Adult Social Care

Paul Burstow Excerpts

Monday 16th July 2012 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

Let me begin by striking a note of agreement between Government and Opposition, before moving on to the areas where we disagree. I agree with the hon. Member for Leicester West (Liz Kendall) that our debates about our ageing society are too often couched in terms of burdens and impacts on public expenditure, when they should be a cause for celebration as we have more people living longer and living healthier for longer. That stands as a tribute to our national health service, our local authorities and many others besides.

I sat in the House for 13 years in opposition to a Labour Government, and it became very clear to me that, despite the wealth of the nation being much greater at that time than it is now, the Labour party was not willing to tackle the pressing need for serious systemic reform of social care. I shall talk in a moment about the Labour Government’s last-minute moves to address that agenda.

Social care is Bevan’s orphan. It was left over after the NHS was established in the 1940s, and it has suffered ever since. It has been hidden behind its favoured sibling, the national health service, out of sight until life takes a turn and tips people into crisis. Social care’s founding principles date back to the Poor Law; it was a poor relation to the NHS, ripe for reform, but neglected for decades.

Much of last week’s reporting about the Secretary of State’s statement in the House and the publication of the White Paper and draft Bill gave the impression that the only subject that was talked about was who pays for care—where the line is drawn between what an individual personally is responsible for in meeting their care costs and what costs the state would pick up. The Government do not dispute that that is an important issue, and we have made significant progress on that agenda, but it is not enough simply to redraw the boundary between personal responsibility and state support, because the system of social care in England is undoubtedly broken.

Given that there were 13 years of Labour inaction, the hon. Member for Leicester West must face up to some of the challenges in respect of social care. A White Paper finally emerged in the dying days of the last Labour Government; it was published on 30 March, just seven days before a general election was called. That is not good enough; it is too little too late. What did that White Paper say? It talked about national eligibility, but when? It was by 2015, so it was going to take Labour five years to introduce that change. On portability, it did not commit to ensuring that support would be provided immediately in the area to which the person was moving. In other words, there was still a risk of interruptions. In addition, that Labour White Paper said nothing about the rights of carers. The hon. Member for Leicester West was absolutely wrong when she told the House that Labour was responsible for introducing carers legislation. Back-Bench Members in this House, tirelessly arguing the case, were responsible—[Interruption.] Labour, Conservative and Liberal Democrat Members supported those many measures over a number of years, but none came from the Front-Bench and none came from the Labour Government.

[Hugh Bayley (York Central) (Lab)]

I would like to get back to the issue in hand and call a spade a spade. The only substantial asset that most families have to pass on to their children and grandchildren is the home they live in. If the Government want a new inheritance tax, would it not be fairer to levy it at the same percentage rate on rich and poor alike, and not simply target those people who have the misfortune to fall ill at the end of their life?

[Paul Burstow]

I will come in a moment to our response to the Dilnot commission recommendations, so I will deal with the hon. Gentleman’s point at the right time.

[Hugh Bayley]

Now would not be bad.

[Paul Burstow]

No, I am talking about the time at which in the sequence of my speech I will make the point about the Dilnot commission recommendations.

I wish to make one other observation on the national care service White Paper that the Labour Government published seven days before the last general election was called. Our White Paper addresses the end-of-life care issues, but Labour’s failed to address them.

[Mr David Anderson (Blaydon) (Lab)]

The Minister is rightly critical of the failure of the previous Government to bring in care for the people of England. Does he support what was done in Scotland by the previous Government?

--- Later in debate ---

[Paul Burstow]

I am not certain which thing the hon. Gentleman is inviting me to support. Many measures were introduced by the coalition Government in Scotland over a number of years to reform the social services system in Scotland, not least some relating to adult safeguarding which this Government are now making progress on.

[Andy Burnham (Leigh) (Lab)]

I think that the Minister has unfairly misrepresented the process we went through in the last Parliament. We did not just have a White Paper before the general election. We had a Green Paper in the summer of 2009, and the whole process was kicked off in the 2007 spending review. Upon a request from the then shadow Health Secretary, I agreed to cross-party talks. So the Minister is unfair in saying that nothing was done and then a rabbit was produced from the hat. May I say to him that the White Paper that I produced before the election addressed both service reform and funding? I am afraid that the same could not be said of the White Paper that emerged last week.

[Paul Burstow]

That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

[Mark Field (Cities of London and Westminster) (Con)]

Does the Minister not recognise that any cap, be it at £35,000 or £60,000, as was initially proposed by Dilnot, is likely within a very short time to be wholly inadequate, given the funding constraints that we are under? The harsh reality is that people who wish to preserve an inheritance for their children—that is an understandable desire—must recognise, as must their children, that those children will have to take on the burden of looking after aged parents, in both time and financial terms. It sounds like a hard truth, but it needs to be put on the record, because otherwise we are not going to get any further forward in dealing with this matter.

--- Later in debate ---

[Paul Burstow]

The hon. Gentleman expresses an opinion that is held by many people, but the Government’s position is not to take that view. We take the view that a cap on care costs is an important component in a redesigned system for funding in this country. What we have said clearly is that we have to address how that is paid for as part of a spending review. That is why we believe that both a cap and an increase in the means-test threshold provides the necessary assurance for a family to plan and prepare for care, and provides the mechanisms by which the financial services industry can grow and develop to offer appropriate products.

[Mark Field]

Is there not a problem with what the Minister has said? I understand that this is an incredibly difficult issue, which we all have to deal with. I have lost both my parents. One died at the age of 70, only 18 months ago, at a time when we were on the cusp of putting her into full-time care, which would have been ruinously expensive. Is not the problem with all this that if we put in place today any system with a fixed cap, it will almost certainly be superseded by events and will then be seen as unjust for future generations?

[Paul Burstow]

The hon. Gentleman identifies one of the issues associated with the design of the introduction of a cap. It is worth pointing out that the interaction between the cap and the means-test threshold means that every family would have a different level for which they would be liable to meet their care costs. The issues relating to design are real, as are those about how to meter the system from the point someone enters it, and they require detailed work as part of the design of an effective implementation alongside the costings of it.

[Hugh Bayley]

The hon. Member for Cities of London and Westminster (Mark Field) is right to identify that there is a link between inheritance and the high cost of end-of-life care for people. May I put it to the Minister that if there is a cap of £100,000, the entire inheritance could be wiped out for a family who have a modest home in the north of England, whereas somebody living in a home worth 10 times as much in southern England would still maintain a large proportion to pass on?

[Paul Burstow]

That is why we have to explain this clearly. By lifting the means-test threshold to £100,000, the interaction between the absolute cap and the means test means that the amount the individual will ultimately pay as their lifetime contribution towards their care costs is related to their wealth. I urge the hon. Gentleman again to look at both the tables and the graphs in the progress report, as he will see exactly how it protects the assets of a family, even in the scenario he has described.

It is also important to understand that redrawing the boundary between what the individual pays and what the state pays does not—things all too often were conflated in this way last week—add any new spending power to the system. That leads me to the question of getting funding into the system. Before the 2010 spending review, the Dilnot commission urged the Government to protect baseline funding for social care, and we did just that. In October 2010, we confirmed an extra £7.2 billion of support for adult social care, which, together with a programme of efficiency, was sufficient to protect access to support. That included an unprecedented £4.2 billion of NHS resources to support social care, to promote integration and innovation, and to support the expansion of reablement services. The Labour party wants to paint a picture of doom and gloom up and down England on these services, tarring every council with the same brush of being crude cutters of services, when that is not the case.

[Kate Green (Stretford and Urmston) (Lab)]

Perhaps I could describe to the Minister what is happening in Trafford, which has a Conservative council and is where my constituency is located. We are seeing a twin squeeze, despite the Minister’s apparent sanguinity about the funding. On the one hand, we are seeing thresholds for access to care being raised as a means of rationing the way in which the money is spent. On the other hand, as care providers are telling me, commissioners are reducing and reducing the price they are prepared to pay providers to the point where they can hardly sustain their business at all or meet minimum wage legislation.

[Paul Burstow]

We know from the surveys that although last year there was a cash freeze in the increases that local authorities paid to provider organisations, this year across the country the average was a 1.4% increase. Again, that does not quite tally with the picture that some hon. Members want to paint.

It is also worth saying that the picture of local authorities grappling with tough budget settlements is complex. Different councils are responding to the pressures on budgets in different ways. Some are acting in a very smart way, as the Demos report, “Coping with the Cuts”, revealed. Such councils are protecting access by focusing on reablement services, helping more people to get back on their feet without the need for long-term support, which is better for the individual and more cost-effective. Indeed, the latest figures from the Association of Directors of Adult Social Services reveal that councils are protecting front-line care.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Would the Minister agree to look closely at the report of the all-party local government group on social care, published today? It makes it very clear that a funding gap still exists and recommends that NHS money should be used to plug that gap. Will the Minister commit to continuing to do that and to considering the other recommendations in the report?

[Paul Burstow]

Obviously, I will happily look at the report and I look forward to meeting the all-party group to discuss its findings and recommendations later.

I want to report to the House the findings of the ADASS survey, which was published recently. Last year’s survey found that for every pound saved by local authorities in social care, 69p came through greater efficiency. This year, it found that that had risen to 77p in every pound. Yes, some councils are cutting services, and last year 23p in every pound that councils saved came from service reductions, but this year that figure is just 13p in every pound. Local authorities are getting smarter in organising their services, so I want to pay tribute to those councils and councillors who have worked hard with service users, carers and providers to protect services to make the best possible use of the extra money the Government have provided. As a result, between last year and this year, council budget spend on social services has gone down by just 1%.

[Sheila Gilmore (Edinburgh East) (Lab)]

On the question of efficiencies, would the Minister include councils that tendered a service and made a saving, but to the detriment of the end user of the service? That is how we got to the 15-minute, short-term care options. Is that an efficiency or a cut in service?

[Paul Burstow]

When there is a crude race to the bottom and contracting is by the minute simply to ration access to the service, resulting in a care home provider or home care provider delivering care on a very time-and-task oriented basis, that is totally unacceptable. We know that in places such as Wiltshire, where home care services are organised on an outcomes basis, that is delivering better results for the service users and releasing resources to reinvest in services.

[Richard Fuller]

When I intervened earlier, Mr Deputy Speaker, I forgot to refer hon. Members to my entry in the Register of Members’ Financial Interests as the director of two care companies.

The Minister is absolutely right to say that there is a patchwork of responses from local authorities. I absolutely welcome the end of per minute billing, which is a tremendous step forward, but I draw the Minister’s attention to the comments made by the hon. Member for Stretford and Urmston (Kate Green). She talked about the pressures of meeting the minimum wage and the pressures that local councils are putting providers through. The Government must consider that issue, because there is exploitation in some areas. As businesses and charities try to meet the requirements local councils are putting on them, workers are finding it difficult to achieve a sustainable wage in providing care services.

[Paul Burstow]

My hon. Friend is absolutely right to highlight that issue, which the Low Pay Commission has commented on over a number of years, including before this Government came into office. In our White Paper, we make it very clear that local authorities, as the commissioners of such services, must be mindful of their responsibilities in ensuring that the resources they provide to providers are sufficient to allow them to fulfil their legal obligations.

[Heidi Alexander (Lewisham East) (Lab)]

The Minister talks about the financial pressures faced by local authorities in providing care to elderly and disabled residents, but is he aware that the cost to local authorities of self-funders who have to fall back on the state is in the region of £1 billion a year? Does he agree that that is a very unpredictable thing for local authorities to deal with? What proposals does he have to help local authorities in that regard?

[Paul Burstow]

I am grateful to the hon. Lady for her question, because it allows me to talk about some of the points I think will directly address it. Reform of our care and support system is about more than just who pays for care; it is also about some other very important issues. A central proposition in the White Paper we published last week concerns the move from a service focused on managing crisis, and often not doing so very well, to one focused on supporting people’s well-being by concentrating on early intervention and prevention. That is why, alongside the White Paper, we published a draft Bill that will underpin the reforms we intend to make, consolidating, simplifying and modernising the legislation. The Bill sets out for the first time in statute some very clear governing principles about how decisions are made in social care, focusing on people’s well-being and living by the idea set out by our first White Paper in government of “No decision about me, without me”.

The Bill sets out a number of important changes that go to the heart of people being able to plan, prepare and have proper choice about the care available to them. First, it makes it a requirement for local authorities to ensure that there is a universal offer of information and advice so that people can plan and prepare. Secondly, it requires for the first time local authorities to focus on prevention. Thirdly, it requires a sufficiency of quality care so that choice is available to people locally. Fourthly, it requires integration and co-operation not just between the NHS and social care but between those agencies and housing.

The Bill will not only do that; it will simplify the point of entry into the state system. It will ensure consistent national eligibility and, for the first time in Government legislation, will ensure that there are rights for carers not just to an assessment of their needs but to support for those needs. It will also deal with the often mentioned issue of protection from disruption when people move from one part of the country to another or when a child moves from children’s services to adult services. It will guarantee continuity of services, which is not currently provided for.

Personal budgets, which were started by the Opposition but have not stuck well because of the legal framework, will for the first time be given a clear legal basis. I am delighted to say that whereas when this Government came to office in 2010 we inherited 168,000 people receiving personal budgets, by March of this year 432,000 people were benefiting from them. There will also be clear legal duties on the NHS, police and councils to safeguard people.

At the heart of our White Paper reforms is the notion that we need less variability on quality, to ensure that providers are responsible for driving up quality and accountable for doing just that, and to have more and open information about the quality of provision. That is why our provider quality profiles will provide that information in a way that will allow people to compare and rate providers for the first time and why we are putting an extra £32.5 million in to support those services.

[Andy Burnham]

The Minister is mentioning the things in the White Paper that he will ask councils to do. Can he give us a figure tonight for how much the Government have estimated that the cost to councils will be of providing all those things and tell us how councils will pay for it?

[Paul Burstow]

I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

[Andrew George (St Ives) (LD)]

I am grateful to my hon. Friend for his remarks. I hope I am not taking him back too far, but given that he is talking about the integration of services, particularly among authorities, and implying the portability of assessments for those with care packages, will he comment on the extent to which the Local Government Association has approved and supported the proposals in the Government’s White Paper?

[Paul Burstow]

On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

[Jim Shannon (Strangford) (DUP)]

The Minister has used the term “integration” several times. In Northern Ireland we have an integrated health and social care system, which is working extremely well. I am conscious that that is very different from the position on the mainland. Are there lessons from the integrated system in Northern Ireland that could be applied here? We have done it well in Northern Ireland. Perhaps the example could be used here.

[Paul Burstow]

From my own limited study of the system and from visits that I have made over the years, one of the conclusions that I would draw, which is at the heart of our reforms as well, relates to culture and collaborative behaviour across the various parts of the system. That has been essential to delivering genuinely integrated care in some parts of Northern Ireland. I believe it is essential to delivering genuinely integrated care in England as well.

I mentioned earlier that end-of-life care was an omission from the Labour Government’s last White Paper. It has not been omitted from ours. We are doubling the budget of the pilots that we have instituted to test the patient funding mechanisms and to make sure that we have the necessary data to understand the benefits of a free social care system at end of life. We want to make it clear that we see the merits of such a change, and it is why we want to make sure that we have the information on which we can base the final decision.

Our goal is to shift the focus of the system to prevention and early intervention, not to wait for the system to stutter into life when a crisis strikes. We want to make it easier for people to plan and prepare, both to avoid and reduce the need for care and to meet the need for care in the first place. Last week we laid out a reform agenda of universal information and advice, national eligibility, deferred payments, integration of health, housing and social care, better transition for children to adult services, and support for carers. Together those constitute the most comprehensive overhaul of adult social care in 60 years, and they are a contrast to the motion before us, which adds nothing, says nothing about how change will be paid for, and says all that it can to scare people about the current system.

Rather like 13 years of a Labour Government, today’s motion gets us nowhere. That is why we are investing an extra £300 million in the system to support change, and why I urge my right hon. and hon. Friends to vote against the motion.

[Several hon. Members]

rose—