Social Care Reform (Disabled People)

Debate between Norman Lamb and Heather Wheeler

Thursday 11th July 2013 Westminster Hall

[Heather Wheeler (South Derbyshire) (Con)]

It is a pleasure to serve under your chairmanship, Ms Clark.

I warmly welcome this Back-Bench debate, which allows us the opportunity to discuss the findings of the joint all-party group’s important report on social care reform for working-age disabled people. I congratulate my colleague, the hon. Member for Bradford East (Mr Ward), on securing the debate, and it is a pleasure to follow him.

I take a moment to thank the right hon. Member for Stirling (Mrs McGuire), the Baroness Campbell of Surbiton and the all-party disability group for joining me and the all-party local government group in writing our report, “Promoting Independence, Preventing Crisis”. I also thank Scope for all its superb help in facilitating the inquiry.

Social care reform is a cross-party concern and provides a clear example, notwithstanding what has recently been splashed across the media, of how all-party groups do good work in Parliament. I applaud the Government’s commitment to investment in social care, which they set out in the 2013-15 spending review—£3.8 billion is not a small sum. As our joint inquiry underlined, the social care system has faced decades of underfunding, and the Government’s understanding of the need to address the problem effectively should be recognised.

It was extremely important to me to be involved in the all-party group’s inquiry. For the first time, we managed to bring together the voices of working-age disabled people with those of local authorities. That represented a valuable and timely opportunity to continue to build on the Government’s positive vision for social change, and to develop the positive disability strategy, “Fulfilling potential: making it happen”.

We want to bring the focus of social care on to working-age disabled people. I praise the Government’s ambition to deliver a care system that is capable of meeting the needs of both the older population and working-age disabled people. The plans to improve integration and closer working between health and social care bodies have been a positive development. However, in the Chancellor’s speech on the spending review no reference was made specifically to the one third of care users who are working-age disabled people. I hope that the Minister will confirm the Government’s commitment that the purpose of moving the money from the NHS to local government was to meet not only older people’s needs but those of disabled people of working age. We must ensure that this group remains in the spotlight when reforming the care system.

I want to reiterate the importance of addressing the national eligibility criteria that my hon. Friend the Member for Bradford East raised. Despite the intention that the current fair access to care services criteria should be a broadly national framework, councils have considerable leeway in setting the threshold for eligibility. That has resulted in significant variation throughout the country. Moreover, councils have been tightening their own local eligibility criteria in response to budget pressures. That is completely understandable, but the implications are that people are living with the fear that they will lose their support. The new eligibility framework and national threshold proposed in the Care Bill will therefore go a long way towards alleviating the lottery of care, and will be vital in ensuring more clarity and consistency in the provision of care for disabled people in England.

The Government published the draft regulations for the national eligibility threshold on 28 June and confirmed in the accompanying document their intention to set the threshold at a level equivalent to “substantial” in the current FACS system. People tell us that that means that, for more than 100,000 working-age disabled people, the bar has been set too high to receive the care and support they need to live independent lives. I hope that the Minister will respond to that.

[Norman Lamb]

I reiterate that the proposed eligibility level set out in the document to which my hon. Friend referred would maintain for the vast majority of people what already exists within their local authority area and, as my hon. Friend the Member for Bradford East (Mr Ward) said, do absolutely nothing to prevent other authorities that choose to be more generous from maintaining that level at “moderate”, as currently exists in Bradford and about 15 other places around the country. Nothing will take away from anyone what they already have as an entitlement.

[Heather Wheeler]

I thank the Minister for his intervention.

I turn to what social care means to our constituents when real help is given. It means that someone can get up, and be washed, dressed and fed each morning. Those are basic, everyday actions that many of us take for granted. When that level of support is offered comprehensively, the person may hold down not only genuine social interaction but employment. Real social care may also prevent social isolation. For example, a member of the National Ankylosing Spondylitis Society has said:

“I feel overly tired most days. Outside of work my participation in activities has been reducing. I don’t spend as much time as I used to socialising with friends and family. I used to be very active and go out in the evenings but now I have early nights instead.”

It is brilliant that, with help, that person feels able to remain in the work force, but we must ensure that the care offered is not at the cost of other factors, such as mental health or well-being.

Well-being is an unambiguous concern of the Government and is clearly addressed through the well-being principle in clause 1 of the Care Bill. That reflects the fact that it is, first and foremost, a human issue. The principle is the thread that runs through the whole of the Bill and ensures that the care system not only delivers basic support but promotes disabled people’s independence, allowing them to realise their potential by participating more fully in their communities. That is a bold vision for the future and will truly revolutionise the care system.

It has been stated that for some people social care means

“being able to have the same aspirations as others. I hold down a job, live independently and I am able to live life in the way that I choose. I believe this is a fundamental right, but it has also given me an immense sense of freedom and satisfaction as I am able to contribute to society.”

Those great quotes come from our inquiry.

Well-being and independence also means providing support when an individual moves from one local authority area to another. The Care Bill should ensure that the receiving authority has a duty to ensure that any social care provision for an individual will ensure the same outcomes as those of their previous local authority. I stress to the Minister the importance of that portability factor to our constituents. They live in a mobile world.

A preventative social care system not only has benefits for the quality of care and the lives of disabled people but represents a financially sustainable approach for the future. In addressing the concern about the eligibility threshold, local authorities will be in a position to deliver appropriate care at an earlier stage, reducing escalation of the crisis. As the British Red Cross told the all-party group’s inquiry:

“There must be a dramatic rethink to the way social care is organised in the future, with a focus on preventing crises before they occur and keeping people independent for as long as possible.”

Without a truly preventative system, councils will have no choice other than to intervene at crisis points when the personal and financial costs are already too great. The former president of the Association of Directors of Adult Social Services, Sarah Pickup, told the inquiry:

“Prevention is one of the very few things where you can get both a better outcome and a reduced cost.”

The Government have recognised that local authorities are delivering innovative solutions in social care provision, and have rightly chosen health and wellbeing boards as the mechanism through which social care can be delivered effectively. The boards have been implemented fully since April 2013. The Health and Social Care Act 2012 mandates a minimum membership consisting of one local elected representative, a representative of the local healthwatch organisation, a representative of each local clinical commissioning group, the local authority director of adult social services, the local authority director of children’s services and, crucially, the director of public health for the local authority. That will ensure a wide range of views and experience on the boards and will help with the implementation of preventative social care.

If the Government fully resource local authorities to implement preventative social care, the financial returns to local authorities, national Government and the NHS will be significant. Deloitte’s economic modelling in Scope’s report, “Ending the other care crisis”, has shown that a £1.2 billion investment in establishing a lower national eligibility threshold would lead to a £700 million saving for the Government and a £570 million saving for local authorities and the NHS. That is care and compassion at a better net price for the nation.

In addition, that money must be available to be used for care services within communities that are not exclusively health focused such as housing and employment. Such support would aid many disabled people in actively contributing to society as independent, participating, tax-paying citizens. As Sue Brown, head of policy at Sense, told our inquiry, the employment market currently risks losing out on the contributions that disabled people can make. That is the crux of the debate; we want to get disabled people living the lives that they want to lead, and being as independent and as self-sufficient as possible. Not only do they benefit from that, but the economy benefits too.

The National Autistic Society told me that new economic modelling by Deloitte published earlier this month shows that for every £1 invested in support for people with autism—and other disabilities—who have moderate needs, returns of £1.30 are generated. As the Government have rightly recognised, social care is not merely about allowing people to survive; rather, it is about enabling them to live full and independent lives. The Bill explicitly places a duty on local authorities to provide care that promotes the well-being of individuals. Let us now establish that the regulations fulfil the Government’s ambition and ensure that more than 100,000 disabled people with significant needs can live full, varied lives, with the basic dignity that we all take for granted.

To reiterate—and to be absolutely clear—I feel that the care provisions that we put in place need to be standardised between local authorities in order to promote portability. Those affected by the provisions are the most vulnerable in society. We do not want to make moving house an ordeal for people, with tensions and stresses about the level of care that they can expect to receive in the new area. Before the excellent changes to this groundbreaking, joined-up government measure can be implemented, we would like to ensure that a proper impact assessment is undertaken. We would like any administration costs, or other associated costs, to be known to local authorities before implementation. We want to ensure that costs do not force the most vulnerable in society to be left behind, because of new bureaucratic layers imposed on local government.

In conclusion, the Care Bill is a significant, welcome step in the right direction that acknowledges that reforms need to be made. Provided that they are properly resourced and supported, local authorities, working with the NHS, now have the opportunity to demonstrate their considerable experience of delivering social care in a financially sustainable manner. Funding preventative social care in the manner that the report recommends represents a win-win situation for the Government. I look forward to the Minister confirming the new way of working, by recognising that budgets between the NHS and local government, as announced in the recent spending review, will be used, not only for the elderly, but for working-age disabled people. Thank you, Ms Clark.