Social Care (Bradford East)

Norman Lamb Excerpts

Tuesday 5th March 2013 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship for the first time, Mr Caton. I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on a brilliant piece of work—not just the report, which is fantastic, but the degree of discussion, debate and engagement with ordinary people and all the organisations that he listed, to get an understanding of what is going on in his community. That is immensely impressive. He has gone further than anyone else in understanding what is going on, on the ground. I thank him for his work. He is right to say that although the report looks in depth at a particular community and its needs, wider lessons can be learned from it. The report makes a useful contribution.

Like my hon. Friend, the coalition Government know how important it is to reform the current system of care and support. The voices of the people of Bradford reflect what we have heard from care users, their carers and voluntary organisations across the country, regardless of who they are or where they come from. They say that care and support needs to change. We have to move from an old-fashioned paternalistic system, where the council or the NHS knows best, to a personal system where we give real power to individuals to determine what their priorities are, what works for them and what makes them happy and contented in later life, despite sometimes having acute care needs.

My hon. Friend rightly highlights the significant demographic challenge facing us in years to come. About 14%—more than 71,000 people—of Bradford’s total population is aged 65 and over. Bradford’s local joint strategic needs assessment for 2012 predicts that by 2033 the number of local people over 90 will triple from 2,800 to 8,700. We should celebrate that. It is great that people are living to be older and often enjoying great quality of life for more years, but also many people live for years with more than one acute condition, which presents a challenge for them, but also a cost to society. Such a demographic shift will always be an immense challenge. Only if the care and support system changes and adapts can it meet the new demands and expectations of an ageing population in modern Britain.

The organisations that my hon. Friend mentioned are vital partners. This is not something that Government or local government can do on their own. The care and support White Paper, published in July last year, is an important step towards addressing these challenges. Our reforms will focus more attention on people’s well-being and independence throughout their lives, instead of waiting for them to reach a crisis point. They will also put people in control, giving them a far bigger say in their own care and support, and ensure that services are designed around their needs, rather than the needs of an institution.

The White Paper, together with the draft Care and Support Bill, will shape the care sector for years to come. The draft Bill, which my hon. Friend knows has been subject to pre-legislative scrutiny, sets out how we will put the plans into law. For the first time, we will create a single, modern statute, bringing everything together for adult care and support. It is good that that is written in plain English—English that people can actually understand without being a lawyer—which is quite useful. That statute will be clearer, fairer, and built around people, not processes, and around individuals, not institutions. It will empower people in Bradford and across the country to take control.

My hon. Friend highlighted the importance of the reforms to funding recommended by Andrew Dilnot. Last month, the Secretary of State for Health announced groundbreaking proposals to cap the costs of long-term care. That issue has been in the long grass for far too long. Successive Governments have put it in the “too hard to solve” category and just left it. As a result, ever more people have suffered catastrophic loss, losing everything that they have worked for. There is an acute unfairness in how the system almost penalises people for having been prudent and careful throughout their working life.

Individuals currently have little or no protection against the cost of care in older age. In Bradford, for example, some 5,000 people a year turn 65, and around 500 of those people each year could face significant care costs under the current system. Our reforms will ensure that everyone gets the care they need. We are ending the unfairness of, and fear caused by, unlimited care costs, while making sure that most support goes to those in greatest need. People will be protected from having to sell their home during their lifetime to pay for care.

The Government have committed to a £75,000 cap on care costs across England in 2017. I note my hon. Friend’s concerns about the cap’s geographical impact, and he proposes a regional cap as an alternative. The cap provides the same financial protection for people of equivalent wealth from different regions, and everyone will benefit from more peace of mind. However, I would say to my hon. Friend that, in some parts of the country, the costs of care are higher, so people reach the cap more quickly because they have to spend more of their own money. In a way, it is swings and roundabouts.

The other thing I would stress—my hon. Friend was right to point this out—is the significant increase in the range of means-tested support. At the moment, if people have more than £23,250, they get no help at all; they are on their own. That limit will be extended to £123,000. My hon. Friend said the average house price in Bradford is £94,000, so a substantial number of people there will get contributions towards their care costs.

In the spending review, we made clear our strong and ongoing commitment to adult social care by prioritising an additional £7.2 billion over four years—my hon. Friend raised concerns about tight social care budgets. Independent research by the King’s Fund supported our view that that should be enough for councils to maintain services, provided they make sure those services are delivered efficiently. Since that announcement of £7.2 billion, we have added another £500 million. In the context of a challenging local government settlement, that means that local authorities should be able to protect access to care. Ultimately, however, it is for local people and local authorities to determine their care spending priorities.

We cannot improve care and support simply by shovelling ever more money into the system. My hon. Friend was right to say that we must do things differently and work more efficiently to achieve better outcomes. Critically, that will be about a partnership between statutory authorities and the voluntary sector, including the organisations he spoke warmly of, which can really make a difference.

People have told us that the process of determining who is eligible for care and support is confusing and unfair. Decisions are not transparent, and they vary across the country. The result is that people are left without the support they need. The draft Bill provides for the national threshold my hon. Friend talked about. I understand his concern to protect the moderate threshold that Bradford has managed to maintain, and I applaud it for doing that. However, even if the threshold is set at a higher level—it has not been determined yet—Bradford will still be able to maintain a more generous system, if that is what it chooses.

My hon. Friend rightly focused on prevention as one of the key themes running through our reforms. We want a care and support system that is proactive and preventive, rather than reactive—repairing things when they have gone wrong. Such a system helps people to stay healthy and independent in the first place. We need to help people to maintain their health throughout their lives so that they do not, we hope, have to go into acute hospitals when everything goes wrong.

My hon. Friend might be aware that I recently announced a £300 million fund for specialist housing. Bradford already has seven extra care housing schemes, and it has submitted a bid to the specialist housing fund to develop further schemes. I applaud it on the work it has done locally to secure those schemes.

At the end of last year, the Government made available an additional £40 million across the country for aids and adaptations, and my hon. Friend referred to that. Bradford council will receive an extra £336,000. In total, £785 million will be provided over the four years to 2015. That will enable people to remain independent for longer.

My hon. Friend talked movingly about the problems of loneliness and isolation, and it is critical that we challenge them. If people are on their own, with no human contact, their mental and physical health will deteriorate. That is dreadful for them, but it is also costly for the system. We need to be much more effective at maintaining contact and using the voluntary sector—good neighbour schemes and so forth—to maintain human contact and friendship.

I want to say a word about integration. The White Paper sets out our ambition for health, care and support to be organised around the individual’s needs, rather than focusing on organisations and services. My hon. Friend mentioned the case study involving the ridiculously long wait for a ramp, which demonstrates how dysfunctional the system can be. It is crazy that someone returning home needs that little adaptation to maintain their independence, but it does not arrive for so long. That puts them at risk of a fall, which would result in their returning to hospital. That is a dysfunctional system. The Government’s absolute focus on encouraging and incentivising areas to integrate services across health and social care, and mental and physical health, is critical to providing better care and support for individuals.

[Mr Ward]

The absurd thing about this tragic case is that the gentleman was in Pinderfields for five months, and people knew throughout that time that he would go back to his own home. Yet, when he arrived, it was as if they thought, “What a surprise. He’ll need a ramp.” As I said, the gentleman is tetraplegic.

[Norman Lamb]

That is unbelievably stupid. All the preparation could have been done before he returned home so that everything was ready for him when he came back.

The draft Bill will significantly benefit those with caring responsibilities. It will simplify the process of assessments and, for the first time, place a duty on councils to meet a carer’s eligible needs for support. There will be a new resource of £175 million to ensure that that is implemented.

The Government’s independent advisory body—the standing commission on carers—visited Bradford in 2011 as part of a series of fact-finding visits. It had the opportunity to see first hand some of the valuable initiatives, including the carers information service and the emergency planning service, that have been commissioned by Bradford council from the carers resource.

Let me say a word about personal care. One of the best ways we can improve the quality of care is by getting people to exercise choice and control over how their needs are met. The draft Care and Support Bill will place personal budgets on a legislative footing for the first time. Local authorities should be working to meet the objective set out in the vision for adult social care and provide personal budgets for everyone eligible for ongoing social care. Preferably, that should take the form of a direct payment to individuals, so that they can determine exactly how they want the money to be spent. That should apply from April 2013.

My hon. Friend mentioned the importance of information and knowledge. He said that online information is not always accessible to all. IT and providing information online can be transformational in getting vastly more information out to people who need it, but we must always recognise that some people cannot access it in that way, and we must ensure that it is available in other ways.

Let me reiterate the fact that the White Paper, the draft Care and Support Bill and the Government’s decision to reform the funding of care and support represent a radical transformation of the way we meet the needs of individuals, families and communities. That transformation will require close collaboration and genuine cultural change, involving the Government, local authorities, the NHS, care providers, voluntary organisations, care workers, care users and their families, and communities.

I am therefore really encouraged by the brilliant work that has been undertaken in Bradford and by the local engagement and insight clearly evidenced in my hon. Friend’s report. Again, I congratulate him on the dedication and commitment he and his team have shown on one of the most important issues we face as a country. As our society ages, we face enormous challenges, but there is a message of hope, because these reforms will start to prepare us for the challenges of an ageing society.