Care Bill [Lords]

Jim Shannon Excerpts

Monday 16th December 2013 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to make a contribution in this debate. I thank hon. Members who have made what I would call very passionate, compassionate, knowledgeable, personal and spirited speeches.

The Bill will affect every person in the UK in some way or another. As such, it is incumbent on us to get it right. I have been contacted by a great many bodies and constituents and I have also been in contact with the Health Minister in Northern Ireland, as it is imperative for us to take into account what has been put to us by those on the front line who are providing the services catered for in the Bill.

The vast majority of the Bill’s provisions will apply to England and Wales only, but some legislate on Northern Ireland devolved matters. As the House will know, health is a devolved matter in Northern Ireland, but the Bill deals with some specific issues. One of those provisions is the abolition of the Health Research Authority as a special health authority, and its establishment as a non-departmental public body.

Another such provision relates to the enabling powers for cross-Administration care home placements. The Bill will introduce a four-way reciprocal arrangement, which will enable clients to be placed in care homes across all four UK jurisdictions. That was referred to by the hon. Member for Arfon (Hywel Williams) in relation to Wales. The Bill document is very clear about the arrangement between the four regions—it is good news—that will enable that to happen.

Other such provisions are the associated cross-Administration social care provider failure protections, which will extend across the whole of the United Kingdom. The Bill will introduce continuity of care protections for clients placed across the four jurisdictions in circumstances in which providers fail due to a business failure. It is important to have cross-communication between all four regions within the United Kingdom of Great Britain and Northern Ireland to ensure that there are protections for all.

As I mentioned, social care is a devolved matter, so the Executive and my Assembly colleagues have agreed two legislative consent motions. As Members will see from the Order Paper, the National Assembly for Wales has also passed two legislative consent resolutions in respect of the Bill. The principle has therefore been agreed, but the devil is in the detail, which comes in the Bill.

The Bill also covers changes to how care and support is funded, with planned reforms including the introduction of a cap on contributions to care costs and changes to the means test on capital limits. As social care is a devolved matter, those changes will apply in England only, but I always like to inform the House of what is happening in Northern Ireland. It will interest Members to know that the Department of Health, Social Services and Public Safety is taking forward a three-stage process to reform adult care and support. The first stage was a six-month consultation on the discussion document “Who Cares—The Future of Adult Care and Support in Northern Ireland”. The consultation concluded on 15 March and a report analysing the responses and summarising the comments that had been made was published on 14 August.

The Department is now taking forward the second stage, which will involve the development of proposals for reform and will be subject to a full public consultation in due course. The proposals will include changes to both the type of support that will be available and how services are funded, including how people pay for residential care, which is an important issue in Northern Ireland and the whole United Kingdom.

The third stage will be the development of a final strategic document setting out the agreed future direction on the funding of adult care and support, along with the reforms required. It is likely that legislative change will be required thereafter, so the whole process will take some time to complete. However, I believe it is key to ensuring that Northern Ireland has a care and support system that is sustainable and fit for purpose for many years to come.

I ask the Minister what discussions have taken place with the devolved regions to ensure that we have a system that provides the same level of care across the board, not simply a postcode lottery. Perhaps he will clarify how he intends to ensure that the NHS will continue to be a national health service, not simply a regional health service, and that we have similar levels of care across the whole UK.

I wish to highlight an issue that Marie Curie Cancer Care has brought to my attention. At present, terminally ill people and their families can wait weeks to get social care while local authorities test their means and their level of need. That could be rectified through a duty on local authorities to process applications for local authority-funded care swiftly. We need to add a bit of zip and eagerness to the process to ensure that care can be delivered, particularly for those with cancer. Last week a meeting took place in the Methodist hall across the way, at which a shadow Minister spoke. The Conservative party also had a representative there. Everyone outlined the need for help for those with cancer, and that is one issue that really needs to be addressed. There were people from across England and Wales in that room who had specific needs because of cancer.

The situation for terminally ill people and their families is difficult, and NHS continuing health care is supposed to address it. However, local variations and the way in which CHC funding is allocated mean that few terminally ill people gain access to care through CHC, even though it is available. In this age, how can that be? In Northern Ireland, the Assembly has put in place a commissioner for older people and tasked her specifically with looking after the concerns and needs of the elderly population and highlighting their issues. I took the opportunity to bring the commissioner down to a public meeting in my constituency to give people the chance to express their concerns about residential homes, their money, their benefits and their social and health care.

Social care is vital to terminally ill people and their families. A study by the Nuffield Trust showed that terminally ill people who had access to local authority-funded social care were far less likely to use hospital care. Currently, more than 50% of people in the UK die in hospital, despite only 2% saying that that would be their preference. The National Audit Office estimated that 40% of people who die in hospital have no clinical need to be there, and that is thought to be a conservative estimate. If those people were moved to a community setting, supported by social care, they would receive the care they wanted, and it would free up hospital resources for people who need curative interventions. Will the Minister tell the House what progress has been made on securing fast-track access to social care for terminally ill people? Those are vital issues for the people we represent.

Although the new amendments seek to address such issues, I have been informed that concerns remain because the clause does not require local authorities to provide fast-track care for terminally ill people. If local authorities have the option to fast-track social care for terminally ill people and their families, but no incentives to do so, that could lead to a high degree of variation across the country in the availability of social care. Again, that goes back to my earlier point about whether we have a national health service or a regional health service. It is important that the service is the same across the United Kingdom, so that what people get in Scotland is the same as they get in Wales, Northern Ireland or England. I believe we should have such services everywhere, and they should not be different for anybody, no matter what their strata in life.

One major issue is the cap on care provision. Although I welcome the steps taken to alleviate financial pressure on individuals, they do not go far enough. I am joined in that belief not only by most Members of this House, but by the Royal College of Nursing, which stated,

“at £75,000 we are concerned about how many people this will positively affect. The RCN believes that too many may be left unaffected and still face agonising decisions over how to pay their care bills.”

One issue that has come to my office on a regular basis over the years is that of families and those of a certain age who are considering how they will pay for their health care over the next period. Many Members have made passionate speeches today, and it was a pleasure to have been in the House to hear them. They were also very personal speeches, and people spoke of their own relatives who have had to deal with this issue. The RCN continued:

“The RCN calls upon the Government to reflect on its decision around the figure set as the cap and to revise it to one closer to that advocated by the Dilnot Commission of between £25,000 and £50,000.”

I support that as, I believe, do other hon. Members.

Time has beaten me and I am unable to speak about the other issues that have been raised. If the Minister hears only one point from my contribution, let me be clear that we need a national health service rather than a regional health service, with the same level of care and service. That service must be affordable without people having to sell all they own to pay for their health and well-being.