Caring for the Elderly

Part of Opposition Day — [16th Allotted Day] – in the House of Commons at 5:47 pm on 15th July 2009.

Alert me about debates like this

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood 5:47 pm, 15th July 2009

I wish to follow Kali Mountford in adopting a relatively non-adversarial tone, but nevertheless addressing some of the core issues that are at the heart of the debate that the Government seek on this sensitive issue.

The truest words spoken in the House this afternoon have been by the former Minister for Pensions, Malcolm Wicks, who acknowledged that this subject has been avoided by Governments for the previous 25 years. It is therefore true, as my hon. Friend Mr. Waterson said from the Front Bench, that it is disappointing that a Government who came in pledged to action on the subject, which was certainly unfinished business when I left office as Secretary of State 12 years ago, are only now introducing a Green Paper and seeking a national debate. I am happy to enter into that debate, because it is a hugely important issue.

The central problem, of course, and the reason why Governments have consistently failed to address the issue, is not that it is difficult to express the aspiration-the Green Paper expressed many of the aspirations accurately, and I could have used much of the same language myself. The key issue is how we produce the resources necessary to deliver the services that we all aspire to provide for our elderly citizens.

I agree with the Green Paper's emphasis on the importance of carers. As one of my hon. Friends said earlier, elderly people can be carers not only for their elderly relatives-often their spouses or partners-but important sources of care for other members of the wider family community. Engaging in a proper discussion about how to use the voluntary support available from a wider understanding of family connections is an important part of this discussion. That is my first point.

My second point relates to my intervention on the Minister on the subject of direct payments and to the rather larger subject of personalised care, about which the hon. Member for Colne Valley was talking. We must all have experience from our personal lives and in constituency surgeries of money being wasted because it has not been accurately used in a way that reflects the individual preferences-I use that phrase as distinct from a need calculated from a dispassionate point of view-of the service user. The importance of personalised care and, in particular, of the direct payment principle is that it focuses resources on the delivery of service chosen and fashioned by the service user. In my view, that is the best way of securing care that meets the service user's needs.

The third issue that I want to touch on briefly before I come on to what I have described as the core issue of resources is what has been called "a National Care Service". The Government are extremely unclear in the Green Paper about what that phrase means. What, for example, is the role of the local authority in delivering a national care service? Is it to be a service provider? Is it to have local discretion on commissioning? The Green Paper refers to the oft-used "postcode lottery", which is exactly the same concept as local discretion. Do the Government think that all exercise of local discretion is merely a manifestation of the postcode lottery? If so, do they aspire to a single, uniform national service or are they willing to defend local differences of service and not dismiss every local difference as merely a manifestation of the postcode lottery?

I would suggest to Ministers that the phrase "national entitlement" is extremely dangerous, as we have seen not just from court cases in the social care field but from the broader debate about what the national health service should be providing as a national minimum entitlement. The moment we get into a discussion about the concept of a national entitlement, it becomes extremely difficult to produce services in a local area that reflect accurately the needs of people in that area and represent an efficient use of the resources available. Those resources will be different in different parts of the country for a variety of difficult historical reasons and the needs that arise will be different because of the nature of different local communities.

The concept of a "National Care Service"-the balance between the national definition and local delivery and between national priorities and local priorities-is not made any easier by the introduction of initial capital letters. With respect to Ministers, all the difficult questions attached to that phrase are left unanswered by this Green Paper.

I now come to the fundamental issue of resources. In 2006, Wanless analysed the resource implications of moving from social care provision, which we acknowledge does not deliver what we would want it to deliver to elderly people, to either what he called scenario 1, which was the current basic level projected forward for another 15 years, or scenario 2, which met the current aspiration projected forward for another 15 years. One can follow the arithmetic with decimal points, but in back-of-the-envelope numbers Wanless identified a funding gap of £20 billion emerging over 15 years. That funding gap of £20 billion is the elephant in the drawing room. It is the reason why, 12 years on, we have a call from Ministers for a national debate. It is the reason why we have not had the action promised by Tony Blair at the Labour party conference of 1997.

The Government say that it is impossible for tax funding to fill that gap-in their phrase, that is "ruled out"-and I agree with them. I suspect that the Liberal Democrats still believe that it is possible-through a penny on income tax, no doubt.