Care Bill [Lords]

Sheila Gilmore Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right. This Bill promises far-off help for people while services are getting worse right now, because the Government have failed to address the crisis in local government’s ability to fund social care.

[Sheila Gilmore (Edinburgh East) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

I shall in a moment.

What are the direct and practical effects of those cuts to council budgets? First, councils have cut eligibility criteria, so more people are exposed to care charges in a way that they were not before. Secondly, those care charges are now rising above inflation year on year, so more people are exposed to higher charges. This means that they are now more likely to pay right up to the new cap that the Government are introducing. That will not feel like progress to the public, and that is why we are making our reasoned objection to the Bill.

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[Mrs Anne McGuire (Stirling) (Lab)]

For reasons that might become clear later, I am pleased to follow the hon. Member for Bradford East (Mr Ward). Before the hon. Member for Pudsey (Stuart Andrew) drifts away, let me say that his contribution helped to address some of the issues of transition, which can sometimes get lost in this debate.

We should recognise that this issue is not unique to the United Kingdom; it is a challenge that many countries face, and the hon. Member for Arfon (Hywel Williams) recognised that, even within the United Kingdom, the devolved Administrations are looking at how to develop their own social care policies in the context of their own nations.

I want to recognise, as some of my hon. Friends have done, that the Bill makes some progress, but I also want to assert our right to highlight the areas where we think it is failing. That is the justification for the reasoned amendment. We could get bogged down in parliamentary procedure here, but I think it is the right of the Opposition to highlight major issues that we think should have been addressed without undermining our support for the principle of the Bill. I hope that those who think that we are being churlish will think again. It is the right route for an Opposition. Talking about being churlish, let me put it on the record that I have rarely heard an opening statement from a Secretary of State, moving the Second Reading of one of his flagship Bills, that was so churlish, so partisan and, frankly, so disagreeable.

For understandable reasons, the debate on social care often focuses on older people, yet as we have heard—from the right hon. Member for Sutton and Cheam (Paul Burstow) as well as from the hon. Member for Bradford East—a third of those who receive social care are actually working age disabled people. We sometimes overlook their needs, rights and aspirations within the wider debate. Too often “social care” and “elderly” go together, and we need to get ourselves out of that mindset, because although they look the same, I think we would all agree that a younger person’s need for support can be quite different from the support needs of those who are older. The emphasis on older people means that the terms of the debate are often not as relevant as they might be to younger people who require social care. They often want to combine that social care with a life that includes work, education and so forth, and they potentially have a different pace and pattern of life from that of older people.

It was to highlight these issues that the all-party groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler) as chair of the all-party group on local government, and Baroness Campbell of Surbiton and myself as joint chairs of the all-party group on disability, were delighted when 10 parliamentarians of all parties from both Houses agreed to undertake an independent inquiry. The hon. Member for Bradford East was involved in that.

That report was lodged earlier this year and I trust that the Minister and my own Front-Bench colleagues have had the opportunity to consider its recommendations. What came out from all the evidence from disabled people, organisations and professionals was that the current system is not delivering on basic things such as washing, dressing and getting out of the house for many younger disabled people. If social care is to mean anything to the lives of the disabled working adult, it should be underpinned by a real recognition of the importance of an independent life. So the criteria of what is important should also include how the care dovetails into other important elements of daily life such as participation in work or education.

I acknowledge that in clause 1 the Government have recognised that promoting individual well-being is not just about care. They also recognise that it is about

“participation in work, education, training or recreation”

and

“social and economic well-being”

and

“domestic, family and personal relationships”.

However, those ambitions will not be realised unless the issue of eligibility is properly recognised and the substantial anticipated savings highlighted in clause 2 creating a preventive care system will not happen either. I fear that the national eligibility threshold in the Bill is currently set too high. In Committee in the other place, that was recognised by peers from all parties and none. It will shut out 105,000 disabled people from social care and prevent them from living independent lives with dignity.

Councils are now moving at a rate of knots towards providing social care only to those with critical or substantial needs. We cannot divorce what is happening in social care from some of the other changes the Government are introducing. We are moving towards substantial care in terms of social needs and we are withdrawing disability living allowance from people with less complex needs. We are perhaps moving to a situation where those with severe and complex needs will be taken care of and supported while those with fewer needs will not be, so there will be a double-whammy in terms of social care and the DLA transfer.

I recognise that the Government have transferred some £2 billion from the NHS into social care and into making the transition easier, but this cannot be seen outwith the context of a 33% cut in local councils’ budgets by 2014 and the chronic long-term underfunding of the social care system. Over the past three years, £2.68 billion has been cut from adult social care budgets, which is 20% of net spending, but the number of working-age disabled people needing care is projected to rise by 9.2% and the number of older people needing care will rise by 21% between 2010 and 2020.

[Sheila Gilmore]

On my right hon. Friend’s list of changes affecting people needing care, does she agree there is also the issue of the independent living fund which has helped working-age people? The Government have lost a court case in respect of their failure to consult properly on that. Does my hon. Friend agree that that should be looked at carefully?

[Mrs McGuire]

I agree with my hon. Friend and I raised that with the Minister in a Westminster Hall debate. The Care Bill does not address the role that the Department for Work and Pensions plays in supporting social care through the benefit system and the independent living fund is a classic example of that. At present, people who can pay for social care through access to the ILF do not know quite what is happening, because the Minister—as I think he said last week at the all-party group—is still considering his options.

I want to echo a comment by the hon. Member for Bradford East—I can assure him that he will not get so many mentions in any of my speeches again. He pointed to something that I think is often missed, which is that the debate often crystallises around the spend, which is not seen as an investment. I acknowledge the work done by Scope, and carried out by Deloitte, highlighting that for every £1 invested in care for disabled people with moderate needs a saving of £1.30 is generated. The figures are pretty staggering. There would be a £700 million saving to central Government through an increase in tax revenue and a reduction in welfare spending. This Government always tell us that they want to reduce welfare spending; well, there are opportunities to do so without doing some of the things that they are doing. There would be a £570 million saving to the NHS and local government, and £480 million would be saved by local government by avoiding the need for disabled people to enter expensive residential and crisis care.

The Minister knows that there is considerable political and organisational support for a lower eligibility threshold. The draft Care and Support Bill pre-legislative scrutiny Committee recommended that, when setting the national eligibility threshold, the Secretary of State should have regard to the duty of local authorities to promote individual well-being. The report of the joint inquiry I have mentioned also highlighted the issue of eligibility.

We in this House often talk as though we are somehow divorced from the beneficiaries of the legislation we pass, but I say to Members that we are talking about ourselves here. Any one of us could walk out of this Chamber tonight and be in need of social care tomorrow. If we want a good social care system, we should ask ourselves this question: what would we want for ourselves if we had a stroke or a car accident or fell down those marvellous marble stairs outside and cracked our head? That is the criteria that we should be using. This Bill makes small progress, but there is a lot more to be done.

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[Grahame M. Morris (Easington) (Lab)]

I am pleased to have the opportunity to speak in this debate. Like several colleagues who have spoken, including the hon. Member for Totnes (Dr Wollaston), I served on the Joint Committee on the draft Care and Support Bill, under the chairmanship of the right hon. Member for Sutton and Cheam (Paul Burstow), and I also serve on the Health Committee, so I have a particular interest in this Bill. I had originally intended to make a more wide-ranging contribution, but I will confine my remarks to part 1, which deals with care and support.

I had hoped that the Secretary of State would conduct a hearts and minds exercise in trying to selling the Bill, so I was rather disappointed that he turned it into a political knockabout, jumping straight into the most contentious elements, and clause 118 in particular, which sets out the trust special administration arrangements.

I do not think that we can consider the Bill without giving some thought to the background. Let us not forget that over this Government’s tenure, £2.68 billion— at 20% of the net adult social care spend, that is not an inconsiderable sum of money—has been cut from council budgets. Although we were talking about the principle of well-being in relation to clause 1, which I think all Members support, in practice cuts of that level mean that fewer people are getting help with paying for their care and more people are being charged for vital services, such as help with getting washed and dressed and with eating—the basic things that most of us take for granted.

I have no doubt that councils, particularly those in the north that I am familiar with, are doing their best to save money and provide services efficiently by changing the way care is provided and, where they can, working more closely with the NHS. However, the scale of the cuts means that they are being forced dramatically to reduce services and increase charges to balance the books. All the evidence that has come to the Select Committee and the anecdotal evidence that Members receive indicates that is the case.

The Secretary of State got into a little argument in his opening statement with regard to eligibility thresholds, which is a really important point. In 2010-11, 38 councils provided free care to people with “low” or “moderate” needs, and 114 provided free care only to those whose needs were considered “substantial” or “critical.” Those needs really are substantial and critical, as we can see if we look at the definitions, which are set out in the guidance. Now, however, only 15 councils continue to provide care and support to people with “low” and “moderate” needs and 137 provide care only to those assessed as having “substantial” or “critical” needs. That means that in many areas preventive services have all put disappeared. Setting the threshold at such a high level is therefore a false economy.

According to Age UK, as a result of tightening eligibility criteria, 800,000 people in the UK have a care need but are not getting any support. As my right hon. Friend the Member for Stirling (Mrs McGuire) mentioned, there is another care crisis, because a third of the total of those requiring care are working-age adults. Indeed, four in 10 working-age disabled people who receive social care say that it does not meet their basic needs, including eating, washing, dressing and getting out of the house. One in three says that cuts in social care have prevented them from working or volunteering.

Charges for vital care services, such as home help and meals on wheels, are increasing fast. In effect, that is a tax on some of the most vulnerable people in our society, people who have already been hit the hardest by benefit changes. Some Government Back Benchers talked about the need to cut the deficit. There is a need to address the economic situation, but not on the backs of the poorest and most vulnerable. To my mind, it is a question of political priorities. I am proud that my party has pledged to scrap the bedroom tax, which I think brings great shame on the coalition Government because of its impact on disabled people.

Other Members have mentioned the consequences of price variation. I do not want to repeat those arguments, but it certainly is a factor when calculating the care costs for the cap. For example, in Tower Hamlets home care is free, but in Cheshire East—I am not sure which hon. Member represents it—it costs £20 an hour. In east Durham, the area I represent, it is about £10, so there is wide variation in costs.

We cannot improve the quality of care for older and disabled people without improving the working conditions of the 1.5 million people employed in adult social care, many of whom are on low pay and lack job satisfaction. In many cases that can lead to poor care for some of the most vulnerable people in society. Care workers do an incredibly valuable and important job, yet the TUC has estimated that between 150,000 and 220,000 of them are not even paid the legal minimum wage, and over 300,000 are employed on zero-hours contracts.

[Sheila Gilmore]

Does my hon. Friend agree that the problem of low pay and poor conditions, which he is outlining so well, is a concern for not only the workers, but ultimately the people receiving the care, for example because of the lack of continuity of care?

[Grahame M. Morris]

My hon. Friend makes an excellent point. That ties in with home care visits. The United Kingdom Homecare Association has indicated in a briefing that three quarters of home care visits now last 30 minutes or less and that one in 10 last only 15 minutes. There must be deterioration in care if carers are there for only 15 minutes. Care rationed in 15-minute slots is simply unacceptable, and I think that the House should reflect on what is happening. This is important because older people end up in hospital unnecessarily and stay longer than is necessary. There has been a 42% increase in delayed discharges from hospitals since figures were first collected in August 2012. Indeed, last month saw the largest number of delayed days in hospital ever recorded, and there were 78,400 such days in October alone. These delayed discharges now cost our NHS £20 million each month. That money could be used to fund about 1.5 million hours of home care for vulnerable older people and help to keep them out of hospital when they can be supported in their own homes.

Ministers claim that they want joined-up services, but through the Health and Social Care Act 2012 they legislated for fragmentation. Their integrated transformation fund contains no new money but is made up of £3.8 billion that is coming out of existing NHS and social care budgets. I accept that the Bill provides a framework and establishes important principles, and there are things that we can agree with. However, fine words are all very well, but we need immediate action such as the measure proposed by my right hon. Friend the Member for Leigh (Andy Burnham) to use £700 million from this year’s NHS underspend to help tackle this crisis now. We need some vision from all parties but especially from the Government parties.

I looked at some old early-day motions to see how some of these proposals were tackled in the past. My hon. Friend the Member for Sefton Central (Bill Esterson) suggested that this should be paid for through general taxation, and I agree. In one old EDM, a number of Members from all parties agreed with that principle; I see some of them nodding now. It is not such a radical or revolutionary step.

We clearly need a wholesale change in how we deliver health and social care. We need a whole-person approach and a national care service. We need the same ethos that applied during the establishment of the NHS, which brought together disparate entities and groups into one body. We need to bring health and social care together into a single service that provides all the care an individual will need throughout their life.

The Bill has many positives, but it is fundamentally important to deal with the eligibility threshold. If it is set above “moderate”, it will do little to help working-age disabled people.

If the Minister does not mind, I would like him to clarify whether the duties of openness and transparency in the Bill will apply equally to all organisations that provide NHS services, including private contractors who provide outsourced services; he will be aware of my ten-minute rule Bill. I urge people to consider the Bill and to support Labour’s amendment.

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[Sheila Gilmore (Edinburgh East) (Lab)]

Health and social care are devolved to the Scottish Parliament, so I rarely contribute to debates on those issues in the House, but one aspect of the Bill is very relevant to my constituents—the portability of care packages between England, Scotland, Wales and Northern Ireland.

My argument is best explained by reference to the case of my constituent, Neil Kenny, who raised his concerns about the lack of portability of care packages back in 2010, when I was first elected. Mr Kenny suffered a broken neck while serving in the Army. He is paralysed from the chest down and uses a wheelchair. Although he is originally from Edinburgh, he lived in London in the early 1990s, during which time he received funding for his care package from Greenwich council. In 1996, he decided he wanted to move back to Edinburgh to receive additional support from his family, but when he informed Greenwich council of his intentions it indicated that it would be unwilling to continue to contribute to his care package and that if he wanted to move he would have to contact Edinburgh council, which he did but which also said it was unwilling to support him.

The disagreement revolved around the two councils’ conflicting interpretation of the social work group Act 1968, particularly two clauses, one relating to the “authority of the moment” and the other to “ordinary residence”. This impasse continued from 1996 to 2000. In October 2000, Mr Kenny resorted simply to moving to Edinburgh, with help from his family physically to do so, and paying for his own care, which put him into a lot of debt. Although Edinburgh eventually agreed to pay for his care, he should never have had to experience such difficulties. Disabled people should be as free as anyone else to move from one local authority to another—something that simply is not possible at present, it would appear, owing to the ambiguity of the law governing this area.

When I took up the case with the Department of Health in 2011, the former Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), indicated that it would be addressed in the Government’s care and support White Paper. This was published in July 2012, but although it contained a short section on portability between local authorities in England, it made no mention of transfers between England, Scotland, Wales and Northern Ireland. When I raised the matter again in September 2012, I was told that a clause to facilitate cross-border placements would be put in the Care Bill.

Schedule 1 to the Bill makes provision for cross- border placements across England and the devolved Administrations, but this is limited to residential care and does not include community-based packages. As many people have eloquently said today, Government policy has long encouraged people with disabilities and health conditions to live in the community, integrated into society rather than segregated in residential accommodation, so the decision to facilitate the portability of residential packages and not community-based care packages is very disappointing. I wrote again to the Minister expressing my disappointment, and the response emphasised the differences in the care systems and the difficulties of applying rules across borders and suggested that officials were still working with the devolved Administrations to develop principles for how transferring community care packages might work in future.

Given that both the UK and Scottish Governments have known about this issue for a considerable number of years, it is deeply frustrating that it has not moved further forward. The difficulty of applying rules across borders appears to have been resolved within the Bill in respect of residential care, so it is unclear why it is impossible to do the same with community-based packages. I have been in communication with the Scottish Government as well, and they have given largely identical responses to those of the Department of Health. Clearly, both recognise the problem, but have yet to give it sufficient priority to find a resolution.

I hope that I can persuade the Government to recognise the issue fully, and they have the opportunity to do so with this Bill. I shall table an amendment either in Committee or on Report to facilitate the portability of community-based care packages. Today, however, I would be grateful if the Minister provided a more comprehensive explanation of why this has not been provided for in the Bill. That is the specific individual issue that I am particularly keen to see addressed, but let me also offer a few comments and observations from the perspective of north of the border.

In today’s debate and others I have heard during my time at Westminster, a great deal of discussion on the cost of care is about the “who pays?” element. Does the state pay? Does the individual pay? At what point do we take a decision? They are all important questions, but if we spent all our time looking at the cost of care only from that perspective, what would get forgotten is the need to put additional funding into care to make more care possible.

I can look at that from a Scottish perspective because we have been part-way down this route already, albeit only a very small part, with the introduction of free personal care in Scotland nearly 10 years ago. I emphasise that the Scottish provisions apply only to a relatively small part of personal care. After people have heard all the hype about free personal care in Scotland, they tend to assume that everything about it is free, but then discover that it clearly is not. Creating even this relatively small part of care and making it “free” meant that the financing was transferred to the Government, to the taxpayer, to all of us.

At the same time, however, not an extra penny was put into the care system at a time when, as much discussed today, demand was steadily rising. If we add to the mix the difficulties of local government in Scotland—we have had six years of council tax freeze and the reduction of councils’ overall budgets—the result is that my Scottish constituency is affected by exactly the same issues as people have raised here: rising thresholds for care, for example, which mean that only those with substantial and critical needs get any care at all.

I have seen items that can be charged for going up in price. I have seen the outsourcing of many care contracts to save councils money, but at the expense of the care workers and, indeed, the care recipients. I have seen the poorer conditions that lead to the 15-minute care times that we have heard about. We see them in Scotland, which was brought home to me very clearly when my mother-in-law was terminally ill, having been a fit person up until then. The first time the care giver came I was in the house, and I thought I would go on the computer and do a little work. The computer had only just fired itself up when the carer popped her head around the door and said, “That’s it, I’m off now”. It was barely 10 minutes. That situation is very real.

We should talk about who pays and how we divide the payment up—I am not saying that there are easy solutions—but if we do not address the question of the quantum of resource being put into care, we will continue to have these problems. I can assure everyone that this is exactly the situation in which we find ourselves in Scotland.