Adult Social Care

Sarah Newton Excerpts

Thursday 8th March 2012 Commons Chamber

[Sarah Newton (Truro and Falmouth) (Con)]

I beg to move,

That this House believes there is an urgent need to reform the current system of providing and paying for the care of adults in England and Wales; recognises that social care, unlike the NHS, has never been free at the point of need irrespective of income; notes the central role of informal carers in the provision of care; welcomes the Coalition Agreement pledge of reform and legislation; further welcomes the plans for better integration between adult social care services and the NHS; welcomes the extension of personal budgets; urges the Government to ensure that fairness is central to reform, including access to advice, advocacy, assessment of need, care services as well as funding options; recognises the need to break down the barriers to portability; and further urges the Government to publish its White Paper as soon as possible, and to bring forward legislation.

I am pleased that both the care Minister, the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the shadow Health Secretary will be joining us today, and that they have entered into talks to agree a way forward on the reform of our social care system. It is vital that today we show our Front-Bench teams just how much support there is in all parts of this House for their important work. Both teams need to know how important this Parliament feels it is to continue and conclude the talks, so that a White Paper and Bill can be produced as soon as possible.

Today’s debate should also be about our vision: our vision to enable adults living with disability or a chronic illness, or those people who are frail in their later life, to have the support they need to live as full a life in their community as possible. That is something that concerns us all, as it strikes at the heart of the values of our society. There are Members here today who have a lifetime of experience, inside and outside Parliament, tackling the issues we will be discussing today, so I will keep my remarks short to allow their valuable contributions to be made.

Central to this debate is the person who needs care and the people around them supporting them, principally their family members, close friends and neighbours, and the wider community. Of course, care provided by nurses, care workers and other professionals is vital, too. In the few minutes available, I shall focus on the care of the elderly, as colleagues with greater knowledge than I will talk about the care of younger adults, those with chronic illnesses and those living with disabilities. Too often in debates about social care we delve straight into the design details of the services provided by local and national Government. Often, such services were designed many years ago, in response to a very different society, when people died of illnesses and conditions that are now lived with; a society where people lived shorter lives. One of the greatest achievements of the 20th century was a significant increase in life expectancy and the challenge of the 21st century is to respond and to redesign care and support services so that they are fit for this century and the next. That is important not only for the people who need them now but for the young people who have already been born who will make it into the 22nd century.

Let us be honest: if we were designing services to support families who care for their elderly and disabled family members, would we have designed the system we have today? Despite the undoubted good intentions of previous Parliaments, our system has developed in fits and starts since the 1920s. It is disjointed and does not deliver joined-up help for the cared for or for carers and it can be utterly frustrating for care and health professionals.

It has been estimated that a total of £145 billion a year of public money is spent on the elderly in social care, NHS and welfare payments. That is £3,000 for every man, woman and child in this country. It does not appear to me that elderly people and their carers are receiving the quality of services and care that such a sum could provide if it were spent differently and more efficiently.

[Harriett Baldwin (West Worcestershire) (Con)]

Is my hon. Friend going to make the point that this problem will keep on increasing? We are all living longer and one in three girls born today can expect to live to the age of 100.

[Sarah Newton]

Yes. As I mentioned, it is a great achievement that people are living longer, but that will obviously present huge challenges in adapting our society as people live for so much longer.

Unfortunately, growing old or living with an illness or disability is frightening to too many in our country today—frightening both to the people involved and to their loved ones who support them. There is fear about physical and mental frailty, about the quality of care they will receive from the NHS and social services and about whether they will have to pay and how they will afford to do so. We need to alleviate as much of that fear as possible by creating services and a way of paying for them that are fair and easily understood by people of all ages, that deliver high-quality care and support to carers and in which those who are employed feel respected and appreciated.

To achieve that aim requires a vision and a plan that everyone understands. That plan should be fair and should offer a route from where we are today to where we want to be. It will then require all political parties, over a period of time, to implement it. That will deliver the lasting, consistent and sustainable reform that despite many good intentions has eluded all Governments for many years.

I believe that the Government have recognised the challenge and taken a number of steps forward. There is a pledge in the coalition agreement to reform care services and funding and, following the excellent work of the Law Commission and the commission led by Andrew Dilnot, we have been promised a White Paper this spring and a Bill soon after. That process will very much depend on the determination of the Opposition to work constructively with the Government.

The Government have also ensured that while a longer- term solution is found to the current funding issues more money is being given to councils, and they have committed £2 billion. The Health and Social Care Bill will enable the integration of social and health care and, through the health and wellbeing boards, local commissioning of new care pathways will be made possible. I have seen some highly effective piloting work in Cornwall through the “Changing Lives” approach to joined-up services, which is based around the person and their carers.

The Government have launched a carers strategy and a dementia strategy with funding attached, but it is very frustrating that the money provided for those services is not always finding its way to the people who need it most. I am a passionate supporter of localism and returning power from Westminster to people and their communities. I believe that services for people in Cornwall should be designed and delivered in Cornwall, but we must recognise that this is a revolution. Although some professionals in the NHS and councils are relishing the new opportunities, some are not, as many of them have served in these important public services for years and are used to the command and control management of the past. It is difficult for some people to change and these are big cultural changes.

At a time when large-scale efficiency savings are needed in the services that support older people, reform is more important than ever. The nurses, social workers and carers I know are all motivated to deliver a high-quality service but I think Ministers will need to give clear direction about the commissioning of new pathways—new pathways that explicitly deliver integrated and joined-up care and new pathways developed on the evidence from the innovative work being provided not only by doctors, nurses and social workers but in partnership with other organisations such as Age UK, Macmillan and a host of other not-for-profit organisations. Within the new framework of outcomes, new outcomes should enable better integration.

Those new outcomes and pathways will need funding. We know that for every £1 spent on social care, £2.65 is saved from the NHS budget, so not addressing the inefficient split of funding between the NHS and social care will mean that we continue to waste more and more money.

[Mary Macleod (Brentford and Isleworth) (Con)]

On funding, does my hon. Friend agree that we should look at having more respite care for carers, especially elderly carers, some of whom do a 24/7 job and need extra support?

[Sarah Newton]

My hon. Friend makes a very good point, which has been addressed in the carers strategy.

Each year we should aim to use more NHS money on social care, and more money from the NHS budget could be given to councils for the integration of services led by health and wellbeing boards. Eventually, I would like to see the pooling of budgets. Social care has never been free at the point of need, and we know that the NHS will always be free at the point of need irrespective of anybody’s ability to pay. That is enshrined in the Health and Social Care Bill. Despite that, however, most people do not think they will have to pay for care and it can come as a dreadful shock, especially to the one in 10 people aged over 65 who end up paying more than £100,000 for care. Dilnot came up with a framework of shared and capped costs for individuals needing social care—shared costs between the individual and the state. I am sure that framework is receiving a great deal of attention from the Front-Bench teams, but I expect that however well the cross-party talks are going, it will take several years to introduce such a system if agreement can be reached. In the mean time, there is an urgent need to design a fairer system based on shared responsibility to pay.

There are uncontroversial steps that would not require substantial new resources and that could be taken now as part of a longer term plan. The legal framework and assessment processes that are used to decide who is entitled to what help could be sorted. We also need to fix the means test that we use to decide what we expect people to pay. That would help families to understand what help will be available and who needs to pay for what. Families would then be able to plan accordingly. The Government could ensure that people had access to independent advice on the best way of planning and paying for care and they could bring in a universal deferred payment scheme that would tackle the issue that so many people dread—selling their home to pay for residential care during their lifetime.

[Margot James (Stourbridge) (Con)]

I congratulate my hon. Friend on securing this debate and on all the work she does on this issue. Under the present system, people do have to sell their homes sometimes; does she agree that in such cases it would be far better if some of the accommodation were available to purchase on a leasehold basis so that the individual would still have an asset to pass on?

[Sarah Newton]

That is an extremely interesting idea, and I would expect no less from someone with such knowledge in this area. I am sure the Minister will want to take that point on board.

Going back to means-testing, we really need to face up to one of the biggest problems facing families—the meanest of means tests in this country: the test for residential care. Making the simple change of raising the upper threshold of the means test to £100,000 would benefit those on modest incomes who are heavily penalised under the current system. It would enable families who have worked hard all their lives and accumulated relatively modest assets—often the first generation of their family to do so—to have something to pass on to their children and grandchildren. It is an understandable and human desire to want to help the next generation. That change would cost £100 million. In this economic climate, such a figure might be too much all at once, but a staged increase in the upper limit would be a step in the right direction.

We are taking this approach to delivering the excellent policy of increasing the personal allowance for taxpayers to £10,000. Apart from spending NHS money more efficiently, there are other sound economic reasons for redirecting public money into social care. While the vast majority of care is given freely, more than 1.5 million people are employed in providing care. We need to recognise better the valuable and challenging work they do. I know that the Minister is doing good work on training and quality standards. Many care workers are paid low wages, so investment in this sector would have the direct impact of putting more money into the pockets of some of the poorest paid workers.

We also need to enable more working age informal carers to combine their caring responsibilities with paid employment. This is even more important as the pension age rises. Much emphasis is put on enabling working age parents to care for their children and remain in paid employment—with flexible working, help with child care costs and financial support through the tax system. We need to put as much emphasis on enabling working age people with other caring responsibilities to remain in employment. Otherwise, we are going to have ever-increasing out-of-work benefit costs to pay.

While I do believe that the Government are starting to develop the processes that could deliver better and fairer access to services and higher quality care, bolder and more determined action is needed to enable more rapid change. I hope that the Minister and the shadow Secretary of State for Health will listen carefully today and bring back to Parliament a shared vision and a clear plan on how together we as a country and as a society are going to create a good place for us all to grow old in.

--- Later in debate ---

[Andy Burnham]

That is absolutely the point. This is not responsible capitalism; it is the worst kind of capitalism—making money by leaving vulnerable people unsupported and, as my hon. Friend says, taking advantage of the commitment and vocation of those on the front line, who will not walk away from the people they care for. It is unacceptable to not pay them and let them buy their own equipment, and to make profits off the back of that kind of behaviour.

[Sarah Newton]

I hesitate to intervene because it is important that the many Back Benchers who are here today are able to share their views. However, although none of us could support the appalling situation that the right hon. Gentleman described, he will be aware that the commissioner—the local authority—has a responsibility for the quality of the service. If he is concerned about it—I would be absolutely furious if I were the local Member of Parliament—he can take it up with the council so that the contract can be cancelled, and ultimately refer it to the Care Quality Commission.

--- Later in debate ---

[Sarah Newton]

This has been an excellent debate in the breadth and depth of its contributions. We have seen the experience, passion and commitment of Members from all parts of the House.

In particular, I thank the hon. Member for Worsley and Eccles South (Barbara Keeley), with whom I work in the all-party parliamentary group on social care. The contributions have been wide-ranging. We have heard from my hon. Friend the Member for South Derbyshire (Heather Wheeler), the hon. Member for Blaenau Gwent (Nick Smith), my hon. Friend the Member for Kingswood (Chris Skidmore), the hon. Member for Mansfield (Sir Alan Meale), my hon. Friends the Members for Southport (John Pugh) and for Banbury (Tony Baldry), the hon. Member for Luton North (Kelvin Hopkins), my hon. Friends the Members for Congleton (Fiona Bruce), for South Thanet (Laura Sandys), for South Northamptonshire (Andrea Leadsom) and for Totnes (Dr Wollaston), and our famous rear gunners, my hon. Friends the Members for Hexham (Guy Opperman) and for South Swindon (Mr Buckland).

There can be no doubt from this debate about the cross-party support for delivering a re-engineered care system for the people who need care and for our vital carers. The system needs to be shaped around the person who needs care and their carers. I wish the Government and Opposition teams good fortune in their vital work to negotiate a new system for providing and funding care, so that we can all be proud to have created a society that we all want to grow old in.

Question put and agreed to.

Resolved,

That this House believes there is an urgent need to reform the current system of providing and paying for the care of adults in England and Wales; recognises that social care, unlike the NHS, has never been free at the point of need irrespective of income; notes the central role of informal carers in the provision of care; welcomes the Coalition Agreement pledge of reform and legislation; further welcomes the plans for better integration between adult social care services and the NHS; welcomes the extension of personal budgets; urges the Government to ensure that fairness is central to reform, including access to advice, advocacy, assessment of need, care services as well as funding options; recognises the need to break down the barriers to portability; and further urges the Government to publish its White Paper as soon as possible, and to bring forward legislation.