Funding of Care and Support

Lord Adebowale Excerpts

Thursday 24th November 2011 Lords Chamber

[Lord Adebowale]

My Lords, I support the debate initiated by the noble Baroness, Lady Pitkeathley. I congratulate her on ensuring that, at this critical time, social care is given the attention that it deserves. I should also declare an interest as CEO of the health and social care enterprise, Turning Point. I apologise in advance as I certainly do not match the expertise or the eloquence of the luminaries who are taking part in this important debate.

Like many others, I support the work of the Dilnot commission for creating a once-in-a-lifetime opportunity to resolve the anxiety created by the current position of those in need of social care. The noble Baroness, Lady Bakewell, has already mentioned that the deal between the individual and the state to provide care in older age is one of the pillars of this debate. Her position is a reasonable one to take, in expecting those with assets to contribute to the cost of care, although with a cap. The noble Baroness set out the argument with admirable clarity and I need not keep the House further by saying any more than that I support her arguments and those of the noble Lord, Lord Lipsey. Indeed, I am going to get a T-shirt made of his credible call to arms: “What do we want? A cap. When do we want it? Some time after the full response of the Government to the Dilnot report has been published”.

The noble Lord, Lord Desai, made the point that if you want cradle-to-grave care, you have to pay cradle-to-grave taxes—a point that would indeed make of the Minister a brave man if he were to agree to it during the course of this debate, which of course I invite him to do. No, Dilnot may not solve all the problems of the future, but it is a good place to start.

However, it is not just the fact that the general population are living longer that means we have to resolve this issue; it is also that those who have complex needs across substance misuse, mental health and learning disabilities live longer. Turning Point is working with many elderly people who have addictions, mental health challenges and learning disabilities. While I acknowledge Mr Dilnot’s recommendation that the cap should be zero for someone who enters adulthood with already established care and support needs, we need to do more.

My concern in the matter of adult social care is that we should more clearly acknowledge the needs of those people who do not fit the stereotype of the elderly in care—or, as someone in one of Turning Point’s services put it, “My worry is that everyone talks about care for the elderly as though everyone will be Mrs or Mr Marple. What about my mum who has been drinking, anxious and chaotic for the last 15 years?”.

It is essential that we ensure that the integration of health and social care is built into the design of social care policy. As the noble Baroness, Lady Barker, pointed out, this debate is not a break from the Health and Social Care Bill; it is mission-critical to its success. If people fall through the care gap, they either keep on falling or they land on the often very painful and expensive health spike. The critical need for new technologies and approaches, as mentioned by the noble Baroness, Lady Tyler, is essential. Where the money comes from needs to be considered in the context of the fact that cuts now will not always save money in the not too distant future.

I support the remarks of the noble Lord, Lord Rix—I said I would—with regard to people with learning disabilities. The fact is that desperate measures are being taken to resolve short-term challenges. Susie’s story is being repeated up and down the country. To use the noble Lord’s phrase, Susie has started to fall into the crack. We need national eligibility criteria as a first step in at least acknowledging that this crack exists.

This needs to be addressed alongside the point made by the noble Lord, Lord Pearson of Rannoch: surely in a modern society the idea of a postcode lottery of care is simply unacceptable. We need funding to follow the funded, along with their care passport. This policy supports the remarks of the noble Baroness, Lady Wilkins. If we do not have a right to care, regardless of location, we cannot have independent living. Why should those with care needs, however complex, not have the right to move and to be economically active, as many wish to be?

I, too, hear the disappointment of those who expected to be given the resources to create a bespoke pattern of care for themselves and who are being denied that opportunity. These people might create a solution to their complex needs, as opposed to being shoehorned into a convenient budget heading. Surely, the horror stories recounted by the noble Lord, Lord Low, might be addressed by empowering care customers to demand better care.

Policy on care for the elderly cannot be separated from other areas of government policy. We are aware that the Government’s White Paper on social care is being designed as we debate this matter. The paper must be cross-departmental in scope and cannot work in isolation from other policies, such as the Welfare Reform Bill, already mentioned by the noble Lord, Lord Low. The impact on this client group needs to be at the centre of our concerns.

I often state somewhere in nearly all my speeches that the future is decided by the undiscussable. All parties—the Labour Party and the Conservatives in coalition with the Lib Dems—have contributed to making social care discussable. The baton of leadership in this area has now passed to the coalition Government. As has been pointed out by the noble Baroness, Lady Tyler, and others, failure to grasp the nettle now in both funding and need will allow fear of need in old age and disability to dictate the future for us all.