Adult Social Care

Fiona Bruce Excerpts

Thursday 8th March 2012 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on the sensitive and caring way in which she brought this debate to the House. I also pay tribute to the 6 million unpaid carers in the UK. Unsung and often unseen, they are heroes and heroines who daily and sacrificially dedicate their lives to caring for others, often for 24 hours a day, seven days a week, 52 weeks a year. They deserve our utmost respect and appreciation, and I wish to record mine here.

I therefore wish to focus on the need to support carers in this era of an increasingly elderly population and greater longevity and with the exponential Treasury challenges that it will undoubtedly bring. Two million people currently move in and out of a caring role each year, but an ageing population and people living longer with chronic conditions mean that this figure is likely to rise significantly, so we must give serious consideration to how such carers, caring charities and community organisations can be better supported.

It is essential that we encourage a major cultural shift to consider how more support can be provided to carers, especially those who care for their families, and to charitable organisations that support carers. Caring charities, such as Crossroads Care Cheshire East, of which I am privileged to be patron, and the Prince’s Royal Trust for Carers, provide disproportionately greater value for money in the support they give than purely publicly funded social care services would ordinarily provide. As one former employee of the Prince’s Royal Trust for Carers told me, they supplement that work with volunteer support and the ability to act flexibly and go the extra mile, while all the time operating to high professional standards.

A significant caring role can affect a carer’s emotional, physical and financial health, but by supporting carers more positively, we can not only help them and those they care for but save the public purse considerable expense, which, as my hon. Friend the Member for Banbury (Tony Baldry) so eloquently said, will be increasingly important in the coming decades—to a degree that we have only just begun to glimpse. Crossroads Care Cheshire East writes:

“A clear agenda to support carers is an essential component of adult social care strategic planning.”

Caroline Hebblethwaite, who has been a volunteer worker with a caring charity in Cheshire, then an employee and now a full-time carer, speaks with unchallengeable authority and has told me of the many ways in which she believes we could support charities that in turn support carers more effectively. She says that longer-term funding commitments would help—beyond, say, two years—because shorter-term commitments make it difficult for organisations to plan and result in unhelpful churning, loss of experienced staff and disruption to well-established, cost-effective services. As Crossroads Care Cheshire East writes:

“Constantly having to reinvent well developed and user led services simply to fit another funding criterion is not a good use of time and money. Innovation is essential but experience should not be ignored.”

Both Caroline Hebblethwaite and Crossroads Care refer to the essential need for carer breaks. Crossroads says that carer breaks

“should not be paid for out of any benefits received by the person with care needs but should be a carer’s service for the benefit and health and wellbeing of the carer. It is not appropriate to assume that service users will use their own personal budgets to allow their carer a break—we know that often this does not happen. Without practical support carers and families will break down—this can be avoided by low level investment at an earlier stage.”

I will give examples of some of the many ways in which relatively low-level investment can be made.

Local authority funding could make a huge difference if a little more was channelled through carers charities, to be paid out at the discretion of the charities’ trustees. Caroline Hebblethwaite tells me that when she worked for the Princess Royal Trust, small grants paid directly to carers—not means-tested—made a disproportionate difference. She tells me, for example, of an elderly man caring full time for his wife for whom that small grant paid for a shed, in which he could pursue his hobby. It gave him that little bit of extra space and helped him to keep going. For another carer, there was a one-off spring clean, while yet another received computer literacy training, and another the occasional massage.

Provision to enable carers who work to remain in work—by having someone call in, just two or three times a day, to check that their loved one is all right—can make such a difference. A sitting service is also helpful, so that carers can go out. One way that local authorities can offer support—at a very modest cost, but making a real difference for those who care—is by funding befriending groups. Such groups enable carers to share experiences, but they need to be local, because carers do not have the time to travel far. Those that have helped in Cheshire include befriending groups that have provided talks on such matters as how to redecorate on a budget or how to make a hanging basket, and have even given advice on healthy eating. That might seem mundane, but it can make a real difference to carers, who often feel run down or a little bit depressed. Such small amounts of support can have a disproportionate benefit, and we need more of this.

Carers, often low on energy and self-esteem, find it hard to get information, advice and support, and I am advised that social workers often do not have much time to signpost them. However, local charities for carers can perform an important function in offering a great source of advice. Another function that they perform is by acting as a counselling service, providing counselling time—again, something that social workers cannot provide. There is a real need to recognise and support carers—for example, by giving them help in adapting to change, or to loss, or grief for a life once lived, or a life that might have been.

Caroline Hebblethwaite also told me about how much carers days have meant to those whom she has supported. Carers days in Cheshire have been held at local hotels, or even at a golf club. Carers are invited to come for special “feel good” days, where they are affirmed and told how much they are valued, and where high-level speakers talk to them, acknowledging the vital role that carers play. More of this is what we need as we move forward.

Local authorities could also ask professional advisers in carers charities to carry out more assessments of carers. This would not only be a valuable source of additional funding for carers’ charities, but also a likely cost-saver for local authorities. Incidentally, I am informed that assessments of carers’ needs are not made as frequently as they should be in many circumstances.

I would like now to deal with one or two other points. First, my constituent Barry Smith has written to me about higher attendance allowance:

“My parents-in-law are both 89, my father in law has advanced Alzheimer’s and my mother in law, in poor health herself, and lacking easy mobility after having broke both hips, is his primary care…We have spent the last few days trying to fill out the forms for…Higher Attendance Allowance and have come to the conclusion that the application itself constitutes a form of discrimination against the elderly. We had been warned…that the form is extremely difficult to fill in…and that the rate of success is only 60%,”

but it seems that

“for most elderly people it is simply impossible to complete…It is as though it has been carefully designed to ensure that the minimum number of applicants receive their entitlement”.

Hopefully that is something the Minister will look at.

I commend the proactive work of Cheshire East council, the local authority area in which my constituency lies, to support older people, as illustrated in its innovative “Ageing Well in Cheshire East” programme, 2012-17, which has just been launched. It focuses on how to support people from as early as 50 upwards—a little depressing for some of us at that age!—on the basis that the earlier we plan, the better those plans will be for later life, given that we all want to live well for as long as possible.

The aim of the programme is to ensure that older people live well and have access to the right levels of different services and support, including crisis support, at appropriate times in their lives. The programme aims to ensure also that they have a strong voice in influencing local policy and services; remain healthy, active and independent; receive help to plan their finances long-term; live in a safe environment, with appropriate housing; access appropriately constructed public transport; benefit from and contribute through employment, volunteering and learning; keep their links with family and friends; are actively involved in their communities; and maintain their roles as partners, carers and grandparents.

I commend in particular the wide-ranging network of relevant public, private and voluntary sector bodies which the Ageing Well programme has fostered, garnering a commitment to the programme that will be essential if we are to maximise our support and provide the effectively integrated care that has been talked about today. The programme has secured a commitment from agencies as wide-ranging as Cheshire fire and rescue, the police, clinical commissioning groups, local councils, the faith sector, housing providers, care charities and even the chambers of commerce.

The programme is already tackling older people’s concerns, such as those about disjointed services, the variable quality of care and social and economic isolation, and it is also improving volunteering opportunities. Such forward-thinking work is an essential component of our successfully rising to the challenge of caring for the elderly in the years ahead, and it is particularly important in an area such as Cheshire East, which has a rapidly ageing population and, in fact, the largest elderly population of any area, per head of population, in the north-west of England. The number of over-65s in the area will grow by 50%, and the number of over-85s is set to double, by 2025.

Cheshire East has funding challenges, however. The Government funding for the area is among the lowest of any in the country, despite the challenges that we are going to face and, indeed, already face in caring for such a large elderly population. We are given £191.62 per head, while Tower Hamlets, by way of comparison, is given £968.18, meaning that we can afford to spend per head £753.42, while Tower Hamlets has almost double, £1,428.16.

The funding context of each local authority area is an important influence on the services that can be provided, and in an area such as Cheshire East, with low funding but an increasingly elderly population, that is going to be a challenge, so I ask the Minister to consider it as we move forward.

I commend the Minister’s commitment to build on community capacity as the way forward, helping people to stay independent, healthy and well for as long as possible. Indeed, perhaps a better term for independent living would be inter-dependent living, recognising the importance of, and the need for, all of us to give and receive care at various stages of our lives. The more we can encourage caring within families, by friends and in communities, the healthier our society will be. We need to do all that we can to foster support and to encourage the sharing of caring, and we need to treat with gratitude and respect those who do care.

The words of the chief executive of Carers UK are apt:

“Our health and social care services could not function without the contribution of the unpaid care provided by families—which we estimate to be the equivalent of £119 billion a year.”

The basic building blocks of a healthy society are found in relationships—the networks of reciprocal responsibility that are found in the family, in friendships, in church, in community life, in work, and in schools. Through these basic building blocks, individuals meet the needs of their community. It is as much, if not more, the role of Government to help society to meet its needs through those relationships rather than seeking to take control and trying to meet those needs itself. As human beings, one of the ways we grow is through the challenge of meeting the needs of others in our relationships within our communities. Our national mindset needs to be increasingly directed towards that goal. Looking to the selfless example of our country’s 6 million carers would be a very good place to start.

Alcohol Strategy

Fiona Bruce Excerpts

Tuesday 7th February 2012 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

Given the shortage of time, and in order to give other Members the opportunity to contribute, I will restrict my remarks to one of the topics on which I wished to speak. I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this timely debate. She has made the case well for the need to address excessive drinking, particularly among the young. I want to draw attention to the important role that parents play in teaching their children how to drink responsibly.

I wish to highlight recent research produced by the think-tank Demos. A few days ago, I was privileged to host a meeting at which it launched a report on alcohol and parenting. The report compared parenting styles, and found—perhaps unsurprisingly to some—that parents who are actively involved in their children’s lives and know where they are, what they are doing and who they are with, and who get involved in their children’s leisure activities and know their friends and even their friends’ families, and who offer love and affection as well as setting clear boundaries, will materially decrease the likelihood that their children will binge-drink at age 16. According to the report, parents who bring up their children in a disengaged way with low levels of the sorts of attachment that I have described, run the risk that their youngsters will be eight times more likely to engage in binge drinking at age 16.

Even more surprising was the effect that parenting styles have into adulthood. The research found that children bought up in an environment with high levels of attachment were far less likely to engage in excessive drinking at the age of 34, which shows that good parenting has a lasting effect on us as adults. I was encouraged by that report, and it reassured me that all those hours that I have spent freezing on the touchline at football matches across Cheshire may have a greater impact than that of simply cheering on my son’s football teams.

Although the Demos report did not recommend that the Government make grand changes in the way they educate parents about bringing up their children, I would like to comment on that subject. The research highlights the fact that active parenting is a key aspect of personal responsibility, and it is good to be reminded of that with reference to excessive drinking. Ideally, appropriate levels of personal responsibility in relation to that issue would substantially reduce—indeed, negate—the need for greater Government intervention.

As part of their alcohol strategy, I suggest that the Government think laterally and consider seriously the positive contribution that parenting classes or education could make, particularly in terms of prevention rather than cure. The Government are currently trialling parenting classes in three parts of the country, but such things are rare. Over time, the broader availability of such classes could reap substantial benefits in the lives of many—that is particularly true in an age when many young people who may become parents have not experienced ideal parental role models in their own lives.

In conclusion, we cannot resolve every problem of excessive drinking in our country, but we should not act only at personal, community or national levels. We need to do something at all those levels, because doing nothing is not an option.

Care of the Dying

Fiona Bruce Excerpts

Tuesday 17th January 2012 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I support all that has been said by those hon. Members who have spoken today. I want to touch particularly on the importance of how we can develop the excellent hospice care that already exists in our country today. Dame Cecily Saunders has been quoted. She said that the hospice movement should have three components: care, research into good care and education of professionals and the community in care and end-of-life issues. Communities today need hospices to operate at that level not just within their buildings, but outside. Fantastic care is given in hospices, but to a relatively small number of people.

In Cheshire, for example, St. Luke’s hospice, which serves my constituency, has just 14 beds, but through various initiatives, it has a far greater beneficial impact on the wider community. I should like to share some of the initiatives that St. Luke’s is developing. It has recently been invited to share those initiatives with the all-party group on dying well. To give confidence and skills to others to share well the care of family members, it has a community outreach programme, and I will refer to one of those programmes in my constituency.

The village hall in a village near Alsager opened its doors one day a week, but that is now being extended, so that those who are not within the hospice may come for day care. Nurses from the hospice spend a day at the village hall, and a group of volunteers cook lunch for the community’s elderly residents, who are often in some difficulty with their physical and mental capabilities. They can have counselling in a private room, a massage, treatments such as manicures and pedicures and engage in hobbies. I saw some wonderful art work that they had done over a period of months. They are provided with an excellent lunch, preceded by a small glass of sherry if they want it. There is much laughter and much support, and that enables the people who visit the centre not only to remain in their communities, but to have their lives enhanced and supported by the work of the hospice, augmented by a substantial number of local volunteers. In turn, those volunteers go into those people’s homes.

[Jeremy Lefroy (Stafford) (Con)]

I am grateful to my hon. Friend for describing the innovative care that hospices in our local communities provide. In my constituency, Katharine House hospice does the same. I want to draw her attention to the community lodges that the Douglas Macmillan hospice has set up in an area near her constituency. They allow families to come together and to support their loved ones in a lodge as they are dying.

[Fiona Bruce]

My hon. Friend is absolutely right. As Siobhan Horton, the director of St. Luke’s hospice said:

“Hospices need to actively transfer their enormous expertise in health and social care more broadly to ensure more benefit from high quality care”

for more people. St. Luke’s also provides education for all those in the Cheshire area who are involved in hospice work. I have visited the hospice. The ground floor contains 14 beds, and the first floor is a resource centre with a library, and advisers to inform and enable carers and professionals to extend their expertise throughout the Cheshire community and beyond. Hospices can do that excellently, because of their unique expertise, not only in this country, but throughout the world.

Another project that St. Luke’s is undertaking is to develop a public health approach to end-of-life issues, so that ageing well and dying well are part of living well. It is working with the local community to improve communication with family members who are coming to the end of their lives, to resolve outstanding issues, to reduce regrets, to open up conversations that others may be reluctant to engage in, to work with family members and to encourage the engagement of their wider community in supporting the family and individuals who are struggling to support themselves towards the end of a life in the family. The aim for all who are supported in that way is a good death. I think that we all have that aspiration: a death within the loving embrace of our family and local community. St. Luke’s is undertaking serious research into that, and I look forward to hearing more about its developing public health approach to end-of-life issues.

I want to touch on the work that St. Luke’s is doing in connection with care homes. It has been involved in care home education for many years, and although it believes that some care home care is excellent, it also believes that much expertise can be shared both ways. It is considering how to have a closer, more supportive relationship with care homes locally and is commissioning a report on strategic planning and what sort of relationship and support would make a positive difference to care home delivery of end-of-life care. Let us support such innovations and others throughout the country to develop the excellent work of the hospice movement here, of which we can all be proud. I look forward to hearing from the Minister how the country and the Government can continue to support and promote the extension of the excellent palliative care in this nation.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 10th January 2012 Commons Chamber

[Paul Burstow]

I will certainly pass on the hon. Gentleman’s request.

[Fiona Bruce (Congleton) (Con)]

8. When he expects residents in Congleton constituency to benefit from investment in telehealth and telecare services by the NHS.

[The Secretary of State for Health (Mr Andrew Lansley)]

I am pleased to say that patients in Congleton who have health conditions such as heart failure or chronic respiratory disease can already benefit from these technologies. I am committed to supporting the use of telehealth and telecare services by working with industry to improve the lives of 3 million people across the country who are living at home with long-term conditions.

[Fiona Bruce]

I thank the Secretary of State for that reply, and indeed innovative schemes in my constituency and across the Cheshire East council area, such as DemenShare, are already using this technology. But what other schemes and advances will the Government introduce for an area that has the highest level of elderly people per population head in the north-west of England and where the number of over-65s will grow by 50% and the number of over-85s is set to more than double by 2025?

[Mr Lansley]

I am grateful to my hon. Friend for her question. She rightly talks about this increasing number of older people in the community and rightly says that we want to support them to be independent and to improve their quality of life.

The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why we are so determined to ensure, over the next five years, that we reach out to older people who are living at home with long-term conditions and improve their quality of life in this way.

Pregnancy Counselling

Fiona Bruce Excerpts

Monday 12th December 2011 Commons Chamber

[Fiona Bruce (Congleton) (Con)]

I commend the hon. Gentleman for introducing this important debate. Does he also agree that where such counselling is offered, it should be provided by counsellors who have specialist training and experience in advising those who are in the situation he describes?

[Gavin Shuker]

The hon. Lady makes an extremely good point. I agree, and I will go on to say a few words about some of the criteria that we should look for in people providing such counselling in future.

I believe it is perfectly reasonable, in a debate as complex and fractious as this, to suggest that given the issues we have talked about, the most sensible thing the Government could do is take out of the equation the financial link between counselling and the procedure. I accept that there are opinions in all parts of the House, but one simple principle to enact—and one potentially complex thing to do—would be to take the financial link out of the process. Many would see it as wrong that pregnancy counselling is currently monopolised by those who are pro-choice. There is an imbalance in the system which means that, by and large, counselling is provided only by private abortion clinics. I encourage hon. Members, whatever their perspective on the issue, to consider this simple question: can it really be right that the only taxpayer-funded pregnancy counselling available is currently given by those working for abortion providers?

Counselling in this context should always be non-directive, client-centred and universally available, and the right to it should be legally protected, but I do not believe that it should be subject to a duopoly, as it is at present. If a provider can produce genuinely client-centred and non-directive counselling that is free from a financial link to any given procedure, I believe that the NHS should fund it. There are more than two such providers in the UK today.

In that light, I very much welcome the commitment that the Minister gave the House in September. She said:

“Whether women want to take up the offer of independent counselling will be a matter for them, but we are clear that the offer should be made.”—[Official Report, 7 September 2011; Vol. 532, c. 384.]

She also spoke of the difficulty in defining what was meant by “independent” in this context. For some it simply means non-directive, but for others it means independence from finance or independence of the organisational structure from the abortion provider. As I understand it, her Department has not yet given any assurance that the offer of independent counselling would by definition mean counselling by persons or bodies without any kind of vested interest in abortion provision. I ask her to reflect on this and reiterate her commitment that women will be offered independent counselling and that the way to ensure that is by creating a regulatory framework that recognises the provision of alternative sources of pregnancy counselling to those offered by the big two.

In this country we have more than 40,000 trained counsellors who are members of either the British Association for Counselling and Psychotherapy or the UK Council for Psychotherapy. I hope that the Department will liaise with both organisations and the Royal College of Psychiatrists in developing an entirely new approach to how pregnancy counselling is provided in this country.

I know I speak for many, both in the Chamber and outside, when I say that my preference would be for abortion clinics not to be provided in pregnancy options counselling, ensuring that every woman seeking such counselling would know that there is no financial relationship between counselling and the provision of a termination. However, I accept the Government’s position that the right way forward on this issue is through consultation that allows all parties to express their views. It seems entirely practical and plausible for the Government, using the resources currently available, to develop a system in which every woman considering her pregnancy is offered counselling, should she wish to have it.

Non-directive pregnancy options counsellors, who are excluded from the present state settlement, can offer practical advice and help for women who choose to take their pregnancy to full term and often an ongoing support relationship. The focus of existing providers, understandably, is whether to abort or not. Just as choices are wider than simply whether or not to have an abortion, so counselling should give recognition to and advice on adoption and fostering when a woman considers continuing with her pregnancy.

Let me turn to the inevitable charge that allowing counsellors who are pro-life in their personal lives into the system would be inherently damaging to women. It starts with an assumption that the present system is both neutral and independent and hinges on a prejudice about those who hold such convictions. Allow me humbly to disagree with this notion. First, if the debate this autumn taught us anything, it is that no one is neutral. On an issue of conscience, right-minded and well-meaning people will rightly disagree and end up on different sides of the debate, but they will hold a position of conscience that they feel strongly about, hence my suggestion that we do what we can do now, hence my call to break the financial link between counselling and the termination procedure, and hence my desire to ensure that there is no nagging doubt at the back of any woman’s mind about who is looking out for their interests.

Secondly, there is an assumption that people cannot park their personal convictions at the door. Every counsellor knows that pressure in any direction is counter-productive for a woman who wants to continue her pregnancy but needs the space to reach that conclusion herself. In a new system, every counsellor should know that, whether they are personally pro-choice or pro-life, any moves that depart from non-directive principles should endanger their ability to do such work in future.

Equally, I hope that being pro-choice would mean being pro-all-the-choices available to women and that some providers are more expert at providing additional choices to those currently available and funded within the present system. That is why I hope that providers who, as many Members have mentioned, are doing amazing work to support women who would otherwise have felt no option but to undergo an abortion will be welcomed into our present system.

As a House, we have always had the ability to bridge divides, overcome prejudices we see in one another and together find a better arrangement for those we are here to serve. I feel certain that there are women who are let down by the current arrangements. The right response for us is to come together in a spirit of respect, excluding no one or their views. The ongoing consultation by the Government is an opportunity for us to do so, and I hope that we will not be found lacking.

Social Care Funding

Fiona Bruce Excerpts

Thursday 10th November 2011 Westminster Hall

[Sarah Newton]

I am sure that that is right. It is certainly a point that the Dilnot commission and people who have responded to it have made. They are very supportive of the Government’s plans to integrate social care with the health service.

It is a major worry for most families that they cannot protect themselves against the very high costs of care. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) pointed out, looking after people with dementia can involve very considerable costs. However, the availability and choice of financial products to support people in meeting care costs is limited.

[Fiona Bruce (Congleton) (Con)]

Does my hon. Friend agree that one of the highest priorities for the allocation of funds should be to support those families who care for elderly relatives at home? They often make great sacrifices and incur great costs. We must ensure that we give them the recognition and appreciation that they deserve, and one way in which we can tangibly do that is by ensuring that they have clear access to support from funds. Often, a very small amount of funding can make a big difference to those families and can ensure that they are able to continue caring for their relatives in their own homes for much longer. Should we not be treating that as a priority?

[John Robertson (in the Chair)]

Order. That was a very long intervention.

--- Later in debate ---

[Sarah Newton]

I agree. My hon. Friend makes that important point extremely well. Local authorities and the NHS have had a silo mentality on commissioning. Undoubtedly, funds that could have driven up the quality and choice of care to support people have been wasted. I hope that the reforms that the Government are setting in train will overcome those issues. When the health and well-being boards come into play, if they link up properly all the providers in a community and set the agenda for commissioning services to improve health outcomes, they could have a powerful impact and achieve some of the things that my hon. Friend has highlighted.

In this debate, when we are talking about the budgets of the NHS and of local authorities, we must never forget that it is families who care for their grown-up children with disabilities or for elderly family members. Informal carers provide more support than any Government could ever afford to pay for. The most recent research from the charity, Carers UK, estimates that there are more than 6 million carers in the UK. The care and support that they provide to help people remain safely in their own home are valued at a staggering £119 billion per year, which is far more than the annual cost of all aspects of the NHS. Support to carers must be central to the future provision of services. It is informal carers, families and, in the majority of cases, women who worry most about cuts to services that enable them to help and care for their elderly and young family members.

Who pays for care is just one of the questions that the Government’s reforms of social care must address. There are issues of quality and regulation of services, training and pay for those working in this sector, as well as choice. The Government’s reforms need to look at finding solutions that work for different generations. Young people who will be saving for their old age and auto-enrolled into pension schemes could be incentivised to make an additional contribution each month to an insurance policy that will pay for their care later in life should they need it. The package of reforms developed by the commission has been welcomed by the financial services industry, which sees opportunities to develop new products to enable people to pay for their contributions towards the costs of their care.

The Dilnot commission’s package of reforms to support families in their caring responsibilities will require an extra £1.7 billion a year—a figure that will rise with an ageing population. Whether or not the commission’s reforms are implemented in part or in entirety, it is clear that more money needs to be found for social care and NHS integration. While I do not underestimate—I am sure none of my colleagues in the Chamber do—how difficult it will be to find that sum during this Parliament, constructive ideas have been given to the Treasury on how that spending commitment could be achieved without increasing taxation or borrowing more money. Consideration should also be given to removing the upper age limit on national insurance contributions, which could raise £3 billion a year, and to further reform to pension tax relief for higher-rate taxpayers.

[Fiona Bruce]

Should consideration not be given to reviewing the planning regulations when families seek to build extensions to their homes? There are far too few multi-generational homes in this country, yet there are some pedantic planning regulations to which local authorities strictly adhere without recognising the wider value to the community that such extensions can bring.

[Sarah Newton]

That is a good point and it should definitely be considered by those responsible for reforming planning policies.

We all have an important role to play in building momentum for change, contributing constructive proposals and trying to build consensus for vital change. I hope that this debate provides the Minister with a welcome opportunity to hear the concerns and constructive ideas of hon. Members from all parts of the House as he develops his White Paper.

I was particularly pleased when the Backbench Business Committee allotted me this date for my debate. It is the eve of Armistice day, when we remember all those who have served their country and made the ultimate sacrifice. As there are so few survivors remaining from the first world war, our thoughts and prayers naturally turn to those who are serving in conflicts around the world, particularly in Afghanistan. Many of us will also be thinking of the survivors of the second world war. There are some 11.7 million people living in England today who survived the second world war, and they make up 22.5% of the population. We owe a great debt to that generation for our freedom and for the way of life that we enjoy today. Rationing ended in the 1950s, so that generation really understands what an age of austerity means. For those of us who were born after the war, it is our turn to show not only our respect for them but that we have not forgotten their sacrifice. We must take care of them as they grow older.

Over the 50 years in which we have enjoyed peace in most of Europe and a growth in prosperity, we have singularly failed to make preparations for the care of that generation. The welfare state was a great post-war legacy. However, there are gaps in funding in the main provisions—the NHS and pensions—as increases in life expectancy have been consistently underestimated. It is essential that we make lasting reforms to the welfare state so that it can deliver on the promise made to the generation that created it.

Oral Answers to Questions

Fiona Bruce Excerpts

Tuesday 25th January 2011 Commons Chamber

[Paul Burstow]

I and the Minister responsible for disability issues in the Department for Work and Pensions meet regularly. In fact, a further meeting on this and other matters is coming up shortly.

[Fiona Bruce (Congleton) (Con)]

5. What recent steps he has taken to reduce levels of alcohol misuse among young people.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The public health White Paper, “Healthy Lives, Healthy People”, sets out how society can harness the efforts of individuals, families, local and national Government, and the private, voluntary and community sectors to take better care of our children’s health and development.

[Fiona Bruce]

I thank the Minister for that reply. Hon. Members will be aware of the recent publicity given to vodka eye-balling, which is a dangerous practice. Members of the ArcAngel volunteer team in my constituency are going into schools seeking to alert young people to this and other dangers of binge drinking and excessive alcohol abuse. What support can the Minister offer to ensure that we can eradicate, in particular, the dangerous practice of vodka eye-balling?

[Anne Milton]

I thank my hon. Friend for her question, particularly in highlighting this extraordinary practice. I have to say, it was news to me. I congratulate the efforts of that local organisation on highlighting this sort of issue with school children. There is no doubt that vodka eye-balling can cause damage to the surface of the eye, ulceration and scarring. Although it has got some publicity, however, a lot of young people are likely to be drunk in the first place when they do it, so the effects are probably overestimated.