Adult Social Care

John Pugh Excerpts

Monday 16th July 2012 Commons Chamber

[John Pugh (Southport) (LD)]

I want to be constructive. I fear that this debate may take a different route from that taken in the recent consensual Back-Bench debate. We all recognise that the cost of adult social care is a problem not just for this country, but for every advanced society that we can think of. The outline is fairly familiar: funders, private and public, feel stretched and frightened by demographic change and the elderly are scared and anxious about mounting costs. Treasuries throughout the world are nervous whenever the issue crops up, and normally they vacillate. Last week, the Government were, in part, accused of that—of dragging their feet.

That is nothing new. Back in 2009, following the publication of the Green Paper, there was very much the same thing. The current Secretary of State, who was then the shadow Secretary of State, said:

“One debate always seems to roll into another with this Government. We need a decision, and we need serious, costed proposals to be the basis for that decision.”

The current shadow Secretary of State, then the Secretary of State, said:

“we are putting forward three broad options for the country to debate, and it would be wrong to force the pace of that debate.”

For the Liberal Democrats, my hon. Friend the Member for North Norfolk (Norman Lamb) said that the Green Paper

“comes 12 years too late. It is this Government’s shameful legacy that they will leave office having failed to reform a system that the Secretary of State”—

now the shadow Secretary of State—

“himself has described as a cruel lottery.”—[Official Report, 14 July 2009; Vol. 496, c. 160-62.]

When social care is viewed as a sustainable enterprise, Governments always see it as involving a big—and, worse still, an uncertain—sum, and that is why Treasuries usually baulk at it and we make very little progress. Governments are far happier in clarifying people’s rights and then passing the buck to local authorities. What paralyses Governments is the potential, not the identifiable, cost—what it is and how we are going to share it out —and that amounts to a huge political headache.

In order to resolve this, we need to do two things. First, obviously, we need to get a handle on the costs; but secondly, we need to work out a way of trying to defray them. Elderly people to whom I have spoken following our recent debates and last week’s statement have spoken in slightly different terms from how we speak here. They are sceptical about some of the Armageddon scenarios. They are resentful about their perceived lack of contribution to society—not in the past but currently. They do not see themselves, en bloc, as a drag on society.

We know that some people incur massive costs because they are frail, disabled, suffer with dementia and so on, and the social, personal and family costs are appreciable, but we also know of many pensioners who make a huge family and social commitment, and some who are even in employment. My predecessor, Lord Fearn, still has a delivery round of 500 copies of “Focus”, as does his wife, and they are both in their 80s. That shows the benefits of delivering “Focus”. We do not know enough, and need to know more, about how we get people into the category of the fit and keep them out of the category of the frail. We need to know why people end up in one category or the other and what the relative costs are of maintaining them there in terms of drugs, treatment and so on. We do not know whether by advocating an active, healthy old age we are deferring costs or eradicating them. The science of gerontology has an appreciable way to go. It is not clear to me, and probably not to many Members, how public health can move people into the better category of the fit and away from the category of the long-term frail.

My main point—to some extent it is not mine, as it was suggested to me by what the hon. Member for South Thanet (Laura Sandys) said in a previous debate—is that even if we accept that there is no way of avoiding the cost of the last years of life and the fact that as people get older their maintenance gets more expensive in terms of calls on the NHS, there is a case for considering whether we should do some serious number-crunching to re-engineer social care in order to sharpen up and prioritise interventions, as we have seen with dementia and arthritis. We do not know at this stage what the true benefits of that could be. I am not quite sure what I mean by re-engineering social care even as I say it, but we need to find out what it means and try to implement it in order to defray the costs.