Social Care Funding

Neil Carmichael Excerpts

Thursday 10th November 2011 Westminster Hall

[Sarah Newton]

My hon. Friend makes a very good point, reminding us that people are living much longer, because the causes of mortality that prevented people from living so long in the past—especially cardiovascular disease and some cancers—are now more survivable, so people suffer from other conditions, which are sometimes far more complex to live with and to treat, especially diseases such as dementia and Parkinson’s. The fact that people are living well into their 80s and 90s and beyond 100 presents new challenges for the NHS and a range of other services—indeed, for society as a whole—so my hon. Friend makes a very good point.

The commission goes on to say that most people are unable to plan ahead to meet their future care costs. Assessment processes are unclear. Eligibility varies according to where people live, and there is no portability if people move between local authorities. The provision of information and advice is poor, and services often fail to join up. All of that means that people and their families often do not have a good experience.

[Neil Carmichael (Stroud) (Con)]

My hon. Friend is absolutely right in what she has said. One of the key tools is integrating the NHS with social care, so that we can have a much more seamless approach to caring for people, and they understand where they can go for support. I am talking about breaking down the unnatural barriers between local areas, as well as about the funding that is necessary and a more transparent understanding.

[Sarah Newton]

I am sure that that is right. It is certainly a point that the Dilnot commission and people who have responded to it have made. They are very supportive of the Government’s plans to integrate social care with the health service.

It is a major worry for most families that they cannot protect themselves against the very high costs of care. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) pointed out, looking after people with dementia can involve very considerable costs. However, the availability and choice of financial products to support people in meeting care costs is limited.

--- Later in debate ---

[Neil Carmichael (Stroud) (Con)]

Thank you very much, Mr Robertson, for calling me to speak. It is a great pleasure and honour to speak in a debate such as this, and I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate to bring the issue of social care to our attention. As she said herself, the debate is also extremely timely, because tomorrow, of course, is Remembrance day and it is absolutely right that we remember those who achieved so much for the cause of freedom and for this country during the world wars and indeed afterwards.

I want to echo the point made by the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the chair of the all-party group on social care. She made the point that we need to think very carefully about social care funding and that it is important to take an all-party approach to it, because it will affect many people for an extremely long period. We are talking, obviously, about elderly people, but everybody gets old and this is a long-term policy, with long-term implications.

We have to embed a set of policies—a framework, really—that can last, because one point that keeps coming up when we discuss the funding of social care is that we do not really know how to plan and we do not know, as individuals, what sort of structures will be in place; consequently, many individuals do not plan. The Government have a huge opportunity effectively to create the reasons why people can plan for their retirement and, as they arise, their care needs.

As other speakers have suggested, Dilnot makes it clear—or at least, implicitly clear—in his report that the sort of measures that he is talking about, including the ceilings that would apply before people have to pay for care and so on, will effectively create a situation where people are planning financially for their forthcoming care needs. We need to remind everybody of that when we discuss this issue in increasing detail, as a White Paper and so on arrive on the table.

In my constituency, I visit care homes quite frequently and I have often been asked to meet people who have just celebrated or are about to celebrate their 100th birthday; a huge number of people in my constituency reach that age. When I first started visiting them, it was really quite an honour, because members of my family never get to 100—although, obviously, they are going to.

[Kelvin Hopkins (Luton North) (Lab)]

The hon. Gentleman could be the first.

[Neil Carmichael]

That is very kind. [Interruption.] Hon. Members are all very optimistic.

[Glyn Davies]

It might be a good point to throw into the debate that, a fortnight ago, I visited a woman who was having her 108th birthday. The interesting thing about her—I think it contributed to her longevity—was that she had been a member of the Conservative association ever since she was allowed to join in 1928.

[Neil Carmichael]

Well, we certainly have experience in our Conservative association back at home. An interesting thing about my constituency is that I came across somebody who was 106. She wanted to make a complaint and she came up to me at some speed. I did not think it was anything to do with the care she was getting, and it was not: she had received a birthday card from Her Majesty the Queen every year for the past six years, but unfortunately she had received the same one each year, and she wanted a different one.

As that story shows, we have an ageing population, and that brings challenges, of which dementia is obviously one. More and more people are experiencing dementia, not just because they have it but because a family member has, and that can be just as challenging. We need to prepare the ground because an increasing number of people have dementia.

[Mrs Helen Grant (Maidstone and The Weald) (Con)]

One million people will have dementia by 2025. Does my hon. Friend agree that this terrible disease must have a proper place in any funding review or funding reform?

[Neil Carmichael]

That is exactly the theme I was about to develop, so I will simply agree with that excellent point.

In my constituency, we are promoting the “Write it Down” campaign. If somebody thinks they or a member of their family is getting dementia, but they are not quite sure, it is a good idea for them to write down sequences of events, because that will trigger a recognition or an acceptance that they or their loved one are forgetting things. The campaign is gaining quite some traction in my constituency, and I recommend that hon. Members promote it in theirs. Gloucestershire is getting quite a lot of accolades for the campaign, and families are successfully using this tool to diagnose dementia, which, we should remember, is not an easy thing to do.

I want to talk briefly about carers. Their role has been mentioned, and rightly so, because they do an enormous amount, and their numbers are huge. A fact that is sometimes overlooked, however, is that a lot of carers are surprisingly young, and some still go to school. We need to bear that in mind.

[Kelvin Hopkins]

The hon. Gentleman is making an important point. In my constituency, I have been visited by a group of people with young family members who suffer from dementia. A number of people develop dementia when they are quite young.

[Neil Carmichael]

Absolutely. I take the point that young people can also have dementia—that is certainly true—but the point I was making was that young people are caring for people once they return from school. That is a measure of the challenge we face in dealing with the role of carers, so the Government have to think carefully about the structures around carers and about the ability to give these people appropriate support and respite.

[Barbara Keeley]

It is good for us to be concerned about young carers, but is the hon. Gentleman concerned about the loss of education maintenance allowance? When I talked to the young carers project in my constituency, it told me that all but one of its young carers had been receiving EMA, and they were really afraid that they would lose all their incentives to stay in education. There is therefore an issue about support for young carers.

[Neil Carmichael]

This is certainly becoming a surprisingly wide-ranging debate. We have thrashed out the issue of EMA very carefully and thoroughly in the House of Commons—indeed, those of us on the Education Committee produced a useful report on the subject—but the Government have to think about wider issues in connection with post-16 education and so on. However, that is a separate issue; the important point here is that people who are going to school are carers, and I want the Department of Health to register that.

Another important aspect is the number of people with Parkinson’s. That problem is increasing all the time, and it is right that we focus our attention on it. The reason I mention such difficulties—not to the exclusion of others—is that it is important that we think carefully about personalised budgets so that people get tailor-made provision that they are happy with, and so that we join the NHS up with social care. I made that point in an intervention on my hon. Friend the Member for Truro and Falmouth but I want to repeat it, because part of the answer is to ensure that fewer people end up in hospital, and we can do that by ensuring that the social care structure spots problems before they become serious or overwhelming and prevents problems from starting in the first place. If the social care system dovetails completely with the NHS system and is accessible and transparent, people who need care, and families with members who require care, will feel they are being properly listened to.

[Glyn Davies]

Let me make a point in the form of a question. It touches on several of the issues that my hon. Friend has just mentioned, and particularly on Parkinson’s disease. Does he share my concern that once people enter a care home, there is not the same awareness of the need to look for dementia or Parkinson’s disease as there is outside? There is not the same awareness of the onset of those diseases, because people are deemed just to be elderly, when in fact they are suffering from an illness.

--- Later in debate ---

[Neil Carmichael]

That is a good point. Earlier I mentioned the problem of diagnosing difficult illnesses —I obviously focused on dementia, but there are others. My hon. Friend is exactly right.

One theme that I have been picking up in care homes in my constituency is that increasingly, people do not enter care homes until they are older and actually need care because of their various illnesses. The pressure on care homes is therefore intensifying as a result of the changed profile of the people going into them. That has obviously put pressure on care homes’ finances, and there are differences between those that are supported by private provision and those supported by local authority provision. We need to explore thoroughly the question of the funding arrangements for care homes, and that should be part of the process that we get involved with as we move towards the publication of the White Paper.

My hon. Friend the Member for Portsmouth North (Penny Mordaunt), who is now out of the Chamber, mentioned commissioning, which is critical. Local authorities need to commission with a huge amount of sophistication, and they need to be fully aware of how to specify what they are commissioning for. The one good thing about the county council in Gloucestershire is that it is embracing the personalised care theme vigorously, but I would like to make one point. All personalised care is excellent if it is properly specified and funded, but we must be sure that the assessment process is fair. I constantly seek reassurance that that will be the case.

In my remarks I have signalled two general points that I think are important. First, we need to think long-term. We do not want a party political dingdong about this. We need carefully considered, thoroughly researched and above all well-meaning outcomes in the provision of care for elderly people, because we are setting foundations that should, I hope, last decades. Secondly, we must not think of the issue in terms of various silos providing care, while we hope for the best. We must be more holistic. As people grow older they will want to get access to different things. They do not want to be channelled by various bureaucratic systems. They want, effectively, to consider their options and decide for themselves, and they hope that when they cannot decide for themselves there will be a mechanism, in their family or through advocacy, to enable them to maximise the quality of their life for as long as possible. In the end, that is in all our interests. First and foremost we must create a system that people recognise as decent, fair and honourable.