Adult Social Care

Simon Burns Excerpts

Thursday 8th March 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I, too, congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on bringing this important debate to the House. They make an impressive and persuasive double act for this most important of causes, and are right to challenge both Front-Bench teams as this is without doubt the biggest unresolved public policy challenge facing the country. So far, between us, Parliament has failed to face up to it, and as others have said the result is a developing care crisis in England.

We must all bear our share of the responsibility for allowing that to happen, but the best response is to resolve to find lasting solutions. This century of the ageing society demands it, and the earlier we do it, the better. If we do not, to Beveridge’s five giants of the last century we might add a sixth for the 21st century: fear of old age. We cannot let that happen, and people are looking to us all to put point scoring aside and to work constructively to find a solution. In that spirit, I welcome much of what the Minister said.

I commit the Opposition to doing the same, and as a sign of our intent, the Leader of the Opposition has appointed a member of the shadow Cabinet with specific responsibility for these matters. I refer to my hon. Friend the Member for Leicester West (Liz Kendall). The House might have noticed that she is not here today. I send her apologies. [Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is absolutely right. She has a good excuse: she is in Leicester with Her Majesty the Queen at the commencement of the diamond jubilee celebrations; otherwise of course she would have been here. I hope that I am an acceptable substitute.

[The Minister of State, Department of Health (Mr Simon Burns)]

You are.

[Andy Burnham]

Thank you.

I wish to demonstrate today Labour’s commitment to this issue. The House might remember, as my hon. Friend the Member for Worsley and Eccles South said, that I made reforming social care my top priority as Health Secretary, and I did that for a very personal reason: I have never forgotten my grandmother’s dispiriting journey through England’s care system and the battles that my mum fought to preserve her dignity. The day I visited her in a nursing home near where I lived to find that her engagement ring had been wrenched off her finger and stolen was the day that I knew something was seriously amiss with how we looked after our older people.

We all have our own personal experiences, and we all know that we have to do much better. Looking after other people’s relatives, particularly the most vulnerable in our society, should be one of the most highly valued and respected callings there is, but sadly the reverse is the case. England’s care provision is too often low status and low wage, with about 70% of the work force having no qualifications and many earning at or around the national minimum wage.

With every year that passes and every year that we do not achieve a lasting and better solution to the funding of adult social care, the cruel unfairness in the system gets worse and the quality of service diminishes even further. People are paying higher charges, and the most vulnerable, as the Minister said, are losing everything. Families are being wiped out physically, emotionally and financially by the situation, carers are under intolerable pressure and councils are struggling to cope with the demographic pressures.

But there is hope. I did not think that the White Paper and cross-party talks that I led before the election achieved as much as they might, but perhaps I was wrong, because they might have prompted the Government to establish the Dilnot commission, on which we congratulate them. We also congratulate Andrew Dilnot and his commission on the intelligent way they addressed their brief and delivered a solution that politicians on all sides can work with. It provides a basis for progress, and we should take it.

Since then, we have also had the Health Select Committee’s excellent report on social care, which made a persuasive case for integration. At present, the social care debate is happening in isolation from the debate about NHS reform, which is unhelpful. We are looking at a Bill called the Health and Social Care Bill, but there is not much about social care in it. Indeed, it is slightly odd that a Bill of this name is going through Parliament, yet a social care White Paper is not due until May, as my hon. Friend the Member for Worsley and Eccles South said. It is essential that we start viewing reform of social care and the NHS as two sides of the same challenge—how to provide integrated, people-centred and preventive care in the century of the ageing society.

The Committee’s recommendation of a single commissioner for older people was an important one, and I was pleased to hear the hon. Member for Truro and Falmouth endorse it. I do, too, not least because it was precisely what I would have done had I returned to the Department of Health as Health Secretary had we secured a different result at the general election. However, I am worried that this vision, which we share, is made more difficult by the Health and Social Care Bill and the new landscape that is developing.

Those are the issues that the Government need to address in the White Paper. We are grateful for the opportunity that the Minister and the Secretary of State have extended to us to take part in cross-party talks and to influence that debate, as well as the crucial issue of how to fund the Dilnot proposals. Speaking for the Opposition, I can assure the House that we will play a constructive and responsible role in those talks. However, I would also like to take this opportunity to place three caveats on the table. First, we need to make it clear to people that although the Dilnot package is an important step forward, it is only that. It is not the whole answer to the challenges that the country faces. Its introduction would make the system fairer than it is today and would deal with the catastrophic costs of care that the most vulnerable people face. However, people would still be liable for high charges, with the vulnerable paying the most.

Secondly, there has to be a recognition from all parties in the House that progress will come only with difficult decisions and nettles being grasped. We need to have a mature discussion with the public about those difficult options, rather than using them for point-scoring purposes. What stands in the way of progress is not the complexity of the issues—they are not over-complex—but the political will to advance a difficult argument. That is what has prevented us from making more progress than we should have. To push things along and give our talks some impetus, it would help if the Government committed to introduce legislation in this Parliament to implement whatever has been agreed. That would bring a useful focus to the cross-party talks. Thirdly, we believe that there is a genuine danger that the debate might focus only on funding the Dilnot recommendations, and not on the existing pressures in the system. That must be avoided at all costs, as my hon. Friend the Member for Worsley and Eccles South said. As one care charity told me yesterday,

“We can’t have jam tomorrow if we have no bread today”.

I, too, was concerned by the comments that the Minister made before the Select Committee on Health, specifically when he said:

“We don’t accept the position that there is a gap. We have closed that gap in the spending review. On the issue of unmet need, I am yet to find any agreement among academics on a definition of unmet need.”

Many councils would struggle to reconcile that statement with the reality of what is happening on the ground. Council budgets are being cut by more than a third over the course of this Parliament, and as we know, adult social care makes up the largest part of those budgets, at around 40%.

The Prime Minister is fond of quoting me on health funding at Prime Minister’s questions, but he only ever uses the bits that suit his purpose. If I may, I would like to give the House the full version of that quotation today, because what I was warning of was the danger of taking an unbalanced approach to public spending. Before the election, the Conservatives were saying that they would give the health service real-terms increases, over and above inflation—which have not, in fact, materialised—within a much reduced overall public spending envelope. My worry was that taking such an unbalanced approach could damage other public services, including those that are intrinsically linked to the health service. What I actually said was:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting. The effect is that he is damaging, in a serious way, the ability of other public services to cope: he will visit real damage on other services that are intimately linked to the NHS,”

such as social care. I believe that this is what we are seeing right now.