Care Bill [Lords]

Sarah Wollaston Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I could not agree more. I would guess that disabled people listening to the debate today will be very worried about what they are hearing. The change will restrict support for them, and it is a false economy. If they cannot go out to work, how on earth does that help them or, indeed, anybody? The change will have an impact on disabled people, with some losing their support.

I was going on to make the point that disabled people and older people are already paying much more for care as a result of changes in recent years. As research by my hon. Friend the Member for Leicester West (Liz Kendall) has shown, they are paying almost £740 more a year for vital home case services compared with 2010, up on average by almost £50 a month. That is a hidden cost of living crisis, because who sees that older people have to pay more out of their bank accounts? It goes unnoticed by the media and large parts of society, but the most vulnerable people in society are bearing the brunt.

[Dr Sarah Wollaston (Totnes) (Con)]

I am glad that the right hon. Gentleman has mentioned older people. Does he accept that although health inequalities are very important in setting funding formulas, age is one of the greatest predictors for establishing need? It is absolutely vital to include such factors as age and rurality in deciding funding formulas, and it is precisely to remove the politicisation of such decisions that we are handing them over to another body.

[Andy Burnham]

The hon. Lady must have misunderstood me. I am not saying that age is unimportant; I am saying that age is important, but so is need. In my view, those two must have equal weighting in the system, as they do at the moment. As I understand it, the proposal is to deprioritise need or deprivation as part of the funding formula, which will have the effect of removing funding from communities in which the expectancy for a healthy life is already shortest. I do not believe that that is defensible, and I would be surprised if she found that it was.

[Dr Wollaston]

Will the right hon. Gentleman give way?

[Andy Burnham]

I shall do so once more, but then I must make some progress.

[Dr Wollaston]

The right hon. Gentleman is being generous in giving way. The point is that we are discussing the Care Bill and how need relating to age is the single greatest predictor of someone’s need. I accept that health inequality is a very important factor, but the formula currently does not take enough note of age-based need and multiple long-term conditions.

[Andy Burnham]

I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.

To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.

Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Sefton Central (Bill Esterson), who speaks so compellingly about his family’s experiences and sets out the case for why we must get social care right.

I welcome the Bill. It was a pleasure to serve on the Joint Committee on the Draft Care and Support Bill and I think the legislation has been greatly improved by its passage through that Committee and through the House of Lords. It establishes that we need a social care system that works around the needs of individuals, as well as the well-being principle and the vital prevention principle set out so compellingly by the hon. Member for Sefton Central. The Bill also consolidates a confusing patchwork of legislation that I remember coming up against in my time in the NHS. People were not sure what their eligibility was, and they could move from one part of the country to another and find that they no longer qualified in the way that they used to.

There are many things to welcome in the Bill. The hon. Member for Lewisham East (Heidi Alexander) compellingly set out the effect of losing everything in the ghastly lottery of eligibility. Setting a cap on costs and raising the threshold from that paltry £23,250 to £100,000 is very welcome. So too is the focus on better information, advice and advocacy, and the assessment and better support for carers. My hon. Friend the Member for South Swindon (Mr Buckland) made some important points about child carers and the transition from children’s services to adult services.

There is a huge amount to welcome in the Bill and I could talk for 10 minutes on why all these aspects are important. Unfortunately, we also need to focus on the challenges. The predominant challenge is demographic. Nationally 2.2% of the population are over 85, but in my constituency we got there 31 years ago. By 2020-21 2.9% of the population will be over 85, but for Torbay that figure will be 4.9%. That represents an enormous demographic challenge. We were discussing with the right hon. Member for Leigh (Andy Burnham) the reasons why age is so important in assessing need. Because of their demographics, places such as Torbay and wider south Devon face additional challenges with rurality, which means that they are under pressure like never before. Although I fully understand that we must take into account deprivation and health inequalities, unless we take sufficient account of age and need in assessing the formulae, the system will collapse.

I should point out that Torbay is not only nationally renowned but internationally renowned. As a member of the Health Committee, when we visited Copenhagen and Sweden, I ended up being shown slides of Torbay—how Torbay organises health and social care. If we look at the challenges facing Torbay, we see that it was those demographic and financial challenges that were the driver for looking at how health and social care could be better integrated and—I refer to the experience of the hon. Member for Sefton Central—how avoidable admissions could be reduced. Enormous progress has been made. Waiting times for occupational therapy have been reduced from two weeks to two days, for physiotherapy from eight weeks to 48 hours, and for urgent equipment to help keep people at home from four weeks to four hours. As a result, Torbay has the lowest hospital admission rate for elderly vulnerable people in the whole of the south-west.

[Norman Lamb]

I am grateful to my hon. Friend for giving way. Does she share with me the excitement at the plan for Torbay as a pioneer to bring mental health back into primary care, properly to integrate that part of patient care? We have seen in other places that this can do an enormous amount to prevent a deterioration of health.

[Dr Wollaston]

Absolutely. I welcome the fact that Torbay will be part of one of the integrated care pilots, and particularly that focus on mental health, as my hon. Friend says.

Services in Torbay have been transformed through the use of care co-ordinators, so that only one phone call is necessary. There has been transformational work in sharing information and records and in rapid response to a crisis and putting prevention in place. The challenge that Torbay now faces is financial. Unfortunately, the elastic can stretch only so far before it snaps. Torbay’s funding is set to fall from £71.2 million this financial year to £63.6 million in 2014-15. Those cuts are in addition to the demographic challenges, the challenging situation in relation to children’s services, and the fact that we know that across the country 2015 is set to be a crunch year for NHS funding.

I welcome the £3.8 billion transfer for better care. We heard in the draft Bill Committee and in the Select Committee how such joint funding arrangements are the best driver to integration. A formula for integration cannot be dictated. What works for central London or central Manchester will be very different from what works in south Devon and in rural areas, but the fund will force people to work better together in a way that fits their area. That is very welcome.

[Bill Esterson]

Would the hon. Lady advocate a single service, and has she any thoughts on how that would operate? I am interested to hear her views.

[Dr Wollaston]

Indeed. It operates very well already in Torbay, but it cannot be dictated centrally. We need to get the hurdles out of the way, allow people to work together locally and facilitate that. We heard on the draft Bill Committee that joint funding streams were the best way to move that forward.

Unfortunately, in Torbay in the crunch year 2015 we will see the funding drop below 90% of projected expenditure. At that point, rather than driving further integration, it will cause systems to start to fall apart because people need to protect their own silos. That is a real danger. As the Bill proceeds to Committee, I hope we look very carefully at the effect of the funding gap and make sure that we are not setting a system up to fail. One of the problems with the Bill is that it sets up many new statutory responsibilities. Councils will have to fund care accounts, which will undoubtedly be complex, bureaucratic and subject to challenge. Councils will have responsibilities for carers’ assessments. There will be increasing numbers of eligible people as the thresholds and caps change. We will see safeguarding adults boards, more rights to information and advocacy, and for many, deferred payments, if they have not already been making those.

Once we create these additional statutory responsibilities, there will be less money to go around for the very things that are at heart of the well-being and prevention principle. That is what concerns me. Would it not be a tragedy if we set up carers’ assessments but there was no funding left for services to respond to needs? Voluntary organisations in my community can function incredibly efficiently on very little money. They do not need to be fully funded, but they need some funding. If that money dries up, I worry about how we will move forward with a genuine well-being and prevention principle.

I want the Bill to succeed. In the remaining minutes I shall touch on those aspects that I think are, sadly, still missing, which were recommended by the draft Bill Committee. One is how we calculate care costs according to their actual cost, not the cost to the council. For a person living in their own accommodation, it sometimes costs a great deal more to access support than it would cost a council to provide it. We need to look at that again.

There is a small but important area relating to powers of entry in exceptional circumstances for those who are subject to abuse in their own home. It would be wrong for us to ignore that possibility. Although the overwhelming majority of carers of course do a wonderful job in challenging circumstances, there are occasions, sadly, when people can be at risk from those who love them. Very often that is as a result of the intensely challenging circumstances that carers face. We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily.

Another issue is free social care at the end of life. We know that 73% of people would like to be able to die at home. In my experience working as a GP in rural areas, where that broke down for most people was as a result of a lack of social care, and the challenge of caring for somebody right at the end of their life, when they may, for example, be doubly incontinent. Until people are in that situation, they may not understand how incredibly demanding it is to have to be with someone 24 hours a day, trying to stay awake and provide the intensive support they need. Allowing everybody to access free social care in those terrible final days would be a very important step forward.

Finally, the duty of candour we have introduced for foundation trusts is welcome, but I think that it should be extended to social care.

[Norman Lamb]

It will be.

[Dr Wollaston]

I thank the Minister for that clarification. Also, an offence of wilful neglect already exists with regard to adults who lack capacity, but I would like the Minister to consider extending it with regard to those who have capacity.

We heard earlier about reconfiguration. We need to streamline reconfiguration processes. It is not right that the NHS’s valuable resources should be spent on long, drawn-out and expensive legal challenges. We know that in many cases we need to reconfigure in people’s best interests. Let us take out the party politics and get it right. Let us ensure that people have the right care and that we face the financial challenges in the NHS in a mature fashion.