Health and Care Bill

Matt Hancock Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I am grateful to the hon. Lady. I do not think that she posed a question, but she made her point clearly, as she always does.

[Matt Hancock (West Suffolk) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

--- Later in debate ---

[Edward Argar]

Before I give way to the right hon. Gentleman, I will give way to the former Secretary of State.

[Matt Hancock]

Is not the right way to think about this change to consider the proposal in front of us and compare it with the current system? The reason that the Dilnot system, as previously proposed, was never put in place was that there was never a proposal to pay for it, whereas this package is paid for. That is why this Government have been able to deliver a package where no previous Government have been able to do so.

[Edward Argar]

I am grateful to the former Secretary of State. He is absolutely right. We deal in the reality and we should compare the reality of the system that we have in place now with what we have proposed here, which not only moves us forward, but is funded and sustainable.

--- Later in debate ---

[Margaret Greenwood]

I thank my right hon. Friend for putting the case so clearly. She hits the nail absolutely on the head: as a result of the Bill, contracts could be handed out to the private sector without the stringent arrangements that one would expect in the awarding of public money. That is a recipe for the kind of cronyism that has become all too familiar, as she says.

I turn to the cap on care costs. I was proud to stand on a manifesto in 2019 that pledged to

“build a comprehensive National Care Service for England”,

to include

“free personal care, beginning with investments to ensure that older people have their personal care needs met, with the ambition to extend this provision to all working-age adults.”

The Conservative manifesto in 2019 did not go that far, but it at least made the guarantee that

“nobody needing care should be forced to sell their home to pay for it.”

We now know that that was a sham—another broken promise by this Government.

Last week, Ministers sneaked out changes to social care plans that would mean that poorer pensioners will not after all be able to count means-tested payments by the state for their care towards a total cap of £86,000 for any individual. The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), described it as “deeply disappointing” that the new plans were “not as progressive” as those put forward by Andrew Dilnot, the economist who drew up the original plans for a cap on individual contributions. Mr Dilnot has said that the Government’s plan is

“a big change that…finds savings exclusively from the less well-off group.”

A former Conservative Cabinet Minister has urged the Government

“to adopt a different approach”,

while another Conservative MP, a former Under-Secretary of State for Health, has said that

“it will be poorer pensioners who have relatively modest assets that will be most affected by these changes.”

I hope that Members on the Government Benches are listening to those points from Government as well as Opposition Members and will do the right thing. Elderly people deserve better. All Members, including Government Members, have a responsibility to vote these measures down.

When the Prime Minister was discharged from hospital in April 2020, having spent seven nights there, of which three were in intensive care, he said that

“the NHS has saved my life, no question.”

Now he and his Government should save the NHS by withdrawing the Bill. The national health service is this country’s greatest social achievement. It is devastating that this Conservative Government are intent on taking it off us.

[Matt Hancock (West Suffolk) (Con)]

I support new clause 49 because I support the action that is needed to make reforms to social care that are long overdue. I have listened carefully to the debate, and it is vital that we understand that the new clause would deliver one part, but not the whole, of the package that was set out by the Government in September. There is no doubt whatever that that package, as a whole, improves the provision of social care, makes the way it is paid for fairer, and removes some injustices that have existed in the system for far too long.

First, the proposal that has been put forward—and I think it is the right proposal—is for a cap on the costs that individuals face in paying for their care. The contributions from the state, even if they are from another part of the state such as local government, are not individuals’ care costs, and it is therefore wrong that they should be contributions towards the cap. The cap has the stated goal of being a cap on the cost of care to an individual, not a cap on the cost that accrues to both the individual and a local authority.

Let us look at what would happen if the new clause were not passed. The provision of care by local authorities is different in different areas, largely according to how well off those local authorities are. A richer council that pays more costs than the statutory minimum as set out in the Care Act 2014 would help local residents to meet the cap sooner than a poorer council that pays only the statutory minimum of care costs, and therefore people who live in poorer areas would take longer to reach the cap, so we would end up, in effect, with a postcode lottery cap meaning that people from poorer areas would tend to have to contribute more. That is wrong, and I am very glad that it is put right by the proposals that are before us today.

Secondly, for those with lower asset values, the rise in the floor in the means test is more important. It is the rise in that floor that makes this system fair. When the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), read out a long list of places with low asset values on average—places where house prices tend to be lower—he listed exactly the areas that will benefit most from the rise in the floor. [Interruption.] We can see what Labour Members are doing. [Interruption.] They are taking a narrow area, and they are taking a specific detail, and they are ignoring all the parts of the package that benefit the people who will benefit from this package as a whole. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. We will not get anywhere if people shout. This is supposed to be a reasonable discussion.

[Matt Hancock]

Thank you, Madam Deputy Speaker.

A further point that is being ignored by those who are trying to make a meal of this new clause is that the cutting of the daily cost offset is much more valuable to those on low incomes than any change in the cap, because the cap, by its nature, is there to protect assets, and those who do not have many assets gain far more benefit from the cut in the daily cost that would otherwise clock up their contributions to the cap much more slowly.

Taken together, these elements make up a package that is beneficial to those on low incomes. It helps to make the system fairer.

My final point on new clause 49 is this. For years and years—including the years when I was Secretary of State, and including the entire 13 years when Labour was in power—nobody fixed the problem of social care. This Government have come forward with a package, and if we pull apart one part of the package, there is a risk to the package as a whole. As Sir Andrew Dilnot said on the radio this morning,

“the whole package is a significant step forward”.

It is always easy in politics, and in life, to say, “I just accept the bits of the package that I like”—and, in the case of the Labour party, to say, “I accept the bits that are very expensive for taxpayers.” Instead, we must look at the package as a whole, which is funded, and which can be delivered, for the first time in several decades, because it hangs together. The Government have presented a whole package, and it is the best possible option in the fiscally constrained times in which we live.

[Dr Julian Lewis]

I am sorry to be unhelpful to my right hon. Friend, but if this element is so integral to the overall package, why was it not brought forward right at the beginning?

[Matt Hancock]

This part of the package was described in September, because it was made clear in September that the £86,000 cap was a cap on individual costs. It did not say then that that included the costs that local government may make on someone’s behalf. I think it is a strong Conservative principle that, when we say we are capping the costs that an individual pays, we do not include the costs that another part of the state should pay. I think that that was clear, and more details have now been set out. Most importantly, this is a package that takes things forward in a way that has not been achieved for decades.

[Rob Roberts]

I do not think anyone across the House would argue that the measures that have been put forward are a significant step forward from where we are. However, as my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for South West Surrey (Jeremy Hunt) mentioned earlier, they are not necessarily what we might have been led to expect. Would my right hon. Friend like to comment on that?

[Matt Hancock]

I will happily comment on that. In the debate over the past few days, many people have been comparing the package put forward by the Government with the proposals from Sir Andrew Dilnot in 2014-15, but there is a reason those proposals were never enacted and never came into force. It is because they had a huge price tag, and there was no successful debate on how to pay for them. It has been easy to ask for social care reform for the past three decades, but until this Government did it, nobody had come forward with a plan for how to pay for it. We simply cannot magic things out of thin air. If we are a grown-up Government, we have to come forward with a grown-up package, which includes saying how it will be paid for. That is what has happened, and that is why this package hangs together. We should support this new clause, because it is part of that overall funded package.

I want to turn briefly to the measures on integrated care systems. The purpose of the ICSs is to have a more preventive, more flexible and less siloed approach than we have under the current clinical commissioning groups, without removing the grit in the oyster that is the purchaser-provider split and without upsetting the 1948 settlement involving local authorities doing social care and having a national NHS. Amendment 76 in particular contains a lot of suggestions that might seem tempting. There are people who have an important voice in the debate. The problem, as we have seen with existing legislation, is that if we put too much into statute, it is far harder to deliver high-quality services that are integrated on the ground. That is why the Government are right to resist putting too much detail into legislation. However, I do support the change proposed by the Government, which makes it clear that the purpose of ICSs is not to have private providers on the board. I can confirm that, as the Minister said, it never was. Mischievous rumours were put about, some of which have been repeated today, that that was the intention, and I am glad that the Government’s amendment puts that matter beyond doubt.

I am attracted to amendments 89 and 90 and, in another group, amendments 91 to 98 and amendment 23, tabled by my hon. Friend the Member for Broxbourne (Sir Charles Walker). I was going to say this before I knew that I would be sitting next to him in the debate today, and I hope that the Government will look on these amendments kindly. The parity of esteem between mental and physical health is incredibly important, and I commend the amendments to the House.

[Several hon. Members rose—]