Care Bill [Lords]

Stephen Dorrell Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?

[Mr Stephen Dorrell (Charnwood) (Con)]

In the interests of explaining his policy, will the right hon. Gentleman confirm that the answer to the question posed by the Secretary of State and the Minister was, “Yes”?

[Andy Burnham]

I say again, with all respect to the Chair of the Health Committee, that I was proposing a fundamentally different scheme to that in the Bill. I was proposing a universal all-in scheme, and several steps were put forward to get us to that. The right hon. Gentleman knows that because the Conservative party and those on the Government Front Bench put posters up about that scheme before the last election. Does he remember that? [Interruption.] He nods, right—that was my proposal, but it is not the Government’s proposal, which is different. I proposed various steps to get to my scheme. Is it about time the Government started answering for their proposal, rather than for mine?

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the Bill. I do not propose to follow the shadow Secretary of State into a discussion of competition policy, as there will be plenty of other occasions for that; it is not germane to this Bill. The reason I welcome the Bill is that it begins to look at health and care from a different point of view from the one with which those of us who have participated in health and care debates in this Chamber over a long period are familiar. When a Bill comes before the House, it usually starts off by describing the function of one bit of the bureaucracy—perhaps creating a strategic health authority or re-creating a different bit of the bureaucracy somewhere else on the landscape. This Bill starts in a quite different place.

Clause 1 talks about the “well-being” of individuals and suggests that if we are to build a health and care system that meets the needs of patients and users for the 21st century, we should, instead of thinking of it as a bureaucracy planned from the top down, think about the service that is delivered to individuals who rely on these services. Clause 1 talks about the needs of individuals, and later clauses place an obligation on local authorities to do needs assessments for those individuals.

Clause 2 introduces something that the health and care system has talked about since 1948, but almost never put real resource into, which is preventing the need for the delivery of health and care services, and particularly of acute health care. This Bill’s emphasis is on the needs of individuals and on the need we each feel as individuals to avoid unnecessary health costs and care. None of us wants to be a patient in an intensive care unit if it is avoidable. That is why clause 2 talks about the importance of prevention and avoiding the need for care.

[Mrs Moon]

Does the right hon. Gentleman appreciate that it is possible to carry out lots of needs assessment—goodness knows, I carried out many of them in my day—but that unless care is available to allow a patient to be discharged from hospital, it does not matter how many needs assessments have been done? In fact, the longer patients are in hospital, the greater their needs will be—they will not be able to walk, their incontinence will increase and so forth. What is important is to put the cart before the horse and make sure that the funding of community-based care is there. It is not there at the moment.

[Mr Dorrell]

I shall come on to that point, but to react directly to the hon. Lady’s point, surely it is much better to intervene before the patient arrives in hospital in the first place, preventing the avoidable episode of care. The hon. Lady talks about discharge, and she is, of course, quite right, but how much better is it to prevent the case from arising in the first place, which is what clause 2 is about?

[Bill Esterson (Sefton Central) (Lab)]

I think that is precisely the point my hon. Friend the Member for Bridgend (Mrs Moon) was making. The money simply is not there in local government. When 20% of the adult services budget has been lost, the services are not there and the care managers are not there to do the assessment to decide whether to keep people at home or to help them get out of hospital. The service back in the community, after people have come out of hospital, is not there either. Does the right hon. Gentleman accept that that money has to go back in?

[Mr Dorrell]

Of course I accept that if we have more money, we can do more, but I do not think that that exempts us, particularly given the public finances we inherited in 2010, from the obligation to see how we can get more for the £125 billion of taxpayers’ money that is already committed to health and social care in England.

That brings me to clause 3. The only way to deliver person-centred care and early intervention to prevent avoidable cases, is to reinvent care on a much more integrated model between the national health service and the social care authorities. That is why there is the obligation in clause 3 to consider integrating health and care. In that way we will not think of the NHS as one bureaucracy and social care as another, but instead think of it, as Mike Farrar said when he was at the NHS Confederation, as a care system that provides medical support when necessary, rather than as a medical system that provides care support when it has got the money—that is how not to do it.

[Andy Burnham]

The right hon. Gentleman will recall that the NHS chief executive stood before him and his Committee saying that the competition legislation was the biggest barrier to achieving the vision he is rightly describing; he and I agree about the vision of person-centred services in the home. If the NHS is saying that before his Committee, why does he say that the competition regime is irrelevant? Is it not fragmenting care, rather than integrating it?

[Mr Dorrell]

I did not say it was irrelevant; I said it was not germane to this Bill—and in the seven minutes remaining to me, I am not going to cover that. All I will say to the right hon. Gentleman is that the difficulty with competition policy that the NHS chief executive talked about is a difficulty that health care systems around the world—in north America and in continental Europe—are finding as well. I agree with the right hon. Gentleman, however, that we need to look at how competition policy can be aligned with the policy prescriptions I am describing.

I now want to list the fourth key premise upon which this Bill is based; in what must be a short speech, I can list only four. It is around the well-being of individuals; it is around early intervention and prevention; it is around integration; it is also, critically, for the first time in statutory form, around doing needs assessments that take account of the needs not just of the individual person, but of their carer and social context as well. In that way, the support that is provided to individuals takes account of the context in which they live, rather than treats them as individuals divorced from the carers and people who care for them when the statutory social worker is not there.

The Opposition spokesman said this is an enormously ambitious set of objectives, and I entirely agree that the objective of redefining the delivery of health and social care in a way that matches the aims set out in the first three clauses and clause 10 around carers is ambitious. The objective is to re-imagine care so that we think of the health and care system not as being primarily around acute hospitals, but as a system designed to meet the needs of that majority of people who are the main focus of those who work in the service—people who primarily have a care need with an occasional medical or clinical requirement. In other words, this is about thinking about the system from the front end rather than viewing it from the top of the bureaucracy. I commend this Bill because I believe it sets that framework in statute.

I also commend the Government because they are not just setting out these aspirations as commitments in law. It is one thing to change the law. It is another thing to change the way the service is actually delivered on the ground. The most effective step the Government have taken to achieve this re-imagination of care is the £3.8 billion that my right hon. Friend the Secretary of State talked about. That is £3.8 billion voted into the NHS but available only if the service at local level delivers the joined-up, person-centred care that is set out in the first three clauses of the Bill. So this is not just a set of wordy aspirations; it is a set of aspirations supported by the resources necessary to deliver the change in the care model that the Bill describes. The £3.8 billion is the catalyst that will allow us to deliver the objectives.

With respect to those on the Opposition Front Bench, it is wrong to say that it is only £3.8 billion out of £125 billion. The £3.8 billion is the minimum that the law will require to deliver integrated care within a locality, through the health and wellbeing boards that are much beloved of the right hon. Member for Leigh (Andy Burnham) and which were legislated for by the Government. This is an important step forward. If the health and wellbeing board in a locality can see a way to use health resources to deliver a changed model of care that puts more focus on prevention and on individuals through the delivery of more joined-up services, there is no constraint in the legislation, as I understand it, to prevent more than £3.8 billion from being used for the delivery of that objective.

Resources are important in this regard. This is partly about the £3.8 billion from the taxpayer, but it is also about individual resources. It is about individual users having their right set out in the Bill to engage with their personal budgets and with direct payments, enabling them to make real choices about how joined-up, person-centred care will work best for them. It is the curse of these health debates to imagine that we can gather 650 people together in this Chamber and work out how we are going to deliver £125 billion-worth of care in a way that will work for an individual old lady in her own home. That is nonsense; we need to engage the people themselves in the decisions on how the resources are used. We also need to assure them that they will not be exposed to catastrophic personal losses by making their own contributions to their care. That is why I welcome the fact that, despite what the right hon. Member for Leigh says, the Bill gives effect to the basic propositions set out in the Dilnot report.

The Bill sets out the vision of person-centred, joined-up, integrated care, and the Government have set out plans to commit resources to turn those fine words into deeds. Also, through the establishment of an independent Care Quality Commission, the Bill will provide independent assurance about the quality of care that is provided right across the health and care system. The right hon. Gentleman claims credit, as he is entitled to do so, for the fact that the previous Government took the first faltering steps down the road to introducing proper regulation of health and care provision, but he cannot possibly believe that the Care Quality Commission that he bequeathed was fit for purpose. If he does, he is the only man in the kingdom to do so. I welcome the fact that this Government are putting in place new management and, importantly, a new statutory framework so that the aspirations that might have motivated the Labour Government to set up the CQC will now be delivered in reality.