Care and Support

Royal Assent – in the House of Commons at 1:59 pm on 5 June 2008.

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Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services) 1:59, 5 June 2008

I beg to move,

That this House
has considered the matter of the future of care and support.

I welcome the opportunity to have this debate on the Floor of the House on a subject that is undoubtedly one of the great challenges that now faces our society, as well as increasing numbers of families and politicians of all persuasions, as we face up to some of the biggest issues in society. I want to use my opening speech to refer to the context of this debate, the progress that we have made over the past 11 years and the changes that we are now making. I shall then move on to the difficult issues that have to be resolved in creating a system that can respond to this new world.

I shall start by describing the context. There is a constant debate about the big challenges that we face, including climate change, globalisation and fundamentalist terrorism. Arguably, demographic change is equally important in terms of the big public policy challenges that this country faces. Undoubtedly, for many people, elder care is the new child care. Care and support might have been an issue for a relatively small number of families in the past, but it is now a mainstream issue for the majority of families in this country.

This is also a question of social justice, whether in regard to the way in which we treat older people in terms of dignity, respect and quality of life, or to our ability to support disabled people and people with mental health needs to have equality of citizenship and a right to live independently as equal citizens in our society.

This issue is at the heart of what we mean by 21st century families. I shall give the House some examples of the changes that we are now seeing. Many parents—mainly women—are struggling to hold down a job and bring up a child while also caring for an elderly parent or grandparent. Many husbands and wives are caring for a partner who is perhaps in the early stages of dementia, yet, at 3.30 every afternoon, they are expected to be at the school gates to collect a grandchild. As a consequence of the fact that, thankfully, disabled people now live full and long lives, some people are now lifetime carers. All those factors are having a massive impact on the nature of family life in the 21st century.

Photo of Kevan Jones Kevan Jones Labour, North Durham

I, too, recognise the debt of gratitude that we owe to the carers of people with dementia and Alzheimer's. Those carers depend on respite care and, ultimately, on their loved ones going into care. Is it not important that we get the home support right, and that the NHS has the facilities to take care of those individuals?

R

the NHS does not provide home care.

Submitted by Rob Kay Read 1 more annotation

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

My hon. Friend is absolutely right. There is an issue about the volume and availability of respite care, and there is equally an issue about the quality and nature of that care. If someone is caring for a parent—or, indeed, a husband or wife—who has dementia, and they feel that the available respite care does not offer quality, dignity or safety, they will be reluctant to use it. It is therefore incredibly important that we expand the availability of respite care in this changing world, and that we ensure that people are confident and comfortable that that care will properly look after their dependent relative.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

I accept what my hon. Friend says about the fear of inadequate care in care homes, but a much greater fear is that there will not be any respite care, and that the excessive pressure on carers in the home will, in time, break them. Is it not of primary importance to ensure that respite care and—eventually, when necessary—residential care are provided, and that we do not pressurise people to keep elderly relatives in the home when they cannot cope?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I partly agree with my hon. Friend. The vast majority of older people want to stay in their own homes for as long as possible, and that is quite a shift compared with the expectations of my generation and my parents' generation vis-à-vis my grandparents' generation, who might have accepted the inevitability of institutionalisation. However, my hon. Friend is right to say that, too often, families are being left to struggle because appropriate residential or respite care is not available in their local community. When we announce in the near future our new deal for carers, one of the most important issues that it will address will be the availability and quality of respite care.

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

On the wider issue, is it not the case that people were promised in 1979, when Tony Blair said that he did not want—

Photo of Philip Hollobone Philip Hollobone Conservative, Kettering

I am sorry; I meant 1997. Tony Blair said that he did not want to live in a country in which the only way that pensioners could get residential care was by selling their home, but that is still happening today, 11 years on. And is not the fact that the situation south of the border is rather different from that north of the border causing growing resentment?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

It is not generally known that, in 1999, the Government introduced the notion of deferred payment, whereby older people do not have to sell their home if they go into care. It is not totally clear how many people are taking up the opportunity to use the deferred payment scheme. I have to say to the hon. Gentleman that, in fact, he got his timeframe right. Between 1979 and 1997, there was no attempt to do anything about the means-tested system. In contrast to the NHS, social care has been means-tested since 1948, but nothing was done about that between 1979 and 1997, so we will not take lectures from the hon. Gentleman about the inevitable consequences of a means-tested system— [ Interruption. ] I will answer his second question. Members of the House are aware that, if we examine the detail of what is happening in Scotland, we see that care is not free. People still have to pay for housing and for food. Also, services are being rationed, which means that people are having to wait for increasingly long periods of time to access care. Scottish local authorities are saying that the current position is entirely unsustainable. Politicians may shroud-wave and make offers that appear attractive, but in reality, the result is the provision of inadequate services.

As part of the debate over the next six months leading up to the Green Paper, let us have an honest and serious discussion about the respective responsibilities of the state, the family and the individual for paying for care, bearing in mind that there are no easy options in regard to fairness and sustainability. The people for whom I feel most sorry under the current system are those who work hard, play by the rules and do the right thing, and who are neither rich nor poor. There is a sense of injustice and unfairness among those people at the way in which decisions are made about means-testing.

I am also anxious to put right the situation in which people who fund their own care are left alone to make difficult decisions about choosing their care and where to go for advice and support. In my view, self-funders should be entitled to a much greater level of protection and help than they get at the moment, but let us not pretend that there are any easy answers or easy solutions.

Photo of David Kidney David Kidney PPS (Rt Hon Rosie Winterton, Minister of State), Department for Transport

On the subject of the need for a debate, will my hon. Friend accept my praise for him in bringing this matter to the fore so that we can have a great public debate on such a big policy issue? Does he agree that there is a role for the media to help in this regard? Will he give credit to the BBC for its recent in-depth and deliberative coverage of these issues, which has tried to include everybody in the debate?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I thank my hon. Friend for his kind comments on my contribution. Other hon. Members, some of whom are in the Chamber today, have made a major contribution over the years to ensuring that social care has been given a greater level of priority. That requirement is still desperately needed in view of the changing nature of society. Of course it is helpful when the media engage in this debate in a positive, constructive, honest and balanced way. Some of the recent coverage has been very balanced. Let us consider, for example, the way in which the "Today" programme reported the lady who went under cover in care homes. Some people were concerned about the ethics of her going under cover, which is a different debate, but that coverage was incredibly balanced. She was encouraged to talk about the positive and good things as well as to highlight the negative experiences that she had in residential and nursing care. All too often we do not present a balanced view. For example, hundreds of thousands of low-paid low-skilled workers work in the care system. They do a tremendous job on the front line of providing care in very difficult circumstances. Yet we always present this industry—this care sector—in the deficit model, in a negative way. Of course, there are massive problems. We only need to listen to the experiences of older people and their families to know that all too often the system does not respond to their needs in the way in which they have the right to expect. Equally, however, we should have a balance to the debate. I welcome the fact that sections of the media are starting to ensure that the debate is far more balanced.

In my view, the care system does not function in a vacuum from the rest of society. We have deeply cultural and attitudinal issues to address about how we treat older people in our communities and society. In the same way as we recognise that investing in children and young people will determine the future of our country, we must also recognise that the way in which we treat older people will determine the character of our country in the future.

We should also remember that older people are not simply passive recipients of care. They increasingly have the ability to make a massive contribution to their communities and families and to our society. It is incredibly important that we have an adult, mature debate about the issue, which poses one of the greatest challenges that we face.

It is also important to reflect on some of the progress that has been made over the past few years. This is the first Government to introduce a serious set of national minimum standards backed up by inspection and regulation. The consequence of that has been a significant improvement in the number of providers of residential and nursing care and of domiciliary services that meet minimum standards. That would not have happened without the dreadful word "regulation". All too often, regulation is presented as a bad thing, but it has begun to make a real difference in the sector. As we develop the new regulator, bringing together health and social care regulation and inspection, it is important that we continue to use that system to help us to raise standards.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

I agree entirely about the need for regulation. Indeed, a number of recent reports have shown that regulation clearly has been inadequate because standards have not been good enough and people have been suffering. However, the Government have proposed light-touch, risk-based regulation instead of rigorous inspection. Does that not pose a risk that the regulation will not be good enough?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I do not agree. There are a number of ways in which we influence the quality of care that older people and others experience. One of them is inspection and regulation; the other is the commissioning decisions that are made by local authorities or the NHS. Frankly, they should not be commissioning with either poor providers or even, on occasion, those providers that can meet only minimum standards. World-class commissioning is about ensuring that we organise services from those care homes and day care and domiciliary care services that offer people a high standard of care.

The other important element is to ensure that individuals and families feel sufficiently empowered to complain and raise concerns if they are not getting the care that they need. Communities also need to take responsibility for ensuring that we treat older people in a positive manner. That becomes even more important as more and more people remain within their own homes. It would not be appropriate to send inspectors and regulators into people's homes, but equally there is an argument for saying that there is a vulnerability and risk to consider that requires us to think differently about the relationship between the state, the family and the individual. We must not make the mistake of believing that the only way to protect older people in this context is through the inspection and regulatory framework, although it is incredibly important.

We have also introduced free nursing care for the first time. I mentioned the deferred payment scheme. It was this Government in 1999 who introduced the first ever national carers strategy. Since then, we have given every local authority a specific annual carers grant to expand respite care and to give better information and better emotional support to carers. There was a period in this country when there was a denial in public policy terms of the contribution and role that carers make. The fact is that carers have distinct needs as opposed to the needs of the people for whom they care. Six years ago we also launched Valuing People, to ensure that people with learning disabilities have the same life chances that many other citizens take for granted, whether it be a home of their own, a job or the opportunity to have a decent quality of social leisure life.

Last year, I introduced a new national framework for continuing care. There were concerns about a postcode lottery across the country whereby some primary care trusts were not accepting their responsibilities in terms of recognising that people have nursing care needs as opposed to social care needs. That national framework has begun to make a difference to people's ability to access continuing care funding.

This Government introduced a specific grant to stimulate the use of telecare. One issue that does not get sufficient attention in the debate on social care is the potential of modern technology to support people to have a more independent high-quality life, particularly within their own homes. We are seeing across the country a significant expansion in the utilisation of telecare to support people, but we have a long way to go. It is important to encourage and stimulate innovation because we are still pretty weak in terms of innovative development of services and innovative approaches.

We also introduced the General Social Care Council to register social workers who move on to domiciliary care agencies so that professional standards are maintained and monitored. Skills for Care ensures that we invest significant amounts in a difficult environment, which has a low-skilled, low-paid work force, to get people who work on the front line of care services to at least level 2 qualifications and beyond.

There has been an improvement in integration between health services, local government and the voluntary sector in some communities, although we still have a long way to go in the terms of the so-called Berlin wall between health and local government. I hope that we will be able to make more significant and rapid progress in the future.

Our White Paper "Our health, our care, our say: a new direction for community services", for the first time commits us to a vision of integrated personalised preventive services. We should not forget in the context of a debate about how we treat older people in our country that older people have been the major beneficiaries of the slashed waiting times and waiting lists for the national health service. That point is frequently not made. Older people used to be made to wait for years for the treatment of health conditions, such as hip replacements and cataract operations, that affect people's ability on a day-to-day basis to have a decent quality of life. I am proud that as a result of the decisions taken and the targets set, the Government have been able slash waiting lists. We will achieve the historic objective by the end of this year of a maximum wait for most treatments of 18 weeks. We should not forget that the major users of the NHS are older people. They have benefited significantly in terms of their independence and health as a result of our policy and the investment that has come directly from the Government.

There has been a major expansion of community-based mental health services. We all know that of course it was right to close those institutions down and to give people the chance to live dignified, decent lives within the community. Anyone who spent time as I did in those dreadful long-stay mental handicap hospitals, where people were shut away from society for 40 years, will know that it was the right thing to do. The Conservative party embarked on that programme when in government, and I pay tribute to it for that. The only problem was that the Conservatives did not transfer adequate resources specifically to people with mental health problems within the community, so many of them were left in vulnerable positions, not having proper and adequate support. I am proud of the fact that we have significantly expanded mental health services in the community, although we have a long way to go.

With regard to the controversy about the new GP contract, one of the other benefits that does not often get referred to is the fact that for the first time we incentivised GPs to take responsibility for the management of long-term conditions. That is another major advance. We should bear in mind that an ageing society is not the only challenge that we face. A major challenge is the number of people who are living longer with long-term conditions developed earlier in life, when they are in their forties and fifties, and making GPs responsible for managing such conditions and taking them seriously is an important way of preventing those people from deteriorating further.

This year's programme of reform and other activities is probably the busiest and the most significant for 20 years. Since April, the Putting People First transformation scheme has been delivered in every local authority area, supported by half a billion pounds of Government funding over three years. It focuses on a shift from the present system, which tends to support people only when they become very ill or very dependent, to a system based on prevention and early intervention. The aim is to offer decent information, advice and, where appropriate, advocacy to everyone, including people who fund their own care.

One of the unintended consequences of the community care legislation of the early 1990s was that people who went to their local authority and said that they had assets or means of £21,000 were told "You're on your own: there is no help for you here". It is crucial for us to ensure that those people have access to high-quality information and advice on difficult decisions relating to care and support for themselves or family members.

Photo of Jeremy Wright Jeremy Wright Opposition Whip (Commons)

Of course information should be available to self-funders. As the Minister knows, they often end up on the doorstep of the voluntary sector, which does a fantastic job in pointing them in the right direction. Does he think there is any scope for the Government to do more to help that sector to provide advice, rather than providing it directly?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

This Government have invested more money in public service and improving the quality of life in local communities than any other Government in living memory, but I agree that the voluntary sector is a major part of the solution. In the past, I have been critical of local government and NHS commissioners who reach for conventional, traditional solutions rather than using the voluntary, community-based organisations that are sometimes far better placed to provide advocacy and contact sections of communities that are hard to reach, such as members of the black and ethnic-minority community and people who do not feel comfortable about using traditional services because of their faith or culture.

Voluntary and community organisations have a crucial role. For many older people, the real issue may be not a need for hard-edged personal care but loneliness and isolation, and the voluntary sector is often in the best position to offer them activities and support. All too often, however, statutory agencies are not commissioning with the third sector as we would wish them to. Despite the unprecedented amount invested in the sector over the past 10 years, it could do more, and in many localities the relationship between it and the statutory agencies could be more satisfactory.

Voluntary organisations have every right to complain about the need for longer-term funding, which currently means knowing only one year at a time how much they will receive, but, arguably for the first time, local government and, within a couple of months, the NHS are to benefit from three-year settlements. That means that there is no longer any excuse for those organisations not to enter into longer-term funding arrangements with the third sector and put the principles of the compact into practice.

Photo of David Drew David Drew Labour, Stroud

I am sure that my hon. Friend is going to mention direct payments, which have been a great success in Gloucestershire. Carers and others in the voluntary sector set up an organisation to act as gatekeeper with the local authority and ensure that proper use was being made of the payments. However, because they had "professionalised" themselves, the local authority forced them to tender for moneys, and lo and behold, they lost the tender. That was a huge knock back. Will my hon. Friend work with his colleagues in the Department for Communities and Local Government to encourage the voluntary sector locally to make the best use of resources, and not to be overtaken by outside organisations?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I entirely agree. I was, in fact, going to say something about personal budgets and direct payments. Obviously my hon. Friend can read my mind, which is usually not a very pleasant experience.

At present direct payments are used by a relatively small, albeit increasing, number of people. We have made clear that we want the vast majority of adults to have personal budgets within the next three years. We want people to have maximum control and power over their own care and support, because we believe in the right to self-determination. Some people will need a significant amount of help to exercise that control and power over their lives, but in principle that is our direction of travel, and we want it to become the norm.

The Government must work with, in particular, local authorities to ensure that the necessary support systems are there to enable people to use direct payments and personal budgets to maximum effect. We encourage the pooling of personal budgets and the bureaucracy that is necessary to make control and choice possible. Our role is to clarify and encourage best practice, and to support local government in the delivery of what is arguably one of the most radical pioneering public service reforms that the country has ever seen.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

Does my hon. Friend agree that we should not underestimate the number, and the type, of people who can use personal budgets? In Wigan I met a man with severe learning difficulties who, with help and the use of a life map, was able to express the way in which he wanted to lead his life, and who, through the use of direct payments, was able to leave residential accommodation and live an independent life in his own flat, despite his severe disabilities.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

As ever, I agree with my hon. Friend. I pay tribute to the work that he did when he was doing my job. He initiated much of the pioneering work that has made direct payments a mainstream part of the social care agenda.

Some people hold the ideological view that certain members of society, to whom they attach labels, cannot exercise control or self-determination, and the state should not put them in a position that suggests that they can. That is not consistent with the views of our party or our Government, although of course there are people who will need a massive amount of help to exercise control and choice.

I shall never forget attending a conference, before I had been doing this job for long, where an individual with learning disabilities stood up at the back of the room and said "Minister, I want a life, not a service."

That individual was making the point, "I am fed up with this collection of agencies and organisations fishing around in my life. Give me a budget, give me the opportunity to exercise control and articulate my needs, and then I can have the quality of life that I really want." All the evidence shows that where people do have that level of control and choice, two things happen: first, they get much better outcomes and quality of life than under the existing, traditional way of doing things; secondly, we get better value for money. It is a win, win. This is incredibly complex because it is a new system that requires a lot of thought, but I am absolutely convinced that giving people control and choice through personal budgets and, where appropriate, direct payments is the right thing to do from a values point of view and a quality-of-life point of view.

I must now make some progress, Mr. Deputy Speaker. Let me rattle through the other changes that we are making this year.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to the Minister, as clearly he is not going to move on to talk about the relationship between health care and social care in personal budgets. Does he agree with me that, given that we are trying to have more co-ordinated commissioning and to break down the barriers between health and social care, it is important—contrary to what the Government said in their White Paper of January 2006, with which we disagreed—that we look to develop opportunities for health care, where it is predictable and stable over time, to be added to social care budgets and managed as a personal budget?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I am absolutely delighted that the hon. Gentleman has supported the recent statements from the Prime Minister, the Secretary of State and Lord Darzi that we ought to use personal budgets as a potentially powerful vehicle to break down the Berlin wall between social care and health care. Lord Darzi said in his interim report that we now need to consider that, and in his final report he said that we need to spell out clearly how we believe it should happen. There is absolutely no doubt, particularly for people with long-term conditions, for example, that over time, the obvious solution for many of them will be to bring together streams of health funding and social care funding in an individual budget that is focused on their personal needs. We need to go about that carefully and to get it right, but I agree entirely with the hon. Gentleman that that is inevitable and, as I said, I am delighted that he endorses the views of the Prime Minister and the Secretary of State.

It is also important to say that we have a new system of local area agreements that is bringing together local government, the health service and the voluntary sector at local level. It is interesting that local authorities have voluntarily identified social care—particularly self-directed support, personal budgets and the needs of carers—among their top priorities for local area agreements. That will also ensure that we have much better joint working at local level.

I have asked the regulator, the Commission for Social Care Inspection, to conduct a review of the eligibility criteria that govern social care. We all know that there is inconsistency of access to social care services both within and between local authority areas, so later this year CSCI will report to me on how we can adopt a more acceptable approach to eligibility criteria. We recently announced the extension of our dignity in care campaign—I am delighted that Sir Michael Parkinson has agreed to be our dignity ambassador—and we will go around the country focusing on this issue. It seems to me incredibly important that in every care home, on every hospital ward and in every domiciliary service, people debate every day what dignity and respect means for older people in their care. There is a limit to what Government can do from the centre, but if nothing else, we can provide leadership and ensure through commissioning and policy, as well as through the things that we say and do, that respect and dignity are seen to be important.

Photo of Susan Kramer Susan Kramer Cabinet Office, Shadow Secretary of State, Liberal Democrat Spokesperson (Cabinet Office)

I really appreciate the Minister's giving way and I apologise for not being here earlier. I was listening to the debate upstairs, and I came to the Chamber because I did not hear a subject that I am concerned about being covered. The Minister talks about dignity; let us consider elderly patients with dementia and their treatment in care homes. As he will know, my hon. Friend Dr. Cable and I have lost the battle to keep open the flagship facility at St. John's hospital, which deals with such people. We are finding that all the alternatives use a chemical cosh to control people with extreme behavioural problems, which surely is not acceptable to anybody in this House. Will the Minister address that issue in the remainder of his speech?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

It is very kind of the hon. Lady to join us and I agree entirely with the point that she makes about people with dementia. I pay tribute to Mr. Burstow for the significant work that he has done to get this issue up the political agenda. That is why, this autumn, the Government are launching the first ever national dementia strategy. We will focus on a number of issues: not only early identification of the symptoms and appropriate diagnosis and referral, but the quality and nature of care that people with dementia receive. We will also focus specifically on the question of inappropriate medication, which is obviously a concern not only to us, but to many families. We have to be careful not to exaggerate the scale of the problem, but it is clear that medication is being used inappropriately—to suppress people, rather than to treat them appropriately. That cannot be acceptable in the context of dignity, or of a civilised society and best professional practice.

Photo of Kevan Jones Kevan Jones Labour, North Durham

Does my hon. Friend agree that although many families want to keep dementia patients and people with Alzheimer's at home for as long as possible, there comes a point when they cannot cope, and the health service needs wards and other facilities for people with challenging or difficult behaviour resulting from their condition? Does he also agree that in places such as Durham, where the local trust is closing down such wards, people will be left in a very vulnerable position?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I agree with my hon. Friend. What is important is that in Durham—I would be happy to talk to him in more detail about this—the local authority and the primary care trust come together to ensure that the right continuum of care, from home-based support to day care, respite care and full-time care, is provided in that community. Some of that care—the full-time care—can be provided in residential and nursing settings. Some of the people concerned will have acute health conditions and might require acute NHS accommodation. From my experience of having, unfortunately, spent some time sat on an acute ward because of a family member's illness, I know that an acute NHS ward is not the best place for most older people with dementia.

The right relationship between the NHS and local government needs to be in place to ensure that enough places are available in nursing care, so that those people receive the quality, dignified and specialist care that they require. That is one of the issues that the national dementia strategy will specifically address, but, as I say, I would be happy to talk to my hon. Friend about the situation in Durham.

Photo of Jeremy Wright Jeremy Wright Opposition Whip (Commons)

The Minister will anticipate part of what I am about to say. He rightly says that the right place for these very vulnerable individuals to be is not an acute medical ward. Let us suppose that the right place is the proper type of care home with the necessary staff and resources to deal with their condition. Would it not be true to say that those people also need to be provided with some medical support from a specialist mental health team, and that such teams should come to care homes more often than they do now to offer support to the staff in those homes?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

Again, I pay tribute to the work that the hon. Gentleman has done on the all-party dementia group. He is right to say that we need a combination of getting universal services to be far more sensitive to the needs of people with dementia and their families and, equally, ensuring that providers of those universal services have access to people with specialist knowledge and expertise. That will be one of the key objectives of the national dementia strategy. In some circumstances, care workers will not have the professional expertise or qualifications to deal with people in the necessary way, so the national strategy will examine that.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I am grateful to the Minister for giving way, because I appreciate that he wants to conclude his remarks. I just want to ask him whether the national dementia strategy will come with some indication of how resources will be redirected and what additional resources will be applied to deliver it. For example, if inappropriate medication were used less, resources could be unlocked to invest in the training of staff, so that they could provide the extra support necessary to deal with the challenging behaviour encountered in many care homes.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

Of course resources are an issue; we must always consider whether we are using existing resources to best effect and whether we would ultimately save money if we shifted money to prevention and early intervention. All of those matters have to be addressed. I say gently to the hon. Gentleman that not a moment goes by without a Liberal Democrat making a spending commitment on the Floor of this House and in a "Focus" leaflet, but such commitments are never costed. The problem with being in government is that all spending commitments have to be costed. Of course, the question of resources has to be addressed.

I come to other issues that we are addressing this year. We are reviewing the "No secrets" guidance, which deals with the protection of vulnerable adults. We want to ensure that we have the right protection framework in place for vulnerable people. It is important to get the right balance between allowing people to exercise maximum control over their own lives and protecting people who may be very vulnerable. It is also important that the adult protection framework reflects the move towards direct payments and individual budgets, so that we do not end up in a contradictory position.

I have mentioned that we will announce soon a 10-year strategy to support the 6 million people who are carers. We are also consulting on the independent living strategy for disabled people. This debate is inevitably skewed towards the needs of older people, but we should not forget that the challenges we face concern all adults, and disabled people now have the right to expect equality of citizenship, independent living and full lives. I am proud of the progress that the Government have made on ensuring that disabled people have the opportunities that the rest of us take for granted.

I recently announced a specific study on adults with autism and Asperger's syndrome—another area that needs to be brought out of the shadows. We have long debated the fact that a growing number of children have autism, and we need to do more to support those children and their families. The Government can be proud of our "Aiming high for disabled children" commitments and reform, and of the record levels of investment, which will expand short breaks over the next three years. All those children with autism will grow into adults, and we know that the choice for many such adults is between learning disability assistance or mental health services. However, many adults with autism or Asperger's have neither learning disabilities nor mental health problems, so we need to ensure that we have the right policies in place to support those adults.

In the next few weeks, we will announce a significant renewal of our policies for supporting adults with learning disabilities to achieve the maximum possible quality of life. We have made much progress since the "Valuing People" White Paper, but we have not made much progress on access to jobs and employment. Many people with learning disabilities, if given the right support and chances, could hold down a job, and it is scandalous that neither the private sector nor the public sector is doing enough to ensure that more jobs are available for people with learning disabilities. I hope that we can see a commitment from both sectors to work together on a specific push to open up job opportunities for people with learning disabilities.

I am pleased to say that we are joining forces with four national charities in a £80 million campaign over the next four years to focus on the issue of stigma and mental health, which remains one of the biggest barriers in our society to people having a decent quality of life. The statistics are clear: mental health issues touch the vast majority of families, but the stigma remains, which is why I welcome the fact that an increasing number of well known figures have been courageous enough to talk about the fact that they have struggled with mental health problems at some time in their life. That is important for people who are struggling with a mental illness, but who do not feel able to seek professional help. That can lead to dreadful consequences, as we are all well aware. My hon. Friend Mrs. Moon is doing remarkable work in relation to the tragedies in her constituency—the issues are difficult to cope with, and we are not quite sure what is happening in that community—and trying to ensure that young people feel able to open up and seek support if they are struggling with mental health problems.

This year, for the first time, local authorities will be required by law to carry out joint population needs assessments. There is a growing emphasis on the importance of joint commissioning. Lord Darzi will produce his report on the future of the NHS. For many patients, it is the connectivity between the NHS, local government and the voluntary sector that determines their health and well-being, so as Lord Darzi maps out the next stage of the NHS's reform programme, it is important that we make those connections and encourage and support integration. The other place is now debating the creation of the new regulator to bring together the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Commission.

I shall end on the subject of the Green Paper on the long-term future of care and support. Both sides of the House are united in believing that we have to address this as a country and as responsible parliamentarians. First, the Green Paper is not just about older people, but about all adults who need additional support to have the best possible quality of life and to live independently in our society. Secondly, it is not about tinkering with the adult social care system, but about an entirely new vision for a care and support system that can respond to a changing society.

We are all aware of the nature of the challenges: demographic change, demand and affordability. We need to answer the financial question about how we will cope with demographic change and rising demand for these services. How will we respond to changing aspirations? An increasing number of people want care in their own home rather than in institutions, but our generation expects high-quality care and will accept nothing less.

We need to tackle the "no help here" culture, where people are told that if they have £21,000 a year or more, there is nothing that we can do to help them to choose care and make difficult choices. If someone goes to the local authority and says, "My mother is lonely and isolated. She is not getting out very much and does not have many visitors to her home," they are told that that is a loneliness problem and a low-level need. We need to do something about the notion that people's loneliness and isolation are nobody's responsibility. We have to tackle the Berlin walls between health and social care and between health, local government and the voluntary sector.

Photo of Roger Berry Roger Berry Labour, Kingswood

Is my hon. Friend also prepared to consider the Berlin wall between local authorities? Are the Government considering making care and support packages portable from one local authority to another?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

My hon. Friend raises an important point. A person for whom I have a tremendous amount of respect, Baroness Campbell—a tremendous champion for the rights of disabled people—is proposing some amendments on that subject to the Health and Social Care Bill in the other place. There is certainly an issue about the possibility of retaining the level of support in the short term when someone moves from one local authority to another, while the local authority carries out the necessary assessment processes. The more fundamental issue is that, as part of the debate, we have to resolve what should be universal and what should be subject to the discretion of local authorities and local PCTs. That will be central to creating a satisfactory new care and support system. Unlike in the NHS, there has been a massive amount of devolution and localism in social care. One of the challenges for the long-term review is what should be universal and what should be subject to local discretion. Of course, we also need to address the questions of the means test, the threshold and, as I said earlier, the group of people who work hard, play by the rules, do the right thing, are not rich, are not poor and feel that the system is unfair to them.

In the end, the responsibility must be shared between families, public agencies, the voluntary sector, the private sector, where appropriate, and local communities. People are absolutely clear about what they want and expect: independence, control, flexibility and, increasingly, personalisation. As the debate rages, it is important to focus first on the quality and the system that people want. We then have to address the difficult question of the respective financial responsibilities. What is it right to expect the state to fund through general taxation? What is it right to expect of families and of individuals?

Every party in this House accepts that the responsibility has to be shared. There are no easy solutions. The debate needs to be about fairness, transparency and affordability. How do we get a system that is seen to be fair, that is clear and that the country can afford in the long term? This is about not only the cost, but the benefit. In the end, we spend a significant amount of money on caring for people when they have deteriorated because the money is in the wrong place in the system. There is a debate about how we can shift money from the acute end of the system to the early intervention and prevention end of the system, so that we prevent people from deteriorating in the first place.

No party in the House now advocates—one party did so for some time—that, for example, free personal care should be a reality. The debate is about the respective responsibilities of the state, the family and the individual. The Government would genuinely like to achieve consensus in the same way as we achieved it on pensions policy. It is a shame that the Conservative party has begun to move away from that consensus to some extent. It would be in the country's interests if we could achieve long-term sustainable consensus on the system, but of course that is not totally in my control.

Finally, I am delighted that we have had the opportunity of the debate. I look forward to hearing the contributions of right hon. and hon. Members. The provision of care and support is one of the great issues that face our society. Perhaps more importantly, an increasing number of families are struggling daily to cope with the realities of ensuring that their older relatives who suddenly become ill have the dignity and respect that they deserve and the maximum possible quality of life. It is our responsibility to come up with the solutions, but we need to do so in partnership with families and local communities.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 2:50, 5 June 2008

I am very glad that we have the opportunity to debate this crucial area of public policy on the Floor of the House today. The assumption is that between one in three and one in five of us will need some form of long-term care, with about one in 10 of us needing to live in a care home. About a fifth of those who need long-term care will have some form of dementia. Two thirds of the care home population have some form of dementia, and that is likely to continue.

I immediately take the opportunity to pay tribute to my hon. Friend Jeremy Wright, who has done such an enormous amount in establishing and taking a big lead in the all-party group on dementia and in giving great advice in authoritative reports to hon. Members in all parts of the House.

What was estimated to be a £14 billion gross spend in 2006-07 is forecast to double to between £24 billion and £31 billion, depending on the decisions that we make now. In addition, the baby-boomer generation, having put its parents through the system, is about to go through the system itself. The national feeling is that those who have done the right thing in paying their stamp, scrimping together hard-earned savings in cash or assets, paying off their mortgages if they had them or sacrificing some lifestyle choices in their earning years to build and earn pensions and are now on ever-threatened fixed incomes—particularly in view of the current rising cost of living—are very anxious as the consumers of long-term care, as are their families. As the Minister said, they are the ones who are unlikely to settle for a system that is perceived as either unfair or inadequate.

This key issue is growing in the minds of English people—technically, given devolution, they are the people we are talking about today, but it is fair to say that the issue has a strong read-across to the other parts of the United Kingdom—partly because of their own experience and partly because of increasing media interest. I single out and congratulate in particular the Daily Mail on its dignity for the elderly campaign, the Daily Express on its respect for the elderly campaign and, indeed, the BBC's "Panorama", "File on 4" and "Today" programmes on raising the profile of the issue. I join the Minister in accepting that, when the media have been responsible, they have indeed helped to highlight the issue.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

It is reassuring to hear the hon. Gentleman describe this as one of the most important issues that we face. The leader of the Conservative party established a working party on social care. Will the hon. Gentleman tell me how often that working party has met and whether it has reached any conclusion?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

The great advantage of working parties is that they advise our party, and I hope that they greatly benefit what we are doing. That working party met very frequently, covering not just social care but health, housing and education. Of course it would be completely wrong to single out any of those parts. The Minister must know, from the research that I dare say he jumped up to try to read into the record, that the working party has met numerous times. It is important to recognise that we are all spending a lot of time and effort trying to understand and grapple with the issue that faces all of us and that is very much on the minds of the people we represent.

Excellent work is being done by organisations concerned with social care. The Wanless review from the King's Fund underpins much of the current debate. The Joseph Rowntree Foundation, Help the Aged, Age Concern, the Local Government Association and the International Longevity Centre UK have all led the debate, with organisations such as Carers UK and the Alzheimer's Society, among many others, feeding in their experience. I pay tribute to those organisations and encourage them to continue to hold the Government's feet—indeed, all parliamentarians' feet—to the fire. I am sure that those of us present hope to do just that today.

The Minister has said that the issue poses as big a threat to the country as climate change; the Secretary of State for Health said the same of obesity. Clearly, that is the metaphor of choice at the Department of Health. The difference is that we have direct control over the issue of social care. We know how the policies that we adopt will affect the future. The question is: are the Government doing enough, or could they be accused of dragging their feet?

The enormity of the issue and the political impetus that it has gained has given rise to

"a large amount of political will at the moment to try and really solve this problem."

That is what I said at the launch of the Caring Choices coalition report last year. The Minister said at that event that it was "absolutely crucial" to achieve political consensus, and the Liberal spokesman on that occasion, Norman Lamb, said that that "ought to be possible".

Consensus will come about only through serious discussion of the issue, underpinned by meaningful, trustworthy research and consultation. It is fair to say that there is consensus in the analysis of the problem, as the Minister suggested. It is right to put it on record that I agree with a great deal of what the Minister said in his opening remarks about the elderly, those who have lifetime conditions and needs, children, disabled people and those who have to take advantage of mental health services. It is important to recognise that we in the House share our analysis of the problem—the need, the demand, the technological opportunities and people's increasing anxiety to take control of their care and lead good, independent lives, often in their own homes, as far as is possible. We have to recognise that what is needed today is a Government proposal for a solution. It is on that point that there is anxiety, and on which I will focus much of my contribution.

If consensus is so important, we might start by placing it on record that it would perhaps have been helpful if a Liberal spokesman and I had been invited to the Prime Minister's launch on the future of social care. The Prime Minister ended his speech on that occasion by stating that he looked forward to building a consensus on the best way ahead, but it is quite difficult to do that if one excludes the very people with whom that consensus needs to be built. I hope that the Minister is committed to consensus in deed, as much as in word. If so, perhaps he should start by getting his Prime Minister to be a little less tribal, and to start to look at the national, big picture, rather than the narrow, Labour party view.

Photo of Roger Berry Roger Berry Labour, Kingswood

The Conservative pledge at the last election to provide free residential care after three years would have benefited the rich and would be worth nothing to people on lower incomes, such as my parents. In the spirit of getting rid of tribalism, will the hon. Gentleman assure the House that his party is withdrawing that policy and listening to the debate?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

Given that I was at a meeting yesterday with the hon. Gentleman, who was there as chair of an all-party group, I am disappointed that he should take such a cheap approach. As it happens, in the 2005 election, our party—not his party or the Liberal Democrats—was the only one that had any policy on the issue. Furthermore, it is absolutely the case that Wanless applauded our limited liability model. The hon. Gentleman tries to suggest, from a sedentary position, that I have just said something untrue; I hope that he will withdraw that immediately, as Wanless went out of his way to praise our limited liability approach.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

Before the hon. Gentleman tries to recover his position, I have said on the record that we are looking carefully at building on the policy that we were able to offer at the last general election—uniquely among all the main political parties—by saying that we are considering the partnership model. That is different, and we are also building on that, but at least we had something to put forward—something that does not just favour the rich, but which would give people certainty, in view of all the uncertainties, that at least some contribution would be made.

I will give way to the hon. Gentleman again if he wishes to correct his original intervention, which he got badly wrong. He should have tried very hard not to show that he was such a partial all-party group chairman.

Photo of Roger Berry Roger Berry Labour, Kingswood

I am grateful to the hon. Gentleman for giving way. I am sorry—I was trying to correct what I thought was a tribal comment on his part. I was making a simple point about the Conservative policy at the last election. My question was whether they have withdrawn the policy which, in guaranteeing free home care after three years, would clearly benefit the better off and would mean nothing whatever to people on low incomes, like my parents who, after three years, would have seen their savings gone. In the spirit of trying to achieve a fair system, will the hon. Gentleman acknowledge that that proposal ought to be withdrawn? Yes, let us look at partnership models, but that was not one of them.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

It was indeed one of them. The hon. Gentleman should read the Wanless report again. I am very surprised at his inaccuracy. I look forward to our forthcoming manifesto. There may well be a successor policy to the original one, but I am not suggesting that we are withdrawing a policy that made the British public proud that something was at last being offered to them at the previous election.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

Is the hon. Gentleman saying that the current position is that there is no policy, or that the policy that was in his party's last manifesto stands? Does the Conservative party have a policy on the matter? Does the policy in the last manifesto remain its current policy?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

The position is clear. As we approach the next general election, of course there will be a manifesto for that election. In the manifesto that we presented at the last election, there was an offer—uniquely, given that the other two main parties had no policy to offer, and have published no policy since. I shall describe why the Government have been so lacking in offering solutions.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

No. None of us wants to give time to the Lib Dems until they can show where £2 billion comes from.

Tribalism is typically unfortunate as we try to develop a consensus. In the light of the political good will that I shall try to establish, the public interest and the high quality of the debate that has been conducted by third party organisations, it was disappointing that the document underpinning our debate, "The case for change—why England needs a new care and support system", did not seem to come up with a proposal. It forms the basis for consultation and discussion, but it does not offer leadership and a way forward in an area where the third sector and the official Opposition have offered proposals.

The document offers no solutions and few facts, and barely outlines the problems. We were expecting the Government to begin grappling with the detail of the issue, but the document turns out to be, yet again, part of the consultation. I accept that the consultation is what the Government promised in the comprehensive spending review. We were promised continuous consultation, rather than action, and that is what we have. All of us hoped for more from the Government, and it is a shame that we have been driven by reviews. There have been 55 reviews since the Prime Minister started less than a year ago.

We are consulting in advance of a Green Paper, which itself is a consultation document. I am the first to recognise that consultation is important, but at some stage the Government must take action. The Minister said of the by-election in Crewe and Nantwich, the seat neighbouring mine:

"We face a stark choice. This is either the beginning of the end for Labour or a call to action."

I hope he heeds his own call for action. He might say that the Government are consulting now and will publish a Green Paper leading, presumably, to a White Paper and perhaps some legislation. The Government, we hope, will not find themselves trapped in a constant cycle of consultation. I leave aside Tony Blair's cry in his 1997 conference speech:

"I don't want children brought up in a country where the only way pensioners can get long-term care is by selling their home."

For 11 years, Labour has held to that promise and, for 11 years, has failed to do anything about it. The Prime Minister, in launching the consultation—

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

No, I will not give way. Let me finish the paragraph.

The Prime Minister said:

"Younger adults are aware that much of their parents' hard-earned housing wealth may disappear... At some point in the future people may have to sell a treasured home to pay for their own care...Too many people fear the prospect of selling their homes."

After 11 years, we are still in exactly the same position. I remind the House that we were led to believe by the Minister and his predecessors that the last CSR would provide some concrete proposals. That was last year.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

Will the hon. Gentleman acknowledge that the Government have given a sum of money to all local authorities to allow them to put a charge on an individual's home so it does not have to be sold in their lifetime if they do not wish it? The reason why so many Conservative MPs complain that people have to sell their home when they have a care need is because their constituencies are in Conservative council areas that do not bother telling people that this money is available.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

The hon. Gentleman did not produce any figures to justify that. The Minister himself said that he was not clear how much of the deferred payment scheme had been taken up, but it has been very light. I take issue with the hon. Gentleman's belief that that has made any tangible difference to people's concerns about having to sell their own homes. He knows that that is the case; otherwise the Prime Minister would not have said what I have just quoted.

When Sir Derek Wanless published his report on 30 March 2006, the Minister's predecessor, the Minister for Borders and Immigration, Mr. Byrne, headed off the criticism of his Department by announcing his intention—supported by the then Chancellor, now the Prime Minister—to conduct what he called a "zero-based review" starting from scratch to reassess the whole social care budget for older people. The announcement was that the Department of Health would

"conduct a review of social care, starting from first principles on how social care is funded. We believe this is a once in a decade chance to undertake a fundamental review of social care costs."

This review of long-term care funding

"would inform the Department's plans for social care funding, which will be submitted to the Treasury as part of the comprehensive public services spending review in 2007."

Building on the expectations raised by that, the Minister spent the 18 months before the CSR talking up what the Government would do through

"a new settlement in social care", a quote I have often used with him, in the CSR.

In February last year, the Minister said:

"We continue to negotiate with the Treasury to secure a fair and reasonable settlement as part of the comprehensive spending review."

In March he said:

"We will assess the proposals for the future provision of long-term care services as part of the long term vision of the comprehensive spending review 2007."

In June he said:

"We are arguing forcefully...with the Treasury about the importance of a good settlement for social care under the comprehensive spending review."

Yet when the CSR came, there was no evidence of any zero-based review having been undertaken and little evidence of any impact of negotiations with the Treasury. There were certainly no solutions to the funding of long-term care.

Furthermore, I have asked a raft of parliamentary questions about the zero-based review. It has met only four times in total; in June, July, October and November 2006, concluding a year before the CSR. The Department did not quantify the work of the group; that is supported by a written parliamentary answer. I cannot track down any evidence of the work done, any report, any recommendation or any impact at all. I should also mention the concordat "Putting People First," another bundle of paper with no firm commitments, proposals or bases for action.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

Perhaps I could develop my argument a bit more; the Minister did very well to take a full 50 minutes. He was keen to paint a record that was very lopsided.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

The "bundle of paper" to which the hon. Gentleman referred was signed up to by a gentleman for whom I have a lot of respect—Sir Simon Milton, who is a member of Boris Johnson's cabinet. He is the most senior Conservative councillor in this country.

Far from being a "bundle of paper", what the hon. Gentleman referred to is the beginning of a three-year radical transformation programme, supported by more than £500 million of Labour Government money in every local authority area in the country. Does the hon. Gentleman wish to withdraw his description of it a "bundle of paper", given that it is in fact a three-year transformation programme supported by more than £500 million?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

The Minister has admitted that he regards that not as taxpayers' money, but as Labour Government money—a rather unusual approach to identifying other people's hard-earned money. What is key is that there was no firm commitment or proposal as a basis for action on the issues that we are addressing today. That is the central point.

The Minister has said that the Prime Minister is "out of touch"; that may be why the Prime Minister and the Government are so desperate to consult. At least we have the promise, on the record, that the Green paper will be published in early 2009—given what has happened in the past, "early" means any time between January and July. Assuming a three-month consultation period thereafter, the White Paper will come out at the end of 2009 at the earliest. Will that really come five months before the last possible date for a general election? It would seem that legislation will be undertaken by the next Government at the earliest—nearly six years after Wanless published his review. The inescapable conclusion is that the Government appear to have tried to kick the issue as far as they can away from the current parliamentary Session.

What the Government should be doing is simple: getting together good data on the issue, as we have been arguing, so that parliamentarians can make policy from an informed position. The Government should have done that in the past 11 years. All the forecasts of demand are predicated on morbidity remaining constant as the population ages. What assessment have the Government made of that?

More scandalously, the Government do not know how much is currently being spent across public and private purchasing, different Government Departments and local authorities. A cursory glance at the Official Report shows a raft of hundreds of questions, from me and many other hon. Members from across the House, that are answered with statements such as, "The information on numbers and costs is not held centrally." The Government have also failed to do any modelling on how different funding structures might impact on public and private finance, consumer and provider incentives and the shape of the market.

The National School for Social Care Research, launched last week, will, we hope, provide some of the academic rigour needed to underpin this debate. We will be watching closely to see that it does. If it lives up to its billing, the school will be long overdue and much welcomed.

Sir Derek Wanless flagged up Kent county council's long-term care insurance. It looked promising to him, but neither the Department of Health nor the Treasury would fund further study, as each said that it was the other's responsibility. Other councils, such as the Conservative-controlled Isle of Wight council, have recently started to provide free social care to all those over 80. Why are the Government not investigating those? As we assess the Government's action, it is fair to ask why in the past 11 years they have not done what was easily identifiable as necessary.

I shall move quickly over the Liberal Democrats' free personal care proposals during the last election; the policy was unaffordable and their health spokesman called—

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

Boring! You're so tedious!

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

Ah! I am pleased to see the hon. Lady in her place. She, the Liberal Democrat health spokesman, called that policy during an Adjournment debate, on the record, "dishonest"—an appellation that she went on to attach to all Liberal Democrat manifesto writers.

It seems that the policy has been quietly dropped by the latest Liberal Democrat leader, Mr. Clegg. Many weeks after it was originally said that it had been dropped, it has also finally been dropped from the Lib Dem website. The Liberal Democrat spokesman will no doubt tell the House that the Lib Dems have committed to a "care guarantee" based on Wanless's partnership model, along with a £2 billion price tag. It is fair to say, however, that until the Liberals have said what each person might be guaranteed and given an indication as to where the money will come from, the House need not be detained by giving the proposal any credence. It is interesting to note that the Minister said that the free personal care that was offered in Scotland had never been deliverable, let alone delivered, because of the disparities between local authority provision in Scotland and because it completely omitted the so-called hotel costs of accommodation and food. As there was a combined Labour-Liberal Administration at the time, I am sure that the lesson has been taken to heart that that policy could not be afforded. That is another element in building the consensus that has at last been arrived at.

We need to find a way forward on carers, on whom the Minister spent a little time in his speech. There are about 6 million carers in the UK, and more than three in five of us will become carers at some time in our lives. Too often, carers bear the brunt of inadequate provision of care and support, and they are among those who are suffering most because of the Government's prevarication on reform. In its helpful briefing for this debate, Help the Aged calls for carers to be supported as an integral part of the care and support system. I pay tribute to the work of Carers UK and many other partners of carers week, which takes place next week. We are still waiting for the new deal for carers; I think that the Minister said that it will be delivered relatively shortly.

It is important to recognise that carers have become very concerned about the changes made to service provision and regular respite care, particularly locally, through changes to the carers grant. I make a distinction between the announcement on emergency respite care and the need for regular predicted respite care, which remains of serious concern to many carers. Carers suffer most because of squeezes by councils on eligibility criteria. We are therefore looking seriously at how carers can be included as part of the original assessment of the care needs package of the cared-for person. We need to include a recognition of the effects on the social and other aspects of the carer community. That may be a pointer in terms of the consensus that is being developed across the parties and across the House.

This applies equally to the grave concerns that we all share about young carers. In 2001, the census found that there were approximately 175,000 young carers in the UK, although that figure is believed to be higher by those working in the field. The average age of young carers is 12. One in three regularly misses school and one in four has no external support. That has led to tragedies such as that of Deanne Asamoah. Those of us who understand and are concerned about this issue know that there is a need to support young carers, not ban them. It is important that it is part of a family's choice, and often the young person's choice, that they wish to care for a parent, grandparent or other relation. The needs of young carers should be part of the original care assessment, as I said in relation to carers generally. When making the assessment of the cared-for person, there must be clarity about the needs of the young person and those must be taken into account in assessing the package of support that is required.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I agree entirely with what the hon. Gentleman said about young carers. Does he welcome the fact that in the bundle of papers he referred to, there is, for the first time, a requirement on adult services to ensure that, as a result of the decisions that they make about an adult, no child or young person is left inappropriately caring for a parent? He is right to say that we cannot stop children and young people loving a parent who has an illness, and nor should we, but no child should have their childhood stolen through being asked to take on inappropriate responsibilities. Does he welcome the fact that in the bundle of papers he dismissed earlier, we call on adult services to ensure that that never happens to any child or young person?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I certainly acknowledge that there is a call. The issue has been support in resource terms to ensure that it happens. That support has not been translated into what is happening on the ground, which is why the matter has caused concern throughout the House and has been the subject of some debate. It is important that we try hard to maintain the consensus on young carers and carers in general, because the regularity of respite care is important to the health and welfare of carers, who are ultimately the people who will be able to deliver the best care.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

No, I think I have given way generously to the Minister. There will be a chance at the end of the debate for him to put anything he wants to on the record.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I am going to move on because I think that the Minister has had more than a fair chance.

We must also tackle the issue of dignity. On Tuesday, the Commission for Social Care Inspection report on dignity for those in dementia care identified that only a quarter of the care homes inspected had detailed care plans that gave guidance about the residents' preferences for care. CSCI issued statutory requirements to half the care homes, detailing actions that they had to take to improve care provision, and an astonishing one in five were given requirements on maintaining people's privacy and dignity. It is clear that that is simply not good enough, but at the same time, we must praise and celebrate much of the good work that goes on in care homes, carried out by people who give such a lot of professional support.

The problem is not limited to the social care sector. The Healthcare Commission's report, "Caring for Dignity", which was published in September last year, looked at 23 trusts at high risk of non-compliance with dignity standards. The report noted that the profile of dignity had been raised in the NHS, and I am sure that the whole House will wish Sir Michael Parkinson well in his role as the dignity ambassador. Raising the profile is one thing, and concrete action is another. The Healthcare Commission noted serious failures of non-compliance, most often due to failure in providing single-sex accommodation. In addition, most trusts found it difficult to engage with patients with dementia and inadequate arrangements were made for uninterrupted meal-time environments.

As we know, the Healthcare Commission's most recent in-patient survey, published on 12 May, showed that one in four patients had to share a sleeping area with people of the opposite sex when first admitted to a hospital ward, and that one in five had to share a sleeping area with the opposite sex when moved to a second ward. Nearly a third of patients had to use the same bathroom or shower area as the opposite sex. The survey also highlighted malnutrition, with one in five patients not given enough help to eat their meals. It is important for the House to note that those failures are not primarily the fault of front-line care staff—far from it—or hospital managers. It is a question of the gulf between the words that are spoken and the ability to translate them into action.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

Does the hon. Gentleman welcome the fact that in the NHS operating framework for this year, it is made clear to NHS managers that minimising mixed-sex accommodation has to be a top priority? Does he also welcome the fact that the director general of Age Concern, Gordon Lishman, is overseeing an action plan to improve nutrition in the health and social care system? Finally, does the hon. Gentleman's party have any policies at all on how we will enhance support for carers in our society?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

The Under-Secretary was right to say that Age Concern referred to malnutrition and I am glad to note the important work that will help tackle the problem. However, the problem emerged in responses to a series of parliamentary questions, which I tabled. The Government eventually gave the information, which showed a seriously adverse move, I think from 10 to 11 per cent., in the proportion of those going into hospital who left more malnourished. Government figures acknowledge that. It is interesting that Gordon Lishman said:

"What we need is not just a discussion but a timetable for action. These problems have been with us since Labour came to power".

The Under-Secretary needs to be careful about whom he prays in aid.

Mixed-sex wards cause "indignity" and "distress"—a quote from Tony Blair in 1996. He said:

"Is it beyond the collective wit of the Government and the health administrators to deal with that problem? It is a question not just of money, but of political will."—[ Hansard, 19 November 1996; Vol. 285, c. 832.]

Yet the Government have reneged on their promise to end such wards, although the Secretary of State attempted to make a weaselly distinction between mixed-sex wards and mixed-sex accommodation. The Under-Secretary was rightly keen to identify dignity as central to many of the arguments about social care, but we must consider the Government's track record.

The Under-Secretary also rightly identified the importance of individual budgets for older and disabled people. We look forward to the publication later this year of the Green Paper on the individual budget pilot programme, which finished at the end of last year. We accept that individual budgets are key to giving more control to individuals. The Institute for Public Policy Research report, "Just Care?", which was published last week, called for joined-up services and consideration of the community and family context of care, a greater voice for the community, clarity in outcomes and supporting individual choice through budgetary control of services.

Oldham is a pilot site for the Department's individualised budget scheme and a "total transformation" site for In Control. To date, the pilot scheme has made an 8 per cent. saving in the overall budget. In the feedback from participants, 86 per cent. reported an improved quality of life, 56 per cent. said that opportunities to take part and contribute to their community were increased, 72 per cent. reported greater choice and control over their lives and 74 per cent. said that they had more dignity in their support. People should be able to take charge of their care and not be forced into accepting "one size fits all". Direct payments and individual budgets do not simply deliver savings—far from it—but give people the freedom to take charge of their lives and design their care services around their individual needs. It is vital to acknowledge that, although individual budgets and direct payments are no answer in themselves, they are positive when appropriate and should be encouraged.

Tightening the eligibility criteria has also caused great concern. As was pointed out earlier, yesterday evening, I attended the launch of the National Centre for Independent Living's report for the Coalition on Charging, entitled "Charging into Poverty?" It states that rising care charges put older people and disabled people at risk of not being able to afford to eat, heat their homes, wash or get essential support. It found that 80 per cent. of those surveyed who no longer use care services said that charges contributed to their decision to stop their support. A fifth of those surveyed who currently use support suggested that they would stop if charges increased further, and 29 per cent. of respondents did not feel that their essential expenditure on impairment and health conditions was taken into account in financial assessments for paying charges. That means that they have to choose between essential support and equally essential food, heating and utility bills. Nearly three quarters of those surveyed believe that the Government should think about the charges that people pay for support at home in adult care reform plans.

The Coalition on Charging is calling on the Government to conduct a thorough review of the impact of care charges from 2008 and for those issues to be addressed in adult care reform in England. We await the outcome of the eligibility criteria review from the Commission for Social Care Inspection, which the Under-Secretary mentioned, in relation to a power that I hope that the Health and Social Care Bill will not remove. We discussed that with the Minister of State, Department of Health, Mr. Bradshaw, in Committee and we hope that that power will not be temporarily suspended until the next general election. The continuing operation of CSCI and its successor, the Care Quality Commission, will be an advantage for all.

Often, the most vulnerable people affected by the various issues in long-term care and care for the elderly are the low earners and those subject to the means test. The Resolution Foundation, headed by the former special adviser to Mr. Blunkett, has done some work on the impact of care charges, particularly the means test, on low earners in the UK. There are 15 million low earners in this country, 3 million of whom are over 65. Low earners are 25 per cent. more likely to be carers. They find the system complex, inaccessible and unfair, and have found it difficult to access the advice and information that they need. Again, I am happy to share the Minister's view on the importance of having access to good information and advice.

Low earners often have limited savings and their primary source of wealth is, as it happens, their homes. The Resolution Foundation's report says that 72 per cent. of low earners have levels of wealth that can exclude them from free care and argues that reform of the long-term care system is more important even than improving hospitals. That is the call for action coming from so many of the people who find that long-term care is their primary need.

I share the Minister's view, as I am sure hon. Members in all parts of the House do, that finding adequate resources to meet all those demands is a major challenge, given all the other challenges that we face. That is why it is important to get the Minister to urge all his colleagues and the processes within Government to come up with the final reviews, so that the final recommendations can be made and decisions taken. The principal frustration, at least on the Conservative Benches, is that we have been subjected to such a series of reviews that people do not have that base of information that is so important in coming to the conclusions required.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

In his opening remarks, the hon. Gentleman was critical of the Government for publishing a consultation document that was long on analysis but short on prescription. Surely the way for him to start goading the Government into developing their policies is for the Conservative party to set out what it would do, but that is signally not what we have heard so far. Will he tell us what the Conservative party thinks about such issues?

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

All in good time—and that is not just a light aside, but a serious point. When a Government are in office, they have a responsibility to produce the data that we have called for, upon which everyone can then make an informed judgment and formulate policy. [ Interruption. ] The Minister may say from a sedentary position that Wanless has done that, but the Government have said that they did not use the Wanless report as the base upon which they made recommendations. Indeed, the Minister's predecessor said that there needs to be a zero-based review, but that has not come forward. That is why we are all so mindful of the fact that the Government have not yet produced the base upon which policy is to be articulated.

The issues are wider than just care. Work force issues come high up the agenda in any reform of the sector. In 2007, Dame Denise Platt reported on the status of social care, with recommendations on supporting the work force with the establishment of a skills academy, a research centre, which I assume is what the Government launched last week, a journal and social care awards. I should be grateful if the Minister could update the House in his winding-up speech on those recommendations that he did not touch on earlier.

There are other issues, too. On Monday, The Times reported that criminal records checks for thousands of migrant staff are not being done. According to The Times, an estimated 240,000 foreign-born individuals were employed in the care-related sector in 2006, and they are vital to that sector, as the Minister said. The concern is not only that such individuals are going unchecked. Care providers are also concerned that they have paid £36 a time for checks that are not properly undertaken. Can the Minister tell us whether the providers are told when a proper check has not been carried and, if not, can the provider get its money back?

The issue is one of some interest. I understand from representations that I have received that the amounts of money are significant, which is causing care home owners and others to become anxious about a process in which they are obliged to engage. If the Minister cannot answer my questions immediately, I would be grateful if he agreed to write to me and anybody else who is interested.

This is a crucial debate for the House, and if it will speed up the Government's production of their review—I know that I speak for millions of people in this country in saying this—we would love that to happen. We would give a resounding cheer if it did. However, we are trapped in a consultation process, or even paralysis, when what is really needed is hard data collection, costed options and a grown-up discussion that can lead to a consensus policy approach based on the Government's proposals and recommendations.

I pay tribute to the many third-party organisations that are campaigning on this issue, and I urge them to continue to hold the Government's feet to the fire. I urge the Minister to put the vast resources of his Department, and the army of civil servants at his disposal, into collecting the necessary data and to bring those data, along with some serious measures, to the Floor of the House so that we can reach consensus on what is best for the most vulnerable people in our society. As Gordon Lishman of Age Concern said:

"What we need is not just a discussion but a timetable for action. These problems have been with us since Labour came to power".

The Crewe and Nantwich by-election might have been, as the Minister has suggested, the beginning of the end for Labour. The Prime Minister and the party he represents might, as the Minister has indicated, be out of touch, but there is certainly a call to action on this issue. It is up to the Government to answer that call with more than just words; they need to translate them into deeds.

Photo of Roger Berry Roger Berry Labour, Kingswood 3:36, 5 June 2008

I very much welcome this debate. I do not feel completely paralysed about talking about policy while waiting for someone else to produce some data. I genuinely hope that the national debate, and the response to the consultation document, will produce a consensus that will take us forward. I genuinely agree with Mr. O'Brien that it is important for these matters to move quickly. Like him, I note that the Green Paper is planned for next year, and I urge my hon. Friend the Minister to ensure that it is produced early next year, if possible, and that decisions are made soon thereafter.

My hon. Friend the Minister is doing an outstanding job— [ Interruption. ] I have just agreed with the hon. Member for Eddisbury, yet he is churlish enough to speak from a sedentary position. I will continue, however. The Minister is doing an excellent job of developing this agenda, and I very much welcome the actions that the Government have taken thus far. Inevitably, however, there are certain things that we can urge them to do better and more quickly. Again, I agree with the hon. Member for Eddisbury—

Photo of Roger Berry Roger Berry Labour, Kingswood

I note what my colleague says.

I agree with the hon. Gentleman that urgent action on some issues is necessary. The needs of many disabled people, older people and carers are not being met. The system is bureaucratic, wasteful and inefficient—

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

My hon. Friend is making a very good point, but he missed out one important word: underfunded. That is the problem, is it not?

Photo of Roger Berry Roger Berry Labour, Kingswood

If my hon. Friend had allowed me to continue my sentence, or indeed my speech, I would have said that. I will come to the issue of funding in a moment.

There is little doubt that we have unmet need and inefficiencies—multiple assessments are an example—and my hon. Friend the Minister has acknowledged that there are inconsistencies in local authority provision. Those factors, together with the fact that care packages are not portable between local authorities, mean that many disabled people, older people and their carers do not have the freedom of choice that they have every right to expect. I want briefly to discuss those issues.

It has been well documented that more than 70 per cent. of English local authorities restrict access to support to those who meet the highest eligibility criteria. There is an issue about access and about charges. Yesterday evening, I hosted a meeting on behalf of the National Centre for Independent Living to draw people's attention to a report that the centre has published on charging for care. It was a pleasure to be at that meeting with the hon. Member for Eddisbury. I will not repeat the conclusions that he brought to our attention, and I am grateful to him for doing so, but it is a fact—albeit, in this study, based on a small sample—that people are being discouraged from securing the care and support they need because of charging. They are afraid of increases in charging in the future. That is notwithstanding the fact that the Government have put far more funding into social care than the previous Government. It is a fact that funding for local authorities more generally has been significantly higher than under the previous Government. However, we all know that demands are increasing for demographic and other reasons, and that aspirations are, understandably, increasing.

The Coalition on Charging is right to say that we need an urgent review of charging policy in the context of the debate about care and support. It represents 18 well-known organisations, including Age Concern, Radar, the National Centre for Independent Living, Disability Alliance, Carers UK, the Alzheimer's Society, Mind and Mencap. Those very well-known, competent, professional and knowledgeable organisations are all urging us to tackle charging.

Photo of Jeremy Wright Jeremy Wright Opposition Whip (Commons)

Does the hon. Gentleman agree that one of the difficulties with charging is defining what is a social care need and what is a health care need? The Minister described a number of times the Berlin wall between health and social care. Is not the problem that sometimes some of the issues are being smuggled in or over the Berlin wall between those two, so that what is really a health care need, which should be funded entirely by the state, is called a social care need, and the person receiving the care has to make a contribution?

Photo of Roger Berry Roger Berry Labour, Kingswood

The division between so-called health care and so-called social care has been a problem since 1948. Indeed, it was a problem before then; it was just that in 1948 our predecessors set up a national health service and did not attach a similar importance to setting up a social care system. I should declare an interest, although no longer financial, because both my parents are in the advanced stage of dementia. I therefore have direct experience of the problem, as well as the experience that we all have from our constituents. I have never understood why dementia, as a medical condition, means that the NHS can abandon its responsibilities and hand people over to the social care system, whereas for those with cancer, which is also a medical condition, it does something different. The logic is clear: if people have needs as a result of their condition, we should have a uniform policy.

In terms of funding, as a society the taxpayer needs to make a significant contribution. As my hon. Friend the Minister said, it is right that individuals and their families inevitably will make a contribution. That is the nature of the debate. However, I do not find it useful, and never have found it useful, to distinguish between health care and social care in the sense of trying to find one set of principles for access or funding that can be applied to health care, and then making a great leap and saying, "But by the way, there should be a completely different set of principles that apply to funding and access in terms of social care."

We are, as a society, trying to make progress—there is much closer working, for example, between the health services and social services in my area than there was 10, 15, 20 years ago. There is joint commissioning and joint budgets. For reasons that I do not need to repeat, I share the hon. Gentleman's concern that often we apply different principles in different circumstances without being able to justify them intellectually or in any other way.

On charging, my understanding—I hope I have got this wrong—is that the review of charging announced in the independent living strategy, to be led by the Office for Disability Issues, is set for 2009-11. I hope the Minister will tell me that I have misunderstood, and that it will be brought forward to become part of the welcome overall review of care and support.

Let me make a point that arises from the report published yesterday by the Coalition on Charging. As I have said, many organisations have expressed concern about this issue: organisations representing 10 million disabled people, 6 million carers, and who knows how many millions of older people, depending on the definition. Of course there is some double-counting and, indeed, some treble-counting, but the community of interest in care and support represents a very large proportion of all our constituents.

Disability organisations, older people's organisations and carers have united on this issue, as they have on the related issue of independent living. We would be well advised to recognise that, according to a major body of public opinion, it is time we did more to ensure that disabled people, older people and carers have the same rights, choices and freedoms as everyone else, along with access to good-quality care and support. Whether we agree with those organisations or not, as elected representatives we must recognise that they speak for a fundamental and significant group of our constituents, who will rightly demand action from us. A coalition of interests is emerging that I did not observe three or four years ago, and it is clear from the Government's response to the concerns expressed in the consultation document that they recognise that as well.

The report by the Coalition on Charging refers to the additional costs incurred by disabled people for such necessities as heating, equipment and accessible transport. Disability-related expenditures are important to the determination of charging policy, but it is often said that many of them are not taken into account for that purpose. We need to address charging policy extremely seriously.

Photo of Linda Gilroy Linda Gilroy Labour, Plymouth, Sutton

I am very interested in the meeting that was held yesterday. I am not sure whether Leonard Cheshire Disability is a member of the coalition, and I do not know whether my hon. Friend has read its report "Your Money or Your Life". According to that report, when social care support is cut, family members are much more likely to leave their jobs to become full-time carers, and families then slide into debt, poor health and endless worry. Is that covered in the coalition's comprehensive report, and does my hon. Friend agree that the Government should take it into account?

Photo of Roger Berry Roger Berry Labour, Kingswood

Leonard Cheshire Disability—another admirable organisation, for whose work I have great respect—has raised such issues on a number of occasions, and they are very pertinent. Earlier this year, it examined the implications of disability-related expenditures for the extent of poverty among disabled people. It is relevant to the debate, for obvious reasons, that according to official statistics three in 10 disabled people—3 million out of 10 million—live in poverty. If necessary expenditure on extra heating, adaptations, equipment, accessible transport and personal assistance are taken into account, according to the most conservative estimate a disabled person's cost of living is 25 per cent. higher than that of a non-disabled person. Leonard Cheshire Disability deserves credit for coming up with what must be the most conservative estimate, but if it is true, that means that not three in 10 but six in 10 disabled people live in poverty.

The additional dimension that I therefore want to introduce into the debate on the future of care and support is that—despite the Government's achievements in reducing poverty very significantly, including for disabled people, the extra money going in and all the other policies—we must recognise that as of today, there is a real challenge here, because many disabled people are living in poverty. When we talk about charging policies for care and support, we must not forget that fact.

Nor must we forget the obvious, which is that means-testing does provide disincentives for people to save. Gosh—I am agreeing with the hon. Member for Eddisbury again, but I am sure that we all know that. This is an important issue, particularly for those living on very low incomes. Indeed, if the Government are to meet their poverty targets, which I believe they will, they will have to address disability poverty, because we will not meet our child poverty reduction targets without reducing disability poverty. So this is an enormous agenda, and it is all related to the future of care and support.

My hon. Friend Kelvin Hopkins raised the question of funding, and the truth is that we get the social services and social care that we as a society are prepared to pay for. I have always accepted the view—indeed, a sane person could not do otherwise—that taxation is the price we pay for a decent, civilised society, so it is self-evident that anyone who wishes to spend more money in a particular way has to be prepared to vote for it and to indicate where that money comes from. That is as true now as in any other circumstances.

I would add, however, that there are significant savings to be made in the social care system. There are ways in which—I am sure that the Government are looking at this; the organisations certainly are—the system could be made less bureaucratic, wasteful and inefficient. First, there are multiple assessments for benefits. I am often driven to tears, as we all must be, when a constituent tells me how many forms they have had to fill in to access benefits. Then, there is social care, housing, accessible transport, adaptations and so on—the list goes on and on. I met a constituent the other day who had assessments going into double figures. This is a complex issue and it is not easy to solve, but we can do better than that.

Photo of Kevan Jones Kevan Jones Labour, North Durham

On adaptations, does my hon. Friend agree with me that it is not just a question of the bureaucratic cost involved, but the delay? For example, in County Durham the assessment is done by the county council and the adaptation by the district council, and the delay involved is sometimes not weeks but months. Throughout that time, the person who needs the adaptation is clearly suffering and having a very poor quality of life.

Photo of Roger Berry Roger Berry Labour, Kingswood

I agree with my hon. Friend; we will all have encountered that experience.

It must be said that sometimes, it takes a long time for the assessment to take place, and then it might be out of date, so another assessment has to be made. Alternatively, the assessment is made when one is absolutely convinced that the relevant local authority has no intention of sanctioning the expenditure. Resources are spent assessing people's needs when there is grave doubt, to put it mildly, whether the resources are there to meet those needs. That is not a very efficient way of using money.

Also, reducing delays in meeting people's needs can be not only the right thing for the individual but incredibly efficient in using public resources. The Office for Disability Issues has examined a range of initiatives on independent living and has pointed out, for example, that investing in housing adaptations and improvements can result in long-term savings. If we invest in the adaptations necessary today, we are less likely to have to spend on social care or residential care further down the line. On occasion, I am not sure whether we have a system at all. We have a jigsaw puzzle; we have a mixture of initiatives, some coming from one area, some from another. The collective effect of our complicated system is that if decisions were made quickly, they would often result in overall efficiency in the system. Some up-front funding in a range of areas, including housing adaptations and support, could lead to the efficient use of resources in the future. We must recognise that we get the care and support system for which this country, as a society, is prepared to pay.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

Does my hon. Friend agree that another problem is that the one significant area of a council's budget that is not ring-fenced is the adult social care budget? That means that it is in the council's interest to raise charges, to extend eligibility criteria and to exclude people from care, because it can then use the money somewhere else, if it wants to do so.

Photo of Roger Berry Roger Berry Labour, Kingswood

My hon. Friend, who has great expertise in this area, is absolutely right; the point has been well made, and I hope that he will get the opportunity, in a moment, to make it at greater length, because it is significant.

I have been talking about the fact that investing more in improving the care and support system can, in many respects, be good finance, because money is saved further down the line. We should not forget the obvious: that investing in enabling people to live better quality lives not only gives them their rights, but it enables them to contribute to society. The Minister made the point that we are talking about individuals who not only have rights, but who, if they are enabled by having the same freedom, choice and opportunity as everybody else, can make enormous contributions to our society. We should get away from any notion of a burden.

I wish to give others time to contribute to the debate, so I come to my final point, which relates to the inconsistencies in local authority provision and the fact that care and support packages are not portable from one local authority to another. I was first made aware of that major problem more than 10 years ago, when there was a lobby in support of disability rights in Westminster Hall—that has since been repeated. I met someone from Lambeth who told me that he wanted to move to Southwark—I cannot remember whether he wanted to move in order to work or to live in Southwark, or to do both.

This individual wanted to move from one London borough to the borough next door. When I did that—I used to live in Lambeth and I now live in Southwark—I encountered no problem; I just moved. He faced the serious problem—it was not the trivial problem of just finding and sorting out somewhere else to live—of not being able to take his care and support package to the next-door borough. He was terrified of the prospect that if he moved from one borough to another, he would lose his entitlements and, moreover, that it might take ages—his perception is more important than the reality, but we know that these things take time—perhaps a year or so, for his care and support package to be sorted out by the next-door borough. He told me, "I am a prisoner in Lambeth. I don't have the freedom that you have. It took me ages to sort out a decent care and support package. I am happy with it, because it is a good package, but I want to live somewhere else." We are not talking about another country, because he was moving next door, to another London borough, yet his package is not portable.

For many years I was a local councillor and I believe that localism has many merits, but it also has many disadvantages. The hon. Member for Eddisbury and I were at a meeting last night and the one occasion on which I got a round of applause—perhaps the rest of my speech was not very good—was when I said, "This is localism gone mad." The disabled people, older people and carers present knew what I was talking about. Baroness Jane Campbell and many others have made the point that the lack of portable care and support packages denies disabled people freedom and choice. It is not good enough that each individual local authority should have its own packages.

My personal view is that disabled people and others want a fair and universal system for care and support packages. I am not saying that local authorities should not be the very important agents that implement the packages or arguing that we should reduce their important role in this matter. However, it imprisons disabled people if they cannot move their care and support packages.

Care and support is a vast and challenging area, and I commend the Government on the progress that they are making. It is part of the commitment to make progress on independent living. However, we still have a long way to go before everyone can exercise the freedom, choice and rights that independent living means. It should be a priority for policy developers and for resources, because millions of our constituents deserve nothing less.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons) 4:01, 5 June 2008

I welcome this debate on the Floor of the House on a key aspect of public policy that all too often does not get the attention that it deserves. It is especially good to follow Roger Berry, who rightly drew the House's attention to the coalescing of coalitions around the need for a much more rights-based approach to the delivery of care as a key part of making progress on this agenda. I hope that at the end of the debate the Minister will respond to the hon. Gentleman's remarks about portability, because it is nearly impossible for people with a care package to move from one locality to another with confidence that it will continue in place.

Listening to the remarks by Mr. O'Brien, I thought that they were a model of the speech that someone should make if they were keen to be spotted through Google. All the key words were trotted out, such as Alzheimer's Society and Age Concern—it was a list of the key words that people interested in the issue would punch into a search engine, but anyone who found the hon. Gentleman's speech in that way and started to read it would find that it had nothing at its heart. It had no substance: we heard nothing but analysis, with no prescription or any attempt to suggest that the Conservatives had any policy, other than during an exchange with the hon. Member for Kingswood about the Conservatives' 2005 policy.

That 2005 policy is, we understand, the party's current position on the funding of long-term care. It is described as a "limited liability model". Well, it is certainly limited, in a range of ways. Most importantly, it is deceitful in saying that the state will step in to meet the care costs of an individual in long-term care only after three years. That is deceitful to the public because the average life expectancy of someone in care—these figures are quite dated—is little more than 18 months. For most people, therefore, the liability is limited absolutely and they would never become eligible for state support under the system proposed by the Conservative party at the last general election. The reality is that, in the past few years, because of tightening of eligibility criteria, life expectancy in care homes has become even shorter.

We also heard the curious argument that the Conservative party is in some way frozen, unable to develop a policy, because the Government have not yet published all the data. The hon. Member for Eddisbury gave us data by the bucket load, yet the Conservative party still cannot articulate a policy of its own. I hope that the timetable that the hon. Gentleman urged on the Government will soon be published by the Conservative party, too. The people of this country need to know what the Conservative party, as well as my party and the Labour party, has to say on these issues.

I want to move on and say something about my party's position.

Photo of Linda Gilroy Linda Gilroy Labour, Plymouth, Sutton

Before the hon. Gentleman moves on to the subject of his party's position, did he notice, as I did, that the hon. Member for Eddisbury spoke with some pride about a Conservative council that gave free care to the over-80s? Does his analysis of that coincide with mine, which is that in those places—I would call them the leafy suburbs, although the Isle of Wight, which he was talking about, hardly fits that description—where people are better off, they tend to live longer? That means that the better-off are favoured compared with those who struggle throughout their lives to live, to eat and to have good health.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

Those issues are inherent in the system. There is that difficulty. The hon. Lady has made her point very clearly and it is now on the record.

When I approached my preparation for this debate, I was overwhelmed by an incredible sense of déjà vu. More than a decade has passed since Labour came to power, promising to tackle the long-term care issues that were facing this country. Secretaries of State and Ministers have come and gone, and so have consultation papers, Green Papers and reviews—even Prime Ministers have come and gone. Yet one constant remains: social care in this country is still a poor relation of health policy and of almost any other aspect of public policy. It is undervalued and underfunded, and there is much within it that is unfinished business.

Why do I say that? One has only to look at the record. For example, in March 1999, as the then Secretary of State for Health, Frank Dobson, concluded his statement on the royal commission on long-term care—I am sure that some hon. Members will remember that august group and the publication that it produced, which is still gathering dust in many parts of this House—he said:

"I hope that the royal commission's report and the debate that it will stimulate will help us to find a way of ensuring that people have access to high-quality long-term care that is fair to both individuals and the taxpayer. I hope that it will be founded on a consensus that will stand the test of time: a dependable contract across the generations. That is of great importance because, second only to good health, elderly people seek financial certainty and security, and that is what the Government are determined to deliver."—[ Hansard, 1 March 1999; Vol. 326, c. 743.]

Some determination—10 years have passed, but those words could have been almost exactly replicated by the Minister today. Indeed, in some ways, they were.

I do not deny that it is good to have consultation and dialogue and to build consensus, but the Government embarked on the process in 1999, and 10 years on we are still waiting for the action that will begin to transform the system. Ten years on, the system for funding long-term care is as confusing, unjust and unfair as it ever was. Instead of acting, the Government have been content to defend and tinker with the status quo, introducing piecemeal changes of the sort that have been set out by the Minister in his speech today, but failing to tackle the fundamental unfairness in the system.

In those 10 years, the health service ombudsman found that the NHS and the Department of Health had allowed thousands of elderly people to be ripped off, paying for care that should have been fully funded by the NHS. Just this week, a constituent of mine wrote to me to tell me of the long-running battle to recover the costs of their mother's care, which, as is now accepted, should have been funded by the national health service. She has just received a cheque for £91,000 as a consequence. The sums that have been repaid to people as a consequence of what is, frankly, the mis-selling of care by the Government and the NHS run into hundreds of millions of pounds. Yet, thanks to the conspiracy of silence between the NHS and far too many social services departments around the country, people have been means-tested, which happened to my constituent's father, who was forced to sell his home to pay for long-term care.

Even now, the lottery of access to care continues. Huge disparities remain between the numbers of people primary care trusts say will qualify for NHS continuing care funding. Of course, the new framework is welcome, but it does not yet appear to be getting the traction necessary to effect the sort of change that the rhetoric suggests is being demanded. For example, figures from Age Concern just last year show that, in Gloucestershire, funding for continuing care covered just six out of every 50,000 head of population, compared with Coventry, where 88 out of every 50,000 people got access to NHS continuing care. Any plan for the future of care and support must deal with the funding question.

A new financial settlement for social care must strike a better balance between the funding of health and social care by local and central Government and individuals and families, as well as the mixing in of private and voluntary sector contributions. The royal commission on long-term care offered a way forward to deliver such a rebalancing of the system, but the then Chancellor of the Exchequer set his face against the commission's central proposals. Indeed, by the appointment of those who served on the commission, he sowed the very seeds of its own failure and destruction.

I regret the fact that the then Chancellor chose to set his face against the commission. I believe that good policy demands that we look at the evidence and that we learn from experience. That is why the Liberal Democrats championed the case for implementing the commission's central proposal. In government, that is exactly what we did in Scotland, and we saw the idea made reality. Perhaps it is not a perfect reality, but we still believe to this day that we should see that as a cause of pride, because it made a difference in Scotland and because those who independently assessed the scheme acknowledge that it made the system somewhat fairer, although perhaps not fairer overall.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I will take the hon. Gentleman's intervention, as we sparred on a number of occasions on these subjects when he was a Minister.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

The independent assessment that said that that policy was a good idea was carried out by the man who came up with the idea in the first place.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I am referring to the assessment done by the Joseph Rowntree Foundation a couple of years ago, which was separate from Lord Sutherland, who, quite rightly, has also done such an assessment, in which he was prepared to acknowledge both the warts and the good points. The Joseph Rowntree Foundation acknowledged in its assessment that the system had been fairer than the one that still operates in England.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

I have been agreeing with the hon. Gentleman, and I strongly support the royal commission's conclusions on paying for care. Since then, however, the Liberal Democrats have backed off and joined the Tories and the Government on these matters. Is he not speaking against his own party?

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

Not at all; I am taking some interventions that have stopped me getting to the point of my comments. At the top of this part of my remarks, I simply said that no good policy and no one involved in policy making can ignore evidence and experience. Although there are good aspects to the delivery of free personal care in Scotland, some aspects of it are not working. Some perverse incentives have been built into the system. We accept that they mean that we must change our policy, and we are doing so.

Let me set out what we think needs to happen. Even if we are changing our policy, we are the only ones who still have a policy and are prepared to articulate one. No policy has been articulated by the Conservatives, and we have not yet had one from the Government. As Dr. Ladyman rightly suggested in his intervention, Lord Sutherland said that the system in Scotland had problems, but he also acknowledged that it is working well in many ways. In recognition of those difficulties, we have changed our policy.

In striking a fair balance of funding, it is essential that absolutely everyone is clear about who pays for what. Lack of transparency is the fatal flaw in the current system that must be addressed. We believe that when framing new policy, any Government must clearly mark out what funds come from the state through the taxpayer, and what comes from the individual. The foundation of any new system must be the principle of universality, to ensure that every person has access to a guaranteed minimum standard of care.

Liberal Democrats believe that the work that Derek Wanless did for the King's Fund offers a practical way forward: that work suggested a personal care grant based on need, not ability to pay, for those who require personal care. Under our proposals, that payment will be set at two thirds of the cost of all the care that a person needs, guaranteeing a minimum standard of care. On top of that, every pound that an individual spends to make up the other third should be matched pound for pound by the taxpayer. That would create the climate necessary to incentivise and reward saving and ensure that there is the necessary means to fund fully a care system. Those who are on low incomes should be entitled to support for their care costs through the benefits system.

Putting that new settlement in place will not be without a cost. The point made in interventions in this debate is absolutely true: we cannot get something for nothing when it comes to trying to drive up standards and deliver better quality care.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I shall just develop my point a little bit, if the hon. Gentleman does not mind. Based on the modelling that has been done for the London School of Economics by Julien Forder, who was involved in the Wanless work, it is estimated that the cost to the taxpayer of our proposal for paying two thirds of the cost of care and matching additional individual contributions pound for pound would be £2.1 billion. That cost, and how we pay for it, will be set out in detail in the costings documents that we always publish as part of our manifesto, which are always appraised independently, found to add up and found to be effective in demonstrating how measures are delivered.

Several hon. Members:

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Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I am spoiled for choice. I will give way to the Minister.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I respect the hon. Gentleman's contribution to our debates, but from an economic literacy point of view, how on earth can one come up with a policy without identifying how it will be paid for? He has just conceded that his party has not yet done that, but says it will find a way of doing so at some point. He has identified the policy and how much it will cost, but he has completely failed to identify how it will be paid for. How much extra tax would the average taxpayer have to pay if the policy were delivered?

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I will not take any lectures from Treasury Front Benchers, given the debacle of the doubling of the 10p tax rate and the fact that extra money was borrowed to get us out of that policy. The Government's record on fiscal responsibility went out of the window then. We have said that we will identify specific savings, which will be earmarked to pay for our policies, and we are doing so. We have already set out some, and we will set out more. We will deprioritise some issues in order to prioritise care of the elderly. Surely that is what any sensible Government do when allocating resources.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

No, I would like to make progress. I will take another intervention in a minute, if the hon. Gentleman will bide his time. I am sure that we will still be somewhere near the subject when he gets his chance to intervene. It is not just our belief but that of many independent experts that that £2.1 billion extra a year is the minimum necessary to provide the care guarantee that every elderly person in the country needs. Such an approach has been welcomed by a wide range of organisations. I will not make a "Google point" by listing them. Let us be clear: there is no cost-free solution, as much as the Government might want us to wriggle on that hook, and might want to try to embarrass my party and me because we have outlined how much extra we think needs to be spent. The current system is unfair and not fit for purpose, and additional investment is essential to allow the system to move on to what we need for the future.

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I will; the hon. Gentleman is persistent.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

I am grateful to the hon. Gentleman. He described his policy as a two-thirds-for-free package, followed by a pound-for-pound match by the taxpayer. According to my simple arithmetic, the Liberal Democrats have moved away from free personal care to five-sixths free personal care. In other words, the only extra money that the individual will provide is one sixth of the total cost of personal care. Given the demographic changes that we foresee in the next 20 years, that is not a £2 billion cost but a cost of something like £10 billion. Where will he get that sort of money from?

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

The hon. Gentleman will recall from his detailed study of the royal commission's report when it considered projections that it concluded, first, that we should not allow ourselves to be driven to distraction by the myth that a demographic time bomb is about to explode and make it impossible to provide dignity in old age; and secondly, that in terms of the share of GDP that will be necessary over the next 20 to 30 years, the increase will be less than 1.1 per cent of GDP to realise the free personal care proposals.

In his report, Derek Wanless set out the implications for GDP. By 2050, the cost reaches about 2.6 per cent. of GDP, compared with its present level. As a price that society should be prepared to pay, a slightly increased share of GDP for dignity in old age is a price that I am prepared to go to the electorate and argue for. I am disappointed that the hon. Gentleman is not. There is no cost-free option.

Derek Wanless published a report for the Government which advocated increased investment in health care. It was a seminal moment after the 2001 general election, which gave the Government the case that they needed—the Chancellor's case—for a significant boost in spending in the national health service. We strongly supported that and voted for the extra resources to be made available. That report contains the seeds of a further concern of mine.

In his report on health spending, Derek Wanless rightly made a link between health and social care spending. He rightly identified that social care spending had lagged behind health spending. Over the past decade, NHS spending has increased by 70 per cent., whereas social care funding has risen by 14 per cent., yet in so many ways they are two halves of the same system: underfund one, and we undermine the other.

The Wanless report recommended a review of social care funding. The then Chancellor said no to such a review. Is that still the present Prime Minister's view? Is he willing to commit to the investment in social care necessary to deliver a sustained and better future for social care? That is the question that the Government so far have not answered, yet they expect us in opposition to do so. We have been clearer about our position and how much it will cost than the Government have been prepared to be so far.

All the indicators point to a system that is under huge pressure. Care is being rationed ever more tightly. The Commission for Social Care Inspection, in its report "The state of social care in England", paints a depressing picture of the system's difficulties. The number of older people receiving services has fallen year on year, while the number of people with unmet needs has risen. More than 120,000 fewer people are receiving home care than when the Government came to power. The commission found that more than 250,000 people are receiving no support at all from local authorities, charities or commercial care providers for the daily tasks with which they need help, and almost 500,000 are receiving less help than they need to maintain a decent standard of well-being.

That adds up to over 700,000 older people in England who are not getting the care package that they need. At the same time, there has been a 25 per cent. fall in the number of people having their care costs met by local authorities in the past 10 years, as a direct result of ever tighter eligibility criteria. The Leonard Cheshire report "Your Money or Your Life" has been mentioned. It paints a disturbing picture and presents ample statistics. I do not want to cite them, but I shall give two quotes from the report about the impact of ever tighter eligibility criteria on real people's lives.

The first is this:

"He tried to commit suicide by drowning himself—he has fallen and banged his head".

The other quote is as follows:

"He had 77 hours of care a week and it's been halved—he can't be on his own—he now shuffles around on his knees. He needs constant care."

Care is now routinely restricted and rationed in this country to those with substantial or critical need. I had to look up the definitions to be clear what that meant—just how critical one had to be, how substantial the need had to be.

The rhetoric is all about independence—a vision we can all share and embrace. The hon. Member for Kingswood rightly talked about the need for far greater emphasis on independent living in what the Government do. But to qualify on the basis of critical or substantial need, one has to have been the victim of abuse, to be the potential future victim of abuse or at death's door. Those are key criteria used to sift out those who are entitled to the largesse of the state and its support and those who are turned away.

The future of care support has to be a lot more ambitious. We must connect the lofty goal of independence to the reality of people's experience of the system on the ground. That is why the review of eligibility criteria is important, but it should not just ensure a level playing field. The level is so low at the moment that we have to do more to be ambitious to get the quality of life that we want people to enjoy.

It is not just who pays for care and the level that the taxpayer contributes to that care that have to be addressed. There is also a need to overhaul the legislation governing adult social care. Today, there are more than 40 Acts of Parliament governing the organisation and delivery of social care in this country. The legislation has all the hallmarks of its piecemeal evolution, with differing philosophies of care, reflecting the era in which the legislation was drafted. The National Assistance Act 1948 is a good example: crafted for a rather different view of the world in terms of how politics and public services would be delivered.

Private Members' Bills have attempted to crowbar important reforms into statute, the carers legislation being an obvious example. That is a good example of individual private Members leading the policy agenda in the House through legislation, but surely the Government need to take stock of the carers legislation. There are also considerable gaps, overlaps and contradictions between different existing pieces of legislation.

How is any practitioner, or anyone who wants to access the system, supposed to keep abreast of all the primary legislation, let alone the regulations and guidance? It is a mystery to me how we expect that someone we wish to take control of their budgets and personal lives will be able to do just that. The Minister was right when he talked about unintended consequences of the community care legislation, which to an extent left self-funders out of the system of being given support and helped to navigate through the system. That is why we need a new comprehensive adult social care Bill, which would consolidate and reform the way social care is organised and delivered, setting out in law the key principles that underpin the system. In many ways, this would address how we deliver that notion of independence.

The only way we can deliver a notion of independence is by empowering individuals to have the rights, even through the courts, to demand what they are entitled to. If it is down to care plans, guidance, Ministers making promises at Dispatch Boxes or local executive members of councils promising things, none of those is ultimately as tangible as the ability to take them to court and hold them to account. We need to look at how we ensure that the system is reformed in that way. At its heart is the idea of empowering users of services and carers to get what they need. In this way, the essential needs of carers can be met too.

No matter how good or gold-plated the social care system becomes, there is no substitute for the huge contribution of family carers. I have no doubt that the new national carers strategy, which is to be published next week, will contain much that will be welcomed on both sides of the House. Many will have contributed to the consultation, but unless carers have a legal right to services, too many will continue to shoulder a burden of care, paying the price with their own health and well-being as a result.

The Minister knows that I have raised concerns over the years about the scandal of elder abuse in this country. Elder abuse is a serious matter and the Government are to be applauded for funding a study that found that 342,000 people over the age of 66 are the victims of one form or another of abuse: fraud, theft, psychological or emotional abuse, assault, restraint and various other things. The study set some pretty high hurdles before someone could be counted in it as a victim of abuse. It excluded those in care homes, who are now to be included in their own new study, and anyone with dementia. The study's figures must be a conservative estimate of the problem.

To be honest, I would rather we went beyond just catching and punishing abusers. That is important, and the Government have introduced measures that might help us to do that, but we need a system that prevents abuse in the first place. A new adult care reform Bill could place the user and carer clearly at the heart of the system so that they can determine the service provision that they need. Getting the service right will reduce the risk of abuse happening in the first place. In that context, I hope that the Government will give local authorities and the courts the powers necessary to protect vulnerable adults from abuse.

There have been proposals; they have been around for more than a decade. In 1995, the Law Commission said that it had no confidence in the adult protection procedures that existed at that time. However, not a lot has changed since then. The Law Commission proposed that to protect vulnerable adults, social services departments be given powers similar to those to protect children: a duty to investigate; powers for magistrates to issue entry warrants; temporary protection and removal orders; and an offence of obstructing officers acting on behalf of the courts. However, all that was put to one side, and we had the guidance issued in the form of "No Secrets"—worthy words that have not changed hearts and minds or secured the change necessary on the ground.

In 2006, Action on Elder Abuse completed its own study on behalf of the Department, and it found that "No Secrets" was not being taken up consistently across the country. It recommended that in respect of protection, vulnerable adults be placed on a statutory footing equivalent to that for child protection and domestic violence. That was in March 2006. Two years later, in March 2008, there was a welcome, perhaps overdue, Department of Health announcement—of yet another review. It was a review of "No Secrets" and one that may consider legislation.

When Victoria Climbié tragically lost her life because of neglect, abuse and failure in the system, it convulsed the child protection system and galvanised the Government into doing something. It cannot be right that we should have to wait for a similar shock to the adult protection system to achieve long-term, long-overdue reform and action.

In conclusion, the case for a new deal for social care is overwhelming and there are two essential elements for delivering that transformation. The first is dealing with the unfinished business of who pays for care. That must be settled. A partnership model that shares the burden clearly and fairly between the state and the individual is now the best way forward and the only way to secure a lasting consensus. Secondly, the transformation of the system that hon. Members want can come only by giving the users and carers power to drive change themselves. I am thinking not only of policy change but of statute. That means clear legal rights to services through a reform of adult social care law. Those most vulnerable and in need in our society deserve no less; I hope that in their remaining time, the Government do something about those two key challenges.

Several hon. Members:

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Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. Before I call the next hon. Member, I should say that the speeches so far have been extremely lengthy, perhaps for good reason. However, the whole House can see how many people are seeking to contribute. If hon. Members make shorter contributions, we can try to get everybody in.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet 4:33, 5 June 2008

I pay tribute to my hon. Friend the Minister for his leadership on this subject. It takes only a short review of his curriculum vitae to see that he has the portfolio towards which his entire career had pointed him. That experience is being put to good use, as he shows real leadership on this subject. I congratulate him on that and on his opening speech.

As far as the opening speech made by Mr. O'Brien is concerned, the least said the better. However, I should like to offer one particular criticism. Like many Conservative speeches, it fell into the trap of using a stereotype of what care is all about. I well remember that when I had the ministerial portfolio on these matters I was constantly having debates with the Conservatives about care homes. They were convinced that we had to take immediate action to keep care homes open around the country even though people did not want to go into them. There were shades of that view in the hon. Gentleman's speech, indicating that they still have not heard that we want to create a new vision for social care.

As for the speech of Mr. Burstow, he is right that we had many enjoyable jousts when I was in that job. However, I must take him to task over the arithmetic that underpins the Liberal Democrats' policy. We clearly heard him say that their new policy is to invite the public to pay one sixth of the cost of personal care with the state picking up five sixths of the cost, instead of the entire cost, which was their previous policy. Let us examine that. There are 1.2 million people working in social care at the moment. The wages for 1.2 million people, even if they are on the national minimum wage, must be about £25 billion or £26 billion a year. The state puts £14 billion into the cost of social care, so the private sector, at the most conservative estimate, must be providing £12 billion. The hon. Gentleman's policy is to raise £2 billion from some undisclosed place and invite the public to kick in £2 billion of their own money, after which the missing £10 billion will be magically found from somewhere else. If he had said, "The Liberal Democrats' policy is that we need to kick an extra £10 billion a year into social care", I would have replied, "Well, all right, that is in the right sort of ballpark. With an extra 4p or 5p on income tax, you go away and take that to the public and see how you get on at the next general election." However, they are not going to take that policy to the public, because they know that the sums that they have come up with are profoundly dishonest.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

My hon. Friend is trying to frighten us with big numbers, as so often in the past. The royal commission suggested that the figures would be far less, even over the next 50 years. Does he accept that such sums are scare figures and in reality are much smaller, and that even if they were at that level, the majority of the population would probably agree to pay for them out of taxation, provided that it was fair?

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

First, I would say that the royal commission is entirely wrong. Secondly, the figures that I quoted are today's figures, not tomorrow's figures or made-up figures. There are 1.2 million people working in social care. Their wages, paid for by the public sector and privately, must be in the region of £25 billion. The public sector only kicks in £14 billion. The difference is the cost of personal care made up for by people's personal contributions. If the Liberal Democrats are saying that they are going to pay for that, they must promise to pay for all of it, not some mythical small amount.

My hon. Friend Kelvin Hopkins mentioned the royal commission and its idea that social care can somehow carry on over the next 50 years as it is and that we should not let the potential demographic time bomb deflect us. Let us look at those figures. We know for a fact that the number of older people has quadrupled in the past 100 years and doubled in the past 75 years. We know that the number of people over 65—currently 9.3 million—will increase to at least 17 million by the middle of this century. We know that the number of people over 85 will at least quadruple by that time. We know that the number of people with learning disabilities—about 800,000—will increase to 900,000 by 2020—

Photo of Paul Burstow Paul Burstow Shadow Chief Whip (Commons)

I am sorry to interrupt the hon. Gentleman as he trots out those important demographic statistics, but may I ask him about his attack on the position of the Liberal Democrats? Our policy is founded in the research and modelling done by the London School of Economics for and on behalf of Derek Wanless in respect of his work for the King's Fund. Is the hon. Gentleman saying that that was complete rubbish and therefore should not be the basis for any policy making?

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

The Chancellor has already indicated that he will not use that work as the basis for policy making, and one reason why may be that he shares my concern about the number of people for whom we will have to provide care in the future. In a moment, I shall come to my vision of how we should resolve these issues. I have some proposals to put to the Government, and I do not know whether they will be taken up.

We have to start planning for a transition from where we are today, spending about £10 billion from the public purse on older people's care and another £4 billion on the care of people with disabilities, to the position in 2050. We should be planning not on spending twice as much at that point, but on spending three or four times as much to provide the same level of care as we do today. I agree with my hon. Friend the Member for Luton, North, who I see is shifting in his seat waiting to intervene, that that is not enough. We are not spending enough today, and we have to plan on spending three times more just to stay still, if we are to carry on doing the same thing.

Einstein used to say that madness is continuing to do the same thing and expecting a different result. My argument is that we have to start repositioning social care. We have to think again about what social care will look like in the future, because we cannot plan on the basis of its looking as it does today. Not only do we need a completely different vision of social care and the way in which it will work, we need a completely different vision of how we will pay for it. When the hon. Member for Sutton and Cheam and my hon. Friend the Member for Luton, North, whom I shall give way to in a moment, talk about social care funding, it is clear to me that they are talking about where the money goes to, but in my view they are failing to think about where it comes from. I shall give way to my hon. Friend; I am sure that he will tell me that he would be perfectly prepared to put up income tax to pay for such care. I suspect that our voters would not be.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

I have asked many of our voters about this issue, and they say that they would be happy for income tax to be raised to pay for care so that they would get it. Why do we not look at the models of Scandinavia, Germany and France? Even today, France and Germany spend 2 per cent. more of GDP on health than we do—£30 billion more on health in British terms. We are miles behind the levels of spending in Germany, France and Scandinavia, and we should be spending at those levels.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

I agree with my hon. Friend that we need to spend more on social care. We are not putting as much into it as we ought to be. All I am saying is that even if we put that right today, and carry on providing social care for the next 50 years in the way in which we do now, we will not be able to afford it in 50 years' time. We have to start investing in different ways of providing support for people that will reduce the cost of social care.

My hon. Friend Roger Berry touched on some of those ways. Adaptations and telecare have a huge potential to lower the cost of social care by allowing people to be provided with care and support remotely. We should be making significant up-front investment in helping people to implement telecare. We need to be thinking of providing tax breaks to those who are prepared to put such adaptations into their homes, if they want to be self-supporting and they do not already have them.

I have argued passionately for some years that we need a huge expansion of extra-care accommodation; I know that the Department is keen on such accommodation. We need to get that message across to the Department for Communities and Local Government as well. Extra-care accommodation is where people live in their own flat or bungalow in a community in which flexible care packages are available. People go into those communities when they are relatively fit, hale and hearty, and if they have the flu for a couple of weeks in the winter and need a bit of care, a flexible care package is available. If their condition deteriorates as time goes on and they need more care, they can build up their care package. As they are living in a community where many people have different needs, care can be provided in a very cost-effective way. Most of all, it maintains people's independence. When one asks people what two things they want out of the social care system, my constituents reply, "We want to maintain our independence and stay in our own home. We don't want to go into a care home. We understand that some people may have to go into care homes and nursing homes, but we don't want to be those people." The extra-care model provides that independence. People have their own front door and the ability to stay behind it if they wish. In addition, private home owners can lock away some equity in the cost of the home. People want to continue to have some equity and pass it on.

I shall cut my comments short because so many colleagues want to speak, but I encourage my hon. Friend the Under-Secretary to examine some research by the International Longevity Centre. I provide some advice to the UK branch, and a researcher called James Lloyd recently produced some excellent research, which considers inheritance packages in this country. It shows that there is huge expectation among people of a significant inheritance. Approximately 2 per cent. of people a year get a significant inheritance, but many people expect to get an inheritance of tens of thousands of pounds at some time. That does not apply to everybody, but it suggests that more than enough wealth is locked away in personal property for many people to provide for their social care and a comfortable standard of living in their old age, if they can find ways to free up equity that do not put their entire equity at risk but allow them to manage their affairs appropriately. Buying extra-care accommodation is one method of achieving that.

Another method of unlocking some of the equity and putting it into social care that the International Longevity Centre recommends is a social insurance model. That encourages those who can do so to make a lump sum payment into a social insurance model at the age of 65. The money will provide the billions needed to provide free social care to all those who contribute to the model for the rest of their lives. It would provide the sums of money that the hon. Member for Sutton and Cheam needs to seek and the free personal care that people need. It would share the burden between everybody who reached that age. Existing state funds could then be used for those who do not have the equity or the means to contribute to the social insurance fund. Those are not the only ideas that we should consider, but I believe that they should be given some thought in the consultation on which we are about to embark.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

I have asked many people whether they would prefer to put at risk their small amount of equity in granny's family home or pay slightly higher taxes. Without exception, everyone said that they would much prefer paying a slightly higher rate of tax to putting the small amount of equity at risk.

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

I take my hon. Friend's comments at face value—I am sure that his constituents say that. However, my constituents do not say it to me; perhaps we have very different constituents. I also stress to him that I have not proposed models that put equity at risk. In both models—extra-care, whereby people buy into care communities, perhaps with some sort of tax incentive from the Government, and social insurance, whereby people use some of their equity at the age of 65—the remaining equity would be protected. Their inheritance to their kids would be protected if that is what they want. The rest of us would not be faced with a demographic time bomb and potentially huge increases in income tax to pay for such care. Perhaps my hon. Friend would like to propose his idea of paying for all that through extra income tax. I am perfectly happy for that to be on the table, but we should consider the full cost, not the Liberal Democrats' mythical £2 billion. We should consider the full £10 billion or £15 billion and then see whether people are prepared to pay the hike in income tax that would be needed to cover it.

Photo of Paul Holmes Paul Holmes Liberal Democrat, Chesterfield

If the hon. Gentleman's constituents are not willing, as other people are, including in my constituency, to pay the extra income tax needed to provide coverage across the board for everybody, can he clarify why they would be willing to put their equity into a care community or social insurance, knowing that everybody who was not doing so would be paid for by the taxpayer? Why are people not willing to pay through taxation, but happy to use the system that the hon. Gentleman describes?

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

Because of the standard of care that people will receive, as they will be able to maintain their independence in a way that might otherwise not be possible and because the Government might encourage them through income tax breaks, since that system would be more profitable for the Government than relying on income tax. The hon. Member for Sutton and Cheam has been telling his constituents that they can have free personal care for only £2 billion, which is about 0.5p on income tax. I am sure that we would all pay 0.5p on income tax for free personal care. However, the cost will not be 0.5p on income tax; it will be 4p or 5p, and our constituents will not stand that.

Let us have a sensible debate about the future of social care. Most of all, let us ensure that we are aiming for a vision of social care that allows people their freedom and independence, and achieves the generally higher quality of care that we shall all be looking for when we reach that age.

Photo of George Young George Young Chair, Standards and Privileges Committee, Chair, Standards and Privileges Committee 4:51, 5 June 2008

It is a pleasure to follow Dr. Ladyman. He was the architect of some of the reforms that we have debated this afternoon and has made a plausible bid to get his job back by sharing with us his vision of social services in the future. I hope that he will excuse me if I do not follow him down the same path.

The only point that I want to pick up from previous speakers is that which Roger Berry made, quite rightly, about the lack of portability of social care packages. It is not just local authorities that do not provide portability; it is the national health service. We can move from one GP to another and find a totally different prescribing philosophy or find that a new primary care trust has a totally different approach to IVF, for example. The hon. Gentleman put his finger on the problem, but it is much broader than he described.

I want to focus on one aspect of social care, namely the move to self-directed support in social services, which is the most radical and exciting change currently taking place in social policy. Before I talk about that, however, I want to say a word about two carers organisations in my constituency.

My hon. Friend Mr. O'Brien, in a powerful speech, mentioned young carers. Growing up nowadays is difficult enough, but it is even more difficult if, at the same time, a young person has to care for a parent or sibling. I pay tribute to the work of the Andover young carers project, which cares for about 150 children between the ages of eight and 17 by providing somewhere to meet, homework clubs, support groups in school, short trips and holidays. The project is a lifeline for vulnerable families and enables them to function effectively. The other organisation is the Princess Royal Trust for Carers. I am sure that other hon. Members have branches in their constituencies and that, like me, they will be launching carers week in their constituencies next week.

We have made enormous progress in enabling people who work to care at the same time, by developing flexible working. We now need to make similar progress in enabling people who care also to work, in order to achieve their goals and raise their incomes. Both the organisations that I have mentioned survive on a shoestring, and I am sure that that is the same for many voluntary organisations in other constituencies.

I want to talk about personal directed support—the move from an inflexible, institutionalised response to personal care needs, individual budgets and personalised care or self-directed support. Personal directed support is a much more user-friendly response to social care, which, as the Minister said, means that people will have a life, rather than a set of services, which often entrench further dependency on the local authority.

Hampshire county council, which is a progressive authority led by Ken Thornber, with Nick Georgiou as director of adult services, has set up a commission to take the policy forward. Serving on that commission is this year's president of the Association of Directors of Social Services, a local authority chief executive, leading academics and representatives of the voluntary sector. I sit on the commission as a humble observer.

I want to make three points about the change to personal directed support. First—the Minister touched on this—there is a parallel between the debate about personal directed support and a similar debate that took place 30 years ago, when I was the doing the job that the Minister is now doing. At that time, we had large numbers of elderly people in long-stay geriatric wards in hospitals and even more people in mental hospitals with learning difficulties, or mental handicap as it was then called. Most of them did not need to be there and did not want to be there. They were disfranchised and institutionalised; they were not in charge and they could not choose what to do. So, we moved to a new policy—care in the community—that enabled people to become de-institutionalised and to lead as normal a life as possible in the community. We hear the same kind of language today about the need to move away from today's institutions—adult training centres and residential care, for example—to other forms of personal support.

At this point, I need to mention the Treasury. The Minister was briefly a Treasury Minister. When the debate on care in the community was going on, the Treasury's interest was aroused. It saw enormous savings; pound signs flashed before its eyes as the mental hospitals were closed, the land was sold off, and the public sector employees in hospitals and mental hospitals were dispensed with; informal and "cheaper" care in the community was just round the corner.

The policy was never going to save any money. The reason for introducing it was not to save money; it was done because it was the right thing to do. Moving away from large-scale institutional provision to more tailor-made individual provision is likely to cost more. In the short term, it will certainly cost more, because of the need to keep two systems going in parallel. We had to develop the services in the community before we could close the mental hospitals. I think that the same will be true of the move to personal directed services. It will not save money if it is done properly.

I think that it was the university of Lancaster that carried out some research on this subject, which showed that less can be spent on individual budgets than on local authority-provided services. However, part of the reason for moving over to a new regime is to intervene earlier and to help all those people who are not being helped at the moment. I think that my hon. Friend the Member for Eddisbury mentioned CSCI—other hon. Members certainly have—which has criticised the tightening of the eligibility criteria. Many people with substantial needs—let alone those with low levels of need—do not get any help at all at the moment. This is before we even start to consider introducing the Wanless model, in which everyone gets something for nothing, and which must cost more. The lesson of history is that these types of social reform will not save public money and that, if we are to achieve the goals and unlock the potential, they will actually cost more.

My second point might help to solve the first one. Other potential sources of funds could go into individual budgets besides what is being spent by adult services. The primary care trusts, for example, might be able to put some money into the kitty. As Mr. Burstow said, the trusts have had much more generous settlements over recent years than social services. Other local authority departments, such as adult education, could chip in. The potential pool to be spent is therefore bigger than the one currently being spent by adult services. Indeed, one could argue that disability benefits should also go into the pot. If the aim of a disability benefit is to enable someone to overcome their disability, should it not form part of the pot of personally directed support?

My final point on personalisation, or self-directed support—

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

Will the right hon. Gentleman give way?

Photo of Stephen Ladyman Stephen Ladyman Labour, South Thanet

The right hon. Gentleman is making an excellent speech, and I am enjoying it very much. I agree with an awful lot of what he is saying. May I encourage him to look at a 10 Downing street strategy document that was produced about two years ago, which covered personalised budgets? It included the recommendation that we should indeed investigate taking money from all those sources and putting it into people's personal budgets.

Photo of George Young George Young Chair, Standards and Privileges Committee, Chair, Standards and Privileges Committee

Indeed. The point that I was about to make was even broader: personalisation need not be confined to social services. We could apply it to education, and to higher education. Indeed, once the personalisation genie has been let out of the bottle, where do we stop? We almost reach the point of education vouchers if we go down the path of personal budgets or individual budgets for personal care.

Finally, I want briefly to touch on the implications of the new policy. There are obviously going to be implications for social services departments. At the moment, they are the funder, the advocate and the supplier. They provide all three functions. Once we move to personally directed support, they will be the funder, but they will not be the advocate and they will probably not be the supplier. This will have enormous implications for the structure of the departments, and they will have to make absolutely certain that independent advocacy services are available. It is not true to say that older people do not want choice, but it is true that most of them do not want the hassle of navigating the care system without easily accessible advice and support. At the moment, sadly, information and advice services are exactly those that are being cut back, and that needs to be addressed if the roll-out of self-directed support is to be feasible.

The supply side of personal social services must respond. There will be a whole new market as individual buyers try to invest in particular packages of care to meet their needs and a whole new infrastructure will have to be created to respond to the change in the market as resources are shifted from institutional provision to more individualised provision. There will be fewer block contracts, much more transparency on costs and, crucially, a need for more trained providers who can provide the individual packages that people want. That has implications for those working in the adult training centres and in residential care. All the pilot studies of those local authorities that have gone down that path show that there is reduced demand for that type of provision. On the commission that Hampshire has set up, which I mentioned, we have already heard the concerns of those who work in social service departments, thinking that their jobs are threatened or are at best going to change.

Related to that is the viability of the traditional services as some people opt out and it becomes uneconomic to keep the adult training centres going. That has happened in, I think, Oldham, which makes the case for a gradual phasing in of the new regime and retraining those whose jobs may go. Then there are some people who may choose not to choose—people who prefer to stay in a comfortable institutional setting—and we need to look after them.

There is the issue of risk. How do we reconcile the right of the individual to determine how he or she spends his individual budget with the obligation of a local authority to ensure that public money is wisely spent and to discharge its responsibility to look after vulnerable people. Risks were taken with care in the community. Some of them were unacceptable, and people were discharged who should not have been. The risks with personal directed support are different—that the resources will be misapplied or inappropriate services might be bought. Safeguards exist—the local authority will have to validate the plan before it can be implemented—but the fact that there is an element of risk is not a reason for holding back. What I find unacceptable is what is done at the moment in the name of risk avoidance—the curtailment of activity, particularly by elderly people in residential care, some of whom are sent to bed under sedation because of inadequate supervision in the communal lounge.

Any new system must be simple and easy to access. One reason why so few people have accepted direct payments—I think only 5.4 per cent. of those eligible have accepted them—is because of the paperwork. We have to make it absolutely clear that local authorities or the advocate can handle the paperwork once the individual has decided on the package.

A point made by other hon. Members is that the new regime must reach out to everybody who needs help, not just current users. One of the problems of the current regime is that the self-funders are left struggling while those who are eligible get a decent service.

Some real issues arise for carers. Can the funds in the budget be used to pay for what the carer does at the moment for nothing? Can they be used to help them remain in work and carry out other responsibilities? Can they be extended to help them and pay them beyond retirement age?

My final point is about resources. The issue of calibration is crucial: how much money do we allocate to individual budgets? There is a risk of getting the whole policy wrong if we make unrealistic provision for it and for the budgets, with people then finding that they get less support. At the moment, we can send someone to an adult training centre for three days. There is no transparency on costs and the cost is irrelevant to the individual. With personal directed support, the costs are of enormous importance and are very transparent. The experience with direct payments is that in some cases the sum allocated has been wholly inadequate to purchase the care that was needed, perhaps explaining why take-up is low. The policy will have to be adequately resourced, not least if we are to help more people and intervene earlier.

I make the point, which I have made to the Minister in other debates, that we need a step change in how social services are funded. I have expressed disappointment in earlier debates at the recent three-year settlement, which has left social service departments severely squeezed. The Treasury has got to be at the table if the policy is to fly. The new policy provides real, challenging opportunities. The challenge is to find the necessary resources, but we have an opportunity to make a real difference to the social care system—to come up with a system that is fairer, is seen to be fair, is more accessible, and makes a difference to everyone's life. I hope that all Members can rally behind that objective.

Photo of Barbara Keeley Barbara Keeley PPS (Rt Hon Harriet Harman QC (Minister for Women)), Leader of the House of Commons 5:05, 5 June 2008

I have been involved in social care issues for some 13 years, first as a council executive member and later when researching health and social care issues with national carer charities. I believe that social care is in a more prominent position now than at any other time during those 13 years. Even during my time in the House, it has risen on the political agenda. The demographic changes that we have discussed today are a big reason for that, but the Government's commitment to the agenda is a key element as well.

The Prime Minister has placed social care and carers high on the agenda, but I also commend the personal commitment of the Under-Secretary of State for Health, my hon. Friend Mr. Lewis, who has won wide recognition among stakeholder organisations for the determined way in which he has driven social care issues to prominence. At a recent consultation event, he said that we should be judged by our actions and not our words in our commitment to social care. I look forward to seeing plenty of action to improve social care services in the coming months and years.

As next week is carers week, I shall focus on carers in my speech. One of the aims of carers week is to reach out to hidden carers and ensure that they know where to find help and support. Once they have been identified, they can gain access to the services that are available to them. As a result of recent policy developments, the number of such services has increased. Carers are to receive pension credits in recognition of their caring work, more money has been allocated for emergency respite care, and new information and help services are planned. That support and recognition is crucial to carers, as all the consultations for the strategy review have shown. However, we cannot avoid the fact that we cannot support carers better until we identify them more thoroughly.

In my constituency and across the country, there are to be many events to mark carers week. I congratulate all who do such work. One event, at St George's high school in Walkden, aims to raise awareness of the most vulnerable group—young carers. A study by the charity Barnardo's found that 91 per cent. of teachers feared that young carers were falling through the net, and about three quarters of them thought that pupils were hiding the reality of their circumstances from friends and teachers alike.

The teachers felt that it should be the responsibility of GPs and families rather than schools to identify young carers, but I think it important that schools and local authority children's services take some responsibility for them. Teachers can develop an understanding of the burden felt by young carers, protect them from bullying, and support them if they fall behind in their work. I pay tribute to young carers projects such as the one run by the Princess Royal Trust Salford Carers Centre, which is working with St George's high school.

On Friday next week I shall attend an event at Hope hospital, Salford, supporting the Salford carers centre's efforts to make contact with hidden carers. I attended the same event last year, when we handed information keys to people as they passed our stand. I was amazed to discover how little recognition there was among even hospital staff that their role in caring for family members meant that they were really carers themselves. I discussed that with one person who questioned whether she was a carer, and whether the information applied to her. Clearly, she was. Although the hospital has a carer support worker on its staff, the message had not reached the staff that help and support were available and that their own organisation was in a position to help them, for example, by allowing them time off to attend medical appointments with those whom they looked after.

That is a typical example of the problems involved in this issue. As Members of Parliament, we state that there are 6 million carers, but we do not think about how many of them we are not reaching, helping and supporting. Those people think of themselves as daughters, sons, husbands and wives but not as carers, and even in political discourse the word "carer" is often used to describe paid care staff.

I discovered recently that the problem is often even greater among black and ethnic minority communities. At a national conference of carers from those communities, it was emphasised that language and cultural differences increased their problems. One carer said that in his language there was no word to describe schizophrenia. He cared for a son with the condition, but he could not describe it to others in his own language.

On two occasions I have introduced 10-minute Bills which would give health bodies a duty to identify carers and then require them to be referred to sources of help and support. Identification of carers should result from an holistic view of the patient and their family. Opposition Front Benchers have expressed a similar view—that we must move toward that more holistic approach. If the patient needs substantial care and support, GPs should be looking around and asking who is providing it and how they, as health care professionals, can support the person providing the care.

The need for GPs to identify patients who are carers and patients who have a carer was first stated by the Government nine years ago, in the first national carers strategy. The five-point checklist given to GPs in that strategy suggested, for example, that they check carers' physical and emotional health at least once a year, that they tell them that they can have an assessment, and that they help them to find local support groups or carers' centres. Clearly, that does happen—Members may be aware from their own surgeries of carers who know that such help is available—but even though my constituency has a wonderful carers centre, many of the people who come to me do not know about the help and care available to them.

The GP contracts established in 2004 appeared to offer an ideal opportunity to ensure that GPs undertook the work of identifying carers, but out of a maximum of 1,050 "points" available in the contracts for the quality of GP services, only three relate to identifying carers. In my view, that gives insufficient incentive to GPs to undertake what is becoming a vital task. I hope that the updated carers strategy and developments based on it in the months and years to come will ensure that we take on the vital task of identifying carers, making it something that GPs must commit to contractually, rather than just optional. Because the contractual reward is so small, many GPs simply have not bothered with it. We talk about personalisation, but as there is very much more for a family and a carer to take on board, knowing at the right point of diagnosis where all the care and support can be found is vital.

The "case for change" document asked which is more important: local flexibility or national consistency? It is crucial that we reach a consensus now on the balance between local decision making and ensuring a basic national entitlement to care. I believe that local decision making is important in many service areas, but, as other hon. Members have said, we have moved to a point where there are unacceptable differences between the level of social care services offered by local authorities and the continuing care services offered by various local NHS bodies.

Let me give an example of decisions on the eligibility of patients for continuing care, which can be crucial. A constituent of mine, Mrs. Reade, desperately wanted to care for her husband at home when he was diagnosed as terminally ill with an aggressive form of motor neurone disease. His final weeks of life ran across Christmas and new year. The Ashton, Leigh and Wigan primary care trust turned down the request for continuing care because there were so many delays in reaching a decision, mainly caused by staff absences during the holiday weeks. The absence of a social worker in the hospital proved crucial to things going wrong there. Sadly, the letter conveying this decision to Mrs. Reade, which was written in very difficult, technical language, arrived just days after her husband had died in hospital. We can and must do better than that.

Because I have two local authorities in my constituency, there is different provision for those of my constituents with moderate and substantial need; the services vary, depending on which council area they live in. I hope that the CSCI review of eligibility criteria helps to iron out those differences.

Many speakers today have touched on the need to recognise that service development is being pursued at different rates. Telecare, which I see as vital, has been used to great effect in some regions of the UK, such as West Lothian, and in some authorities—Oldham has been mentioned—but other authorities are not pursuing the new technologies at the rate that they should. I am very pleased that the Department of Health has announced the piloting of telecare and the £31 million investment to ensure testing on a large scale, but following the pilot, it will not be acceptable if some areas are allowed to lag behind in providing services involving telecare. My belief is that we have to accept the principle that people are entitled to equal care wherever they live.

In conclusion, I commend the progress made by the Government in developing support for carers and greater choice and flexibility, in recognising the need to regulate and develop skills in the social care work force, and in the recent and earlier developments in telecare. As we set out on a path towards that new care and support system, which I am sure all hon. Members want, I hope that we can embrace the two developments that I have discussed. First, we must ensure that GPs and primary care staff identify carers, because there is no way that they will obtain the advice and support they need if the primary care people do not do that. Secondly, we must ensure that local decision making does not get in the way of offering decent minimum standards of both social care and continuing care.

Photo of Jeremy Wright Jeremy Wright Opposition Whip (Commons) 5:15, 5 June 2008

I am pleased to follow Barbara Keeley, whose commitment to and enthusiasm for carers' issues I recognise and entirely share. The debate has made yet clearer the scale of the challenge we face in constructing a social care system that is adequate and decent, and that covers to a good standard those whom it needs to cover. It is right that funding plays a large part in that, and we have talked a little about how that funding might be found. It has also been sensibly said that we first have to decide what kind of system we wish to fund, and I wish to discuss that initially.

I agree entirely with the hon. Lady and with others that it is too easy to talk only about the challenges that we face and not enough about the opportunities that the development of modern technology has presented to us—telecare is one of those. It is hugely encouraging and exciting that we can now examine ways of providing people with the reassurance that they and their families wish to have, while preserving their independence and their dignity, as the Minister mentioned, with a form of care that is not intrusive, but which works well for them. Those aspects of telecare give us some reason to be cheerful.

Of course, we face a number of problems and we cannot ignore them. Some operate at a very high level, being widespread and difficult to resolve, whereas others operate at a very small, personal level. I shall identify one such problem that will be familiar to all hon. Members who speak regularly to carers. In any system that involves people supplying care from social services departments or elsewhere, we should find a way of ensuring that as often as possible it is the same individual who turns up at a person's door, because one difficulty we face is that often a different individual rings the doorbell each time. That means that it is difficult for a good relationship to be built up with the person who is being cared for. It also means that it is more difficult for anybody living at the house—perhaps a permanent, so-called, informal carer—to say, "If they're five minutes late, I'll leave the door open", or "I feel happy to go out and have them in the house when I'm not there." These minor, personal issues have a huge effect on the quality of care provided and on the overall experience.

It has been said—this point goes back to the macro level—that one of the major issues is the system's complexity. There is no doubt that those who have not previously experienced it are befuddled by how someone goes about finding the care they need, and where they go for the help they want. As has been mentioned, one of the places people often end up looking for that help is the voluntary sector. It does tremendous work in this area, on which we should congratulate it, and I am sure that there are ways we can support the sector further. I heard what the Minister had to say about that, and it is encouraging.

We can perhaps be more imaginative still, by finding other ways of providing that assistance, support and guidance in other scenarios and circumstances with which people who use such things are familiar. We have spent a good deal of time in other debates in this House trying to think of ways of supporting the rural sub-post office network; we have tried to think of things that we can allow sub-postmasters and sub-postmistresses to do that will give them a ready supply of income. Providing this sort of advice on how to find the right social services and how to gain access to these networks is something that rural sub-postmasters and sub-postmistresses and, indeed urban sub-postmasters and sub-postmistresses, could do very effectively. That is because of the relationship of trust that they have already built up with the sort of people who are likely to be the main customers for social services, in addition to being regular customers in their local post offices. I hope that we can also explore that.

Much of the complexity and many of the problems arise from the relationship, or lack thereof, between the health care sector and the social services sector. The Minister described it as a Berlin wall, but in many ways it is more like the Grand canyon. There is a gap between health and social services into which too many people regrettably fall. To give just one example, there is the game of pass the parcel between health and social services when someone who is in receipt of social services support is admitted to hospital—perhaps a rehabilitation hospital for a short time to get them back on their feet.

That seems to be a signal to social services that the person should no longer have any action taken on their file, which is put into a drawer. The person is now a health service responsibility, and no further work will be done on that file unless or until the person comes back to the front door of social services. That is regrettable, if we are serious about the sort of joined-up working that phrases such as "multidisciplinary teams" suggest should already be happening. I hear that phrase all the time, but I do not see much evidence of it taking place. It is common ground that we need more joined-up thinking, but the problem applies to cases in which assessments have been made and when short stays in hospital break up what was previously a reasonably effective social services provision.

It is impossible to ignore the economics in the context of this debate. The problem arises from the dysfunctional relationship between health and social services over exactly what is classed as a health need and what is classed as social care need. I make no apologies—nor would the Minister expect me to do so—for raising again the issue of dementia. As Roger Berry made clear, dementia is a classic example of the problem. As those with dementia find it progressively more difficult to feed themselves and to deal with other care needs, those needs are assessed not as health needs but as social care needs, resulting in a contribution being necessary—where appropriate—from the individual or their family. They regard that as bitterly unfair, and I am sure that the House can understand why that is. People with dementia and their families are by no means the only ones in that position, so any system we develop must find a fair way to identify needs. It is accepted that some contribution will be needed in the appropriate cases, but we need a way of distinguishing which those cases are, without trying to pretend that what arises from a medical condition does not in fact do so. That is an issue that we must consider.

Dementia will have a much wider impact on the social care system—either the existing system or one that we will construct in the future. The Minister knows the figures: 700,000 people have dementia now, and that will rise to well over 1 million in less than 20 years. Those people will put extra pressure on the care home sector and on the care delivered in the community. The Minister knows, because we have had this conversation, of my strong view that we should have mandatory training for those who work in the care home sector who will inevitably deal more and more with people with dementia. That argument applies equally to those who provide social care to the two thirds of people with dementia who live in the community. The care providers must understand the condition and the symptoms it presents.

The hon. Member for Worsley mentioned what is sometimes referred to as "informal care", which forms a substantial part of the care provided. I personally do not like the term, as it suggests care that is casual or sporadic, whereas in most cases it is neither. In fact, it involves people sacrificing their own lifestyles for the benefit of the lifestyle of another. People prepared to do that deserve the greatest possible consideration in any debate on the future of social care.

Nor can we ignore the economics of the issue. It is correct that we will face a huge funding shortfall if we continue to provide only the level of support that is currently provided. Dr. Ladyman was probably right to say that the current figures are an underestimate, but the Government predict a £6 billion shortfall over the next 20 years.

According to Carers UK's last assessment, carers save the state some £87 billion through the work that they do. It does not take much more advanced mathematics than even I can manage to work out that if those carers, for whatever reason, were unable to do even 10 per cent. of what they now do, we could swiftly more than double the deficit. Of course we have to think about ways to solve the financial crisis facing social care, but if nothing else we should not make it worse. That means ensuring that whatever we do, we support carers in all that they provide to the system and make life as easy as we possibly can.

I want to focus briefly on a minor subset of the people whom the hon. Member for Worsley described. Some 1.5 million of the 6 million carers are over 60 years of age, and I suspect that that proportion will only increase over time. Those people face particular challenges. It seems remarkable, looking at the figures, that 8,000 carers are over 90. How those people manage is completely beyond me. It shows that a large number of people who have considerable problems of their own are carrying out the functions of a carer.

As I say, the phenomenon will only grow because families will become yet more far-flung as time passes. There will be less support from other members of the family and spouses will often be the carer. Given that those being cared for are predominantly elderly, their spouses will be, too, and, because of increasing life expectancy, a carer might be a son or daughter of pension age. We have to think about the particular requirements of those people, which are obvious in many ways. The more elderly are more likely to fall victim to illness, and we know already that carers are more vulnerable to illness. We know that the physical requirements of moving someone around get more difficult the older the carer gets.

Some of the problems that face all carers face older carers more dynamically. I shall focus on two of those. First, respite care has already been mentioned and it is crucial to all carers, but one tends to find that the older generation are less willing to ask for respite even though they are more in need of it. The second problem is the relationship between carers and social services departments. That seems to me to be a major structural problem.

Among carers of all ages, there is the constant refrain, "We are not listened to. We are not respected. We are patronised and talked down to and we know the people whom we care for much better than social services do." There has to be a better relationship between carers and social services departments to ensure that carers remain keen and enthusiastic to do what they do against all the barriers to their doing so, which will always exist. Any programme to deal with social care must address that problem.

We need to talk about funding and social services departments but, as the hon. Member for Worsley said, we must never forget the substantial portion of care that is provided by those who do it voluntarily, and who do it very well.

Photo of David Kidney David Kidney PPS (Rt Hon Rosie Winterton, Minister of State), Department for Transport 5:28, 5 June 2008

I want to add my praise to the Minister for the policies and spending programmes that he has been responsible for introducing as he described. I also praise him for bringing the Government to the position that they are in, with the beginning of the consultation that we have debated today.

We are coming to the end of the welfare state mark 1, which was designed by William Beveridge. I have always been slightly curious about the life of William Beveridge because for all my childhood I lived in a house in Beveridge close in Stoke-on-Trent. I always wanted to know why the street was named after him. It is tremendously to the credit of our predecessors, the politicians of 1941, that, in the depth of a dangerous war when the survival of our democracy was in the balance, they appointed William Beveridge to design the state of Britain that we would hope for when the war was won. The welfare state that was then implemented by the 1945 Government—the national health service, social security and the philosophy of support for every citizen from cradle to grave—has stood us in good stead until now, but the faults and strains of 60 years of pressure have been well described.

We have reached the stage where we need to design the welfare state mark 2, which must take account of the complex health and social care needs of many more older people than it did in the past. As my hon. Friend the Minister said, that involves an adult care system for many people other than old people; it is for all those who are disabled, those with learning difficulties, those with autism and carers.

I am pleased that so many hon. Members mentioned young carers. Although we have been talking about adult care, youngsters often care for adult family members and we must ask to what extent the pressure is on them to provide that care because of failings in the social care system. As adults, we must ask what is our responsibility and why we deprive youngsters of their childhoods, as they take on those grown-up responsibilities of caring for adults.

I hope that, in the consultation, we will design a system that can cope with all the new pressures and demands and be affordable. The Government are right to start with a fairly open consultation, with not very many constraints and restrictions, because there are big questions to answer about what we want in the system, how much it will cost and precisely what the public are prepared to pay through their taxes and through their personal expenditure from their own pockets, as they contribute to the debate during the six months of consultation.

I want to spend the very short time that I have to contribute to the debate in describing an event that I jointly hosted at Stafford with Staffordshire university a few months ago, before the consultation began. We set ourselves the objective of contributing to the national debate, while anticipating changes in future national policy and starting immediately to implement them locally in Staffordshire. Our audience involved three Departments, the Association of British Insurers and other insurance representatives from the national scene. We had regional representation from the health, social care and voluntary sectors, as well as the main players from the local providers of health care, social care and voluntary services.

We came up with five things that we thought it important to adopt in the policy. First, a conceptual change is required to assist an ageing society. We thought that universal provision must be taken as a prerequisite if we live in a fair and equitable society. Alongside that, we need a speedy integration of health and social care. It is important to invest in prevention as a high priority, echoing the King's Fund report "Paying the Price". We recognise that a significant debate is required on the balance between state responsibility, individual responsibility and family responsibility.

The second thing was the future work force. We need a work force who are both flexible and fit for the future. Work force projection and planning require more sophistication for the future. Although we now see a slow movement from secondary to primary care health provision, the move of mental health services into primary care advances at a much slower pace.

The third thing that we talked about was financing and communicating systemic change. A viable, fair and equitable system will cost more than the present one, but insurance alternatives need to be explored. A pooled finance system might help, by utilising state and individual components, and pass the equity test.

The fourth thing was intergenerational support. How do we persuade young people to start to think about old age and to plan for later life? What are the incentives for them to do so? Although the dignity in care agenda has started work on valuing older people, much more is still to be done.

The fifth thing that we wanted to talk about was the future focus of the system. Prevention must become a key priority alongside incentivising the health agenda, not the illness agenda. Technology needs the development that many hon. Members have commented on already today. They are the five points that we wanted to project. We want to move on to develop our services locally, anticipating what we think will be the national decision.

Before concluding, I want to tell my hon. Friend the Minister that Staffordshire university was a great help to me. It has a centre for ageing and mental health, and it wants to contribute to the debate. I would offer its help, with its agreement, to my hon. Friend in any way that he wants, perhaps by hosting events, running panels to contribute to the debate and advising the Department of Health if it wants it. On the same basis, I want to offer my assistance, as a Member of Parliament, in the consultation, and suggest that other MPs want to do the same. We are a very good resource for collecting the views of our constituents, and for explaining to people that the consultation is taking place and how important it is. If necessary, we can host events ourselves to contribute to the debate over the next six months.

There is so much more that I wanted to say, but there is not time to do so. I want to point out, as many people have done, the importance in any future care system of quality, the dignity of the individuals being cared for, and their protection from abuse. My last point takes the Minister on to a slightly different agenda. In the Queen's Speech in the autumn, there will probably be a Bill on equality. One of the burning issues is whether there will be a full-blown outlawing of age discrimination in the Bill. Given all that we have heard in today's debate, I urge the Minister to do his very best to make sure that the Bill outlaws age discrimination.

Photo of Paul Holmes Paul Holmes Liberal Democrat, Chesterfield 5:35, 5 June 2008

Like the previous speaker, I will cut short some of my comments, because we want to make sure that everybody can contribute before the end of the debate.

I will be fairly brief on the funding issue, which has had quite a good airing. We have already established that provision of care in all areas is underfunded, and the situation will get a lot worse. We have an ageing population demographic, people are living longer as a result of more prosperity and better health services, and not only are more disabled people being born, but they are living quite long and fruitful lives when they would not have done so 30 or 40 years ago, due to the sort of policies and medical capabilities that there were in those days.

Somewhere, someone will have to pay for the care that is needed. That can be done through general taxation, which is mutual insurance paid for according to ability, hopefully, although the Government's tax policies penalise the poor more than the wealthy. The other way is to follow the extreme USA example, in which the emphasis is on the individual being responsible. If the individual has not earned or saved very much, for whatever reason, that is tough. About five years ago, I was in Lincoln, Nebraska. Those of us visiting met a voluntary group that gave us a fantastic explanation of how it helped elderly people to access support, care and so on when they needed it. There came a point when we suddenly realised that all that it did was advise elderly people on how to spend whatever money, personal insurance or benefits they had got for themselves. There was no state aid, effectively. I hope that we do not move towards that extreme in the coming years.

The Conservative and Labour Back-Bench spokesmen, but not my party's spokesman, have today suggested that we cannot possibly consider taxation. They say, "We will not put forward any suggestions involving that side of things, because that would cost money and upset voters." One way or another, we have to pay if we are to provide the decent society that various Members have talked about this afternoon. The money has to come from somewhere. It can come from a mix of taxation and payments; otherwise, there are the extremes: it could all come from taxation, or we could take the USA approach, which leaves one in five Americans with no medical cover at all. When they reach old age or have a disability, it is even worse.

We need to bite the bullet and be honest, especially given that we have only just reached the average level of western European taxation. We are not a highly taxed nation, contrary to what everybody on the street will tell you, if you ask them. I even read one analysis this morning suggesting that tax levels are lower than when the Conservative Government left office. I have checked the figures, so I know that we have just reached average levels of western European taxation. On health and education, which have had money poured into them, the average western European levels of investment has just been reached. We should not sell the pass completely and just say, "We are an incredibly highly taxed nation; we cannot afford to provide decent pensions, care, support and so on." However, I shall not go into huge detail on that point.

Every MP has many examples brought to them by constituents. We have heard some today that illustrate the need for more and better targeted care services and care funding. One MP pointed out that he has two parents who are suffering from dementia. Many of us will have that experience in our families. Ten years ago, my father died with Alzheimer's. Last summer, my mother-in-law died with aggressive dementia as a result of multi-infarct. A few weeks ago, my mother died with Alzheimer's at 82. As so many others in the Chamber have done or will do, I have gone through all those problems that constituents bring us about ageing parents who physically need more help at home, and then start to lose their mental faculties. They may consider doing what we did: we moved my mother-in-law into our dining room and made it into a bedsit, and tried to cope in that way. As the dementia got worse, it became impossible. She needed 24-hour care. When one looks for care homes, all the issues of selling property, funding and payment arise. One way or another we will all go through that with members of our family, or ourselves, with our children going through it for us. The problem is widespread and we all have those experiences.

There are further examples that constituents have brought to me. One of them is early onset Alzheimer's. Terry Pratchett, who was recently diagnosed with early onset Alzheimer's, is a famous example. One constituent came to me five years ago and the problem has still not been solved. Her husband in his early 40s was diagnosed with early onset Alzheimer's, which is quite rare at that age. As a result, no care home within decent travel distance was suitable. Although at 40 or 42 he had Alzheimer's, he knew when he looked around the care home full of old-age pensioners that there was something wrong—that was not his generation of people.

My constituent's husband ended up in a care home some miles up the motorway, up past Rotherham, with his wife trying to travel back and forth every day to visit him. We had round table meetings with all the medical professionals and social services. We all agreed that it was an immense problem, and five years later we have still not solved it. That will become more common as we get better at diagnosing conditions such as early onset Alzheimer's.

Respite care has been mentioned, so I will not go into detail about it. We can all think of constituents with autistic children. We have had examples of elderly people looking after elderly parents, where both sets are old-age pensioners. I can think of at least three sets of constituents where the old-age pensioner has been looking after a disabled child who is now an adult—pensioners who need care and respite themselves, but who have 30 or 40-year-old adult children living with them. One, for example, was born with mental disability and was blind, and is still living with his elderly pensioner mother. She is approaching 80 and he is 30 or 40-odd. Such cases are becoming more common and need support and funding.

The entire year's budget for Derbyshire for disability adaptations to housing could be spent in the first three months of each financial year clearing the previous year's backlog. That would leave not a penny for anybody who applied for a disability adaptation to a house in the current year. That is an ongoing problem and I am sure it is not specific to Derbyshire. Other Members must have come across it as well.

Some hon. Members have mentioned direct payments, usually with great enthusiasm. We all welcome direct payments. They are excellent in intent and in effect for the vast majority of people who access them. Some people want them to be spread into some areas of NHS funding and support, for example, but how good is the guidance and support given to people who access direct spending?

What happens for people who access direct payment and become a small employer for the first time in their life, perhaps when they are a vulnerable adult? What will happen, for example, to a 73-year-old man who becomes blind virtually overnight, and at the age of 74 takes on direct payment and becomes a direct employer? First, he has carers through care agencies, but as one hon. Member commented, people do not like that. They have lots of different care workers coming in and they are never sure who is coming each day. In the example to which I refer, the man became a direct employer of one care worker, which worked well for a while.

What happens if the person falls foul of employment law and ends up facing thousands of pounds of legal fees and compensation—about £20,000 in all, for a 79-year-old constituent who is blind? How do we avoid that happening? How widespread is that? I hope the Minister may be able to comment or write to me. I shall send him details of the constituent in question.

Derbyshire country council might give me a substantive reply on the matter fairly soon. I wrote a month ago and asked some specific questions. I asked the council to provide me with hard copies of the documentation on being an employer that it provided to clients like my constituent five years ago, clearly indicating where it emphasised the legal obligations that direct payment would entail, and the guidance and training that it gave on the requirements of employment law. I understand that the situation was pretty chaotic five years ago and that Derbyshire county council undertook a massive rewrite of the procedures for that reason.

In the council's latest newsletter to clients using direct payments, which came out only a few weeks ago, on 24 April, it said that it had a three-year-old manual that was prehistoric and needed rewriting because it was so out of date, and advised clients to take out employer and public liability insurance. Did it do that five years ago, four years ago or three years ago? How widespread is the problem? The Minister may know about that from cases that have reached his desk. I have asked colleagues, some of whom say that they have come across the problem. I will write to him with full details.

Now that I have raised the issue in the House of Commons in a fairly gentle way, Derbyshire county council will give me a full, detailed and substantive response. If not, I shall seek an Adjournment debate to deal with the matter in rather more detail.

Photo of Kevan Jones Kevan Jones Labour, North Durham 5:45, 5 June 2008

The debate today has been very good, and the thrust of the consultation document was to try to ensure that we not only support people in their own homes for longer, but make sure that their quality of life in old age is rewarding and comfortable.

There are cases, however, where it comes to the point at which people cannot be kept in their own homes. We need the fallback, especially in rural counties such as County Durham, of locally provided, resourced and staffed units to look after some of the more challenging and difficult cases with which relatives cannot cope at home.

Sir George Young mentioned the movement to community-based support for mental health services and said that the Treasury saw it as a way of saving money. My problem with the present policy is that lessons that should have been learned in the past are not being learned. My experience of working with local Alzheimer's charities is that they give people with severe dementia or Alzheimer's a tremendous amount of support. A lot of relatives want to look after those people at home for as long as possible, but we all know—reference was made to this earlier—that behaviour can become challenging and it can be difficult for elderly carers to look after those people.

In Durham, we have the Earls House site, run by the terribly named Tees, Esk and Wear Valleys NHS Trust. The trust covers County Durham and some of us pointed out that it might have been a good idea to put County Durham in the title when it was formed, but we were ignored. The unit on the Earls House site, which covers the north of the county, provides accommodation for dementia and Alzheimer's patients with challenging behaviour. The trust is just about to announce the unit's closure. I take issue with the idea that we can have a consultation document where the preferred option by the trust is already there. As the right hon. Member for North-West Hampshire said, the budget is driving this matter rather than the provision for elderly people in the north of the county.

The only provision for these patients will be 40 to 50 miles to the south of the county. We are hearing the right noises about supporting the community, but the beds are needed to support elderly people with difficult situations. For example, a Mrs Swann came to see me last week. She has a 77-year-old husband who has severe Alzheimer's and has been in one of the two wards at Earls House, Appletree and Inglewood. She goes three times a week to visit her husband, who is grateful for the support he gets in that facility. She will now have to travel about 40 miles if the two wards close. Let us not make the mistakes that were made in the past, to which the right hon. Member for North-West Hampshire referred. We will need provision in local areas, and the idea that everything can be closed and pushed into the community is not the answer.

My other concern was raised in a good speech by Jeremy Wright. It is how we give carers and relatives a voice. Frankly, I opposed the setting up of the NHS Appointments Commission—the independent arm's length commission making appointments to various health trusts, because I am a bit old-fashioned. I believe that politicians should take responsibility for decisions.

Local accountability is not there in respect of the weirdly named Tees, Esk and Wear Valleys NHS Trust. How will Mrs. Swann and other relatives have a say in what happens about the two wards earmarked for closure? The consultation is out, and my hon. Friend Dr. Blackman-Woods and I are objecting to the closures. Will those people be able to have an impact and change the situation? I doubt it.

We need to ensure that we give a voice not only to carers, but to relatives. As we know, the individuals in these cases are often unable to articulate the views that are needed. We should have the debate by all means, but let us be careful not to get into a situation in which facilities are closed and we more or less say that somehow people will cope at home. They will not.

I also want to mention something raised by the right hon. Member for North-West Hampshire: the relationship between social services, acute trusts, local NHS trusts and primary care trusts. How do those interact? How do people work their way through that network? We need to consider that carefully. If we are to keep people in their homes for longer, we cannot have the silly situation mentioned earlier, in which, for example, the county council does the assessment for adaptations, the district council direct labour organisation does the work when it finally gets around to it and the poor client is unable to hurry up the case or, in many cases, to get an answer about some of the assessments. I hope that the abolition of the single-tier local authority in County Durham will help. However, if we are to have these joined-up care packages, I am concerned about how people will have that seamless service, whether they are in hospital, local authority care or, like Mr. Swann, in a hospital ward run by the acute trust.

This has been a good debate and the document is the right way to start the consultation. However, at the end of the day, what we are discussing will not be a cheap option for care. If all parties enter the process with that starting point and realisation, we may be able to get a system that is better not only for recipients of care, but for their carers and loved ones, who are also important and want their elderly relatives to be treated with pride and dignity.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services) 5:53, 5 June 2008

With the leave of the House, Mr. Deputy Speaker, I should say that, on the whole, this has been an excellent, high-quality debate. However, I have to turn to the contribution from Mr. O'Brien, which demonstrated that Conservative Front Benchers have no policies, no vision and no substance when it comes to these and many other issues. I asked the hon. Gentleman how often the group set up by the Leader of the Opposition to consider social carers had met, and his answer was, "Many numerous times." Will the hon. Gentleman write and tell me how often it has met?

Will the hon. Gentleman also speak to Sir Simon Milton about Putting People First, probably the most radical transformation of social care for a generation? It is happening in every local authority area. The hon. Gentleman described it as "a bundle of papers". I should tell him that there was never any commitment to a Green Paper specifically on individual budgets; later this year, we will publish the results of the evaluation into the individual budget pilots in the 13 local authority areas. The rest of the hon. Gentleman's contributions were very constructive.

I can assure my hon. Friend Roger Berry that there is a commitment to issue a Green Paper early next year. There is no doubt that as we consider fundamental reform of the system, we must take seriously the question of differential approaches to charging and, specifically, the portability of care packages. I pay tribute to his long-standing contribution to championing the rights of disabled people.

On behalf of the Liberal Democrats, Mr. Burstow must answer the question about where the money for their policy would come from. Would it, as he hinted, come from cuts to spending elsewhere, such as in the NHS? Would there be a tax rise to fund it? He must also say whether their policy is genuinely sustainable in the long term or simply intended to get them through the next general election. I greatly respect the work that he has done on elder abuse and on dignity for older people, and I hope that he will think that the review of the No Secrets guidance comes up with an appropriate system for adult protection that reflects some of the tensions and challenges that have been evident in the debate.

Everybody I have spoken to regards my hon. Friend Dr. Ladyman as having been an excellent Minister for social care. He put in place the foundations that led to many of the reforms that have taken place in recent times. He is right that it would be wrong to talk about the future funding of social care being based on the existing system and model. The challenge is whether we can have a vision for the future that reflects people's changing aspirations, the opportunities presented by technology and extra-care housing, and people's behaviour in terms of financial incentives. This is not simply about tinkering with the existing social care system.

I pay tribute to the contribution by Sir George Young. He clearly "gets it" in terms of self-directed support. It is one of the most radical reforms of public services—a redistribution of power between the state and the citizen the like of which has not been seen previously in public services. It is important that the policy is explained to people and that they are enthused by it, because it is an incredible example of social justice and equality of opportunity in action. He is right to point to the obstacles and barriers and to the lessons that we need to learn in putting into practice this entirely new approach to vulnerable people's rights to exercise self-determination and maximum control over their own lives.

I pay tribute to my hon. Friend Barbara Keeley, who has championed the cause of carers for many years since she entered this House. I hope that she will not be disappointed when she sees the new carers strategy on the role of GPs as regards identifying and acting specifically on the needs of carers. She is right to refer to the appropriate balance between universal entitlement and local discretion, which has come up time and again in the course of the debate.

I pay tribute to Jeremy Wright for the work that he has done in the House on raising the profile of dementia. We have to bring dementia out of the shadows—that is one of our great challenges. He is right to prioritise the need for carers to have access to appropriate respite and to note that professionals sometimes do not treat carers with the respect that they deserve.

I pay tribute to my hon. Friend Mr. Kidney, who is right to say that many of these issues are at the frontier of the new welfare state—they are the new challenges to which any responsible Government, and indeed Opposition, should face up. He rightly identified five themes from the work that he has done with Staffordshire university.

We did not speak enough about the work force. If we are to make a reality of this new agenda, it is essential to get the quality of the work force right. With a low-skilled, low-paid work force, we have a lot of work to do in thinking through the implications of the new system in terms of the people who will be required.

Paul Holmes said that Labour has poured loads of money into health and education. We do not often see that acknowledgement in "Focus" leaflets. He advocated significant tax hikes, although I am not sure that he will do so in his own constituency. However, he is right about guidance on issues such as direct payment.

My hon. Friend Mr. Jones rightly talked about the nonsensicality of proposing the reorganisation and reconfiguration of services without being clear about the alternative provision that will be in place and the fact that that needs as far as possible to be available locally. There will always be a need for residential and nursing care, and sometimes acute hospital beds, for people with dementia. Decisions need to be made not just about the here and now, but with regard to planning for the long term needs of his constituents. I agree with him that there should be a genuine consultation but it must be about future provision and demand for people with dementia. It is important that the voice of relatives is heard in that debate.

It being Six o'clock, the motion lapsed without Question put.