Adult Social Care

Kelvin Hopkins Excerpts

Thursday 8th March 2012 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I am very grateful for the opportunity to speak in this debate. I start by thanking the Backbench Business Committee for granting it and my hon. Friends the Members for Truro and Falmouth (Sarah Newton) and for Stourbridge (Margot James) for securing it and leading it so well.

I have chosen to speak early in the debate because I want to spend the majority of it listening to colleagues. I undertake to respond to their questions in writing if necessary to ensure that we have a clear record of the Government’s position on these issues.

I pay tribute to the Care and Support Alliance. The lobby that it organised this week was a truly powerful event, because of the testimony of individuals who made the journey to Westminster to lobby their MPs. I had the pleasure of spending an hour being cross-examined by a large number of people on that lobby, and I found it a really useful opportunity to talk about social care.

I have been a Member of Parliament for more than 15 years and raised the issue of social care reform throughout that time. For far too long, it has been left in the “too difficult to do” drawer, and it is now due attention from the House and the Government. We must not make the mistake of putting it back in that drawer, which would be dangerously short-sighted.

What does high-quality social care mean? It means helping people to stay healthy, independent and out of hospital. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, it means reducing pressure on the NHS, but above all it means helping people to live the lives that they want—long, safe and comfortable lives with the maximum possible independence. That is why the coalition Government are determined to tackle social care, and we have already set to work on doing just that. We established the Commission on the Funding of Care and Support, chaired by Andrew Dilnot, to make recommendations on how we could develop an affordable and sustainable funding system for social care. My hon. Friend the Member for Truro and Falmouth outlined those recommendations.

[Kelvin Hopkins (Luton North) (Lab)]

There is constant emphasis on the importance of independence and of people living their own lives, but many people who depend on care want company. Some would prefer to live in decent, appropriate care than to be left on their own in their home and not cared for appropriately. Is the Minister not aware of that?

[Paul Burstow]

I am most certainly aware of that. Social isolation is a huge burden on the individuals affected by it and has huge consequences for health care. That is why, when I talk about independence, I also mean interdependence—the recognition of the value of family support and carers, and of the fact that people need to be active in their community throughout their life. Social care has a role to play in enabling people to do just that, rather than become institutionalised in their own home or a care home. I absolutely agree with the hon. Gentleman about that.

The Dilnot commission made a number of recommendations on the development of a system such as I mentioned, and my hon. Friend the Member for Truro and Falmouth described them well. In the spending review, we allocated an additional £2 billion by 2014-15 —£7.2 billion over the spending review period as a whole. In November 2010, we also set out our vision for social care reform, including the roll-out of personal budgets and greater personalisation. I agree that we need to ensure that that is genuinely about how we enrich people’s lives, not just an opportunity to reduce the available resources to individuals. We are also investing £400 million over four years to help to give carers much needed breaks. We are ensuring that the NHS is held firmly to account for delivering the money in the coming year by making sure that it has to account directly to carers’ organisations locally, and agree with local authorities the plans to provide breaks, spell out how many there will be and the size of the budget for that purpose.

It is also important to dispel a myth about social care, which has been hanging around for far too long—that, in some way, it is just like the NHS and free. As my hon. Friend the Member for Truro and Falmouth said, it is not free and never has been. If people assume that the state will pick up the bill, they are unlikely to prepare themselves. If they do not prepare and they need help, the impact can be truly devastating for them and their families: life savings wiped out, family homes full of memories sold off, and thoughts of a comfortable retirement turned to dust.

We therefore recognise the problem, which is getting worse. Our population is ageing, and that should be a cause for celebration. Too often, debates about ageing in our media are couched in terms of demographic time bombs and the like. However, the current care and support system is not fit for purpose. I agree with the Care and Support Alliance about that. It is broken, and patching and mending it is no longer acceptable.

However, reforming social care will not be easy. As has been said, it will require bold thinking and difficult decisions. The Dilnot commission shed much needed light on the reality of social care funding. Soon, we will publish a White Paper and a progress report setting out our response to the recommendations.

--- Later in debate ---

[Andy Burnham]

Yes, I will. There is no difference between us on that, but there is a difference between us on the funding position that the Minister has set out. The King’s Fund and others have identified that there is a £1 billion funding gap in adult social care in England, not just because of the money but because of the demographic pressures, which we cannot get away from.

The Government’s commitment was to give more money to the health service, but we have produced figures showing a real-terms cut in outturn last year, and we also notice that transfers—indeed, recent transfers—have had to be made to the social care system, which implies that the Government have left it short, and that there is an emergency propping-up of the system, revealing the flaw in their position.

[Kelvin Hopkins]

To reinforce the point that my right hon. Friend makes, on a recent visit to my local hospital I was told by staff that they have more than 20 elderly patients who are perfectly well enough to live in a care home, but the care homes will not accept them and the funding cannot be found for them. Care is free in hospital, but it costs outside, so those people are forced to stay in hospital, and that places extra costs on the NHS.

[Andy Burnham]

The two systems do not work in such situations. The health service is intrinsically tied up with the social care system, and if it collapses the health service cannot discharge people from hospital. It is a false economy.

As for what is happening on the ground, the Minister commented on funding nationally, but in reality eight out of 10 councils now provide care only for those with substantial or critical needs: they are restricting their eligibility criteria. Age UK estimates that that leaves 800,000 people without any formal support, representing plenty of unmet need, and the situation also leads councils to increase charges for home care. The average cost for a disabled or older person paying for 10 hours a week of home care is now £7,015 a year. Never mind a death tax, that is a stealth tax—or a dementia tax, as people pay more and more for the costs of care while they are alive. It is not fair, it is not right, and we should do something about it.

That is why we say to the Government that we must address the question of the local government baseline alongside that of Dilnot. There cannot be a choice; we have to do both. If we do not and we fund only Dilnot, a larger number of people will pay increased charges but with a cap on what the charges might be, and that will not feel like the leap forward or the social progress that the Care and Support Alliance and others are looking for. It will not help us to drive up quality in the care system, either, but we desperately need to do so.

Councils are being forced to stretch inadequate budgets ever more thinly, and that is leading to corners being cut. I shall illustrate that directly with an example from my constituency. Several years ago, Wigan council contracted out home care services in our borough, and staff were transferred to a number of private providers, which have changed hands over the years. Just after Christmas, home care workers in Leigh came to my surgery and told me how things had broken down over the Christmas period, leaving vulnerable people, frankly, unsupported. They showed me the timesheets that they had been given by the company they were working for, and one of them included four simultaneous bookings for 12 o’clock—a point that I think my hon. Friend the Member for Worsley and Eccles South made—on different sides of town, with no travel time built in. Impossible. If we look at the whole day, we find appointments within 10 or 15 minutes of each other, which are meant to include travel time as well as time for looking after older people. That is fundamentally unacceptable.

I was told about staff working extra hours because of that situation, and then not being paid. They said that equipment such as aprons and gloves was not being provided, and that staff were funding them out of their own pockets, which again is absolutely wrong. They also raised concerns about rotas being issued only the night before, and care assistants not having keys to get in to meet the service-users they were visiting. Across the board, there were terrible problems and vulnerable people were being left without support.

Members might think that the company in question is a small, local one, but in fact it is Alpha Homecare Ltd, which is wholly owned by Carewatch Care Services Ltd, a national company with 154 offices nationwide. That is an example from Leigh, but I bet that other Members could cite similar ones.

--- Later in debate ---

[Kelvin Hopkins (Luton North) (Lab)]

I apologise for being away from the debate for a short time, Mr Deputy Speaker. I was speaking in Westminster Hall on another subject. Being in two places at once, even for a Member of Parliament, is rather difficult.

I have long had an interest in this subject. I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on securing this important debate and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on her excellent speech. I also give full credit to the two Front-Bench spokesmen because I believe that they genuinely care about this matter and are not just speaking warm words. I appreciate that.

I will focus on residential care, but I believe that domiciliary care is also in a poor state. I know of many cases in my constituency of people not being looked after well under the new privatised, personalised approach to care. The contrast between that type of care and what people get from an NHS district nurse who goes around to tend to people is extreme. I have spent a day with one of my local district nurses—they are not called that any more, but Members know who I am talking about—and seen how a true professional, a public employee motivated by the public service ethos, treats their patients at home. That is how all sorts of care ought to be provided, rather than by private companies or private individuals who often have heavy work loads, are impatient and do not provide the care and sympathy that they should when they visit people in their homes.

The royal commission on long-term care for the elderly, which recommended that care ought to be free at the point of need on the same basis as the national health service, was absolutely right. The Government of the time rejected its recommendation, and went so far as to ensure that a couple of members of the commission voted against it so that it was a majority view, not a unanimous one. I personally think that was a terrible thing to do. I have raised it before in the Chamber and probably will again, because I think it was so wrong. Nevertheless, the royal commission recommended free long-term care for all, and I absolutely agreed.

I tabled an early-day motion in the 1997 to 2001 Parliament calling for the Government to adopt the royal commission’s recommendations. More than 120 Members signed it, most of them Labour Members, but other parties were represented as well. No notice was taken of it. The current Minister was one of the signatories. I tabled another early-day motion in the 2001-05 Parliament saying the same thing, and it got similar support. I hope I am not embarrassing him, but he tabled a similar motion when he was in opposition, which I supported. We were on the same side at that time, and I like to think that he is doing his best to push that agenda forward within the constraints of the coalition.

My position is absolutely clear: I believe that there should be free long-term care for all, provided by a professional care service of directly employed public service workers. That is how people would be served best, and it would be properly publicly accountable.

[Paul Burstow]

The hon. Gentleman is absolutely right that I signed early-day motions supportive of the royal commission, but I need to correct the record ever so slightly. He is giving the impression that the royal commission recommended that all aspects of long-term care should be free. I am sure he will want to acknowledge that accommodation and hotel costs were not intended to be covered by its proposal.

[Kelvin Hopkins]

I thank the Minister for his correction, and I think the situation is possibly similar in the health service.

I come to the problem of affordability. I remember that in the early days after 1997, the Government were trying to keep down public spending, and there was a crisis in the NHS because of under-spending. That crisis was inherited from the previous Government, but for the first two or three years after 1997 nothing happened. We got well behind in what we needed to do to fund the NHS.

During that Parliament, the standard rate of income tax was reduced by 1p, and nobody even noticed. I believe that at that time, 1p on income tax was the equivalent of about £3 billion, and that income was just lost. It could have been spent on long-term care or the health service, but the decision was taken to reduce tax. Later on, in the last Parliament, the then Chancellor decided to reduce the standard rate of tax by 2p. I am not suggesting that the standard rate of income tax is necessarily the way to pay for care, but it is not right to say that things are unaffordable when big tax cuts are being made. I believe that 1p on the rate would now raise about £4 billion or 2p about £8 billion—plenty to pay for free long-term care for all who need it.

[Laura Sandys (South Thanet) (Con)]

Of course money is important, but is this really just about money? Is it not really about how we believe the service needs to be delivered? We need to ensure that people are kept out of care, not in care. Until we re-engineer what we are delivering, we will not be able to consider the funding mechanisms. If we just fund what we currently have, we will be funding something that is broken.

[Kelvin Hopkins]

I thank the hon. Lady for her intervention, but I think that the system is broken because it is underfunded and we have forged ahead with privatisation. In my constituency, we had a wonderful care home, which I knew well because my mother-in-law lived there in the last few years of her life. She and the other residents loved being there. They had permanent, dedicated staff, all from the local community, who loved working there. All the health advisers and professionals who came into the home thought that it was wonderful. It was closed. The pretext for that was that it did not meet care home standards because it did not have en-suite facilities. It was a trick—a pretext for closing homes and forcing them into the private sector. That home was closed, the land was sold and all the residents went into private care, some of which was not very good.

[Glyn Davies (Montgomeryshire) (Con)]

I thank the hon. Gentleman for allowing me to intervene because it gives me an opportunity to contribute to the debate, a lot of which I missed because of the debate on the common agricultural policy in Westminster Hall that I had to attend.

The hon. Gentleman’s speech is about residential care homes. With the best will in the world, no matter how successful we are in developing domiciliary care, private sector residential care homes will play a big part in care for the elderly. Does the hon. Gentleman agree that, after the stories about the lack of regulation, including financial regulation, in private care homes in the past couple of years, we in Parliament will have to ensure that all residential care homes meet a certain standard for long-term sustainability so that people are not moved around without any real control?

[Kelvin Hopkins]

I agree with the hon. Gentleman entirely. The Care Quality Commission was encouraged to have light-touch regulation and to do only occasional inspections, of which the homes were usually warned. The inspections were not adequate, and many homes fell below the standards anybody would expect. If every care home was rigorously inspected, with spot checks from time to time, we might ensure that they lived up to the standards that we expect. However, it could cost a bit more because they might have to employ more qualified staff and so on.

We should professionalise the system and ensure that it is properly regulated and checked, even if it stays in the private sector. I personally prefer public provision, with people who are motivated by what I call the public service ethos. I have seen that working and I have seen what has replaced it. People come to my surgery and complain about being forced to move out of care homes that are being closed. That is especially difficult for those with dementia. People are pressed to go into other homes, which the residents’ families often find inferior. Some are good, but not all, and people are unhappy that three care homes in my constituency have closed.

The first home closed 10 to 12 years ago and I remonstrated with the local authority officer concerned. After an hour, he finally said that it was about costs: that private care homes pay lower wages, and that the staff work longer hours and have shorter holidays. I said that at least that was honest, but it was not right.

I disagree with my right hon. Friend the Member for Leigh (Andy Burnham) about young people paying. Most taxation involves redistribution to ourselves at other stages of our lives. When we pay national insurance contributions for pensions, we are in a sense saving for ourselves later through a state system. With the health service, we pay in when we can and take out when we need. It is a redistribution to ourselves. The young paying in now for long-term care is a sensible approach, especially as it will be proportionate.

[Andy Burnham]

The young would not be paying for their own care; we would be asking them to pay for the care of people who are already at an age when they might need the care system. In a world where those old people have built up valuable housing assets but young people cannot get on the housing ladder, is it right for us to say, “Here’s another tax for you to pay—for care for older people”?

[Kelvin Hopkins]

We must start getting the system right somewhere. We can adjust taxation provision in other ways in the short term, but in the long term we must have a properly progressive taxation system to pay for adult social care. I have just been to Denmark. Many Government Members and others say that high-tax countries are weak economies, but the tax take in Denmark as a proportion of gross domestic product is 18% higher than in Britain. The Danish have free tuition at universities, and students are paid €5,000 a year to go there up to the age of 25. I am not saying that we should do that, but I am making the point that taxation at that level, provided it is fair and progressive, does not ruin economies.

It is matter of choice. I have told the story of my young children many times in the Chamber. When my son asked for a second ice cream, my wife would say, “Mummy can’t afford it.” She was saying not that we could not afford it—we could—but, “You’re not having another ice-cream.” When people talk about affordability, they are saying, “We choose not to pay.” Those who constantly campaign for a low-tax society are doing down people who are in need. We must accept that if we want to be looked after when we are in need, we must pay taxes.

When people on the doorstep ask me what my problem is, I say, “I don’t pay enough tax.” I am sure other hon. Members do not say that. My income is now more than sufficient for me to live a very comfortable life, but the income of many young people is not sufficient for them. There is nothing wrong with shifting the burden of taxation to those who are on higher incomes or those for whom most expenses are over. It is unfashionable to say such things, but I happen to believe they are right.

I mentioned the care homes in my constituency, but another issue is that of payment. Our tax gap was not so long ago estimated at £120 billion a year. If we collected just 5% of that, we could pay for free long-term care without a problem. To be fair to the Government, they are starting to wake up to the need to close that tax gap—not enough, but a bit. We have left it alone for too long, because they do not want to upset rich people who are investing in the Cayman Islands or wherever.

The Government are starting to put a little pressure on and are employing a few more tax collectors. I know from my local VAT office that every inspector collects many times their own salary, so why not employ many more to get the VAT in? People recently went to prison for a tax fraud whereby they used VAT for import and export. Such people make billions out of hon. Members and our constituents. Let us round up a few of them and stop that loophole, and ensure that people who are well off and who should pay taxes do so.

I have known Andrew Dilnot for many years—he is a civilised, highly intelligent and wholly admirable man. He did a good job in his report of trying to find the fulcrum point—the Treasury might just wear what he is proposing, but if he went further it would probably say no. There is a parallel with Adair Turner, another intelligent, civilised man. He tried to change the pension system a bit. He knew that if he pushed the Treasury too far, it would react and he would not get what he wanted. Indeed, he had a hard job persuading the previous Chancellor to accept his proposals.

The authors of those reports try to come up with recommendations that will be acceptable to the Government and the Treasury instead of coming up with what they believe to be a strong position. The problem is not the electorate, but the Government and hon. Members on both sides of the Chamber. Ministers and officials will not accept the approach I suggest for a more civilised society.

Like all hon. Members, I do a lot of public speaking. I say, “What would you choose? Would you take the risk that your family member’s house will be compulsorily sold, and all the money used to look after granny, or will you pay a tiny bit more tax over a lifetime to make sure that granny is properly looked after without being forced to sell the house?” For wealthy people, that does not matter, but it does matter for many working class people, including first-time owner-occupiers. In many cases, they have bought council houses, which I do not believe is a good idea. They have a bit of equity in their family for the first time ever and it can be used to help their children—or grandchildren usually—to stay in the owner-occupied sector, but it is being eaten away by their being forced to pay for care for elderly relatives. Indeed, owner-occupation is now falling as a proportion of housing tenure. Whatever one thinks about owner-occupation or renting, that is happening, and a factor in that might be that people are being forced to sell houses to pay for care, and the equity is in effect being lost in rich taxpayers’ pockets, because they are the ones who can get away with not paying enough to ensure that granny is looked after.

We have to accept that people are living longer. We have not found a solution yet to Alzheimer’s or dementia. I hope that we do—it will solve many problems—but while we have not, we have to ensure that elderly people are cared for, which means that we have to pay for it properly. We will all get old one day, and we all might need this care one day. Certainly, for me and my family, I want to ensure that, as and when any of us need that care, it will be there for us and provided properly in a civilised and caring way.