Debate on the Address

Debate between Meg Hillier and Stephen Dorrell

Wednesday 9th May 2012 Commons Chamber

[Mr Dorrell]

My hon. Friend leads me neatly to my next point. It seems to me to be an odd argument to suggest that if the Government have not yet clearly made up their mind precisely how they propose to deliver the important issue of social care reform, it then becomes a source of criticism that there is not a Bill with a commitment to legislate. I am old-fashioned enough—as my hon. Friend suggests most of us interested in this issue are—to think that the most important issue is to deliver a clear policy and then to legislate. I do not criticise the insistence that we have a clear policy before we have a Bill and a commitment to legislate.

I welcome the fact that the process of clarification of policy is continuing, provided that it takes us beyond discussion about funding. While Dilnot made some important points about the need for a fairer system of distributing the cost burden among those who pay for social care—some of those ideas will be part of the eventual conclusion on health and social care—the problem is that he was asked to answer the wrong question, and that is becoming increasingly obvious as the public discussion continues. The question put to Dilnot was how to restructure the payment arrangements for the existing structure of social care. But if we step back from the question of funding and look at how care is actually delivered in each locality—between the social care system, the primary health care system and the community health care system—the inescapable conclusion is that the structure is no longer fit for purpose. It was designed primarily to deliver health care to people who had a burden of disease that was the pattern 30, 40 or 50 years ago, whereas today’s health and care system needs to meet the needs of a very different group of patients. It is a difficult thing to measure, but depending on how one chooses to do so, between two thirds and three quarters of the resources employed in the health and care system are devoted to people with long-term, complex needs. Their requirement is for joined-up care that supports them and enables them to lead lives that are as full as possible during the period of their longer life expectancy.

[Meg Hillier]

As a former carer for two adults with complex needs, I counted that at one point I was dealing with 13 different agencies to provide their care. The right hon. Gentleman seems to suggest that simplification of the system is as important as proper funding. Funding may be a big challenge, but simplification is vital if we are to deliver the domiciliary aspect of care.

[Mr Dorrell]

I entirely agree with the hon. Lady’s view. Reform of social care is not the same thing as reforming the funding system. In my view, we cannot deliver a good value, high quality health and care system just by changing funding flows. What is required is something more fundamental, which is changing the way in which care is delivered in each locality, in order—as the hon. Lady rightly says—to reduce the number of competing, and often non-communicating, bureaucracies in the system.

If the time that the Government are taking will be used to answer the question of how to deliver more integrated, joined-up care, and then how to pay for it, it will be time extremely well spent. If it is simply a delay while we try to solve the problems of how to pay for the existing system, we will continue to ask the wrong, unanswerable question.

On social care, I have made a specific point, but on the Queen’s Speech as a whole, I have made a more important point with a broader political reach. The Government have a clear purpose, both in our economic policy and in our broader views about the type of society that we are seeking to create. It is not a coincidence that my right hon. Friend the Member for Haltemprice and Howden spoke today about liberty and justice, or that the right hon. Member for Bermondsey and Old Southwark focused on the importance of individual responsibility and rights as opposed to the collective tradition that comes from parties on the political left. I support the Queen’s Speech and this Conservative-led coalition, because it already has achievements of which both Conservatives and Liberal Democrats can be proud. The Queen’s Speech makes clear the continuing commitment on the part of the Government to build on and follow through the achievements of our first two years.