Health and Social Care

Debate between James Cartlidge and Damian Green

Thursday 16th January 2020 Commons Chamber

[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Blaydon (Liz Twist). As somebody who is in the early weeks of their seventh Parliament, I can say that I have therefore sat through many waves of maiden speeches over the years. The quality of the speeches that we have heard not just today—we have just heard from my hon. Friend the Member for Sevenoaks (Laura Trott) and from several Members from the Labour Benches—but throughout this debate over the past few days has been breathtakingly high. As somebody who has been round the block a few times, I can say that that is not only very welcome, but slightly alarming.

What I want to do is concentrate specifically on the social care element of today’s debate. It is a hugely important part of the wider health agenda and also obviously vital in its own right. I welcome a number of elements in the Government’s approach. The first is the recognition of the urgency of the need to solve the issue of social care, which has been left on the backburner for far too long. The second is the desire to work on a cross-party basis. I appreciate that that is going to be challenging for the Opposition Front Benchers over the next three months, because they will have other things on their mind, but for the past 18 months I have been working from the Back Benches with both Labour and Lib Dem Members. Although none of them is here at the moment, there are Lib Dem Members who are interested in this issue. I think that that cross-party approach is the best one. The third element is the Government’s recognition that the system today is incredibly fragile and needs extra money to tide it over. I am glad that the Government are helping local authorities with £1 billion in the coming year, but although it may be the world’s most expensive sticking plaster, it is still a sticking plaster, and we all know that we need a much more wholesale approach.

Many aspects of the problem need solving. There is the question of where the workforce are going to come from. Home adaptations will be needed so that more people can live in their own homes for longer. We will need the provision of extra places in care homes, where a shortage is developing. There are also problems when it comes to dementia patients. I think the Alzheimer’s Society has sent many Members a briefing for this debate, and everything it says is very sensible, but beneath all these questions is the issue of money. Where is the extra money going to come from? If there were a simple solution, a Government would have adopted it a long time ago.

I warn Ministers against reaching for the simplest and easiest solution, because the easy solution is to say, “We’ll make it free and we’ll fund it out of general taxation.” That is easy and seductive, because many people think social care is free anyway, but that would be wrong and unfair. It would be wrong not just because of the public spending implications, but for intergenerational fairness. If we fund the solution from the taxation paid by working-age people, we would be telling 20, 30 or 40-somethings not only that we are going to tax them to pay for their own social care if they need it in the future, which would be fair enough, but that we are also taxing them to pay for the social care of their parents’ generation, which would not be fair. That would be particularly unfair in this country, where there is a preponderance of wealth among the baby boomer generation. So much of the wealth in this country is tied up in housing, and that generation are far more likely to own their own homes than their children’s generation.

[James Cartlidge]

My right hon. Friend is making a brilliant speech, with great passion. Surely the definition of “sustainable” here is someone in their 20s who is entering the workforce and being asked to pay into a new system believing that the same quality of care will be available when they reach their 70s or 80s. That will not be the case if the model is unsustainable.

[Damian Green]

My hon. Friend is exactly right, and I wanted to talk briefly about the various ways in which we can achieve a sustainable system. We could have a compulsory social care payment that is made by everyone of working age and, indeed, beyond working age. That has been recommended by Select Committees of this House. Alternatively, I would suggest that we could have not a tax, but a hugely desirable saving, based on the model of the pension system, whereby the vast majority of people are encouraged to—and do—subscribe to auto enrolment pensions, but it is not compulsory.

In that pensions model, we would have the equivalent of a state pension—a universal care entitlement—which would have to be better than the current provision of care. On top of that, we would urge millions of people voluntarily to save for a care supplement, as they do for a private pension. That would guarantee them the quality of care that they would want in their old age. Of course, not everyone will be able to make those savings, and the system needs to be better for those who cannot contribute towards their own care if they need it in old age, but it is essential that we use this massive wealth, particularly among those who are 60 and above; a small sliver could help us to achieve these aims.

At the moment, the equity in housing of those over the age of 65 is £1.7 trillion. Just a small sliver of that would provide a much greater sum of money and therefore a much more sustainable system. The Prime Minister is absolutely right when he says that nobody should be forced to sell their own home to pay for care. People have worked for that, and will want to give some of it to future generations, but a small sliver saved into the sort of insurance system that I am suggesting would make a huge difference and would put the social care system on a sustainable level.

I have a final thought, which puts these ideas in the wider context of today’s debate. If we do not sort this issue out, the long-term plan for the NHS will not work. The 2020s need to be a decade of hope for the NHS, and every one nation Conservative will want that to happen, but to make that real we need to solve the social care crisis. I wish Ministers well in achieving this, and urge the House to reject the Opposition amendment.

Oral Answers to Questions

Debate between James Cartlidge and Damian Green

Monday 9th January 2017 Commons Chamber

[Damian Green]

I am keen to improve their effectiveness in that regard, and I also take my hon. Friend’s point about the pressure on GPs. In the consultation document we consider the possibility of extending the issuing of fit notes to other healthcare professionals, and I shall be interested to see what response we receive, not just from those who receive the fit notes but from the professionals involved.

[James Cartlidge]

I strongly support my right hon. Friend in respect of this specific policy. Does he agree, however, that as the consultants—as it were—to whom patients are referred will be work coaches, it is critical that those people receive training that will enable them to deal with the hardest cases among those who are unemployed, particularly those with pressing mental health problems?

[Damian Green]

I agree with my hon. Friend and am grateful for his support. I am happy to reassure him that all work coaches will complete specific training for their role, including a course that combines the knowledge, skills and behaviour that they will need to deal with the people with whom they work, particularly those with mental health conditions. Obviously, work coaches will need specific skills to handle the many issues that will arise from such conditions.

State Pension Age: Women

Debate between James Cartlidge and Damian Green

Wednesday 30th November 2016 Commons Chamber

[Damian Green]

I feel that the hon. Gentleman has had his fair share of the time, having used more than 35 minutes of a three-hour debate, and I want to turn to the specific option that he proposed. He mentioned the Landman Economics report that modelled the impact of several options. The SNP’s preferred option would roll back the 2011 Act entirely, returning to the timetable in the 1995 Act. He said that that option would cost £8 billion, but I disagree. Our analysis suggests that the cost has to go beyond 2020-21 and must include the effects on national insurance payments and tax collection, which his economic model entirely ignores, and that it would cost over £30 billion.

Even if we accept the hon. Gentleman’s figures, his other suggestion is that the costs could be met from the surplus in the national insurance fund that he conveniently discovered. In fact, there is no surplus in the fund because it is all used to pay contributory benefits. If we take from the national insurance fund £8 billion, £30 billion or whatever number one cares to mention, we take it from people who receive benefits. The surplus of £16 billion that he identified is two months’ expenditure—an advisory level recommended by the Government Actuary as a prudent working balance. The money has been put there by a Treasury grant to maintain the fund at the recommended long-term balance. The Government Actuary does not forecast a long-term surplus, so this convenient pot of money for the SNP does not actually exist.

[James Cartlidge]

May I add to that? Others have tried to alight on this fund as a source of expenditure, but the then Financial Secretary Ruth Kelly said in 2003:

“The national insurance fund provides security for those contributory benefits. It is ring-fenced and cannot be used for other Government expenditure.”—[Official Report, 21 October 2003; Vol. 411, c. 231WH.]

[Damian Green]

I am grateful to my hon. Friend, who is knowledgeable about such matters.

The hon. Member for Ross, Skye and Lochaber used to work in the financial services industry and has been a fund manager, so he knows what he is talking about. However, he must know that his characterisation of the national insurance fund as involving some kind of individual contract that relates what someone gets out of it to what they pay in is not true. The state pension is a social security benefit, funded through national insurance contributions.

Under-occupancy Charge

Debate between James Cartlidge and Damian Green

Monday 14th November 2016 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

I am reassured to hear my right hon. Friend say that the number of claimants for this subsidy is actually falling and that part of that is due to the fact that people are moving into work from benefits. There are always difficult cases in the welfare system—cases that fall outside the normal rules—but the big picture is that worklessness, which is the biggest cause of poverty, is at an all-time low, and that the spare room subsidy has played a part in delivering that.

[Damian Green]

I agree that the subsidy has played a small role. It is also consistent with the rest of our welfare policy, which is about making sure that, as work is the best route out of poverty, as few people as possible face worklessness and that they are helped better than ever before. We have helped more people to get into work and progress in work. [Interruption.] I am afraid that the Opposition do not understand any of that.