(4 years, 9 months ago)
Commons ChamberIt is a pleasure to follow the hon. Member for Chesterfield (Mr Perkins) and all the other contributors. There seems to be cross-party consensus that we need to find a solution for all our constituents. I welcome the new Care Minister to her place. We entered the House together, and I know that this subject is a real passion of hers. I am very excited that she is in post, and I think we can expect great things from her in this area of reform. I also thank her predecessor, my hon. Friend the Member for Gosport (Caroline Dinenage); on the day that the chairs were rearranged, she was in my constituency opening a new hospice, and she was absolutely wonderful to all the staff and patients.
It is a delight to speak in this debate, because this issue is the key concern in my constituency, as it will be in many constituencies. We talk about the fact that 18% of people across the UK are over the age of 65, and that that figure will rise to just shy of 25% of the population by 2040. But in my constituency, 30% of constituents are already over the age of 65. That is absolutely fantastic because we are rich in seniority, but it does mean that there are people who have difficult needs and challenges. In a constituency such as mine, people tend to retire down to the coast and downsize, which means they live in smaller properties and pay much less council tax. However, they also tend to need more services from the local community. It is for that very reason that we cannot continue with the concept of council tax funding social care. It is a postcode lottery, and the places that need the most are given the least when it comes to yield.
I would like to see the system centralised, but rather than having another NHS system, we should inject a bit more reform and interest. That is why I said to the Secretary of State that it would be right for us to follow the German model. In the ’90s, Germany had the exact same issues that we have today, with regional imbalances meaning that parts of the German republic just could not afford social care at a local level. There was also great unfairness in the country because certain people just could not access the care that they needed, and it would wipe out their assets. Both parties then fundamentally agreed that it was in the interests of all their constituents to work together on a cross-party basis to deliver reform. That was when the policy of long-term social care insurance funds was established.
The German model requires individuals to pay in. No individual pays more than €138 a month, and the employer matches that amount. Retired people pay the full amount themselves, so the policy gives a nod to intergenerational fairness. It takes risk out of the system; if one individual has greater needs than another, that is not factored into the amount they pay. Crucially, it has been popular. People do not talk about social care as a political issue in Germany in the way that they do in this country.
In a way, this situation is an absolute tragedy. Opposition Front Benchers rightly talk about the years that we have had in Government in which we could have fixed the issue, but they do not focus on what had gone on since 1997. The Labour Government absolutely ducked this issue and were faced with calls from the Conservatives of “death tax”. In return, we got that back in spades when we talked with honesty in our 2017 manifesto and proposed a policy that was then labelled the “dementia tax”. Our constituents—all of us, across the House—must absolutely despair.
I will give way to the hon. Lady, because a couple of years ago when I made the point that I hoped we could work on a cross-party basis, the talk back to me was, “Actually, that cost you the election, and we wouldn’t work with you on that basis.” I found that response rather frustrating, so I hope for more.
I do not recall that I ever said that, but there is a key point in what the hon. Gentleman is saying. Our recollection is that it was not the Labour party that labelled the Conservatives’ proposal the dementia tax. I think it was actually one of the national charities and the phrase then got taken up by the media, so I ask the hon. Member not to pin that one on us. It is important that we establish cross-party talks, but the people he should be addressing his comments to are on his own Front Bench. Ministers have had since October to follow up on the point I raised with the Secretary of State about cross-party talks, but they have done nothing. We keep hearing about cross-party talks, but they are not happening because the Government are not doing anything about it.
I remember well the exchange that I had with the hon. Lady a couple of years ago. The point I was making was that we did not seem that far apart—she talked about the fact that more funds needed to be raised, and so did we, perhaps with people taking individual responsibility—but the response I got back was more like a lesson on why such policies cost us our majority. That may have been a fair point, but my frustration was that we were being honest and straight with people that if we actually want to reform the system, we may need to ask people to pay more in. Most people do not realise that they already have to pay for it; it is only when they access the service that they fully understand what it really costs them. A lot of people—about 50% of the population—think that the NHS takes care of social care for them. They do not understand.
Whenever we try to propose reform around election times, it turns into a political football. In a way, this is the time to have the conversation, because I do not believe there will be an election for many years to come, so there is the opportunity for us to work cross-party. The hon. Lady is absolutely right: for cross-party talks to occur, she needs a proper invite, and I very much hope that that will be forthcoming. However, given that we now have a Conservative majority, in the event that, sadly, these cross-party talks do not work out—as I say, I hope they do, because that is the greatest chance we have of delivering reform and persuading the public that we are all in this together on their behalf—then I very much hope that we will use our ideas, our mission and our majority to put reform through rather than saying that it has faltered because we cannot get consensus.
The most vulnerable, the elderly and the people who have worked hard all their lives are now lacking in dignity within the system because we simply do not have enough money in place. We have not delivered the reforms that we talk about in this place constantly but still fail to enact. I very much hope that this Government will do that, hopefully on a cross-party basis, but if that does not reach fruition, then by inputting our own principles, our own policies and our own devotion to the people I am talking about, so that we give them and the generations to come a better future.
(7 years, 1 month ago)
Commons ChamberThat is absolutely the case. In fact, in a recent meeting with Unison, I was told that, in our area in Greater Manchester, one person could be paid more for putting toppings on to pizzas at Morrisons than for providing care—often to people with dementia or to those who really need that help.
The hon. Lady talks about a squeeze in funding. On that basis, does she agree that it would be right to ask those who do have the means to contribute more towards their social care in the home?
No, I do not agree with the hon. Gentleman. That is one of the reasons why his party’s dementia tax policy failed so badly. Suddenly to bring hundreds of thousands of people into means-testing using their homes was one of the biggest flaws in the policy that the Conservative party floated.
I will now make a little bit of progress on the state of care, because the fragility of the care sector is a key issue. We heard from my hon. Friend the Member for Luton North (Kelvin Hopkins) about closures in his area, but councils cannot even influence these closures much any more because home care providers are handing back contracts. Indeed, one in five councils in the ADASS survey reported closures in all three services: home care, residential care and nursing home services. There are also serious issues of care quality in many areas of the country.
The survey reported that 70% of the councils surveyed had experienced quality issues across all three types of care services. ADASS estimates that 28,000 people have been affected by care-quality issues or by a change of service due to contracts being handed back. We know that it is a big issue for a person with dementia to have a continual change in the care staff visiting them. Those arguing in favour of cuts need to think about those 28,000 lives affected negatively by cuts to local authority budgets. Worryingly, the Care Quality Commission now reports that almost a quarter of care services are not meeting standards on safety, and nearly a fifth of services require improvement overall.
I said earlier that budget cuts mean that more than 400,000 fewer people are now getting publicly funded care. Of course, councillors, council leaders and social workers have had to make difficult decisions about cutting budgets and cutting support to local people. It is of great credit to councils and council leaders that so many still continue to prioritise adult social care in their budget setting, but the overall position is one of cuts. There will be a real-terms loss of £6.3 billion to adult social care by the end of this financial year, and we heard earlier from my hon. Friend the Member for Manchester, Gorton (Afzal Khan) about the level of cuts in the city of Manchester. The cuts have an impact on staff working in social care.
As I said earlier, I will come to our proposals; I do not want to jump around in my speech too much more.
Going back to staff working in social care, it is important to remember and think about social workers, not just care staff. A recent study found that less than half the social workers surveyed felt that decisions about a person’s care and support were being left to their professional judgment; it is now all about budgets. More than a third said that they had felt unable to get people the care they need. Less than half felt supported to have necessary difficult conversations about changes to care with people needing care and their families.
The social care crisis is a direct result of the cuts that this Government have chosen to make. The King’s Fund, the Health Foundation and the Nuffield Trust estimated that there would be a funding gap in social care budgets of £1.9 billion for this year, but the extra funding in the Budget was only £1 billion, so there is still a funding gap of £900 million this year. Labour pledged an extra £1 billion for social care this year to start to deal with that funding crisis. However, the Government have chosen instead to put the pressure on local authorities and hard-pressed local council taxpayers to deal with that social crisis, which was made in Downing Street.
Delayed transfers of care due to social care cuts increased by more than a quarter in the 12 months to August this year, putting extra pressure on local councils. Now, sadly, Ministers are threatening councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care cannot be met. Indeed, ADASS reported that half the social services directors it surveyed believe that their targets for delayed transfers were unrealistic. It is barely believable that the Government’s response to the social care crisis is to threaten to make the situation worse by cutting funding for social care even further. Some councils experiencing problems meeting targets were even summoned by NHS leaders last week to a meeting to review their performance challenges.
Many people have said that the approach of blaming and penalising local councils is not sustainable. The Conservative chair of the Local Government Association, Lord Porter, said of the warning letters sent from Ministers to councils:
“No council wants to see anyone stay in hospital for a day longer than necessary. These letters are hugely unhelpful at a time when local government and the NHS need to work together to tackle the health and social care crisis.”
The president of the ADASS, Margaret Willcox, has described the Government’s actions in threatening councils with further sanctions as, “frankly bizarre”. David Oliver, who is clinical vice-president of the Royal College of Physicians and a geriatric consultant, said about delayed transfers of care:
“Some of these delays are due to systematic cuts to social care budgets and provision. Others are due to a serious lack of capacity in community healthcare services…attempts to solve the problem through initiatives like the Better Care Fund or pressure from NHS England have failed”.
Interestingly, Andrea Sutcliffe, the chief inspector of social care at the Care Quality Commission, said:
“I worry that if people focus just on moving people through the system quickly then does that mean that they will force the discharge of somebody that is old and frail into a service which we have rated ‘inadequate’”.
We now have a Government who are driving the NHS to be obsessed with dealing with delayed transfers of care, seemingly above all else. This obsession causes further problems if patients are discharged without planning what they need outside hospital.
Age UK give an example that was brought to it:
“Terry’s father Richard, 85, is in hospital following a stroke. He is ready for discharge and has been assessed as needing rehabilitative care through two home visits a day. However he was then told that there are no reablement services available in his area. Terry has been told to ‘get his father out of hospital’ and to look for and fund the care himself.”
My own local hospital, Salford Royal, sadly seems to have similar issues. Last week, I spoke to a constituent who described her own discharge by saying, “I was thrown out of hospital.” Having had surgery for an infected bite that caused sepsis and a hand that she could not use, my constituent was given no discharge summary, no advice on how to manage her wound and no advice about her recovery. When she struggled to get dressed, she was told that she had to get out quickly, otherwise, “This will count as a failed discharge.” This a theme we may remember from last winter.
I remind the Minister that the British Red Cross talked then of a humanitarian crisis whereby people were sent home without clothes or into chaotic situations. Those chaotic situations involved them falling and not being found for hours, or not being washed because there were no care staff to help them. Ordering patients out of hospital when there is no reablement service for them, without advice about wounds or recovery, or to a care facility rated as inadequate just to meet unrealistic targets on delayed discharge is a recipe for an even worse crisis this winter.
The social care and hospital budgets have been merged in East Sussex, where my constituency is. As a result, the A&E is now the fastest-improved A&E department in the whole of England. That change is working. Would the hon. Lady’s local authority consider the same model?
My local authority has the most advanced example of an integrated care organisation in the country—we have already transferred all our social care staff to work for Salford Royal. I have just quoted a situation that shows how the pressure being put on hospitals because of delayed transfers of care is causing them to treat people such as my constituent in the way I described. Conservative Members ought to listen to that, because it is their Government and their Ministers who are causing this pressure to be put on hospitals.
We know that demand on social care is increasing as more people live longer with more complex conditions. The number of people aged 75 and over is projected nearly to double by 2039. That ought to be something to celebrate, but instead the Government have created fear and uncertainty for older people by failing to address the health and care challenges raised by those demographic changes. Indeed, the Conservative party is spending less money on social care now than Labour was when it left office in 2010. The Government seem to have no plan to develop a sustainable solution to the funding of social care in the longer term; they have talked only of a consultation followed by a Green Paper.
Furthermore—and this is raising real fears—the focus has been entirely on the needs of older people, without consideration being given to the needs of the 280,000 working-age people with disabilities or learning disabilities in the social care system. That is profoundly short-sighted, because the financial pressures on local authorities due to the increasing care needs of younger adults with disabilities or mental health problems are now greater than those due to the need to support older people.
(8 years, 5 months ago)
Commons ChamberThank you, Mr Deputy Speaker, for calling me to speak in this important debate. I thank my hon. Friend the Member for Eastleigh (Mims Davies) not only for securing the debate, but for bringing to the Chamber her powerful experiences and sharing them with us. I also want to thank the Minister for all that he does to ensure that carers are given the support they need and deserve.
I want to sign up to the suggestion made by my hon. Friend the Member for Chippenham (Michelle Donelan) that we should extend the pupil premium to all young carers. There are 160,000 young carers whose life chances are disadvantaged by the amazing duty that they perform. Extending the pupil premium to all those young people seems to me to be a very fair exchange for all that they do.
Looking at the other end of the age spectrum, 28% of my constituents in Bexhill and Battle are over 65. By comparison, the national average is 17%. Accordingly, I have a very high number of older carers in my constituency. That is what I want to focus my contribution on today. The 2011 census revealed that there are over 1.8 million carers aged 60 and over in England—almost 16% of the population in that age range. The number of carers aged 85 and over grew by 128% in the past decade, according to a report published last year by Carers UK and Age UK, and it is expected to double over the next 20 years, according to a Government report from 2014.
East Sussex has the highest proportion of over-85s in the UK. Again, that group will be highly pertinent to my constituency. Supporting this army of carers is absolutely essential if we are to ensure that our NHS continues to function. Given the Government’s welcome desire to support keeping people at home in their advancing years, rather than placing them in hospital, that support is even more important. I welcome the passing, by this Government when in coalition, of the Care Act 2014. The Act granted significant new rights to carers in England and placed duties on local authorities to ensure that support is delivered, advice is given and information is provided. It also placed a duty on NHS bodies to co-operate with local authorities in delivering Care Act functions, which, if the clinical commissioning groups in East Sussex can work as a whole, will lead to a “Better Together” integrated health system in East Sussex.
I am conscious that the delivery of those rights is contingent on local authorities having the necessary financial resources in place. I welcome the devolution of business rates to my county, but the yield in East Sussex is low and the demands from a population with above-average ageing is high. Our county will need more time to deliver and more investment in infrastructure to attract new businesses to the coast if this is going to provide for carers and other groups who need local authority finance and support.
I welcome the new 2% levy that local authorities can apply to council tax, provided that it is spent on adult social care. While I champion the rights of carers within the home, many carers are caring for loved ones who reside in care homes due to complex or advanced needs. It is absolutely essential that those carers have the comfort of knowing that their loved ones will be well cared for when they are not in the home to deliver it. I have championed the care home industry, which features heavily in my constituency. Funding them properly via the new 2% levy will, I hope, result in better Care Quality Commission ratings than those that have been awarded following recent investigations.
Across East Sussex, 60% of our care homes were found to be inadequate or needing improvement. It concerns me greatly that, because of these poor ratings, many of our carers may choose to soldier on at home when a care home would be the better choice for their loved ones. All the care homes that I have visited in my constituency have been fantastic. It is important that those that need to improve do so with the extra funding that the Government have procured.
In a rural constituency such as mine, social isolation can be a particular concern. This is exacerbated for older carers looking after loved ones. According to a report published in 2011, more than two thirds of older carers reported not getting breaks away from caring at all, with a further third getting a break only once every two or three months, or less. Let me therefore take this opportunity to thank all those constituents who do so much to give carers a break. While I am at it, let me name-check my mother and my two sisters, who regularly host teas at home attended by carers who do not get the chance to get out of the house and get looked after by someone else for a change. While it is right to look to the Government to be the ultimate support, very often it is the community and their acts of kindness, via visits, conversations, moral support and basic errands, who improve the welfare and wellbeing of our elderly carers. I salute all those who do it.
I am keen for the Government to look at the following suggestions that were made to me by the fantastic Care for the Carers team in East Sussex. First, we should help national partners reach more carers. Would it be possible to make it a duty for the NHS to identify carers, in the same way that the Care Act does for local authorities? Secondly, we should ensure that carers have good support. Would it be possible to ensure that local authorities do not charge carers for the support that they are entitled to? East Sussex is currently not charging carers, which I recognise and celebrate.
I thank the hon. Gentleman for his point about the NHS having a duty to identify carers. I have tried three times to introduce that in a private Member’s Bill, so I am really pleased to find support for it among Conservative Members.
I am pleased, as a novice in the House, that there is agreement across the House on that cause.
Thirdly, there should be help for carers in complex situations—those caring for people with dementia or mental health problems. It seems to me to be an obvious ask to promote good practice recommendations to commissioners and health professionals and to promote it in national policy making.
Finally, I thank and express huge admiration for all those who care for others in my constituency and beyond. I know that they seek little praise, but it is right that we should praise them this afternoon.
(9 years, 2 months ago)
Public Bill CommitteesI think businesses might say, “About time,” given the history of the allowance. As the Minister said, the clause increases the maximum amount of the annual investment allowance from £25,000 to £200,000 for expenditure incurred on or after January 2016. In fact, that is a cut to the existing temporary level of £500,000.
The allowance ensures the immediate deduction of expenditure on most plant and machinery from taxable profits. The history of the allowance’s levels is entertaining. It was set at £50,000 between 2008 and 2010 and then it increased to £100,000. It was cut to £25,000 in 2012 but then increased to £250,000—supposedly temporarily—in 2013. In the 2014 Budget, as we just heard, it was raised again to £500,000 and, as was announced in the Budget, it is now being cut to £200,000 in 2016. The Institute for Fiscal Studies said:
“These changes and instability create costs and uncertainty and distort behaviour.”
In 2010, the Chancellor cut the main capital allowance rate and reduced the annual investment allowance to just a quarter of its previous level, from £100,000 down to £25,000. The Government then increased it, but on a temporary basis. Such unpredictability and complexity makes it difficult for businesses to plan the long-term investments that the allowances are intended to support—that is their whole purpose.
That said, taking into account fluctuations over the years and the fact that it was a two-year stimulus, does the hon. Lady agree that the key part to the provision is that it is permanent, thus allowing businesses to plan in the way she advocates should be the way forward?
The hon. Gentleman says that, but, looking at what people say about this, it seems that they do not have confidence that the allowance is permanent because of the way it has chopped and changed. That the Government acted in 2010 to reduce it to a quarter of its earlier value—it was £100,000—is part of the problem. One can see from what I just read out that it jumped around.
To answer the hon. Gentleman’s point, both the Institute of Directors and the British Chambers of Commerce have called for the annual investment allowance to be retained at £500,000. Crucially, the IFS also states that
“restricting the AIA to investment in plant and machinery only creates distortions through differential treatment of assets.”
The IFS has estimated that setting the annual investment allowance at £200,000 from January next year will cost £0.8 billion.
Will the Minister explain how the Chancellor reached the figure of £200,000? As I say, the allowance has jumped about: it was cut to just £25,000 and is now going to be £200,000. There were calls from some small and medium-sized businesses to set a level over £500,000. The IFS says that over the past few years there has been
“an absurd degree of inconsistency”
in the setting of the allowance. As highlighted earlier, PricewaterhouseCoopers’ “Paying for Tomorrow” campaign put forward a strong argument for a need for a long-term view on tax, with a simple, focused approach to tax reliefs. The history of the allowance is anything but that.
The inconsistency has a damaging effect on businesses’ confidence to plan for the future. The move to make the annual investment allowance a permanent rate is welcome, and we support the move to encourage investment and productivity, but we question whether the measure goes far enough. As I said, a number of small and medium-sized businesses have called for the allowance to be set above the current level of £500,000. As with business rates, they feel that the Chancellor has not listened to them. There are calls for him to look again at how he helps businesses to continue to spend and grow.
Other reliefs should also be considered. Consultations are out on business rates—although the Minister did not seem keen to tell me more about that one—enterprise investment schemes and venture capital trusts. We encourage the Government to focus more than they have on the needs of small businesses. I have many questions about how the annual investment allowance has been handled by the Government to date, but of course we welcome some degree of permanence, as guaranteed in the summer Budget—if it is to be permanent. However, the overall system of tax reliefs for businesses must be considered if we are to have a competitive and fair system for businesses to invest and grow. I hope that the Minister will adopt Labour’s new clause and launch a public consultation on reforms to the system of tax reliefs for businesses. I hope also that Members will support the new clause when we vote on it later.
(9 years, 2 months ago)
Commons ChamberI agree completely. The cut in corporation tax allowed this Government to justify the increase in the living wage, as it offsets that. Such a change would put all that at risk, although I very much hope that we will never see that day.
(9 years, 2 months ago)
Commons ChamberThere seems to be the assumption that the entire increase will be passed on—perhaps in part it will—but I visited one of the country’s largest insurers in my constituency and it did not seem to have cause to pass on the increase. Perhaps the hon. Lady should reflect on that and see that passing on such costs may not be automatic. It may be that a reduction in corporation tax means that the costs can be absorbed.
I think that I have already covered that. In a debate in 2010 it was accepted that these costs are almost always passed on. Almost every commentator has said that the costs will be passed on. Aviva and RSA have already announced that they will pass them on, so all the signs are that they will be passed on. Clearly, it would be good if any part of the insurance industry decided not to pass on the costs, but what we are seeing is an increase in premiums across the piece.
This tax increase on a merit good like insurance could undermine the message that individuals and society benefit if the correct level of insurance is taken out. An increase in the insurance premium tax of 58% punishes families and individuals for acting responsibly. When there have been previous increases in the tax, they have been something in the order of around 1%. There is a major concern that this steeper increase could be large enough to alter the coverage chosen by customers, which means that they would become underinsured. It may be that Conservative Members do not face problems of underinsurance in their constituencies. I must say that I have seen a lot of it in my constituency. People really suffer when they are underinsured. If levels of crime are high and there are other issues affecting them on the roads, underinsurance is a real issue.
The Government need to ensure that tax policies do not lead to a situation in which families struggling on low incomes decide to forgo insurance or let their previous policies lapse because prices have risen and they decide that they can no longer afford insurance. That could leave many families at risk of great loss in the event of burglary, or if they have a road accident.
Underinsurance could be a consequence of this rate rise. People could also opt for cheaper policies, which means that they do not get the right coverage, or they opt for higher excesses, which effectively means that their coverage is less. Buying insurance can be a complicated business and a good price may often take precedence over having the right level of coverage.
The HMRC policy paper for this rate rise estimated that there would be
“a small reduction in the demand for standard-rated insurance.”
Any fall in demand for insurance that leaves families open to greater risks should be avoided. Where does the Minister believe this “small reduction” is likely to occur and what is she doing to prevent reductions in the demand for insurance?
Finally, HMRC suggests that there could be changes in the behaviour of insurance companies. It states that there is likely to be
“a small increase in tax planning activity by insurance companies.”
What are the Government doing to minimise this further potential unwanted consequence?
Clause 43 is a typical measure from a Conservative Government who promise one thing and then deliver the opposite. In this case, the Chancellor promised before the election that he had no need to raise taxes, but then he raised this tax, which will have an impact on households throughout the UK and on their usage of insurance. The increase could have a number of negative consequences. Higher insurance premiums may lead to fewer families and individuals purchasing much-needed insurance to protect themselves against everyday problems, which happen much more often in some parts of the country than in others. I am talking about burglary and damage to property and possessions.
The Government must provide more information and analysis of the wider impacts of this tax increase, as well as strategies to prevent the negative consequences that are likely to result from this policy. Labour’s amendment to clause 43 asks the Government to consider the impact of any future increase of the tax.
The Institute for Fiscal Studies has called for a road map to indicate a long-term strategy for our tax system. The CBI has outlined its concerns about the UK tax system in a letter to the Financial Secretary, stressing the need for Ministers to recognise that
“changes to the tax system that appear innocuous can have wide-ranging effects.”
The CBI also stated that there was a need for “renewed discipline” in tax policy making and that the lack of consultation and notice period for tax changes can cause great uncertainty for businesses. None the less, the Government continue to increase and lower taxes for short-term policy goals. Labour believes that we need to consider how to reform our tax system so that people and businesses are taxed efficiently and fairly.
As I have outlined, there are particular concerns about this and any future potential rise in insurance premium tax because of the impact it might have on the price of insurance policies and the take-up of insurance by families and individuals. With that in mind, will the Minister comment on the potential for any further increases in the insurance premium tax during this Parliament, given the comment of her colleague in the Lords that the tax is an easy target?
Labour’s amendment will ensure that the impact of any future increase is properly considered by the Government. It will ensure that there are careful deliberations—much more careful than we have seen on this occasion—on the short and long-term consequences of any further increase in the insurance premium tax and its effect on families and business. I ask Members on both sides of the Committee to support our amendment tonight.