, Mencap, Scope and the Bradford and District Disabled People’s Forum say that this is good and they like so much of the Bill, but they raise their eyebrows and say, “Will the funding be there?” That is the big question that is asked over and again. Through new clauses 7 and 9, we can at least give them some faith that we recognise that it is a big issue and that we are seeking to identify and meet our responsibilities to fund what we all want to do and see.

[Barbara Keeley]

In introducing new clause 3, the right hon. Member for Sutton and Cheam (Paul Burstow) said how he felt that the NHS institutionally must change to identify and support carers. Of course I agree with that. My hon. Friend the Member for Leicester West (Liz Kendall) introduced new clauses 19, 20 and 21. She mentioned my private Member’s Bill, which I feel is having its last outing today in these new clauses; it proposed measures on the identification of carers. I want to touch on how long these issues have been around.

Eleven years ago, I completed a project on identifying and providing support for carers and co-wrote a report on that. The report made recommendations to Government, NHS bodies, GPs and their teams on how important it was to identify and support carers. That project mapped 36 primary care support initiatives for carers run by the Princess Royal Trust for Carers. We are talking about a long time ago. We felt that the role of carers, including their contribution to the work of the NHS, had generally been under-recognised and under-valued.

Through the 1990s, to the point where I wrote that report, we had carers assessments following the excellent Carers (Recognition and Services) Act 1995, introduced by Malcolm Wicks. That was strengthened by the Carers and Disabled Children Act 2000, which enhanced the carer’s right to an assessment. We even had in 1999 standard 6 of the national service framework for mental health, which said:

“all individuals who provide regular and substantive care for a person on the Care Programme Approach should have an assessment of their caring, physical and mental health needs, repeated on at least an annual basis”.

Even at that point, the Department of Health said that the implementation of the carers’ right to an assessment four years in was

“patchy. Assessments are not always carried out. Some carers are offered very sensitive practical and emotional support. But others receive very little, or no help”.

Fast-forward 15 years to the Care Bill, and carers are still in a similar situation. The identification of carers and referring them to sources of advice and support is still not happening on an adequate scale, and we have had all that legislation and good practice. Carers UK has told us that two thirds of carers that it surveyed said that, although their GP knew they had caring responsibilities, their GP did not give them any extra help. We have heard examples of what that can mean.

Carers week is in June, and we look forward to that. We know that in that week we meet carers at events. There is a common theme: they tell us repeatedly they are not getting advice and information to help them care. They can be carers of people with cancer, carers for people with terminal illness, carers of people with Parkinson’s or of people with dementia. Does the Minister want to start changing that for carers week this year? Does he want to go along to carers week events and have carers start to say to him, “I have been identified by my GP and my GP does recognise my caring role”? I hope he does, because I have heard so many people say how much it would have meant to them and what a difference it would have made to their caring if their GP had recognised it.

Even for conditions such as Parkinson’s, only one in 10 carers has been offered an assessment. These are people who are caring very often more than 50 hours a week, and, as a disease such as Parkinson’s progresses, up to 24 hours a day. They and the people caring for somebody who has had a stroke or who has dementia are the people who really need advice, support and breaks. These are the reasons we must support new clauses 3, 19, 20 and 21.

The Care Bill puts great emphasis on carers assessments rather than on the identification of carers, and I introduced a private Member’s Bill on that in September 2012. The clauses in that Bill, which we see again today, would have ensured that NHS bodies had procedures in place to identify carers and to promote their health and well-being and ensure they receive information and advice. I believe the key reason in identifying carers should be because we have a concern for their health, particularly those with the heaviest caring commitments. That is one in five of all carers, and that is more than 1 million people, which is just too many.

Those caring for more than 50 hours a week are twice as likely to suffer ill health, particularly those caring for a person with dementia or stroke. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) has just talked to us meaningfully and movingly about the impact of that caring role on her family. We want early identification and support for those carers so they can maintain their health and manage and sustain their caring role. I agree with my right hon. Friend that they should be fast-tracked for appointments. As hopefully we move towards integration and, beyond that, whole-person care, local authorities cannot be expected to act alone to identify and support carers.

As has been touched on in this debate, we also have to face the fact that the number of people receiving social care services is shrinking. In Salford this year, because of budget cuts, 1,000 people are going to lose their eligibility for social care services and 400 people who would have become eligible for care will not become eligible. The unpaid carers in those families will be taking on that substantial burden, yet, sadly, the GPs and doctors around them will not identify them, will not help them, will not make sure they get advice and support.

This Care Bill is the place to make the change, and I say to the Minister let us not wait another 15 years to make the change and place such a requirement on health bodies—and schools, universities, colleges and further education colleges in the case of young and student carers. Let them just have policies in place to identify carers and to provide support for them.

Dementia Care and Services

David Ward Excerpts

Tuesday 7th January 2014 Commons Chamber

[Alec Shelbrooke]

I am most grateful to the right hon. Lady, and I congratulate her on the work she does with the all-party group on dementia. She and all hon. Members will recognise that on this subject the whole House is fairly united in trying to get the Government to make those changes, regardless of whether we sit on the Government or Opposition Benches.

Our international partners, many of which attended the G8 summit in December, have ambitious long-term plans. In the US, for example, President Obama published a dementia strategy that runs until 2025, well beyond his own term as President. France has recently published its fourth dementia strategy. The economic case for having a clear directive for dementia is overwhelming. Dementia costs the UK £23 billion a year, which is more than cancer, stroke or heart disease, yet the annual research spend into dementia is about £51 million, rising to £66 million in 2015. That compares with £521 million spent on cancer.

The ambition announced at the recent G8 summit to double the spend on research in the UK by 2025 is an excellent step forward, but a new national dementia strategy that covers all aspects of dementia, including research into prevention and finding a cure, will ensure that the momentum gained from the good work undertaken by the coalition Government will be turned into improvements for people affected by dementia. To be clear, I am not suggesting that money be taken from the other crucial health causes I have mentioned; I wish merely to illustrate the numbers involved.

What plans does the Minister have to renew the current national strategy on dementia? That point was left unanswered in the Backbench Business Committee debate last year. As past statistics have shown, the introduction of a national strategy for dementia in England has caused a rise in the rate of diagnosis, although the level is still worryingly low at 48%. More needs to be done on prevention, particularly further investigation into whether the small change of introducing homocysteine level tests on the NHS could act as an early-warning sign in identifying the problem.

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

Bearing in mind what the hon. Gentleman has said about low diagnosis rates, does he agree that the national strategy should include promoting greater awareness for many of those close to dementia sufferers who do not identify with the condition? They think people are just losing their hearing or becoming visually impaired as they grow older, and the diagnosis is then made far too late because symptoms are not realised early enough.

[Alec Shelbrooke]

That is a very helpful intervention from my hon. Friend. I will move on to cover some of the care homes in my constituency that are tackling those issues as one, but as he says it is important that a national strategy has accountability written into it so that these issues can be tracked as we move forward.

More than half of people with dementia cannot access the treatment, services and support they need because they have not officially been diagnosed. Furthermore, carers of people living with dementia also suffer. They have the uncertainty of knowing that something is wrong with their loved one, but have no official diagnosis. Patients and carers are therefore denied expert support through health and social care services and often feel that they cannot approach organisations such as the Alzheimer’s Society without a proper diagnosis.

In my constituency, the two clinical commissioning groups that are spread across Elmet and Rothwell have wide-ranging and impressive plans to increase diagnosis rates, but their ambition can go even further. Currently, NHS Leeds North diagnoses 50.85% of people with dementia, while NHS Leeds West CCG is only slightly better with 54.35%. My constituency reflects the picture across the rest of the country, meaning that half the people living with dementia are denied the certainty of a diagnosis.

--- Later in debate ---

[Norman Lamb]

I completely agree. This disease knows no country boundaries. We all face the same challenge across the whole of the UK and, critically, across the world. That is why we pursued the matter in the G8 summit of December. There should be good collaboration across the UK through all of the devolved Administrations and the Government here. I am always happy to engage with colleagues from Northern Ireland to understand what we can learn from Northern Ireland and also because the exchange of information helps everybody to improve.

We recognise the need to build on the strategy. That is why the Prime Minister’s challenge on dementia is now the main vehicle for change and improvement across health and care, in the community and for the purposes of research. The Prime Minister’s challenge runs until 2050, not just outliving the dementia strategy, but broadening its vision and providing better accountability.

Last year we hosted the G8 dementia summit. I was delighted that the right hon. Member for Salford and Eccles participated in it, and challenged me during one of the sessions. The summit attracted interest all over the world, and harnessed the efforts and expertise of the G8, health and science Ministers, the World Health Organisation, the OECD, industry, researchers, philanthropists and civil society to secure much greater international collaboration in order to tackle and defeat dementia. The declaration and communiqué announced at the summit set out a clear commitment to working more closely together on a range of measures to improve early diagnosis, living well with dementia, and research.

The G8 announced an ambition to identify a cure or a disease-modifying therapy by 2025, which we hope will focus minds internationally. It is backed by a commitment to increase significantly, together, the amount spent on dementia research—we know that at present it is a fraction of the amount committed to research in other areas of medicine—and to increase the number of people involved in clinical trials and studies of dementia. The United Kingdom has committed itself to funding a global dementia innovation envoy to draw together international expertise, stimulate innovation, and co-ordinate international efforts to attract new sources of finance. That will be incredibly important if we are to crack this disease.

In partnership with the OECD, the WHO, the European Commission, those involved in the EU joint programme on neurodegenerative disease, and civil society, the G8 will hold a series of high-level forums throughout 2014 on social impact investment—it will be critically important to attract new sources of funding—new care and prevention models, and academia-industry partnerships, which will also be extremely important. The G8 will meet again in the United States in February 2015, along with other global experts including the WHO and the OECD, to review the progress that has been made on the research agenda. That will enable us to focus minds and try to increase the momentum.

The G8 is an exciting global initiative, and I am immensely proud that the United Kingdom led the way in that regard. However, we are also keeping our focus on dementia in England, and we have made progress since the launch of the Prime Minister’s challenge. We have launched a new dementia friends scheme—which has already been mentioned—to make a million people more aware of what dementia actually is, thus helping to break down the barriers between people with the condition and their local communities. It is important to challenge the stigma that still exists in many places. The Alzheimer’s Society has published guidance setting out the criteria for becoming a dementia-friendly community. I was pleased to hear that Rothwell, near Leeds, is becoming a dementia-friendly community: that is very good news.

The NHS continues to support dementia care in hospitals through its CQUIN scheme—commissioning for quality and innovation—which is generating between 3,000 and 4,000 referrals for diagnosis each month. We have allocated £50 million to 116 schemes to make health and care environments such as hospital wards and care homes more dementia-friendly. Making the environment in which people live with dementia more dementia-friendly is critical to the provision of a calm atmosphere. When we see places to which attention has been given and in which investment has been made, we realise what a difference can be made. The Government’s mandate for the NHS prioritises dementia, and, as I said earlier, includes the ambition of a diagnosis rate of two thirds. My hon. Friend was right to say that the current rate is far too low. We are letting people down in many parts of the country by not securing early diagnosis.

[Mr Ward]

Obviously there is an opportunity to do something once a person has been identified as needing a diagnosis, but in my experience the problem is that other things are usually taking place in people’s lives, and GPs often assume that they are just part of the ageing process. There is a failure, often because of the lack of skills of the GPs, to recognise that diagnosis is required.

[Norman Lamb]

My hon. Friend is absolutely right and there are still GPs who do not really believe in the importance of a timely diagnosis. I have heard GPs say, “What’s the point, because it will make no difference?” However, we know it does make a massive difference not only to the person with dementia but to the rest of their family, in understanding the condition and what they can do to help. Education among GPs is incredibly important, and attitudes are changing but we still have a way to go.

Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.

Health Education England has prioritised dementia training and has already delivered 100,000 dementia-trained staff. Again, ensuring the work force within health and care have a proper understanding of dementia is critically important.

Care Bill [Lords]

David Ward Excerpts

Monday 16th December 2013 Commons Chamber

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

I had to leave the Chamber earlier, Madam Deputy Speaker, for an hour or so, but I assume we have been approached by similar groups and organisations that no doubt will have been quoted in previous speeches, so I might be able to curtail my remarks.

I begin by paying tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has been heavily involved in this issue from day one, with the inception of the White Paper. I thank him for coming to Bradford and talking to people there about local issues, and I welcome his contribution tonight. This is probably the most important Bill we will be considering this Parliament, because it deals with one of the most important areas of public policy that we have to face. There is no choice about it; it is something we have to face. It has been referred to over the years as a ticking time bomb. The good news, of course, is that people are living longer, but that will be accompanied by an enormous cost if we are to ensure that people are provided with the quality of care that they are entitled to and desperately need. It is hugely important.

Like the hon. Member for Gloucester (Richard Graham), I am confused by the reasoned amendment. I come from a place where people say what they mean and mean what they say, so I find it difficult to read a so-called reasoned amendment that is so scathing of a Bill and then listen to people say, “Well, actually, we’re not opposed to it and will not necessarily vote against it.” I do not understand that. Perhaps this is just a really strange place that I still need to spend more time in before I understand those things.

As I understand it, a Second Reading debate is about the principles, which is why I will avoid going into too many details. From my experience of working with many organisations and groups in the past few years, including very closely in the past 18 months or so, it seems to me that the principles in the Bill are pretty well applauded out there. There is a general acceptance that something needs to be done and that this is a pretty good attempt to lay down some basic principles. That was why the initial skirmishes and exchanges were disappointing.

[Paul Burstow]

My hon. Friend has taken a close interest in, and campaigned on, the Bill during its passage through the other place, and he said how widely welcomed it was outside the House. Would he be interested to know, therefore, that in almost every session of the scrutiny of the draft Bill—

[Paul Burstow]

I apologise to you, Madam Deputy Speaker. I have been here long enough to know that I should speak through the Chair.

I simply wanted to say that during consideration of the draft Bill, when asked, many people told us they had nothing by way of criticism of the Bill, although they saw areas where it could be further improved.

[Mr Ward]

I thank my right hon. Friend.

Acceptance of the principles—certainly acceptance of them by myself—is there, but as the Minister knows only too well, as I have bent his ear on the subject so many times, I have some serious concerns, particularly about the FACS—free access to care services—criteria. He will probably not know—it is a recent decision by Bradford council—that the Labour council has decided to move from “moderate” to “substantial” in respect of the criteria. It has to go into a budget process; unfortunately, this will happen. We campaigned hard against that, with a 1,700 names on a petition opposing it, but it is going to go ahead.

What was unfortunate about earlier exchanges was a certain degree of dishonesty. This thing did not happen all of a sudden three years ago. Conservative, Labour and possibly some Liberal authorities—I do not know—up and down the country were from 2005 onwards moving away from “moderate” to “substantial” FACS criteria way before the change of Government and way before the vicious cuts took place as part of the austerity programme. Indeed, it was before the recession really bit, and I regret that. What seemed to be happening was a “follow my leader” approach—“Every other authority seems to be doing this, so why shouldn’t we?” It was seen as a way of reducing the budget. What I argued, continue to argue now and will continue to argue all the way through until this Bill becomes an Act, is that this is a false economy. I have made all those points to the Minister several times, including, in detail, in a Westminster Hall debate.

I believe that eligibility is the gateway to care, but I am not convinced by the proposed savings that are supposed to be made. We worked closely with various organisations, including Scope, which has done a fantastic job of looking at the issue of working age disablement, which accounts for one third of benefit recipients. People desperately need care to live a more fulfilled life, whether it be in education or work. This is just one example—there are many others—where savings can be accrued, but taxation can also be generated if people are given just a small amount of support to become economically active.

Other charities and organisations have raised serious issues. Principles are most important, but data collection is crucial. Charities that exist to help people with Parkinson’s and other neurological conditions identified the fact that they had no idea how many people with Parkinson’s actually received social care. How can that be the case? How can that happen? Something must be sadly going wrong with data collection. Macmillan Cancer Support pointed out that free social care at the end of life needs to be a crucial element of any changes we are looking to make and that, if we aim for true integration, we must have proper identification of carers within their health settings. We should not wait until people are turned out of hospital and go home before identifying who is going to look after the person and provide support. Leonard Cheshire Disability provided further useful information, and I ask the Minister to look further into some of the issues it raised.

Important principles are at issue here. On the national criteria, I may not like the level, but it is important to have standardisation. On the carers assessment, we should be applauding the fantastic proposal to make carers the centre of attention, as they are so often forgotten. How many times have carers ended up being the people who need care because of the lack of support they receive? A young person I know has come to my office on a regular basis to express serious concerns about the people he was caring for, but I have seen with my own eyes that person deteriorate over the last 12 months or so as a result of the lack of support that he has received. The Bill introduces a wonderful innovation, which we should all appreciate.

I have already mentioned the principle of integration. We have the framework: the health and wellbeing boards are still in their early days, but this way of bringing together the different parts of social care, public health and the national health service is so important. The links between health and social care are crucial. I cited a case in the Westminster Hall debate of a man in his 50s who had an accident at work when reversing his vehicle. He had no seatbelt on, as he was just backing into the car park, yet he became tetraplegic. He was in Pinderfields hospital for five months. He received superb support and everyday attention, but when he went home in the ambulance, he could not get into the house because there was no ramp. He had to go away again. Then the local authority provided the money for a ramp and the hospital brought him back again, but he could not get in because it was a wooden ramp and they did not dare take him on it because that would have broken it. That is madness in this day and age, and it needs to be dealt with.

On the cap on lifetime payments, we do of course need to discuss in detail what it should be and how it should be operated, but please let us not talk it down, because an incredibly important new public policy is being put forward here, which we should applaud.

Let us try to forget what happened earlier. It was unpleasant to see and I do not think it truly represents the true passion and commitment of people on both sides of the House to improving social care for the people of this country.

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.

Care Services (Bradford)

David Ward Excerpts

Monday 8th July 2013 Commons Chamber

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

The very first time that a son or daughter is asked by one of their parents, “And who exactly are you?”, is a chilling and frightening experience. It is a question of good days and bad days. In most cases there will be many good days—many fun days. It is not the end of the world, but it is very much the end of a world that the son or daughter knew. My hon. Friend the Minister is more conversant with the figures than I am, but they are startling for us as a nation. Some 800,000 people suffer from dementia. We are told that the figure will increase to 1 million in the next 10 years or so. The Alzheimer’s Society believes that the cost to us as nation of supporting those people is £23 billion, and that is with only half of those who have dementia being diagnosed with it.

However, I am here to tell a good story, about the work going on in Bradford. I would not be forgiven by Cathy Henwood, the dementia-friendly communities co-ordinator in the Alzheimer’s Society, if I did not point out that we were doing dementia-friendly work in Bradford before the Prime Minister’s challenge, which I will return to later. The dementia measures taken in Bradford have been well supported by the council. Stage one of the work included the recruitment of a small pilot group of organisations, such as the gurdwara, the Church of England, the community centre, a local branch of Lloyds TSB, a pharmacy and others. They were asked to review their organisations and write action plans. A checklist was produced by the Alzheimer’s Society to help them do that. That list was developed with people who had dementia and those who cared for people with dementia.

The second stage of the work is where my patch of Idle, where I live, came in. It is a village—yes, I was an Idle councillor for 26 years. The Alzheimer’s Society developed a community-based approach to supporting people with dementia which started in Idle and Thackley. The area happens to have three Liberal Democrat councillors, I am pleased to say, and they were determined to put together supportive structures for those with dementia in their ward development plans. Councillor Jeanette Sunderland leads the Lib Dem group. She and her colleagues Councillors Griffiths and Reid, working with the Alzheimer’s Society, held a community meeting on a bleak and snowy day in January—we do have some bleak and snowy days in Bradford in January. It was nearly cancelled but it went ahead despite the weather, and 40 participants turned up and 14 people signed up and agreed to stay involved. That meeting was partly for awareness raising, with a speaker who had dementia, and with information about the effects of dementia and how to help, and it was also partly a consultation, with discussion about what is good about living in Idle and what would be problematic for people with memory problems—what could be changed, and so forth.

A number of subsequent meetings have been held, as was a support group meeting, with both carers and those with dementia, at a volunteer event. All was going well. As of April, with some funding from the Joseph Rowntree Foundation and Bradford council, this work was looking to expand out of one ward out of the 30 in Bradford to work with 20 communities in total over a two-year period.

There was an announcement in the Telegraph and Argus about the Bradford District Dementia Action Alliance, which had brought together lots of groups and organisations, including the Yorkshire police, the Bradford royal infirmary and St Luke’s hospital, Bradford university and Bradford college. They have now been granted early adopter status for the dementia-friendly community recognition programme.

This is all really good news, added to which I believe it is important to congratulate the coalition Government on the focus they have placed on this, for example with the Prime Minister’s welcome launch of the dementia challenge. So far, so good, then.

The background to this at the national level is as follows. There is a £2.68 billion reduction in adult social care funding either so far or through to March 2014, and locally a 16% reduction over the last two years in adult and community service budgets, which amounts to £23 million in Bradford. A joint survey by Age UK and the College of Social Work found that 94% of people witnessed a squeeze on budgets for care services in the past three years, and 81% said they were seeing negative impacts on social care.

The Minister will, I am sure, refer to the Government funding that has recently been made available. That is focused on the crucial integration of health and social care, but integration can happen at any level of support, of course. Eligibility is the gateway to support; it provides the level at which a person can access support. As the Minister well knows, Bradford’s council is consulting on changing the criteria in Bradford, and that consultation will run until 4 August. I am pleased to say that on 15 July the former care Minister, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), will be coming to Bradford to launch the Bradford Cares campaign, which is supported by Scope. It is running a national campaign, but we will run a local version of it, in which we will seek to persuade the people of Bradford to support our campaign against the council’s proposed changes. We feel it is particularly relevant to those with dementia because, as the Minister knows, people with dementia are often physically able. With a little help and support, they are quite capable of looking after themselves.

When I was a councillor chairing the area committee we looked at the issues affecting elderly people and we assumed that they would relate to benefits, housing, adaptations and so on. It became evident that the crucial issue facing many elderly people was isolation, the impact of which, as we know, can lead to a deterioration in a person’s condition, particularly if they have dementia. Early intervention, not integrated intervention, is the key. This is about providing moderate care not only because it is relatively inexpensive, but because we know that investing in this form of support can save up to 130%.

If Bradford council’s decision goes through, it could well affect 2,000 people. We believe that if the council is doing this on the basis of concern about cost, it is very much a false economy, as it will cost the council more in the long term. I fear that despite the great strides that will be made by finally having integrated care systems, a change in eligibility thresholds will mean that hundreds of thousands of people will still not get the key early and preventive care about which I know the Minister cares passionately. They will not receive the care that they so desperately need and that is why it is so important to consider the eligibility criteria. As the Alzheimer’s Society has highlighted,

“setting the eligibility threshold at substantial will fail to make the shift to a system of prevention whereby people get the support they need to cope at home and avoid unplanned admissions to hospital and residential care.”

My Liberal Democrat colleagues on Bradford council have put down a motion for debate tomorrow, applauding the work that is going on in Bradford, particularly the Bradford District Dementia Action Alliance. We have had some cross-party coalition work on dealing with dementia, and I urge all Bradford councillors to support that motion, with the goal of making Bradford a dementia-friendly district by 2015. The dictionary definition of “to care” is to

“take thought for, provide for, look after, take care of”.

We must take care, and we must not care less.

I look forward in particular to the Minister’s response on integration. I know he sees it as a great opportunity, but my concern is that unless it operates at an appropriate level we will not only lose the savings that are possible through preventive work but see a deterioration in many people’s conditions and a growing cost. We are still at an early stage in the development of the health and wellbeing boards, and change is also happening in the national health service as a whole. These are risky days for many people, and although the additional funding to support integration must be welcomed, we must ensure that it is at the appropriate level.

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

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on all the work he has done both in Bradford and to bring the stories from Bradford to a national forum. He has done more than anyone to highlight the importance of care services and working with the community to improve services for people. Indeed, the extraordinary consultation exercise he undertook following the White Paper last year was an exemplar of how to engage with the local community. The extent to which people felt able to comment and give their views and ideas was commendable.

I also congratulate the Bradford District Dementia Action Alliance on its work. My hon. Friend made the point that Cathy Henwood from the Alzheimer’s Society had identified Bradford as developing the concept of dementia-friendly communities before the Prime Minister’s dementia challenge, but I am pleased that he acknowledged that the Government have done a lot to highlight the importance of improving dementia care. The Prime Minister’s dementia challenge highlighted three strands: improving health and care services; creating dementia-friendly communities, which is exactly what is happening in Bradford; and a much greater focus on research so that we can find cures, understand better how to prevent some types of dementia, such as vascular dementia, and understand through research how best to care for people with dementia. The Government are more than doubling the amount spent on research, which is a good thing in itself.

The work about which my hon. Friend spoke started in the ward of Thackley—

[Mr Ward]

Idle and Thackley.

[Norman Lamb]

Idle and Thackley—those wonderful names. Local councillors got the community involved and that is exactly what needs to happen. When we talk about how to meet the extraordinary challenges of the future, with an ageing community, there must ultimately be collaboration between statutory services and the community. Bradford appears to be showing the way in which that can be done and I stress that it requires the integration of services and care shaped around the needs of the individual with preventive care to stop the deterioration in their condition.

My hon. Friend will be aware of the need for the care and support system to change as local authorities face challenges resulting from an ageing population. That is why the coalition Government have decided to reform the system of care and support. He talked about the situation in Bradford and I understand that more than 71,000 people there are aged 65 and over, about 14% of its total population. Bradford’s joint strategic needs assessment for 2012 predicts that by 2033—not that far off—the number of local people over 90 will increase from 2,800 to 8,700, an increase of more than 200%. We all face an extraordinary challenge.

As we debate access to care and support services, I am aware that City of Bradford metropolitan district council sets its eligibility criteria at moderate. The report that my hon. Friend published earlier in the year indicated that 97% of people who replied to his survey welcomed setting the eligibility criteria at that level. Bradford council now proposes to change its band to substantial, because of pressures on its budget, and that would affect about 25% of people who currently receive care and support. I completely understand that the Bradford Cares campaign wishes to ensure that services are maintained at the existing level.

The care and support White Paper, which was published in July 2012, is an important and fundamental step towards addressing the challenges of an ageing society. Our reforms will focus more attention on people’s well-being—that is at the centre of everything that the Care Bill tries to achieve—and independence throughout their lives, rather than waiting for people to reach crisis point. They will also put people in control by giving them a far greater say about their care and support, as well as by ensuring that services are designed around what people actually want and by putting their priorities and preferences above and beyond the needs of the institution. My hon. Friend will be aware that the Care Bill, which has been widely welcomed, will be a single, modern statute for care and support. It will make legislation clearer and fairer, and it will be built around people not processes, and individuals not institutions.

As the Government’s White Paper made clear, our vision is a modern care and support system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives so that they may pursue opportunities, including education and employment, and realise their potential. Assessments will remain an integral part of the system, but rather than acting primarily as a gateway to the adult receiving care and support—or not, if they fail the assessment—the future system will place much more emphasis on the role of the assessment process in supporting people to identify their needs, to understand the options available, to plan for meeting care needs and caring responsibilities, and to reduce or delay needs, when possible.

Any adult who appears to the local authority to have care and support needs, whatever the level of need, has the right to an assessment. That right will cover carers, so this is an extension of their existing rights. The low threshold for entitlement to an assessment will mean that authorities will have earlier contact with far more people with low-level needs.

[Mr Ward]

May I say how much I welcome the policy on the assessment of carers? Many carers who visit my constituency office are on the verge of needing care themselves because of the stress that they are under. It is the failure to identify their personal needs and the support that they require that puts them in such a stressful position.

[Norman Lamb]

My hon. Friend is absolutely right. The Care Bill’s provisions on carers represent an enormously welcome advance. In a sense, they will give carers the same entitlements to assessment and then support, if that is deemed necessary, as the people for whom they care.

The “Fair access to care services” framework was introduced in 2003. It aimed to provide a fairer and more transparent system for the allocation of social care services. The assessment and eligibility framework was reproduced in the “Putting People First” guidance that was published in 2010. The current assessment and eligibility framework is graded into four bands: critical; substantial, which is the case for most local authorities; moderate, which applies to Bradford and some 15 other authorities; and low, which covers only two or three councils. Local authorities can choose which band they wish to set for their local criteria, and Bradford has the legal power to change its eligibility criteria, as long as it consults its local community.

People continue to tell us, however, that the process for determining who is eligible for care and support is confusing and unfair. Decisions are not transparent and there is variation across the country, and the end result is that people can be left without the support that they need. The existing assessment and eligibility framework is therefore not working effectively, and that is widely recognised. That is why we are introducing a national minimum threshold for eligibility through the Care Bill. The Bill will set out the eligibility criteria—the point at which local authorities must meet an adult’s care and support needs, or a carer’s support needs. Local authorities will remain able to meet lower needs locally, if they choose to do so.

On 28 June, we published a set of draft regulations that set out the national eligibility criteria. These are intended to describe an equivalent level to the “substantial” level used by the vast majority of councils. We have committed to providing funding that will maintain the same level of services when authorities move to the new system in April 2015. This is the beginning of engagement with stakeholders before we formally consult on the regulations next spring. I assure my hon. Friend that the setting of the threshold is about establishing a minimum standard, not taking away councils’ discretion to go further. Of course, the more preventive care that can be given, the better, because that improves well-being and ultimately reduces the cost to the system, which is exactly the point that he made.

Under the current spending review, local authorities should be able to protect access to care, but we know that not all the money that was earmarked for care services has been spent in that way. Ultimately, spending on social care is a matter for local people in local authorities, and councils such as Bradford have to make tough decisions. However, we cannot improve care and support simply by throwing ever more money into the system; on the contrary, we need to work in more innovative and effective ways, exactly as is happening in Bradford, where there is really impressive work on dementia-friendly communities. That is exactly the sort of collaboration that we need to encourage.

Local authorities across the country have already been redesigning services to find more efficient ways of working. For example, many local authorities are concentrating on better integration between health and care services, improving co-operation and reducing duplication. That means better use of money, and improved care.

My hon. Friend referred to this year’s spending review settlement. It includes a £3.8 billion pooled health and social care budget to make sure that everyone gets a proper, joined-up service, and the care that they need from whoever is best placed to deliver, whether that is the NHS or the local authority. The £3.8 billion fund, shared between the NHS and local authorities, will deliver integrated services more efficiently for older people and, crucially, disabled people. It covers ensuring that health and social care work together to improve outcomes for local people, through better sharing of information, so that people need explain their problems only once; intervening early, so that older and disabled people can stay healthy and independent at home, avoiding unnecessary hospital admissions and reducing visits to accident and emergency departments; and delivering care that is centred on the individual, rather than on what the system wants to provide. Examples include NHS and social care staff working together to provide seven-day working, and better data-sharing to ensure that people can leave hospital as soon as they are ready.

The Care Bill includes a duty to provide preventive services; that is exactly the sort of thing that my hon. Friend is advocating for Bradford. That new duty on local authorities is seen by many people as potentially transformative. The White Paper sets out our ambition for health care and support to be organised around the needs of the service user, rather than focusing on organisations and services. We want a reformed system, in which organisations work together to give individuals real control and choice over the care that they receive. Good practice already exists, and we need to learn from and build on that.

I understand that Bradford’s clinical commissioning groups are working with Bradford council to deliver a three-year integration programme, which will cover all the services that help to support people so that they can remain at home, stay in their community, and regain and retain their health, well-being and independence. We want to encourage and support local experimentation, to allow areas to provide integrated care at scale and pace. We are working to support local initiatives and to identify what needs to happen to drive change at the national level. We want to learn what works well and how to overcome barriers, and to pass those lessons on to others.

On 14 May, the national partners in health care and support, including the Department, published a document entitled “Integrated Care and Support: Our Shared Commitment”, which sets out 10 commitments that the national partners have made to enable and encourage change to scale and pace, as well as expectations on local areas in return. The national partners have invited the most ambitious areas to apply to become pioneers and act as exemplars to address local barriers and support the rapid dissemination, promotion and uptake of lessons across the country. The national partners will provide the pioneer sites with dedicated central support to help them to break down barriers to delivering integrated care and support.

It is really exciting that the coalition is acting to end that long, historical divide between health and care services and, indeed, between mental and physical health services. The potential for integrated care, with a focus on prevention, and collaboration between the statutory services provided by the national health service and the local authority and the community, exactly as is happening in Bradford, can provide the early intervention that my hon. Friend discussed, and it can address isolation. He mentioned that pernicious problem. Many people live on their own, and often lead lonely lives and, as he said, both their mental and physical health deteriorates. If we can get the community to support the statutory services, providing companionship and friendship, and giving people a better life, the combination with a much more joined-up service from the statutory services can achieve the breakthrough that he described in his community.

I conclude by applauding the impressive community work in Bradford, which began in one local community, but which has the potential to spread to 20 other local communities. That is exactly what should be done, and with the support of the Care Bill, we can make that a reality, not only in Bradford but across the country.

Question put and agreed to.

Health and Care Services

David Ward Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Grahame M. Morris]

I will not read that out because I will come on to the issue in a moment. First I want to talk about integration, so I will press on. Statistics published in Public Spending Statistics in July 2012 show that real expenditure on the NHS fell by 0.02% in 2011-12 and 0.69% in the fiscal year before that. I understand that those are small percentages, but we are dealing with a budget of £105 billion, including the capital element, and I think the public would be concerned because those sums are not insignificant. Those percentages equate to £740 million over two years, and we should think about what that money could buy. In my area, one of the first schemes to be cancelled when the coalition came to power was a new hospital. It was not funded through a private finance initiative but through Department of Health capital resources. That hospital would have cost £464 million, but we are still waiting for it. The figures I mentioned would have built two such hospitals.

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

When talking about budgets, the focus is all on integrating health with social care, so we cannot really consider the overall picture unless we also look at local authority budgets.

[Grahame M. Morris]

That is an excellent point, and my hon. Friend the Member for Worsley and Eccles South mentioned evidence presented to the Health Committee that showed that £2.7 billion of expenditure or allocations has been removed from local government budgets and social care. That has had a huge impact on the service and resulted in changes to eligibility and thresholds, and charges for transport and other things.

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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.