Care Bill [Lords]

Madeleine Moon Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

No, I want to make some progress.

I described the care system we have in England. Surely we can do better. In the last Parliament, the previous Government began a serious attempt at reform. I give this Government credit for continuing some of that work. The Bill contains many proposals originally put forward in my White Paper “Building the National Care Service”, published in February 2010. What most people will remember from the pre-election period was the clash between the parties on funding solutions, but what they might not have realised is that beneath the rhetoric there was much common ground on other matters. I hope that people will welcome that, just as we welcome some of the measures that are carried forward into the Bill.

First, stronger legal rights and recognition for carers are well overdue. For far too long, informal and family carers have been invisible to the system and taken for granted. That simply cannot go on. If statutory services are to be sustainable in the 21st century, they must learn to value informal care and carers and help them do more to help their loved ones. Secondly, we welcome efforts to simplify the social care system. Better information and advice will make a difference to some people. Unifying social care legislation in line with the recommendations of the Law Commission review initiated under the previous Government is sensible and overdue. Thirdly, the idea of a cap on the overall costs of care that individuals can face establishes the important principle that people should not lose everything they have worked for because of their vulnerability in later life.

I am happy to say that those are all important steps forward that we would not seek to oppose. However, let me be clear—this answers the points raised by Government Members—that this Bill is not equal to the scale and the urgency of the care crisis in England. It fails to implement the Dilnot report and does not provide a lasting solution. It does little or nothing to improve care services now or to reduce the costs of care for most people; in fact, it is likely to make things even worse. That is why we have tabled a reasoned amendment to draw the House’s attention to two major problems with the Government’s approach. First, prioritising funding a cap over and above protecting existing council budgets means that the care system will continue to go backwards and get worse, not better. In short, the Government are promising future help instead of helping people right now. Secondly, the proposed £72,000 cap is not what it seems; it is a care con.

On funding priorities, the Government are failing to face up to the scale of the funding crisis facing councils right now. In the cross-party talks on the Dilnot report, Labour stated a clear principle that the cap and the council baseline must be considered together as equal priorities. That was supported by Andrew Dilnot himself, as the right hon. Member for Sutton and Cheam (Paul Burstow) may remember, because he was also party to those talks. As a first step, we called on the Government to use some of last year’s NHS underspend to tackle the care crisis—and, by extension, to ease pressure on A and E—instead of handing the money back to the Treasury. The Government have not listened to that, and this Bill makes matters worse for local authorities by placing new, unfunded and uncosted burdens on them. The fact that it restricts the eligibility of those in substantial or critical need of support is, in itself, a clear admission on the Government’s part that the support system overall is being scaled back.

[Mrs Madeleine Moon (Bridgend) (Lab)]

I spent 30 years making assessments of people who were in care and addressing the care that they needed, often while working in hospitals to get them discharged. After 30 years, the same problem exists: there is not enough money in local government to pay for the care to get people home early to have the rehabilitation they need at home, with the quality of care to make sure that they do not deteriorate further and end up back in the hospital system. This Bill will not tackle that fundamental underlying problem.

[Andy Burnham]

My hon. Friend is absolutely right. This Bill promises far-off help for people while services are getting worse right now, because the Government have failed to address the crisis in local government’s ability to fund social care.

--- Later in debate ---

[Andy Burnham]

I completely agree, and it is unfair that older people have not been given a full picture. People need proper information to plan for the future, and they have not been getting that today. People need the facts. Spin is of absolutely no use to them whatsoever, but that is all that is on offer from this Secretary of State. The truth is that in the end, the Bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes. It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.

[Mrs Moon]

Will my right hon. Friend give way?

[Andy Burnham]

I will make some progress and turn to part 2 of the Bill and measures related to the NHS. It would help to get a few facts clear. The Secretary of State seeks to denigrate Labour’s record at every opportunity, but let me remind him that the Labour party left an NHS rebuilt with the lowest ever waiting lists and highest ever public satisfaction. The previous Labour Government introduced independent regulation of NHS hospitals for the first time, prompted by previous scandals at Bristol, Alder Hey and the Shipman murders. The Secretary of State should cast his mind back a little further before coming to the House and making unfounded allegations.

As Robert Francis rightly acknowledged in his report, there was no system of independent regulation before 1997. It was the independent regulator that first uncovered the failings at Mid Staffs and, later, at Basildon. As the party that introduced independent regulation in the NHS, Labour has no problem with strengthening it and providing legislative backing for the appointment of chief inspectors for hospitals, general practice and social care, but let us be clear: those were not recommendations of the Francis report.

The Secretary of State accused us of not supporting the Francis report. We do support the report; it is the Government who are not implementing its recommendations. Just as part 1 of the Bill fails to implement the Dilnot report, part 2 fails to implement the Francis report. One of the report’s central recommendations was for a statutory duty of candour for individuals, but the Government are proposing that it should apply only to organisations. How will an organisational duty help individuals to challenge an organisation where there is a dysfunctional culture? It will not, and we urge Ministers to think again. They also need to clarify whether the duty will cover the most serious incidents, and whether it will apply to all organisations that provide NHS services, including outsourced services.

My main objection to part 2, however, is that it embodies the huge contradiction that now sits at the heart of Government health policy. The Secretary of State talks of independence for the Care Quality Commission in the same way as the Health and Social Care Act supposedly legislated for the independence of the NHS, but this is the Secretary of State who has taken to ringing up hospital chief executives who are not meeting their A and E targets. The Secretary of State nods, but that is not “independence of the NHS”. This is the Secretary of State who holds weekly meetings with the supposedly independent CQC, Monitor and NHS England. What precisely is the Government’s policy on independence? People are becoming confused. Clause 118 makes it clear that the Secretary of State wants more control: he wants sweeping powers to close hospitals without proper consultation and clinical support.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the Bill. I do not propose to follow the shadow Secretary of State into a discussion of competition policy, as there will be plenty of other occasions for that; it is not germane to this Bill. The reason I welcome the Bill is that it begins to look at health and care from a different point of view from the one with which those of us who have participated in health and care debates in this Chamber over a long period are familiar. When a Bill comes before the House, it usually starts off by describing the function of one bit of the bureaucracy—perhaps creating a strategic health authority or re-creating a different bit of the bureaucracy somewhere else on the landscape. This Bill starts in a quite different place.

Clause 1 talks about the “well-being” of individuals and suggests that if we are to build a health and care system that meets the needs of patients and users for the 21st century, we should, instead of thinking of it as a bureaucracy planned from the top down, think about the service that is delivered to individuals who rely on these services. Clause 1 talks about the needs of individuals, and later clauses place an obligation on local authorities to do needs assessments for those individuals.

Clause 2 introduces something that the health and care system has talked about since 1948, but almost never put real resource into, which is preventing the need for the delivery of health and care services, and particularly of acute health care. This Bill’s emphasis is on the needs of individuals and on the need we each feel as individuals to avoid unnecessary health costs and care. None of us wants to be a patient in an intensive care unit if it is avoidable. That is why clause 2 talks about the importance of prevention and avoiding the need for care.

[Mrs Moon]

Does the right hon. Gentleman appreciate that it is possible to carry out lots of needs assessment—goodness knows, I carried out many of them in my day—but that unless care is available to allow a patient to be discharged from hospital, it does not matter how many needs assessments have been done? In fact, the longer patients are in hospital, the greater their needs will be—they will not be able to walk, their incontinence will increase and so forth. What is important is to put the cart before the horse and make sure that the funding of community-based care is there. It is not there at the moment.

[Mr Dorrell]

I shall come on to that point, but to react directly to the hon. Lady’s point, surely it is much better to intervene before the patient arrives in hospital in the first place, preventing the avoidable episode of care. The hon. Lady talks about discharge, and she is, of course, quite right, but how much better is it to prevent the case from arising in the first place, which is what clause 2 is about?