Health and Social Care

Liz Kendall Excerpts

Monday 13th May 2013 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a great pleasure to speak at the close of the debate after so many passionate and thoughtful speeches from hon. Members on both sides of the House.

My right hon. Friend the Member for Stirling (Mrs McGuire) and the hon. Member for Truro and Falmouth (Sarah Newton), who is not in her seat, rightly stressed that, although many debates on the future of health and care services focus on the needs of older people, social care is critical to adults of working age. My hon. Friends the Members for Bridgend (Mrs Moon), for Worsley and Eccles South (Barbara Keeley), and for Rotherham (Sarah Champion), spoke of the vital role of unpaid family carers, who are the bedrock on which the care system rests. They spoke particularly of the needs of young carers, who often feel that their childhood is being taken away from them by their caring responsibilities.

My hon. Friends the Members for Birmingham, Selly Oak (Steve McCabe), for Easington (Grahame M. Morris) and for City of Durham (Roberta Blackman-Woods) spoke of the growing crisis in social care funding, the increase in care charges that family members must pay, and the pressures on services and support. The hon. Member for Stafford (Jeremy Lefroy) gave, as ever, a thoughtful speech on how we might pay for NHS and social care in future. There will be different views on his proposals, but he made, as ever, a thoughtful contribution.

My hon. Friends the Members for Stretford and Urmston (Kate Green) and for Barrow and Furness (John Woodcock) rightly said that we have a duty to provide decent compensation and care for mesothelioma sufferers. My right hon. Friend the Member for Rother Valley (Mr Barron), my hon. Friends the Members for Vale of Clwyd (Chris Ruane), for Sheffield Central (Paul Blomfield), for Gateshead (Ian Mearns) and for Barnsley Central (Dan Jarvis), and the hon. Members for Salisbury (John Glen), for Mid Derbyshire (Pauline Latham) and for Strangford (Jim Shannon), spoke with passion about the Government’s failure to introduce standardised packaging for cigarettes to reduce premature deaths from smoking in this country. I hope the Government think again on that. Finally, my right hon. Friend the Member for Cynon Valley (Ann Clwyd) once again gave a direct voice to people who have suffered from unacceptably poor standards of care in the NHS. My right hon. Friend and all of us here are absolutely determined to stamp those out.

I want to focus on the measures in the Queen’s Speech on social care. The current legislation on adult social care is complex and confusing, and it needs reform. That is why the previous Labour Government set up the Law Commission review, which has led to many of the measures in the Care Bill. We support the new rights that the Bill contains; they build on the rights that Labour introduced in government, such as the right for family carers to request flexible working.

During the Bill’s passage, we will work to ensure that older and disabled people and their family carers get the best possible deal. We will seek to make amendments where there are serious omissions, such as the needs of young carers, or where improvements should be made, such as introducing free social care at the end of life. Organisations such as Sue Ryder and Macmillan Cancer Support have shown that such care can give people more choice about the place of their deaths and save taxpayers money by reducing the need for more expensive hospital care.

Those new rights, however welcome, risk being meaningless if people cannot get the services and support they need on the ground. That is the reality that hundreds of thousands of people now face. The 70 organisations that make up the Care and Support Alliance are clear that the Bill will not solve the crisis now engulfing social care. They warn that there is now a real danger that most people—not some, but most—will not get the help they need just to get up, dressed and out of the house as councils struggle to cope with swingeing budget cuts and growing demand.

Ever tighter eligibility criteria for council support mean that fewer older and disabled people get the help that they desperately need. Let us be clear. People talk about providing care and support only for people with substantial needs but not for those with moderate needs, but those latter needs are serious. I have seen in my constituency that “substantial needs” involve only people with terminal illnesses or who are incontinent or blind. There are many other very high levels of need. We are missing out support for those who desperately need it.

Even when people do qualify, they routinely face 15-minute home visits—barely enough time to get an elderly, frail, vulnerable person with dementia up, washed, dressed and fed. People wait a long time to get basic help such as grab rails and stairlifts so they are without the support for basic preventive care that helps people to live independently at home, which is what they and their families desperately want. Family carers are left struggling without the breaks that they need just to keep going or even a bit of emotional support and advice on the phone, as local voluntary organisations cut back and close.

The tragedy is not just that older and disabled people and their family carers suffer; it is that taxpayers end up paying more for the price of failure. Elderly people have to go into more expensive hospitals or residential care when they do not need to, because they cannot get the support they need in the community or at home. One in three family carers have to give up work or reduce their hours because they cannot get the help they need to care for their loved ones. Their own health suffers, which puts more pressure on the NHS, and their income suffers. The Treasury loses more than £5 billion a year in lost tax revenues and benefit bills because those family carers have to give up work.

The Government remain in complete denial about the scale of the care crisis we now face. They have been repeatedly warned by local councils about what the cuts in budgets and pressures on services mean. Councils are warning that in 15 years’ time they will not be able to provide the services that members of the community want and like—the libraries, leisure services and swimming —because of the pressures on local council adult social care budgets. The Government refuse to listen.

The Government are not being straight with people about their future plans either. The Prime Minister, Deputy Prime Minister and Health Secretary have repeatedly said that no one will have to sell their home to pay for their care. That simply is not the case. In future, all local authorities will have a duty to offer deferred payment schemes, lending people money to pay for their residential care. However, the loans will have to be paid back, after the elderly person has died, by selling the family home. The Government’s new scheme will charge interest on the loans, unlike under the current system, so people will lose even more of their family home than they do now. However, they have not told the public that they will be paying more, with that interest, under their new scheme. Will the Minister now come clean and tell families how much interest they will be charged? Will the Minister tell us how much interest families will be charged? Will he give a straight answer? He is not going to now. I hope he will when he responds to the debate.

Ministers also repeatedly claim that the Bill will cap the amount people are charged for their care at £72,000. The Health Secretary was at it again when he was at the Dispatch Box today, claiming that the Bill sets “a finite maximum cost” that individuals will have to pay. Again, that simply is not the case. The so-called cap on care costs is based on the standard rate local councils would pay for their residential care in their area—approximately £480 a week nationally—and not what people actually pay for their care. The 125,000 people who fund their own care fully, and many more who pay top-ups, will face far higher bills, particularly in the south and east of England. Government Members should take heed of that point, because if they tell their constituents that there will be a finite cap on their care costs, they will be sorely disappointed. The extra costs, above and beyond the standard rate that councils pay, will not count towards the cap. That means that older people will think they have reached it when they have not. In reality, it will take four years to hit the cap, yet the average length of stay in a care home is just over two years, and a quarter of people in care homes die after just a year. In other words, most people will be dead years before they reach the cap. Even if they are still alive, the state will pay only the standard council rate, leaving self-funders no choice other than to either leave the care home and move somewhere cheaper, or to pick up the extra costs.

The Government have failed to explain that people will not get their care for free if they have income or assets worth up to £123,000, the new increased upper means-tested limit. They will get care for free only under the lower means-tested limit, which is not being increased, and will be £17,500 in 2017. In between, there is a sliding scale of support. However, the way the means test works will mean that pensioners on average incomes—those who have worked hard and saved for a modest second pension of, say, £80 a week—will not get any council support, even with the increased upper means-tested limit, because councils calculate it by determining a notional income based on the capital in people’s homes. That, combined with the average pensioner income, takes them above the level at which they would receive council-funded support.

Government Members look surprised. That is unsurprising, as their Ministers have not spelled out the reality of the Government’s plans. Ministers should be straight about what their plans really mean, so that older and disabled people and their families can plan for the future properly. Instead, they tour the TV studios and make statements to this House giving false reassurances that are simply not borne out by the facts. We all know that people are fed up with politicians who say one thing and do another: claiming that people’s care costs will be capped when they will not, and claiming that raising the means test will help pensioners on average incomes with modest second pensions when it will not. I warn Government Members that that will not help to restore faith in politics or politicians, or help us to plan properly for the future.

Things could and should have been so different. Rather than forcing through their damaging and distracting backroom NHS reorganisation, the Government should have spent the last three years laser-focused on the service reforms people desperately need, shifting care out of hospitals and into the community and more towards prevention. Instead of diluting Dilnot’s proposals and then misrepresenting them to the public, they should have engaged in meaningful cross-party talks to agree a system that helps those on low and modest incomes, not just those predominantly at the top. And instead of driving greater fragmentation of NHS care services, jeopardising some of the best examples of integrated care, such as in Torbay, they should have adopted Labour’s plans for whole-person care, a single service with a single budget, funded through a year of care, that would shift the emphasis out of hospitals and into the community and result in better care for people and better value for money for taxpayers too.

Meeting the challenges of our ageing population is one of the biggest issues facing our country and society. We need a far bigger, bolder, straighter, clearer response, which this worn-out, divisive and divided coalition will never provide.

[The Minister of State, Department of Health (Norman Lamb)]

I thank hon. Members for their contributions to the debate.

Despite all the knocks that Opposition Members like to give it, the NHS is performing remarkably well, with 3.3 million more out-patient appointments, more than 500,000 operations, 1.5 million more diagnostic tests, the number MRSA infections halved and record low numbers of people waiting more than a year for their operations—just 665 people, down from 18,000 in 2010. These are real achievements for the NHS, and we should applaud and pay tribute to a really remarkable work force who have achieved these things despite tough economic times. The last Government rightly set in train £20 billion of efficiency savings, and those savings are being achieved despite the tough challenges.

Despite the doom and gloom heard during the debate, some brilliant things are happening in social care, including in some Labour authorities. In Leeds and Barnsley, for example, great things are happening, with people looking at new ways of doing things and redesigning services, recognising that times are tough and that, even under a Labour Government, they would face the same challenges. I recognise, however, that the system is facing real pressures, so it is disappointing that the Opposition, including the shadow Secretary of State and shadow Minister, the hon. Member for Leicester West (Liz Kendall), sought to polarise the debate by making exaggerated claims about the state of the NHS, when we all know the truth, which is that pressures are growing and have been for a long time. We have people living with long-term conditions, often for many years, and with a mix of mental and physical health problems. Those are the difficult cases sometimes clogging up our A and E departments, so let us have a mature debate about how we deal with the challenges.

We have a completely fragmented system and we are not spending money effectively to achieve the best possible care. Mental health is institutionally entirely separate from physical health, health care is separate from social care, and primary care is separated from hospital care. The whole urgent care system is under significant pressure. [Interruption.] I tell the shadow Secretary of State that on some of these issues we in fact agree more than he would sometimes like us to believe. The system is dysfunctional and we have to change it. We have had 4 million more people visiting A and E since the disastrous renegotiation of the GP contract by the last Labour Government. The hon. Member for South West Devon (Mr Streeter) talked about the significant pressures on A and E. Let me reassure him that Monitor and NHS England have issued a call for evidence on how the tariff system is working, with a view potentially to reforming it.

[Liz Kendall]

Does the Minister agree that in 2009, five years after the GP contract was agreed, 98% of patients were seen in A and E within four hours?

[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

--- Later in debate ---

[Norman Lamb]

I want to make some progress; I am conscious of the time.

The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.

The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.

The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.

The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.

It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

[Liz Kendall]

rose—

[Norman Lamb]

I am going to conclude.

We are two thirds of the way through this Parliament and we have already addressed big challenges that were ignored during Labour’s three terms in office. We have been and will always be 100% committed to an NHS that is not satisfied with mediocrity, but is always searching to be better, more focused, more helpful than ever before. Society is changing, drug costs are increasing and expectations are higher. The NHS and the social care system must change to meet those challenges and we are helping to make that happen, safeguarding the NHS now and in the future.

Ordered, That the debate be now adjourned.— (Mr Swayne.)

Debate to be resumed tomorrow.