Department of Health and Social Care and Ministry of Housing, Communities and Local Government

Mark Prisk Excerpts

Monday 2nd July 2018 Commons Chamber

[Mr Mark Prisk (Hertford and Stortford) (Con)]

I, too, wish to address the issue of adult social care and the excellent joint report—admittedly, I say that as a Committee member who helped to produce it. The issue is of immense concern to many of my constituents, not least the poor souls I have had to help, who were trying to fight this battle, which Members will recognise, somewhere between NHS funding and social care. May I also strongly support the remarks made by my hon. Friend the Member for Totnes (Dr Wollaston) about the principle of our bringing our Committees together? That collaborative principle, which we have shown in Committee, is one I hope both our Front-Bench teams, Labour and Conservative, will now follow. Frankly, the public are tired of party political point scoring on this issue.

I wish to touch on two subjects in the five and a bit minutes I have: integrated healthcare and funding. The Secretary of State has rightly highlighted one principle, namely that we should have whole-person, integrated care, with the NHS and social care systems operating as one. I strongly agree with that. I have seen too many people caught in that system I described, somewhere between NHS funding and social services, and trying to fight that battle with those two fundholders. That binary system has to end. It will not be easy, but the report highlights a number of practical steps. However, I say to the House that for the process of integration to work properly, those two separate funding streams have to become one. Whatever operational or managerial changes are made, if there continue to be two separate funding streams, patients will not experience the benefits. If one accepts that principle of a single funding stream, it is only logical that both clinical and social care be delivered free at the point of use.

I know that that is a major decision and a major financial commitment, but it is essential if the public are to see integration as being of practical benefit. After all, at the moment they see a lottery of disease. They see that if someone gets a major heart problem, the NHS will pay, no questions asked, but if they get dementia and need personal care, the state will look to them and their family first before considering whether or not it should contribute. People feel that that is wrong, and I agree with them.

Let me turn to the vexed question of funding. I am a natural low-tax Conservative. I always think we should remember that when we talk about public spending, we are deciding how to spend other people’s money. But on this occasion if we are going to reset this system for the long term, we have to be honest: these changes will involve paying more, one way or the other. No single tax can solve this problem, as my Committee discovered. That is partly because of scale: the health budget alone is £121 billion. Secondly, the revenue generated needs to be flexible enough to cope with the periods of boom and bust, so drawing revenue from a range of sources is wiser. Thirdly, the current system operates at both a national and local level. That is why the Committee rightly looked at things such as council tax at a local level, where we need to replace the temporary surcharges with a complete overhaul of council tax, including re-banding. The current bands and the fact that, for the most part, the valuations date back to 1991—both the Minister for Care and the Under-Secretary of State for Housing, Communities and Local Government, my hon. Friend the Member for Richmond (Yorks) (Rishi Sunak), who are here today will understand that—show how overdue that reform is. Using council tax as a local element to this would generate additional revenue and would do so on a year-by-year basis. Of course, council tax is also adjustable to meet local demands, so council tax is one element of this.

The second element would be at a national level, because tax revenue will be needed to counterbalance the local council tax charges. That is why I strongly support the notion of a social care premium, which is in the report. Its sole purpose would be to transform and integrate our current health and social care systems. The Committee looked at two options in that regard, and Ministers may wish to look at how broad our consensus was, as it was an encouraging thing to see. One option would be for collection through the existing national insurance system, but separately identified on people’s payslips, with this charged to those 40 and above, including those over 65. That would be relatively easy to set up and run and it would be transparent for taxpayers.

The second option for a social care premium is a social insurance system like the one in Germany. The private sector—probably the not-for-profit insurers—would operate it, with all workers contributing to a pooled fund. I would like the flexibility of a German system, which would, for example, permit cash payments to families which better reflect individual needs in care.

The central point about a social care premium is that it would be acceptable to people if they could see that it would deliver the extra funds needed to integrate clinical and social care; address the rising demand, not least because of the increase in the number of those over 65; and end the healthcare lottery that people currently face. The report offers good ideas that will enable us not only to improve social care but to integrate it with clinical care. The key issue will be whether Ministers and their shadows are prepared to explore a collaborative approach to delivering those improvements.

I really do hope that Ministers will reflect on the report’s principles and individual proposals and that they and their Labour Front-Bench opposite numbers will step forward, perhaps in this debate, and spell out their willingness to work on a collaborative basis. If they do that, the report will have provided a lasting opportunity for real change.