Social Care

Lord Lipsey Excerpts

Thursday 29th November 2012 Lords Chamber

[Lord Lipsey]

My Lords, it is said that there are many Members of your Lordships’ House who habitually recite Trollope in their sleep, but I do not think many of them will have read his novel The Fixed Period, and I do not suggest that they do because it is pretty dreadful. It is set on the island of Brittanula where the law says that on reaching the very advanced age of 67—two years less than the age of the average Member of your Lordships’ House—people should be admitted to the college, as it is called, to spend a final year reflecting on their life. Then they are placed in a warm bath amid the smell of incense and their veins are opened so their life flows away. It turns out that this solution to the problems that we are considering today has certain disadvantages—for example, healthy inhabitants in their 66th year frequently try to flee the island—but, and this is the serious point, if we continue as we are in this country, the disadvantages of Brittanula may seem as nothing compared with the disadvantages of continuing life into an old age which, for poor people in particular, is characterised by neglect and degradation on an incomparable scale.

The signs of stress are already there. Fewer councils provide home care services for those with less than substantial needs. There are tales of care homes on the verge of bankruptcy because they cannot afford to provide decent services on the inadequate rates local authorities pay and of 15-minute home visits, which is barely time to change a diaper, let alone to have a chat.

The Government have sought to take some steps to mitigate the worst effects of fiscal stringency, although whether the extra money notionally made available is actually flowing through to services on the ground is another matter. Care services have been cut by less than other services, as the excellent IFS briefing circulated for this debate shows. There has been a cut of 4% in social care, but planning and development has been cut by 43%. However, this is cold comfort, for the plain fact is that we should not be contemplating spending less on care services—that is, if we want to avoid the Trollope solution—but more because the number of older people is growing rapidly. The number of those aged 65 or more will go up by 27% between 2010 and 2022, according to the OPCS. We should be spending more because the number of old people in impaired health at the end of life is increasing. There will be a 32% rise in those with disabilities in that period, according to the PSSRU at the LSE. The old hope that as we lived longer, we would have shorter or the same periods of ill health at the end of our life is unfortunately not necessarily being realised, and more people seem to be lingering on in more difficult states. We should be spending more because the cost of providing care will escalate. You cannot readily increase productivity in care in the way you can in some other walks of life. Just think about it; how do you change a nappy quicker? We should be spending more, increasingly, I am afraid, as the Government’s anti-immigration policies bite, making it harder to attract decent staff.

We are not allowed visual aids in this Chamber, or I should now hold up the notorious Barnet graph of doom, which was referred to by the noble Baroness, Lady Barker. It shows what the council expects to spend on services and, on another line, what it expects to be allowed to spend in total. By 2030, spending on social services alone, the bulk of that on old people, exceeds the total budget. Either no bins will be emptied in Barnet and there will be no libraries or parks—no town hall, even—or there will be further big cuts for old people.

It is important that the more that needs to be spent does not have to be just public money; we know there are restrictions on that. There is private money available, most particularly, the very large sums that increasing numbers of people have locked up in a valuable asset; namely, their house. It is surely right that they contribute from that to the cost of their care and do not just give it to their children, much though they may wish to do so, and as desirable as it often is. Their care should come first. Of course, half the people in care homes at the moment do not have to pay because their wealth and income are too low. There will need to be public money for them.

Where does Dilnot fit into this? We are in danger of confusing Dilnot with the shortage of funds. Dilnot is not aimed at the shortage of funds problem. It is aimed at quite a different problem: the care lottery which means that some people, the better-off people, will not need to spend anything on care because they will live to a hearty age and then die, whereas others will need to find literally hundreds of thousands of pounds to fund their care. That is deeply unfair.

The Dilnot solution has attracted consensus support. I am part of that consensus, but with one proviso. Public spending is limited. The more we spend to implement Dilnot, the less we will have to put in place better care services. We are given a choice, and we have to be careful that it is weighted in favour of decent care services, not in favour of more help for people to pay for them. I favour Dilnot, but on as cheap a basis as possible, with a £75,000 cap the minimum that should be contemplated, as was floated in the White Paper.

Finally, and wearily, I turn to the integration of health and social care. Wearily for this reason: I, we, all of us have been talking about this for years and years. It features in every single report that comes out on the subject, and to say that progress is “patchy” is to take an extremely optimistic view. I am afraid that I do not expect that to change soon. Everybody pays lip service to integrated care, but the brute fact is that, on one side, you have local authority budgets with one set of incentives, including the incentive to pass as much cost as possible to health authorities; and, on the other side, you have health authorities with another set of incentives, including the incentive to pass as much cost as possible to local authorities. While that persists, we will not get very far. Without integrated budgets, you will not get integrated services. It is as simple as that in principle, if extremely hard to put right in practice.