Dementia Care and Services

Debate between Norman Lamb and David Ward

Tuesday 7th January 2014 Commons Chamber

[Norman Lamb]

I completely agree. This disease knows no country boundaries. We all face the same challenge across the whole of the UK and, critically, across the world. That is why we pursued the matter in the G8 summit of December. There should be good collaboration across the UK through all of the devolved Administrations and the Government here. I am always happy to engage with colleagues from Northern Ireland to understand what we can learn from Northern Ireland and also because the exchange of information helps everybody to improve.

We recognise the need to build on the strategy. That is why the Prime Minister’s challenge on dementia is now the main vehicle for change and improvement across health and care, in the community and for the purposes of research. The Prime Minister’s challenge runs until 2050, not just outliving the dementia strategy, but broadening its vision and providing better accountability.

Last year we hosted the G8 dementia summit. I was delighted that the right hon. Member for Salford and Eccles participated in it, and challenged me during one of the sessions. The summit attracted interest all over the world, and harnessed the efforts and expertise of the G8, health and science Ministers, the World Health Organisation, the OECD, industry, researchers, philanthropists and civil society to secure much greater international collaboration in order to tackle and defeat dementia. The declaration and communiqué announced at the summit set out a clear commitment to working more closely together on a range of measures to improve early diagnosis, living well with dementia, and research.

The G8 announced an ambition to identify a cure or a disease-modifying therapy by 2025, which we hope will focus minds internationally. It is backed by a commitment to increase significantly, together, the amount spent on dementia research—we know that at present it is a fraction of the amount committed to research in other areas of medicine—and to increase the number of people involved in clinical trials and studies of dementia. The United Kingdom has committed itself to funding a global dementia innovation envoy to draw together international expertise, stimulate innovation, and co-ordinate international efforts to attract new sources of finance. That will be incredibly important if we are to crack this disease.

In partnership with the OECD, the WHO, the European Commission, those involved in the EU joint programme on neurodegenerative disease, and civil society, the G8 will hold a series of high-level forums throughout 2014 on social impact investment—it will be critically important to attract new sources of funding—new care and prevention models, and academia-industry partnerships, which will also be extremely important. The G8 will meet again in the United States in February 2015, along with other global experts including the WHO and the OECD, to review the progress that has been made on the research agenda. That will enable us to focus minds and try to increase the momentum.

The G8 is an exciting global initiative, and I am immensely proud that the United Kingdom led the way in that regard. However, we are also keeping our focus on dementia in England, and we have made progress since the launch of the Prime Minister’s challenge. We have launched a new dementia friends scheme—which has already been mentioned—to make a million people more aware of what dementia actually is, thus helping to break down the barriers between people with the condition and their local communities. It is important to challenge the stigma that still exists in many places. The Alzheimer’s Society has published guidance setting out the criteria for becoming a dementia-friendly community. I was pleased to hear that Rothwell, near Leeds, is becoming a dementia-friendly community: that is very good news.

The NHS continues to support dementia care in hospitals through its CQUIN scheme—commissioning for quality and innovation—which is generating between 3,000 and 4,000 referrals for diagnosis each month. We have allocated £50 million to 116 schemes to make health and care environments such as hospital wards and care homes more dementia-friendly. Making the environment in which people live with dementia more dementia-friendly is critical to the provision of a calm atmosphere. When we see places to which attention has been given and in which investment has been made, we realise what a difference can be made. The Government’s mandate for the NHS prioritises dementia, and, as I said earlier, includes the ambition of a diagnosis rate of two thirds. My hon. Friend was right to say that the current rate is far too low. We are letting people down in many parts of the country by not securing early diagnosis.

[Mr Ward]

Obviously there is an opportunity to do something once a person has been identified as needing a diagnosis, but in my experience the problem is that other things are usually taking place in people’s lives, and GPs often assume that they are just part of the ageing process. There is a failure, often because of the lack of skills of the GPs, to recognise that diagnosis is required.

[Norman Lamb]

My hon. Friend is absolutely right and there are still GPs who do not really believe in the importance of a timely diagnosis. I have heard GPs say, “What’s the point, because it will make no difference?” However, we know it does make a massive difference not only to the person with dementia but to the rest of their family, in understanding the condition and what they can do to help. Education among GPs is incredibly important, and attitudes are changing but we still have a way to go.

Clinical commissioning groups are working with their local councils and other partners to better understand how widespread dementia is in their communities, including among people living in local care homes. This will mean they can identify and support people with dementia in a timely way. GPs are now able to use the new directed enhanced service to improve the diagnosis of dementia by asking people in certain at-risk groups about their memory. This proactive approach should help to identify patients who are showing the early signs of dementia.

Health Education England has prioritised dementia training and has already delivered 100,000 dementia-trained staff. Again, ensuring the work force within health and care have a proper understanding of dementia is critically important.

Social Care Reform (Disabled People)

Debate between Norman Lamb and David Ward

Thursday 11th July 2013 Westminster Hall

[Mr David Ward (Bradford East) (LD)]

I was pleased when I heard that you were chairing this debate, Ms Clark, as I know that you have strong views on this issue. Most of us ought to have strong views on it.

In everyday conversation, we tend to use the word “ability” to indicate that we believe that someone has a special talent. We mean that someone has the ability to play the piano or tennis or to speak in public rather well. That is an inaccurate way to use the word, but it can sometimes lead to the false view that a disabled person is seeking special attention. We have heard that for ourselves: “They’re always after something.” Such disparaging remarks are often made. The reality is that that is simply not true. What disabled people seek constantly is not special attention at all—as a good liberal, I would say this, wouldn’t I?—but the basic human right to a normal life.

Of course, that does not mean that people with disabilities cannot ascend the heights and cannot have unbelievable special abilities—we know that all too well, and history is full of countless examples—but the starting place must be the basic human right to access all life’s opportunities, such as work, leisure and family, things that non-disabled people far too often take for granted. As a good left-of-centre liberal, I believe that the state has an important role to play in supporting people, not necessarily through direct state provision but by helping them attain their rights.

I thank the Backbench Business Committee for granting me time for this debate, and I thank the hon. Member for South Derbyshire (Heather Wheeler) for her support, as this debate is co-sponsored. I also congratulate her on the work that she has done on the issue—I am sure that she will refer to it—as the chair of the all-party parliamentary group on local government.

I thank Scope for the great support that I have received so far on this campaign and for the partnership work that we are carrying out in Bradford, where we are preparing at this very moment for the launch of the “Bradford Cares” campaign, part of the wider national Scope campaign “Britain Cares”. The launch will take place next Monday in Bradford, and I am delighted to say that the former Care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow) will be speaking.

To add more power and force to our arguments when bidding to the Backbench Business Committee for this debate, we were rightly asked to justify the time devoted. We were given eligibility criteria, including topicality and importance. As for topicality, we know that social care is the largest remaining area of reform for the coalition Government in this Parliament, and the Care Bill is on its way through the legislative process. The crucial issue of eligibility, to which I will return, is extremely topical, not least for people in Bradford, where the council is one of the few remaining local authorities to use the moderate level of need when assessing support. However, the council is consulting as we speak with a view to moving to assessments of substantial need. That consultation will last until 4 August.

As for importance, we must acknowledge that much of the debate about meeting and funding care needs has focused on the elderly. We understand the reason perfectly, but we must also remember that one third of care users are working-age disabled adults. That one third equates to more than 500,000 people between the ages of 18 and 64. It is a big issue for us as a nation, and the numbers are projected to increase substantially. In addition, working-age adults have considerably different aspirations from the social care system. They are not more important, but they are different and must be clearly understood when developing social policy.

A report called “The other care crisis: Making social care funding work for disabled adults in England” was published in January this year by Scope, the National Autistic Society, Mencap, Leonard Cheshire Disability and Sense. The report highlights the fact that, since 2008, there has been a constant move from moderate to substantial needs as the basis for assessment in local authorities. Since 2008, the number of people using care, at a time when we know need is increasing, has fallen by at least 90,000, or one in six of all people using care. We also know that there is a shortfall of £1.2 billion in the funding required to support social care for working-age disabled adults.

The report states that if social care reforms go ahead as planned, a further 100,000 people or more risk losing vital care and support. I know the Minister, and I know that if that is true, it will not be acceptable him. I am willing to admit that all the organisations that I mentioned and I must be wrong in our fears, but the trouble is that I cannot see how, which is why I wanted to have this debate.

On the first page of the briefing prepared for this debate by the Library, there is an article by Baroness Grey-Thompson, who apparently can see that we are all wrong. She states:

“The Chancellor announced a £3.8 billion investment”—

I know that the Minister will refer to it—

“including £2 billion of new money, in social care—the support disabled and older people get from their council to get up, get washed and dressed and live independently.”

My understanding is that setting the national eligibility threshold at the substantial level of need would mean that that was simply untrue. People would not get that support. The needs that Baroness Grey-Thompson refers to would not be met.

I know that the Minister will say that local authorities can provide support at what levels they choose. They could provide it, as many did for many years, at the moderate level of need, but the trend is moving in the opposite direction and at a rapid rate of knots, hence the figures that I gave earlier, which are getting smaller and smaller, on the number of people receiving support.

We all understand the need to avoid the existing confusion with the so-called postcode lottery—the differing levels of support in different parts of the country—but I must ask a question. What is the value of having the certainty, wherever I live in the country, of being guaranteed a level of support that fails to provide me with my basic human right to live an independent life? That is not a freedom: to be told that I cannot have the life that I deserve. It is not an improvement to provide the certainty of not knowing what care I will get, which we have at present, with the certainty of getting almost no support at all. I know the Minister and that that is not his intention, so I am in the Chamber today not to bury Caesar—not to criticise my hon. Friend—but to understand better how the planned reforms will work. I cannot work them out; we cannot work them out; and we desperately need to know.

I read the discussion document on the draft national minimum eligibility threshold for adult care and support and I do not get it. To me, there seem to be four crucial elements to the provision of care and support, and there may be more. First, without sufficient funding, there will be a problem, no matter how effectively and efficiently we deploy the available resources. Funding will always be vital. The other three parts are integration, eligibility and the actual care services provided.

We are told that £3.8 billion—£2 billion of new money—is there to help with that crucial integration, but good integration will improve the efficiency and quality of care and support at any level of funding. If we were given 1p, through good integration we could spend that penny better than by being disorganised and chaotic. Eligibility, however, will determine the level at which a person can access the wonderfully improved care and support that we will achieve through integration. Eligibility is the gateway, and the integration can take place at any level of care. We could remove all the postcode lottery uncertainty by setting the eligibility level at critical and yet integrate wonderfully, but how would the improved integration help the hundreds of thousands of people whose needs fall below the threshold level? I do not get it.

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

If my hon. Friend were to go somewhere such as Torbay, where completely integrated teams of health and care workers have been created, he would see that those teams can together make rational judgments about the people who need care and support, by identifying the individuals most likely to end up in hospital and allocating a worker from an integrated team to support them. I absolutely recognise that the eligibility criteria play a role, but the joint team can assess the needs in the area and do whatever is necessary to maintain people’s health and to prevent the deterioration of health and people ending up in hospital. Integration seems to be essential to what he seeks to achieve.

[Mr Ward]

It is not an either/or, or a route from one to the other. We can integrate at any level of support, and greater integration would certainly improve the system with greater economies and, we hope, greater equality of provision. If the Government had planned to introduce a whole new system and remove all criteria—looking simply at people and their needs—I could possibly see, with a wonderfully well funded and integrated system, how that might work. What is planned, however, is not that but an eligibility threshold against which people will be assessed. At that point, even with the washing, the getting dressed and all the other things that Baroness Grey-Thompson was talking about, the decision might be made that the person is simply not at the required level—the threshold—to be given support.

In the foreword to the discussion document, the Minister stated:

“We are establishing a system that will place a greater focus on prevention, which will mean that the care and support needs of people will be considered earlier than is currently the case.”

That is good, and it must refer to the early identification of potential future needs through improved integration. From my own background—in particular, in the area of children with special needs—I am well aware that early identification, so that support can be given, even from mainstream provision, can stop those needs developing to a level at which additional funding and support are required.

I understand all that, but a working-age adult can, for example, have a stroke—something that we saw at the Stroke Association event yesterday—and move, within a day, from being perfectly healthy to having needs that might even be classed as critical. On the direction, however, this is not about progression for many working-age disabled people, because they may move from critical or substantial down to moderate, but about how someone who has had a stroke perhaps may never move back to a point at which support is not required and live a truly independent live. The danger is that such people might go down, in terms of the needs as assessed, and fall out of the system. Where will they then end up? Later, at greater cost, they will go back into the system. That is the concern.

The discussion document refers to the creation of a working group to take matters forward. My problem is that it also states that developing and evaluating the research carried out by the working group may take three to four years. Too many disabled people, however, may quite literally not have that long.

--- Later in debate ---

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

I join others in saying that it is a pleasure to serve under your chairmanship, Ms Clark, and I apologise again for my rudeness earlier. I noted that the right hon. Member for Stirling (Mrs McGuire) said that it was a “genuine pleasure” to serve under you. I am not sure what it means when on other occasions she leaves out “genuine”; none the less, it was clearly a tribute to you, Ms Clark.

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate. This is the second time this week that the two of us have discussed and debated care issues, and I know that he cares passionately—and genuinely—about the subject.

I want to make a number of points at the start. I very much welcomed the fact that the hon. Member for South Derbyshire (Heather Wheeler) highlighted the absolutely central importance of the principle of well-being in the Care Bill. The Bill has the potential to be transformational in how it challenges culture—how the system works and how it treats people. In part, it is about a big shift from a paternalistic system in which people get done to, to a personal one in which their needs and priorities come first.

The right hon. Member for Stirling made the point, absolutely correctly, that there is more to life than getting up, being washed, eating and going back to bed. I am not sure who focused on the important issue of social isolation, but the truth is that many people in this day and age live miserable lives. If someone lives on their own and has substantial care needs, and the extent of their life is getting out of bed, getting washed, sitting in a chair and going back to bed, with no one to see during the day, that is a miserable life.

One point I want to make today is that this is not just about care services. If we are talking about a good society and about giving people a good life, there must be collaboration between statutory services and communities, families and the streets on which we live. I have floated the idea of neighbourhood watch groups applying to provide care. We have a national movement that looks out for whether our houses are being burgled, so should we not be thinking—all of us stepping up to the plate—about whether there are people on our streets who have care needs, or who might just be very lonely and could do with a bit of companionship?

If we are to have a civilised society, the focus has to be not just on statutory services but on collaboration within the community. That is all the more important given the extraordinary strains which the public finances are under now and will be under in future. All political sides in the debate must face up to the extraordinary financial challenge and how best to meet it.

Reference was made to setting the eligibility criteria. My hon. Friend the Member for Bradford East argued cogently for the level to be set at moderate, and the shadow Minister, the hon. Member for Leicester West (Liz Kendall), asked whether there had been a cost-benefit analysis. The problem faced by any Government is that the up-front cost for both working-age and older people is £2.7 billion. I absolutely buy into the case for preventing ill health and the deterioration of health and into making another fundamental shift from repair to prevention—the whole system must reflect that—but Governments should be very careful about committing themselves to that level of up-front cost. That would be exactly the same if Labour were in power.

The shadow Minister and the hon. Member for South Derbyshire asked whether the £3.8 billion pooled sum applied to working-age disabled people as well as older people. Absolutely, yes. My passion for integrated care and for preventing ill health and deterioration in health applies to people of whatever age. We have a particular challenge with frail elderly people, but we also have an understated challenge with people of working age who have disabilities, because often the focus is not enough on them.

[Mr Ward]

In relation to the impact on people, “The other care crisis” report states that we must look at not only what may happen but what has already happened over the past two years up and down the country, and the impact there has already been and no doubt will continue to be on people. I understand that the legislation is due to go through in 2015, and there is talk of having a working group over three to four years. That seems an awfully long period before we will have an assessment of what has happened and what may occur as a result of the legislation.

[Norman Lamb]

I will come on to the work that we intend to do on a more sophisticated way of assessing eligibility and responding to assessments. I absolutely accept the current danger that the system in effect says, “Go away, become more ill or more disabled, and when there is a real crisis, we might help you.” I want us to be more sophisticated and to intervene in ways that will help to build capacity and resilience and to stop the deterioration of health. I genuinely believe that the Care Bill will give us the foundations for a much more rational approach.

Care Services (Bradford)

Debate between Norman Lamb and David Ward

Monday 8th July 2013 Commons Chamber

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

I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on all the work he has done both in Bradford and to bring the stories from Bradford to a national forum. He has done more than anyone to highlight the importance of care services and working with the community to improve services for people. Indeed, the extraordinary consultation exercise he undertook following the White Paper last year was an exemplar of how to engage with the local community. The extent to which people felt able to comment and give their views and ideas was commendable.

I also congratulate the Bradford District Dementia Action Alliance on its work. My hon. Friend made the point that Cathy Henwood from the Alzheimer’s Society had identified Bradford as developing the concept of dementia-friendly communities before the Prime Minister’s dementia challenge, but I am pleased that he acknowledged that the Government have done a lot to highlight the importance of improving dementia care. The Prime Minister’s dementia challenge highlighted three strands: improving health and care services; creating dementia-friendly communities, which is exactly what is happening in Bradford; and a much greater focus on research so that we can find cures, understand better how to prevent some types of dementia, such as vascular dementia, and understand through research how best to care for people with dementia. The Government are more than doubling the amount spent on research, which is a good thing in itself.

The work about which my hon. Friend spoke started in the ward of Thackley—

[Mr Ward]

Idle and Thackley.

[Norman Lamb]

Idle and Thackley—those wonderful names. Local councillors got the community involved and that is exactly what needs to happen. When we talk about how to meet the extraordinary challenges of the future, with an ageing community, there must ultimately be collaboration between statutory services and the community. Bradford appears to be showing the way in which that can be done and I stress that it requires the integration of services and care shaped around the needs of the individual with preventive care to stop the deterioration in their condition.

My hon. Friend will be aware of the need for the care and support system to change as local authorities face challenges resulting from an ageing population. That is why the coalition Government have decided to reform the system of care and support. He talked about the situation in Bradford and I understand that more than 71,000 people there are aged 65 and over, about 14% of its total population. Bradford’s joint strategic needs assessment for 2012 predicts that by 2033—not that far off—the number of local people over 90 will increase from 2,800 to 8,700, an increase of more than 200%. We all face an extraordinary challenge.

As we debate access to care and support services, I am aware that City of Bradford metropolitan district council sets its eligibility criteria at moderate. The report that my hon. Friend published earlier in the year indicated that 97% of people who replied to his survey welcomed setting the eligibility criteria at that level. Bradford council now proposes to change its band to substantial, because of pressures on its budget, and that would affect about 25% of people who currently receive care and support. I completely understand that the Bradford Cares campaign wishes to ensure that services are maintained at the existing level.

The care and support White Paper, which was published in July 2012, is an important and fundamental step towards addressing the challenges of an ageing society. Our reforms will focus more attention on people’s well-being—that is at the centre of everything that the Care Bill tries to achieve—and independence throughout their lives, rather than waiting for people to reach crisis point. They will also put people in control by giving them a far greater say about their care and support, as well as by ensuring that services are designed around what people actually want and by putting their priorities and preferences above and beyond the needs of the institution. My hon. Friend will be aware that the Care Bill, which has been widely welcomed, will be a single, modern statute for care and support. It will make legislation clearer and fairer, and it will be built around people not processes, and individuals not institutions.

As the Government’s White Paper made clear, our vision is a modern care and support system that promotes people’s well-being by enabling them to prevent and postpone the need for care and support, and puts them in control of their lives so that they may pursue opportunities, including education and employment, and realise their potential. Assessments will remain an integral part of the system, but rather than acting primarily as a gateway to the adult receiving care and support—or not, if they fail the assessment—the future system will place much more emphasis on the role of the assessment process in supporting people to identify their needs, to understand the options available, to plan for meeting care needs and caring responsibilities, and to reduce or delay needs, when possible.

Any adult who appears to the local authority to have care and support needs, whatever the level of need, has the right to an assessment. That right will cover carers, so this is an extension of their existing rights. The low threshold for entitlement to an assessment will mean that authorities will have earlier contact with far more people with low-level needs.

[Mr Ward]

May I say how much I welcome the policy on the assessment of carers? Many carers who visit my constituency office are on the verge of needing care themselves because of the stress that they are under. It is the failure to identify their personal needs and the support that they require that puts them in such a stressful position.

[Norman Lamb]

My hon. Friend is absolutely right. The Care Bill’s provisions on carers represent an enormously welcome advance. In a sense, they will give carers the same entitlements to assessment and then support, if that is deemed necessary, as the people for whom they care.

The “Fair access to care services” framework was introduced in 2003. It aimed to provide a fairer and more transparent system for the allocation of social care services. The assessment and eligibility framework was reproduced in the “Putting People First” guidance that was published in 2010. The current assessment and eligibility framework is graded into four bands: critical; substantial, which is the case for most local authorities; moderate, which applies to Bradford and some 15 other authorities; and low, which covers only two or three councils. Local authorities can choose which band they wish to set for their local criteria, and Bradford has the legal power to change its eligibility criteria, as long as it consults its local community.

People continue to tell us, however, that the process for determining who is eligible for care and support is confusing and unfair. Decisions are not transparent and there is variation across the country, and the end result is that people can be left without the support that they need. The existing assessment and eligibility framework is therefore not working effectively, and that is widely recognised. That is why we are introducing a national minimum threshold for eligibility through the Care Bill. The Bill will set out the eligibility criteria—the point at which local authorities must meet an adult’s care and support needs, or a carer’s support needs. Local authorities will remain able to meet lower needs locally, if they choose to do so.

On 28 June, we published a set of draft regulations that set out the national eligibility criteria. These are intended to describe an equivalent level to the “substantial” level used by the vast majority of councils. We have committed to providing funding that will maintain the same level of services when authorities move to the new system in April 2015. This is the beginning of engagement with stakeholders before we formally consult on the regulations next spring. I assure my hon. Friend that the setting of the threshold is about establishing a minimum standard, not taking away councils’ discretion to go further. Of course, the more preventive care that can be given, the better, because that improves well-being and ultimately reduces the cost to the system, which is exactly the point that he made.

Under the current spending review, local authorities should be able to protect access to care, but we know that not all the money that was earmarked for care services has been spent in that way. Ultimately, spending on social care is a matter for local people in local authorities, and councils such as Bradford have to make tough decisions. However, we cannot improve care and support simply by throwing ever more money into the system; on the contrary, we need to work in more innovative and effective ways, exactly as is happening in Bradford, where there is really impressive work on dementia-friendly communities. That is exactly the sort of collaboration that we need to encourage.

Local authorities across the country have already been redesigning services to find more efficient ways of working. For example, many local authorities are concentrating on better integration between health and care services, improving co-operation and reducing duplication. That means better use of money, and improved care.

My hon. Friend referred to this year’s spending review settlement. It includes a £3.8 billion pooled health and social care budget to make sure that everyone gets a proper, joined-up service, and the care that they need from whoever is best placed to deliver, whether that is the NHS or the local authority. The £3.8 billion fund, shared between the NHS and local authorities, will deliver integrated services more efficiently for older people and, crucially, disabled people. It covers ensuring that health and social care work together to improve outcomes for local people, through better sharing of information, so that people need explain their problems only once; intervening early, so that older and disabled people can stay healthy and independent at home, avoiding unnecessary hospital admissions and reducing visits to accident and emergency departments; and delivering care that is centred on the individual, rather than on what the system wants to provide. Examples include NHS and social care staff working together to provide seven-day working, and better data-sharing to ensure that people can leave hospital as soon as they are ready.

The Care Bill includes a duty to provide preventive services; that is exactly the sort of thing that my hon. Friend is advocating for Bradford. That new duty on local authorities is seen by many people as potentially transformative. The White Paper sets out our ambition for health care and support to be organised around the needs of the service user, rather than focusing on organisations and services. We want a reformed system, in which organisations work together to give individuals real control and choice over the care that they receive. Good practice already exists, and we need to learn from and build on that.

I understand that Bradford’s clinical commissioning groups are working with Bradford council to deliver a three-year integration programme, which will cover all the services that help to support people so that they can remain at home, stay in their community, and regain and retain their health, well-being and independence. We want to encourage and support local experimentation, to allow areas to provide integrated care at scale and pace. We are working to support local initiatives and to identify what needs to happen to drive change at the national level. We want to learn what works well and how to overcome barriers, and to pass those lessons on to others.

On 14 May, the national partners in health care and support, including the Department, published a document entitled “Integrated Care and Support: Our Shared Commitment”, which sets out 10 commitments that the national partners have made to enable and encourage change to scale and pace, as well as expectations on local areas in return. The national partners have invited the most ambitious areas to apply to become pioneers and act as exemplars to address local barriers and support the rapid dissemination, promotion and uptake of lessons across the country. The national partners will provide the pioneer sites with dedicated central support to help them to break down barriers to delivering integrated care and support.

It is really exciting that the coalition is acting to end that long, historical divide between health and care services and, indeed, between mental and physical health services. The potential for integrated care, with a focus on prevention, and collaboration between the statutory services provided by the national health service and the local authority and the community, exactly as is happening in Bradford, can provide the early intervention that my hon. Friend discussed, and it can address isolation. He mentioned that pernicious problem. Many people live on their own, and often lead lonely lives and, as he said, both their mental and physical health deteriorates. If we can get the community to support the statutory services, providing companionship and friendship, and giving people a better life, the combination with a much more joined-up service from the statutory services can achieve the breakthrough that he described in his community.

I conclude by applauding the impressive community work in Bradford, which began in one local community, but which has the potential to spread to 20 other local communities. That is exactly what should be done, and with the support of the Care Bill, we can make that a reality, not only in Bradford but across the country.

Question put and agreed to.

Social Care (Bradford East)

Debate between Norman Lamb and David Ward

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.