Adult Social Care

Debate between Laura Sandys and John Pugh

Thursday 8th March 2012 Commons Chamber

[Laura Sandys (South Thanet) (Con)]

It is a great pleasure to follow my hon. Friend the Member for Congleton (Fiona Bruce).

My hon. Friend the Member for Truro and Falmouth (Sarah Newton) has been very important in instigating this debate about future policy on long-term care and ensuring that other such discussions are going on around the House. If it is the case that we come into Parliament because of certain issues, then reviewing and reforming long-term care would be one of the reasons that I find myself in this place. I am not sure that anything is more important for Government, Opposition and this House to resolve, and I give a huge amount of support to the cross-party debate that is going on.

However, we must realise that, unlike in other parts of NHS reform, there is not one person in the country who does not have a view on this subject and does not understand what long-term care means to them. They will look at it, and present it, through the prism of their parents or elderly relatives, and in their heart they will be thinking, “That is what my future will look like.” The shadow Secretary of State said that this debate needs to go beyond this House and to engage the public. I welcome that comment. As my hon. Friend the Member for Kingswood (Chris Skidmore) said, this is about a contract. We are entering into a discussion that will end up as a settlement between the country—the hon. Member for Luton North (Kelvin Hopkins) thinks that a little more funding might be needed—and the public, whose responsibility meets that of the state halfway, or perhaps more.

The public know that the system is broken. Its funding has been squeezed and there has been very little reform or innovation—other than in Torbay, which as we all know is the place to move to as one gets older. When people talk about care packages, it sometimes seems as though the patient is the package and it is hard to understand where the care kicks in. I believe that Dilnot has produced something useful and important, but perhaps it is a little pre-emptive. Until we can be explicit about what this care looks like and feels like, and what people’s experiences of it will be, it is difficult to talk to people about how we expect them to pay for it. I do not believe that the public are prepared to fund the current system, so we must first look at changing it.

I have been a carer myself. I cared for my father when he had a stroke when I was 17, and I saw my mother age by 15 years over a five-year period of caring for him. I have seen it first hand, and I understand some of the key issues that people face. I have also worked professionally in the areas of incontinence—not a charming subject, but one that is exceptionally important in this respect— epilepsy and motor neurone disease, so I have seen this from the end user’s perspective.

What could the new system look like? I believe that the system should be re-engineered around the principle of early intervention. The deceleration of the impact of ageing could be achieved by co-ordinating non-clinical services to keep people fitter and out of the care system. The things that social care delivers must change; it needs a total refit. I believe that that could be guided by four key principles. The first is about keeping the new old young. The second is about keeping people out of care, rather than talking about funding them in care. The third is about caring for carers; we need a whole stream of wraparound policy to support those people who are making that ultimate sacrifice—well, not the ultimate sacrifice, but a significant one. The fourth is about the need for top-quality care for those who do end up in residential care.

I hope that we will be able to keep the new old young. Members will be thrilled to hear that most of us have already started the process of ageing. Everything that we do now will have an impact on us in our 60s and 70s, and beyond. Why are we not introducing, through our GPs, human MOTs to look at any challenges to mobility? Owing to distributing far too many leaflets, both my arches have collapsed and I now have insoles in my shoes. That could have become a major problem as I got older. Why are we not looking at people in their 40s and 50s and taking steps to intervene and decelerate the ageing process?

[John Pugh]

Does the hon. Lady not recognise that delivering leaflets is one of the finest ways of keeping the old young?

[Laura Sandys]

I totally agree.

The acceleration of ageing starts to happen before we get old, and we must look at the public health opportunities to engage with and pre-empt some of the issues that we might face as we get older. That leads me on to keeping people out of care. The three biggest reasons for people going into care are dementia, incontinence and accidents, such as falls. Are we looking at those three factors in enough detail? This morning, on the radio, we heard about a drug that could help people to stay more able despite their dementia, and I hope that it will become more widely available.

I said earlier that I had worked in the area of incontinence. It is one of the most easily managed conditions, so why is it not properly supported? Why are so many people referring their family members to residential care for that reason, when the condition can be addressed easily and extremely cheaply? We are not addressing the condition, and we need to look at it in a lot more detail to ensure that more people can keep their relatives at home. I also mentioned falls. Why do we wait until someone breaks their pelvis before going into their house to see whether they have a handrail, whether their lights are working or whether the ramp is in the right place? None of this is rocket science, folks. It is perfectly straightforward, and I do not understand why such interventions are not being made much earlier.

We have a system that is broken, but we are not doing the necessary pre-emptive work. Instead, the system rewards acute services. It finds installing handrails or wet-rooms less thrilling than ambulances and broken hips. That makes no financial sense, and no human sense. The public know where the system is going wrong, and they can see that earlier intervention would make a difference to their loved ones. Many people have spoken about carers today, and we need to do as much as possible for them. They are at the heart of keeping people out of the care sector.

If we re-engineer our care system, making prevention and pre-emption the gold standard, we must look at a re-engineered funding mechanism, too. I believe that there is a policy framework that is a little like the green deal: for those who support people out of care, there is a bonus and an incentive, rather than the current financial model that rewards hospitalisation and pays far too little for those in home support.

I welcome the comments of hon. Members about how little care workers in homes are paid. My word, if we look at the value we get from that particular care intervention in comparison with extreme nurses in hospitals, we should start to understand that we have a very unbalanced system.

In conclusion, if we have a vision for decent and dignified care, the public will enter into a contract with the Government. They might even do so more than the Government think; they might even pay more than we are currently asking them to contribute. However, they will do that only if they see a re-engineered system that places the foremost priority on delivering care—quality care—that they can trust, rely on and understand.

Seaside Towns (Regeneration)

Debate between Laura Sandys and John Pugh

Wednesday 8th December 2010 Westminster Hall

[Dr John Pugh (Southport) (LD)]

I congratulate the hon. Member for South Thanet (Laura Sandys) on giving a focus to this debate by analysing with great skill many of the problems in seaside towns.

I apologise if I do not sound like my usual cheerful self, Mr Crausby. I have a disease that I am trying to throw off. Were I in the sun-kissed environment of Southport, I am sure that this would not be so. I represent Southport, which some people say is only technically a seaside resort, because we have so much beach that it takes some time to get to the sea. None the less, it has regenerated itself successfully in recent years and I am proud of what has been achieved there.

It might help new hon. Members if I rehearsed some things that were done in the previous Parliament. There has always been a group of Members of Parliament from seaside resorts who have got together to co-ordinate their efforts and put pressure on the Government to deal with their specific concerns. In the previous Parliament, we were helped by a report on coastal towns from the Select Committee on Communities and Local Government. I sat on that Committee and I assure hon. Members that it was not easy to get Committee members to consider that matter, because they thought that it was a marginal issue and perhaps not sufficiently substantive to occupy a serious Committee. But that was done, and it was a surprising success.

Initially, the Government response to that report was fairly negative and bland. Phyllis Starkey, then Chair of the Committee, asked the Department to consider its response again and, to our surprise—there might have been a change of Minister—the second response was a great deal more positive. “Sea Change” funding appeared, which was to be administered by the Commission for Architecture and the Built Environment, and there was a clear cross-departmental focus on the problems of seaside resorts, which was wholly helpful. At about that time, regional development agencies were given responsibility for tourism and asked to look specifically at the regeneration of seaside towns, in addition to other topics that they are more familiar with, such as urban regeneration.

We found from the Committee’s report that it was hard to generalise about seaside towns, because they are all so different; they are not only in different parts of the country, but are different in character and history. Some concentrate on fishing and others on fairgrounds. There really are quite stark differences between many resorts. Skegness is not the same as, or anything like, Brighton, although it happens also to be on the sea.

A cluster of problems can be found in most seaside towns. They normally have an interesting past, but equally they have a rather uncertain future, and sometimes an uncertain view of where they should go. I visited Margate with the Select Committee, not too far away from the constituency of the hon. Member for South Thanet, and found a town torn in two directions. People wanted to go different ways. Some wanted the old fairground back and wanted Margate to become a place of pleasure rides, and others wanted to build on the Turner heritage, and the light of that area, and have a more aesthetic development. I am not sure which direction that area went in, but that difference of opinion crystallises a general view that I have formed, which is that all seaside resorts, if they are to go anywhere, need some view of what they are essentially like.

Southport has been successful because it has not tried to rival Blackpool and has a concept of itself as a classic resort, which is distinctive, and it plays to its strengths, such as Lord street and, generally speaking, the Victorian environment—and as a market brand, it works. But like many other places, it also has problems with its housing stock, particularly the hosts of large houses built for the days when thousands of people trooped there regularly to fill out boarding houses. That means that such places end up with a skewed housing stock. In some towns on the Kent coast, that housing stock is filled with a disproportionate number of benefit claimants. There are genuine housing problems. Sorting out seaside towns’ problems is not just about attending to tourism, but about attending to housing and transport, which is a huge issue for most seaside resorts because they are often difficult to access, having been built and grown up in the days when trains were the way forward.

In making changes and developing the character of these places, we should consider that often seaside towns are blessed with a disproportionate number of retired people. That has a good effect, in so far as it ensures that there is a relative level of prosperity in the town. However, in respect of implementing change, as people get older they possibly do not welcome change in the same way as people do when they are young. In resorts that we Committee members visited, we often found contentious political divisions about the character of development in the town. An additional problem is generated by the fact that a lot of people living and working in seaside towns work in the public sector and will feel the impact of public sector cuts.

Sorting out the problems of seaside towns is not something that should just be thrown at the door of the Minister with responsibility for tourism; it should be thrown at the Government as a whole, because it is a matter of cross-departmental working. The previous Government recognised that.

[Laura Sandys]

I totally agree that the issue of coastal towns is a multi-departmental one; I do not detract from that, but I feel strongly that we in coastal communities have to address each of the issues with each of the Ministers, and then bring that together through the cross-departmental committee. It is crucial that Ministers with responsibility, who can have an impact on our communities, understand that we face many challenges and find out what levers they can pull to assist us. The fact that the Under-Secretary of State for Culture, Olympics, Media and Sport, the hon. Member for Weston-super-Mare (John Penrose), has responsibility for tourism and is the MP for a seaside town is a great asset for us.

[Dr Pugh]

Absolutely. I do not disagree with that analysis. Tourism genuinely helps in an extraordinary way. Too often in our tourist propaganda, we forget that our coasts are a fantastic asset. We tend to think of London, Edinburgh and bits in between, such as Stratford-upon-Avon. International publicity does not stress a strength that was well illustrated by the BBC programme. We have a fantastic coast, which is a fantastic asset, and we should make more of it. When I was at an embassy in France, I picked up propaganda for the north-west of England, hoping to find references to Southport, or at least Blackpool, but there were none. I found Oswaldtwistle, but I do not even know what it is, and I have lived in the north-west most of my life.

VisitBritain—I have said this before—has something to learn, but we must all learn how to deal with our new environment. If regeneration of seaside resorts is to progress, we will presumably have to work hand in hand with the new local enterprise partnerships, which will be centred predominantly in urban conurbations and will not have a natural feel for the problems of seaside resorts. They will need to be advised, instructed or directed not to leave out places that will, in most LEPs, be on the margins or the coast.

We must also recognise among ourselves—the community of coastal MPs—that whatever prospects we thought there were, before the time of austerity, of new transport links being delivered overnight have probably receded, and that that will not happen any time soon. We must work hard for our salvation. Most seaside resorts, their communities, and councils who understand the state of play recognise that. I believe that there is a role for the Government—this was the theme of the speech of the hon. Member for South Thanet—in sewing the pieces together and ensuring that good practice is spread, and in ensuring that when resorts have a clear vision of their own destiny and are prepared to pull themselves up by their own bootstraps, they are given every encouragement to do so.