Social Care

Debate between Norman Lamb and Damian Green

Wednesday 25th April 2018 Commons Chamber

[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I think the Opposition are quite right to want to debate this issue, and I also think strongly that the long-term solution to the problem of funding care—particularly for the frail elderly—will require cross-party agreement, so I hope that the debate can take place in a relatively non-partisan way.

I agree with the hon. Member for Worsley and Eccles South (Barbara Keeley) that radical change is needed, but I gently put it to her and her colleagues that in this long-term and complex area, indignation is not enough. Simply saying, “We must spend more money,” at the same time as saying, “But we must restrict the amount of money we take from other people,” which I understood to be the import of part of her speech, does not cut it.

[Norman Lamb]

Will the right hon. Gentleman give way?

[Damian Green]

I will certainly give way to the right hon. Gentleman in a moment, because I am about to mention him, but I am conscious of time.

There needs to be radical change, and the Green Paper needs to be radical and brave, because although in this debate, as in the wider debate on this issue, a lot of people talk about the fact that we live in an ageing society, we have not remotely adjusted as a society to what that means yet. Our population is projected to grow by around 10 million over the next 40 years. Almost all that growth comes from older people, and particularly those in the oldest age group. There are 5.3 million people over 75 in Britain today. That number will double to more than 10 million in 40 years. This is not just a looming problem; it is a problem today. There is a short-term and a long-term problem to solve. Frankly, in the spirit of non-partisanship, no party has a record unblemished by using social care as a political football. Phrases such as “death tax” or “dementia tax” make good copy and can affect the outcome of elections, but they do not help rational debate or, more importantly, help us improve the lot of the increasing millions of older people.

[Damian Green]

I think that the phrase “death tax” dates back to the previous Labour Government’s attempt to solve the problem in 2008, and I am sure that the hon. Lady used the phrase “dementia tax” during the last general election campaign. I hope that she will reciprocate my attempt to be non-partisan—so far it does not feel like it.

In the short term, the challenge for the Government is one of capacity and quality of care. Both problems will become more difficult in the long term. There is a range of things that we must do as a society before people need social care. For example, we need to keep people active for longer, we need to keep them in the workforce for longer, because that is good for their health, and we need to make changes to the planning system so that we can keep them in appropriate housing of their own for longer. In the end, however, the nub of the issue will be funding.

I want to address a point raised by the hon. Member for Central Ayrshire about joining the whole thing up with health funding. I agree with the broad thrust of the 10 principles proposed by the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Grantham and Stamford (Nick Boles) yesterday, particularly the idea of hypothecation, whose time is coming, but I think there is a problem with the idea of simply integrating all health funding and all social care funding.

It is a no-brainer that, organisationally, social care and healthcare need to be much better integrated, so that the individual is not trying to negotiate a very complex system, as the hon. Member for Central Ayrshire said. If we simply roll all the funding together into one pot, however—a sort of national health and social care fund—there are two serious dangers. The first is that social care takes over from mental health as the Cinderella of the health system, never quite at the top of the priority list when money is allocated. The second is that nobody feels that their contribution is related to their personal needs. The effect is that some of the sources of funding that could be made available—I agree with all those who say we need more funding—such as the £1.7 trillion of equity in residential property, of which more than two thirds is held by the over-65s, would be in danger of being permanently excluded, which I think would be a great mistake.

[Norman Lamb]

The right hon. Gentleman is making a thoughtful and reasonable contribution. He suggests that if there was a completely combined united funding stream for health and social care, social care would be relegated and disadvantaged. Of course, social care already loses out here and now—under Labour, the coalition and the Conservatives—compared with NHS funding. He complained about people just using indignation, and he made the case for cross-party working. Does he share my frustration that those of us who have tried to make the case for working together are constantly rebuffed by the Government? Will he join us in pressing the Prime Minister actually to engage in this, so that we can make it a reality?

[Damian Green]

I agree with the right hon. Gentleman that cross-party working is necessary. I gently point out that when I was a member of the Government, I met him and the hon. Member for Leicester West in a cross-party group to discuss precisely this—I was responsible for this policy area at the time—because I wanted to work with them. I thought that was the only way forward when I was in government, and I still do.

There is not time today to go into detailed funding proposals, but I think we have to accept that in the long term the funding of social care will need to be not only more generous than it has been in recent years, but fair, and seen to be fair, to every generation. I make the point, which is not often made in this context, that intergenerational fairness means being fair to older people as well as younger people. The view has taken hold in some circles that being over 60 means being over-privileged. I strongly challenge that view. The current generation of 50 and 60-somethings is the first in which people are often simultaneously trying to help their children with housing and their parents with care needs. This is not special pleading for a particular cohort. It is important to remember the obvious but salient point that young people themselves will grow old. Setting one generation against another is not only a bad basis for policy making but very short-sighted for the individuals most affected. Instead, we need to find a solution that will provide stability for decades to come.

I suspect that Members on both sides of the House would be united by the proposition that, however much better we get at using technology and housing design to keep people in their own homes for longer, the sheer growth in the number of people needing some kind of care will mean that we need to find more money. Precisely because that will be a problem for decades, not just for the rest of this Parliament, it is vital that the solution has cross-party support. Social care is a challenge for all parties.

The fundamental issue of whether social care should be a national or local service is often ignored. I am struck that 44% of Kent County Council’s budget goes on adult social care. That number will only rise. I am also struck that, in contrast with almost every other area of policy that involves local government, when I talk to local councillors about this issue they say, “Maybe this should be dealt with at a national rather than a local level.” They almost do not want it to be their responsibility any more. That is practically unique. I hope that Ministers will address that.

I urge Ministers to include staffing needs, the importance of which has been mentioned by Members on both sides of the House, in the Green Paper. Given what the wider situation will be post Brexit, we need to find ways of using technology, being much better at training care workers from the British population, and raising the status of care work. Labour Members mentioned that, and I agree. Looking at care purely as a business sector, it seems to me a classic case of somewhere that both technology and the human touch are vital. That combination is vital to providing high-quality care. To put it starkly, a robot may be able to do the lifting part of the work, but it cannot provide the equally necessary words of encouragement and comfort. I think social care will be an employment growth sector in the decades ahead.

Getting social care right is clearly one of this Government’s biggest challenges, as it will be for every Government for many decades to come. Over the next couple of years, we will have the chance to reset the debate so that it becomes calmer and more realistic. I know that my right hon. Friend the Secretary of State and the Minister for Care want to provide that calm and realism, and I hope that those of us contributing to this debate from the outside will live up to that, too. I very much look forward to the publication of the Green Paper.