I beg to move,
Today's debate is another welcome sign of the growing debate about the future of social care; it is a debate initiated by our Green Paper "Shaping the Future of Care Together". I am pleased to say that already this has turned into one of the largest consultation exercises the Government have ever carried out: there have been more than 91,000 hits on the website-www.careandsupport.direct.gov.uk-and more than 17,500 consultation responses received, and 35 stakeholder events have been held across nine English regions, with two more scheduled. So there has already been an enormous level of engagement. That is appropriate, because there could not be more important issues for this House to consider than how we fund social care into the future and how we give all people in this country quality of life and dignity in retirement. After too long on the periphery, this issue is now centre stage. There is a building consensus that fundamental reform is needed soon if we are to secure a fairer deal for older and disabled people.
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I would certainly say that it has been an open consultation and that we have not approached the matter with a fixed view about the future. The consultation put forward three broad options for the future funding of social care: the partnership option; the insurance option; and the comprehensive option. It ruled out the two other options at either end: wholly funding the system from taxation, and, in effect, leaving a free-for-all. Those options were ruled out because we do not believe it would be fair across the generations to ask the working age population to pay for the costs of care today. We believe-this is at the heart of this proposal-that, as was identified in all the King's Fund work, a partnership option involving the individual and the state is the right way to fund social care into the future. However, obviously that partnership can be constructed in different ways so as to achieve maximum fairness.
The fact that the Secretary of State is kicking off this debate is an indication of the importance that the Government attach to this subject, and we are grateful that he is here to do that. I attended a couple of the consultation events in my constituency, which were attended by providers of care, people receiving care and various other representatives of those with a stake in all this. Interestingly, at both those sessions the issue of taxation came through as something that people wanted to reinsert into the consultation. Will the results of the consultation accurately report those consultation events that actually vote for taxation to be considered?
I can certainly give the hon. Gentleman that assurance. Obviously we want the results of the consultation to be laid open, and I am grateful that he said he appreciated my presence in this debate. Since I took on this job, this issue has been at the top of my priority list. We urgently need to try to build a consensus in this country for the reform of social care. Of course we want all views to be heard as part of that, but there will come a point at which we have to try to find the compromise and consensus option that carries the greatest possibility of securing support in the country. That is the phase that will come after the Green Paper debate.
Although I realise that the impact of this Green Paper mainly applies to England, parts of it also apply to Wales, particularly in respect of the benefits system. My constituency contains one of the highest percentages of disabled people in the country, and I have received an enormous number of letters from people who are particularly concerned about the withdrawal of disability living allowance and attendance allowance-they claim that that would have a great impact on their lives. Will my right hon. Friend give me some information on that, so that I may pass it on to my constituents?
I can tell my right hon. Friend that this Green Paper contains implications for the care system in Wales and for the benefits system there. I assure her that we are working closely with Edwina Hart and her colleagues to ensure that close co-operation takes place. On the question of benefits, I announced last week that we were ruling out DLA for people who are under 65 from the consideration and the modelling in the Green Paper, in order to provide the kind of reassurance that I think my right hon. Friend seeks. People may say, "That was premature because the consultation hadn't ended." We just thought it was a sensible step to take to put people's minds at rest. We have done that, and I shall return to the theme of attendance allowance later in my remarks.
The Secretary of State just alluded to attendance allowance, which is the other concern of people in Wales. Can he confirm that no consultation specifically on attendance allowance was undertaken, either in Wales or in Scotland, even though the changes suggested in the Green Paper might have a substantial impact in both those countries?
It is important to remind the hon. Gentleman that it is a Green Paper on which we are consulting; we are hearing a range of views not only from England but from all around the country-we would, of course, hear representations made from Wales. It is important that people do not say we are not listening and not consulting; we are doing so. Obviously, we are talking to colleagues in the Welsh Assembly Government and the Scottish Executive, and we will continue to do so. I recognise that the proposals have implications for policy elsewhere in the United Kingdom. It is important that we are sensitive to that and that we balance all views when we introduce our White Paper in the new year.
I just want to pick up on the point made by my hon. Friend Kelvin Hopkins. Can we be clear that the Secretary of State is not ruling out discussions on the type of model that has been proposed by my hon. Friend-a model that should be fully funded by tax or national insurance? Although that is not one of the options in the Green Paper, will the Secretary of State, as he said, be listening and not ruling it out? If he wants to rule it out, I will go home now and get the 2 o'clock train.
Far be it from me to prevent my hon. Friend from getting home this evening. In the Green Paper, we have put forward three options that we believe are the fairest way of funding care in the future. I was going to give some statistics on how the nature of our society will change in terms of the number of working age people in comparison with the number of people in retirement. Those statistics need to be borne in mind by my hon. Friend-I know that he will do so-in considering the fairest way to proceed. Obviously we have a system today whereby people are paying out large amounts to fund their care. They are already making a substantial personal contribution to the cost of their care. In my view, it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation. We have ruled out that option, and my hon. Friend has good time to get up to King's Cross.
I understand, of course, that a large part of this debate will be about how we pay for care. However, does the Secretary of State agree that it is equally important to talk about what we are paying for? I welcome entirely what the Green Paper says about standardised assessments. Multiple assessments are not only wasteful financially but extremely distressing. Will he also address commissioning in his speech, and whether or not we are commissioning the right things at the moment? It seems to me-he might agree-that there is far too much commissioning for tasks and far too little for good quality care overall. Does that not need to be a large part of this consultation?
I could not agree more with the hon. Gentleman. He tempts me back to the substance of my remarks. I do not want this debate to be conducted with a sense that it is simply about funding what we are doing already. We have to consider care and support in the context of reshaping services around the individual so that health and council staff work in a much more integrated fashion, supporting people at home and keeping them out of hospital. That is at the heart of the vision, and I shall come on to discuss it, but the hon. Gentleman is absolutely right to say that commissioning is at the heart of it. Once we have explored the funding, we come to delivery and how best to achieve the kind of services that we want. This is about a vision for the future of social care, and I agree with him entirely.
I thank my right hon. Friend for giving way again, and I want to address this funding matter again. I have spoken on many platforms, suggesting that care should be fully funded from taxation. I have not had a single person disagree with me; they all think that would be the sensible and fair way to do it, just as with the national health service.
The crucial issue is whether my hon. Friend has spoken to all people across all ages and whether he has spoken to a representative sample of the whole population. The idea might be more appealing to older people, who might find it an attractive option, but less appealing to people in their 20s and 30s who are struggling to get on to the property ladder. We have to take a view across the entire population and to consider what will be fair to all generations and sustainable in the long term. That is the consensus that we are struggling to find. If my hon. Friends want to make strong representations to me about reconsidering this matter, we will listen. However, I think the King's Fund was right to say that the best chance of finding consensus rests in the notion of partnership between the state and the individual.
The "Big Care Debate", which began a national conversation about social care, ends on
Only a few days ago, we were reminded why this debate is so important. The recent population projections from the Office for National Statistics tell the story of how quickly Britain is ageing. By 2033, the ONS suggests that the number of people aged 85 will rise from 1.3 million to 3.3 million, while the ratio of working age adults to pensioners-the so-called dependency ratio-will drop below three. Parallel to that, improvements in medical treatment are extending the lives of those with disabilities or long-term conditions. That all points to the exchanges that we were just having about the affordability of any system in the long term and, in particular, the ratio of working age people to those in retirement.
In the context of the figures that the Secretary of State has just announced, when he considers the results of the consultation will he pay particular attention to the fact that as the population gets older, and given that older people have a higher level of dependency, so, within families, do their carers? Increasingly, pensioners are looking after even older pensioners who are their dependants. He cannot ignore that, because the strain on older people in a caring role is very great.
The hon. Lady makes an intelligent and important point. That is the nature of how the world is changing. People in their 60s and 70s have caring responsibilities, which place considerable stress and strain on them. My parents' generation is perhaps the first generation to have seen that and to have had caring responsibilities for children, grandchildren and, at the same time, parents. That places very considerable pressure on some people. As I was saying to Jeremy Wright a moment ago, any system needs to rethink how we provide care and support so that it helps people to cope with that pressure by providing support when they need it, when it is most valuable to them, and so that it makes the life of being a carer more tolerable than it is today. This does not mean replacing or sidelining the role of carers; the only way that the system we are talking about would work would be if we did a better job of helping people cope than we are doing today. That would be crucial in helping us to face the demographic challenges of the future.
Earlier this year, the Government announced a very welcome injection of £150 million for carers over two years. In a debate that we had earlier this year about carers, I asked the Minister of State, Department of Health, Phil Hope, how we could track that money. He quite rightly urged me to go back to my constituency and ask those questions. I did and I finally received a letter yesterday-three months later-to tell me how the money was being allocated. I was told that because the money was being allocated through general growth, specific plans had not been drawn up to spend it on caring activities. My concern is that the £100 million that comes next year will go the same way-it will just be rolled into general spending and will not particularly benefit carers. What can be done to ensure that it gets to carers?
We are issuing guidance on how to commission appropriate services for carers, but I recognise the issue that the hon. Gentleman is raising. The Princess Royal Trust has done some good work on that issue. There is a balance to be struck. The hon. Gentleman and his colleagues on the Liberal Democrat Benches have sat there and lectured us many times about being too top-down, on ring-fencing too much and on target-setting too much. They say we are taking away local discretion and how disgraceful that is, but then the hon. Gentleman says that if we allow too much local discretion, local bodies do not do what we want. There is a balance to be struck. The Government allocated this money because of the importance of the issue, but I stress to the hon. Gentleman that although I and the Minister responsible for care services, the Minister of State, my hon. Friend Phil Hope, have a responsibility to ensure that our objectives are met, it is the responsibility of Members of Parliament to challenge primary care trusts if they are not commissioning services in the expected way.
I was speaking a moment ago about people living longer, particularly those with disabilities and long-term conditions. The life expectancy of people with Down's syndrome is just one illustration of that. Just after the war, a child with Down's rarely survived into adulthood. Today, it is possible for them to live well into their 60s and, with the right support, to enjoy a full and rewarding life. What a wonderful sign of health and human progress that is, yet the sense of a world transformed brings into sharp focus the challenge ahead for social care.
It has been remarked, quite fairly, that if William Beveridge had sat down today to develop the welfare state he would have put social care at the centre rather than the periphery of his plans. More than 60 years after the birth of the NHS, it is worth reflecting that the same unfairness that originally drove Nye Bevan still exists in social care today, and it is this: people with the greatest needs are paying the most; the services that a person receives vary markedly according to geography; and what an individual spends on their care is only loosely linked to their ability to pay for that care.
Hon. Members will appreciate that the spectrum of care costs is extremely wide. About one fifth of people can expect to need care costing less than £1,000; for another fifth, the cost will be in excess of £50,000; and, for a smaller but growing proportion with very high needs, particularly those who develop dementia, the cost can run into hundreds of thousands of pounds. That is a cruel lottery, and the fact that people born after the war, the first real property-owning generation, will soon enter the care system only intensifies the need for change. We could see unfairness played out on a far greater scale over the next 20 or 30 years if we do not make changes to the care system today.
It is therefore no exaggeration to say that the Government's Green Paper "Shaping the Future of Care Together" is a Beveridge moment for social care. It is a chance to rebuild the social care system from first principles and to raise our ambitions for care and support in the future. One of the main messages that I should like to communicate today is this: in the time that this Parliament has left, one collective responsibility is to build an unstoppable momentum for legislation on social care in the next Parliament.
My hon. Friend should study the Green Paper, which talks about the creation of a national care service that will include universal entitlements to assessment, reablement and other services. People will be entitled to have some of their care needs met.
Social care was outside that original consensus, and for that reason has always been a partnership involving the individual, the family, the community and the state-all of them playing a role in the provision of support. Care has always been provided on that basis, but the purpose of this exercise is to ask, "Can we find a fairer way that spreads the costs and the risks across us all and is a collective system that provides more peace of mind for us all?"
The right hon. Gentleman mentioned that the issue will effectively be a problem for the next Parliament. Regrettably, it has come before this Parliament at its end rather than its beginning, but we are where we are. He mentioned dementia, and he knows that that is growing as fast as, if not faster than, the other problems that he has described. He knows, too, that people with dementia are among those who are particularly affected by the mismatch between the quality of the services they receive and the amount of money they pay to receive them. One reason is the lack of training for those who provide dementia care. May I commend to him the report of the all-party dementia group, which I know his colleague, the Minister of State, Phil Hope, has seen? I hope that the right hon. Gentleman will include it in the Government's thinking on the improvement of social care more generally.
I know that the hon. Gentleman chairs the all-party dementia group, and my hon. Friend the care services Minister has just informed me of the valuable work that it does. I must correct what the hon. Gentleman said at the start of his intervention, however. It is not as though we have done nothing, to be fair. The Department of Health has produced a dementia strategy, which has been widely welcomed. Indeed, its preparation drew on a range of voices and outside organisations, and it is an important piece of work. There has been all the work with individual budgets, too.
However, I have said in many speeches-I am owning up here-that politicians have for too long flinched from the debate, because it raises difficult and awkward questions about funding. I am signalling very clearly that that cannot continue, and we have to make care an issue on which the parties lay out their different options. It should feature prominently at the next election, and the expectation should be that if we can agree on one thing it should be this-that we create an unstoppable momentum for legislation in the next Parliament.
On the history of the issue, I note that the royal commission, which the Government set up in 1998, could not find a consensus, but I am clear that we cannot proceed with reforms unless we find a broad consensus across the country. Such is their reach and their importance to us all that we could not implement them with 51 per cent. support for one option and 49 per cent. against, based on the options that my hon. Friend Kelvin Hopkins has pushed towards me. Whatever the option, we would have to implement it with a broader sense of fairness and consensus. That is what we are trying to find, but the hon. Member for Rugby and Kenilworth makes a very valuable point, and we take such issues very seriously.
We have to seize the moment; otherwise we face a bleak future in which inadequate budgets are stretched ever more thinly around an ageing population, providing in the process less and less dignity and a worse quality of life in retirement. It is not a very encouraging prospect; in fact, it is very depressing, and that is why we need to act.
The Government's proposal for a new national care service to sit alongside the national health service is the right and radical answer to the mounting unfairness. Under the national care service, people would have the reassurance of a universal system, the security to plan for the future and the knowledge that they would not need to sell their home if they required high levels of care.
There would be a new standardised assessment to end postcode lotteries in the current system, and free information and advice would be available to all, helping people to navigate the system when they are most in need of a helping hand. The national care service would be anchored in prevention and early intervention, with care services working far more closely with the NHS to ensure that people received the integrated support they needed. In particular, reablement-intensive support, helping people to recover after illness or bereavement-would be at the heart of all options.
Will the Secretary of State address an omission from the Green Paper? It is very important that he does so if we are to understand the direction of travel. The omission is means tests on, and thresholds for, the assets that a person would be able to hold before they accessed state support. The Green Paper is silent on that and on whether the Government think that additional new resources would be needed to achieve an improvement in care quality. Will the Government spell out those points in their White Paper?
They would obviously have to be spelt out. The Green Paper's approach was to consult on principles, providing not all the details of how we would construct the options, but the principles that fit most closely with the consensus in the country. Under each option, we could apply a more progressive approach, whereby those with more would pay more, or a flat fee and universal approach, whereby everybody paid the same. The Green Paper touches on those questions, and in the consultation we want to draw them out. We have an open mind on those questions.
The current threshold of about £23,000 is a crude cut-off point, and we can do better to give people more peace of mind in retirement. That is what we are working towards, but the question about the extent to which any new system should involve means-testing is difficult. It is not a popular subject among older people, and we need to test people's sense of fairness on building a system with either means-testing or a more universal approach at its heart. We are open-minded on that question, as we are on all questions in the Green Paper.
However, one area in which we have indicated that we will go further is the provision of free personal care for those with the greatest needs. The long-term aim of a 21st century care system should be more people living full and independent lives in their own homes for as long as possible. In that respect, the Prime Minister's landmark announcement of free personal care for those with the highest needs is an important staging post for the type of care service that we want to build. It is an opportunity to start to address the unfairness in the system here and now, and to do so in a way that listens to people's fundamental desire to remain independent and in control of their lives for as long as possible. For me, that does not mean creating new incentives to put people into residential care. In my view, it is no solution to say to people that the only way to protect their home is to go into a home.
I am disappointed that the shadow Secretary of State for Health is not here today, either because he felt it was not important enough or could not find the time. Had he been here, I would have wanted to question him closely on how promoting a scheme that provides help only if individuals go into residential care can possibly hold an answer to the future care needs of this country. Surely the future is about helping people to stay in their own homes for as long as possible and giving them access to the support that makes that possible, not having a system that creates an incentive to put people into residential care. That is a depressing view of the future and an inadequate and flawed response to the challenges that the country faces. Though I welcome the Conservatives' engagement in the debate, at long last, I am disappointed that the shadow Secretary of State is not here to speak up and begin to try to explain how the plans that he has put forward could possibly answer the country's needs.
At this moment, people feel pressurised into keeping their relatives at home because they fear losing what may be a relatively small amount of equity to some people, but is a lot to them-and the only equity in the family-if they lose granny's house having been forced to use it to pay for granny's care. That is what is happening. I have come across cases in my constituency of people who are deliberately keeping at home unwell relatives who would be better off in residential care.
I certainly recognise the problem that my hon. Friend describes. That is why reform of the system is growing ever more urgent. There has been a fundamental shift. My parents' generation are the first major property-owning generation. In the past, people in my constituency, a former mining area, did not own their properties, but today they do. People in their 60s and 70s have bought their homes and now have an asset that they own. They may not have a lot in savings or other assets, but they do own a home. It is important that we create options for the future that are not just about residential care. This is about how to help people, and the people who care for them, by enabling them to enjoy and stay in their own home, and if necessary to pass that home on to the next generation. That is at the heart of the entire Green Paper, which is about doing it better than we are doing it today.
I share my right hon. Friend's unhappiness that the shadow Secretary of State is not here. Does my right hon. Friend have any idea how much of the £8,000 that was proposed to be put forward as a donation by anyone going into residential care would be kept by the private insurance company?
That is why it is disappointing that the shadow Secretary of State is not here. We cannot see how a system that requires an £8,000 contribution to care can possibly be workable, on any basis. Indeed, on the eve of the Conservative party conference the Daily Mail had a front-page headline saying "£8,000 to save your home". Two days later, a spokesman for the shadow Health Secretary was saying that "top-ups might be required". The £8,000 figure lasted all of two or three days, yet during the big care debates people have been using it as though it would be the extent of the contribution that would have to be made. We cannot conduct the debate in those terms. People have to be open and honest about the scale of the costs, not put out misleading figures for political purposes that then fall to bits in their hands, and think that they are adding to the debate.
This issue clearly affects all parts of the United Kingdom and serious issues arise in relation to older folk: we have heard about them being kept in their own homes by their family and I have experience of that happening in my constituency. Many families talk about this problem and want to know when it is likely to be resolved. Can the Secretary of State tell us when there is likely to be an indication of the way forward? In other words, how long are we going to have to wait, because these are pressing and urgent matters?
That is why I have put them at the very top of my list of priorities. There is nothing more important than building, first, momentum, and then consensus around reform of the system. I agree that people need to see how this will play out. I have said-I cannot say more than this-that we will have a White Paper before this Parliament is dissolved, and we will then take a proposal to the country on reform of the system. I want to create an unstoppable momentum whereby there will be legislation in the next Parliament. Obviously, I cannot promise that, as it depends on many different things. However, we should, collectively, make it our mission to ensure that the next Parliament legislates on social care. [ Interruption. ] In answer to Mr. Wilson, we are coming forward with a clear vision of the future-ideas to put on the table. The Labour party created the national health service, and now it has a very clear idea about the social care system. I think that people will look to us for ideas because of our history and what we have done in providing better support for people. The hon. Gentleman is chucking jibes over here, but where are his proposals on how he will make life fairer for older people in this country? Where is his shadow Secretary of State, for that matter?
Our vision for the future is about bringing more support into people's homes-not putting people into homes, but giving them more support, using new technology to the full. The answers are out there already. Many Members will be able to call to mind examples from their own constituencies involving telecare and other technologies, helping people stay in their homes for longer, and personal budgets opening doors and extending choice for individuals and their family. A progressive system of care and support should open up options for people, not close them, and that means embracing new ways of thinking about care.
We must also create a system that empowers and enables carers to cope. The biggest challenge to carers is not the inflexibility of employers but the inflexibility of services. Their contribution must remain the bedrock of any future system of care and support. We must continue the journey started by the carers strategy to ensure the provision of care services is shaped around their lives rather than the other way round, in the same way that child care and early-years support was built to help people to balance family commitments with work commitments. In other words, just as Sure Start supports the child while helping parents to return to work, the national care service can achieve the same end by helping and empowering the individual and the family receiving support.
Let me move on to funding. The Green Paper sets out three clear options and gives the indicative cost that an individual would pay to fund the care service. In addition, we are exploring a number of options to pay for the portion of basic care costs that the state would pay for as part of our proposals. Let me reiterate that we have ruled out any suggestion that disability living allowance for under-65s will be brought into the national care service. There may be a case for bringing together elements of some disability benefits, such as attendance allowance, with social care funding. However, that will be done in a way that guarantees that people receiving these benefits at the time of reform would continue to receive an equivalent level of support and protection under the new care service scheme.
May I ask the Secretary of State what that equivalent level of support will be? Will people get care instead of money? If so, does that not go against what is happening in the Welfare Reform Bill, in which we are trying to give people more money so that they can spend it on the care that they want?
The hon. Gentleman makes an important point. We want to place at the heart of the system the control and empowerment that comes from the personal budgets scheme, in many ways replicating the power and control that comes from direct benefits. People will want to look at the details and decide whether that desire has been translated into any new system, and the test of whatever comes out of the Green Paper will be whether it replicates that direct individual empowerment.
The Secretary of State rules out touching the disability living allowance of those under 65 and that is welcome, but he will know that nearly 1 million people over 65 get DLA. His announcement at the conference last week will not have put their minds at rest. Will he say more about whether DLA for those over 65 is covered in the Green Paper proposals?
It is important to make the point that the Green Paper is not about taking away from people. The whole proposal is to do things better for such people. The fact that they are receiving that benefit means that they need significant support, and the whole thrust of what we are trying to do is improving the support that we can offer.
We have to live in the real world, and in the current financial climate, we cannot talk about creating a new system of care and support simply by saying that everything should come through taxation. That would not be a sustainable position for the public finances. Equally, it is not sustainable to say that if we are to build a fairer and higher-quality system of care and support, we should not consider the support that we already provide, such as the attendance allowance. The House has flinched from this debate for too long because it raises difficult questions, but if we do that again, we will let down disabled and older people.
Mr. Harper made a significant point about DLA for over-65s, which is paid specifically for mobility needs. Some of those people have capital commitments with regard to those needs, for instance to Motability, which cause them many problems. I appreciate that this is a Green Paper, but we need to make the Secretary of State aware of the complexities that might arise.
I take the hon. Gentleman's point, and he will have to test what comes after the Green Paper for such people, whose needs are considerable and who deserve the best support that the state can provide. I am talking about enhancing how we look after those people and doing more for them than we currently can. It is understandable that talk of change is unsettling for people, but I hope that he will help us relay to them the message that underpins everything we are trying to do, which is that this is about significantly improving how we provide care and support, not about cutting things, taking them away or leaving people without the support that they need.
What is affordable and what is not affordable is a political choice. I have spoken to many people and explained that improvements might cost, say, 1p on the standard rate of income tax. Everybody has said, "Hooray, we would certainly pay that." People want them to be paid for out of taxation, but my right hon. Friend has made the political choice that they will not be.
My hon. Friend must think about not just the here and now but what the country will look like in 2050. The modellers and forecasters predict that by then, there will be two working-age people for every retired person. Today, that ratio is roughly 4:1. Is he certain that payment through taxation is sustainable and fair in the long term? The question of fairness needs to be tested over the long term, and I do not believe it is fair always to go to the working-age population. People expect to pay something towards their care costs, but it is not fair for them to have to pay out catastrophic levels of cost simply because they are struck down by a cruel condition such as Alzheimer's. We are seeking to end that unfairness, but any system has to be realistic and credible if it is to make progress.
I mentioned attendance allowance and the importance of people receiving an equivalent level of support. We must recognise that by strengthening the care service that we provide, we will not only save lives but save money and strengthen communities. Early Department of Health research indicates that a council can save £1 million a year through investment in reablement, about the same from telecare and more by developing alternatives to residential care.
It is apparent that if we can nip problems in the bud-for instance, by giving an older person the support necessary to stop repeat hospital admissions-we can also save money for the NHS. If we reflect on the fact that falls cost the NHS £1.8 billion, there is a significant "invest to gain" argument for better care and support.
That leads me to another important point. Today's debate must go beyond the architecture of local care services or the funding proposals that underpin them. Fundamentally, the challenge that we are discussing today is part of a wider shift-a drive to build a society for all ages, creating an environment and a culture that supports and empowers older and disabled people in all aspects of their lives, at whatever stage.
In social care, a lot of work is under way to break down assumptions that people of a certain age need a certain kind of support. The "Putting People First" agenda- and with it the £500 million investment that has gone into personalisation-is helping move councils away from the "slippers and sympathy" default position towards a system that treats people as individuals and works with them to find the right answer to their care needs. The growth in personal budgets is extremely significant in that regard, and something that I want at the heart of the national care service.
Despite that progress, however, there is still an undercurrent of ageism across public services-a continued tendency to read the age rather than see the person. That must change as this country's demographics change. That is why we have pledged to eradicate ageism in the years ahead, and why I think that it is important that the ban on age discrimination in the Equality Bill will apply to health and social care at the same time as to other sectors-in 2012.
The door is still open for discussion about the finer detail of the national care service, and that goes for my hon. Friend the Member for Luton, North, too. Those listening to the debate will have heard his strength of feeling about the matter. The Green Paper consultation will continue until next month, and the Government are still listening to people's feedback and ideas before developing a White Paper next year.
The Minister of State has done a superb job in speaking up for social care and carers and in taking the debate forward. He deserves great credit for his work. He and I want to use today's debate to draw out further thoughts from Members of all parties to contribute to the building debate about the future of social care.
I therefore return to the point with which I started. We need to find a clear consensus in the House and a commitment to bold and radical action. If we cannot, we face the depressing prospect of not being able to fulfil the standards to which we aspire for our parents and for ourselves in our later years. We must find a better and fairer way of spreading the risk and funding care in future. I believe that a national care service, built on the principles of fairness and universality, will best serve our ageing society for the future. I hope that we can have a good discussion today on that proposal so that we lay the ground for legislation in the next Parliament.
First, may I give a couple of apologies as a courtesy to the House? The shadow Secretary of State is obviously sorry that he is unable to be here to reply to the debate. It has been well known for at least several days that he is in Washington on a visit to fulfil a long-standing commitment to talk to various parties and interests in the United States about health care reform, at their invitation. It is interesting that we were notified formally of the Secretary of State's presence in the debate only yesterday. When I wrote my letter to the Speaker's Office last week, it was to be the Minister with responsibility for care services and I who would debate the matter. The Secretary of State's cheap shot therefore ill befits his office. After the debate, I hope that he will question his private office to find out why he was not informed about the courtesy that was shown last week. It is sad that he raised the matter on the Floor of the House.
Secondly, I am sadly unable to stay for the whole debate. Again, as I wrote to Mr. Speaker last week, I have to be in Stoke-on-Trent by 7 pm for a commitment that has long been in the diary and for which many people have sacrificed their time. I wish to do my best not to let them down. Mr. Speaker kindly agreed that that was wholly appropriate. Most important, and demonstrating our joined-up approach, my hon. Friend the shadow Minister for disabled people will take my place on the Front Bench for the conclusion of the debate.
Before we delve into the detail of the Green Paper, I shall remind the House of the debate's context. We are faced with the challenge of an ageing population, whose needs will stretch our social care services to the limit if they remain unreformed. In the next 20 years, the number of over-65s will nearly double, and the number aged over 100 will quadruple. The rise of dementia-the issue was raised by my hon. Friend Jeremy Wright, who is chairman of the all-party dementia group-will be especially apparent in the older population.
Help the Aged and Age Concern estimate that 2.4 million older people in England have care needs, and 45,000 older people are forced to sell their homes each year because of the rising cost of care fees. Indeed, Kelvin Hopkins made that point.
However, not only the elderly depend on social services. Those with learning disabilities such as autism, the blind or partially sighted, and the physically disabled members of our society all have needs that are met through social care. Those who care for the disabled and the elderly also derive a great deal of support from the social services. Carers UK estimates that there are 4.3 million carers in the UK, with one in five carers having to give up work to care. It was disappointing that the Green Paper somewhat pushed those groups into the background of social care reform.
The hon. Gentleman is making a point that I wanted to make, and the same point has been made by my local Mencap organisation. The Green Paper does not acknowledge that as well as the likely increase in the number of elderly people, the numbers of the people with learning disabilities is likely to increase because of increased survival rates. The Green Paper does not recognise that or have any answers on funding.
I am grateful to the hon. Lady for raising that point, because it was a disappointment that that broad area was not covered in the Green Paper. The Secretary of State referred to the Down's syndrome example, so to some degree he covered it in his remarks, but the hon. Lady is right to highlight that absence from the Green Paper, which was the point that I was making. Mencap and many others have been anxious about whether that is a signal of an absence of commitment in the area, given that most people are focusing on the elderly- [ Interruption. ] From a sedentary position, the Minister responsible for care services, Phil Hope, is trying to suggest that that is nonsense, but he may have overlooked the fact that I was replying to an intervention from a Liberal Democrat and that I had not actually accused the Government of anything. He should be a little less touchy and a bit less sensitive about his personal reputation, when what we need is some kind of solution for what is a very pressing problem for many people, across all age ranges in society.
It is clear that a growing number of people in our population interact with the social services in some way, shape or form. I hope that the Secretary of State agrees that our thinking on the issue must be underpinned by the acknowledgment that social care has the power either to make or to break the lives of the most vulnerable in our society.
The Secretary of State asserts, a little presumptuously, in the introduction to the Green Paper that
"this is the beginning of a Big Care Debate".
The Prime Minister calls for a "major debate" in his foreword, despite having issued a similar call a year and a half ago in his speech to the King's Fund, when he said that
"we must now look again at the options for reforming our current system of care and support."
It is therefore perhaps important to remind the Government that the debate has in fact been going on for more than a decade. Tony Blair made-as it turned out-the empty promise to reform the social care system as far back as 1997, when he pledged that older people would not have to sell their homes to pay for their care. I am sure that that is written in stone in the Department of Health and the Secretary of State's office.
Rather than getting into a ding-dong dispute about that, I shall just say that I do not accept the hon. Gentleman's underlying point that there were cuts to the budget. However, I accept that there was a shift in approach. Many people were moved out of institutionalised care, particularly elderly people. Often, inappropriate presumptions about mental health problems were made and mental health problems were not properly diagnosed, and there was a move towards care in the community.
There are many arguments on that and it is fair to say, in the light of experience, that to some degree the pendulum went too far, and we are now trying to find a new balance. There is a difference between wanting to preserve people's independence and dignity and their ability to remain in their own homes with a certain quality of life, and wanting to preserve and maintain the dignity and appropriate care of those who on proper criteria need long-term residential care, particularly as they move towards the end of their lives.
Does the hon. Gentleman agree that the assessment of continuing care needs funding is a real problem for people who leave hospital and go into residential care, for instance following a stroke? The Government really need to put out stronger advice and guidance for health authorities to ensure that people's health needs are funded.
The hon. Gentleman makes a point about health needs, and some 30,000 people are under NHS continuing care, which is of course provided. The difficulty is the assessment criteria and the absence, at the moment, of a sufficient number of intermediate and rehabilitation places, which are especially useful for those who need continuing care, whether in the national health system or as they move across into the social services care system, which is of course differently funded and has different consequences. Above all, if we had sufficient places, it would help to remove to some degree the crisis and emergency aspect that characterises so much of the problem as people try to find an available bed rather than a place in a care home-if appropriate under proper assessment criteria-that is suitable to the person's needs.
The elderly, and all those in need of care, are unlikely to be fooled by any Government who claim that they are setting the agenda on this issue. Indeed, Mr. Anderson made the point that this is an issue that has been under discussion for decades. Promising a "big care debate" may sound good, but what people are really looking for is decisive action. As I will outline, my party has made some important decisions, and I hope that it will be recognised that it is the Government-who have issued a Green Paper-who need to be pressed to make decisions, rather than having yet another consultation on a consultation. However, I do not deny that a consultation is indeed taking place.
As for the proposal for a national care service, the Government appear to have plucked the term out of thin air to give the appearance of weight to the Green Paper which might otherwise be absent, because it is so void of practical detail. It is clear that by creating the illusion of a national care service, the Secretary of State-as one might expect-wants to have his cake and eat it. The Government talk of a national care service, but they want personal budgets for individuals and funding autonomy for local authorities, as the Secretary of State confirmed a moment ago. The Government talk of service, but fail to specify exactly what kind of service the public will get for the uncosted £3.5 billion a year commitment. Most worryingly, the Government talk of care, but threaten to cut attendance allowance and DLA for the over-65s, which would deliver a stinging blow to the most vulnerable in our society.
The Green Paper proposals would be more believable if they were locally costed and specific. Instead, the Green Paper waxes lyrical about options for reform without giving the country the road map it so desperately needs. Given that the need for joined-up care services was drummed home no fewer than 40 times in the Green Paper, it is extraordinary that the Government have not felt the need to demonstrate a joined-up approach in their own proposals. Instead, what we have witnessed over the past two months is a quick succession of U-turns and botched announcements.
First, we had the surprise pledge from the Prime Minister himself in his conference speech about the provision of free personal care for those with the highest needs living at home. It is as yet unclear how that proposal relates to the Green Paper or where the money to provide that care will come from. The Prime Minister has specified a sizeable commitment of £670 million a year to provide 350,000 people with the highest needs with free home care, and the Secretary of State described that a few moments ago as a "staging post". But his Ministers were unable to answer our inquiry about which budgets that money would be taken from and how the figure of 350,000 individuals had been reached, as recorded in Hansard at column 809W on
Can the Secretary of State clarify the connection between the announcement by the Prime Minister and the Green Paper, and can he offer any further insight into the funding of the Prime Minister's pledge? There are still no details of the Prime Minister's policy on the Department's website. That, in itself, is of some interest, because any of us who take an interest in such care issues will have been struck by the Secretary of State's effusive response to the Green Paper, compared with the somewhat taciturn reaction to the Prime Minister's home care scheme. No one, however, has been remotely forthcoming about the numbers behind the scheme, leaving everybody questioning where the money will come from.
Given the Secretary of State's exchanges with the hon. Member for Luton, North, who is no longer in his place, it is a little odd, and inconsistent, that the Prime Minister's scheme is to be funded-so it is claimed-through general taxation. However, the Secretary of State said that it is not possible in such areas to consider general taxation as an option for what has been proposed under the scope of the Green Paper. That inconsistency needs to be clarified and explained.
The Secretary of State seemed to take his cue from the Prime Minister's new-found spontaneity last week. The former announced out of the blue that, rather than dissolving the disability living allowance into local authority budgets, as the Green Paper had implied, he would keep the DLA. That was in spite of the statement made early last week in the other place by the Under-Secretary of State for Work and Pensions, the noble Lord McKenzie of Luton. He said that the Government were looking at "all disability benefits" for dissolution into the national care service.
Will the Secretary of State clarify whether the attendance allowance will stay or go? He did not do so when he was on his feet a few moments ago. This point is exercising many people in all parts of the country, and not just in England.
Is my hon. Friend as concerned as I am about another benefit-in addition to the ones that he has mentioned-on which I have received requests from constituents: quite an old benefit called the severe disablement allowance, which is still recognised? It is usually a lifelong benefit for people with lifelong learning disabilities. Is that, too, on the table?
I am most grateful to my hon. Friend, because that could impact greatly on those in receipt of the benefit. We require clarity because we are dealing with people who have arranged their lives completely, having often struggled to have their needs recognised, and who now need to know that that level of support will not be removed. We need clarification, therefore, on the attendance allowance and certainly on the SDA.
If the Secretary of State has decided to axe those-he sought to suggest that there would be an underpinning guarantee, but again he did not specify how it would be put in place-what measure does he intend to take to protect the care of those most dependent on the allowance? His U-turn on the disability living allowance has come as a welcome relief-I do not deny it-to many with disabilities. It was much needed because there really was distress. It also came as a welcome relief to their carers and advocates. However, the Government continue to keep people over 65 in the dark about whether their DLA will be under threat and whether the attendance allowance remains under threat.
If the Secretary of State wishes to offer an explanation, I will be more than happy to take an intervention. Otherwise, it must be taken that there is no guarantee that the DLA will remain for those over 65. His decision to discard some of the benefits is bafflingly contradictory. He claims that he wants to give more responsibility to individuals through personal budgets, and yet he takes this responsibility away again by threatening to cut disability benefits. How can we move towards a more personalised care agenda if he is not prepared to trust individuals with benefits designed to offer more choice and control over the services that they receive? That is fundamental to how we need to move forward.
To be clear, I say officially, as it were, from this Dispatch Box that we have said that we will oppose any plan to cut and redistribute attendance allowance, because in our view it is not the way forward. Unlike the Government, who are trying to create the impression of a national approach to social care, by nationalising it in effect, we believe that personalisation is the right path to take. Attendance allowance is one way for people to commission informal care services. If we were to back the Government's approach, more and more of those informal care arrangements would have to be made formal through local authorities. That would be costly and restrictive for those at the receiving end of care. Although we will continue to examine the evidence, a retreat back to the state as the sole provider might restrict the flow of funding into front-line care. In a society where individuals are often the experts in their own care needs, that would surely be a step backwards.
On top of those concerns about disability benefits, older people continue to worry about whether they will have to sell their homes to pay for their long-term care. That is a feature that Tony Blair himself mentioned in a promise in 1997-a promise that has not been delivered under this Government. Instead, the Green Paper revealed a loose preference for a partnership model for social care, whereby the state would pay for a set proportion of each individual's care fees. It is worth mentioning that the partnership model was discussed in detail in the 2006 review by Derek Wanless-a review that the Government refused to commission and which has been on the table for debate for more than three years. It is only now that the Government have chosen to explore its implications.
I have some concerns about the Government's proposals for a partnership model of care. First, the Green Paper states that
"everyone who qualified for care and support from the state would be entitled to have a set proportion-for example, a quarter or a third-of their basic care and support costs paid for by the state."
However, there is no guidance on how individuals qualify for that subsidy and no firm pledge to provide a specific proportion of funding. In their answer to our parliamentary questions on the issue, the Government could confirm only that there would be no new money involved and that
"Costs would be met from within the public spending envelope set for future spending reviews".-[ Hansard, 12 October 2009; Vol. 497, c. 758W.]
How can we trust the Government to deliver on reform when they leave the public playing guessing games about the funding of their proposals?
By the Government's own admission, older people want security, dignity and independence for as long as possible. Everyone wants to be able to plan and save for their own care needs, but at present the public stand no chance of being able to anticipate whether they will be able to afford the cost of care. The Government have let our elderly down through their lack of detail. The other serious question hanging over the Government's proposal is their failure to deal with the accommodation and food costs of long-term care. Those hidden costs often prove to be the most crippling for older people, as they move from their own homes to a residential setting.
I am coming to that in detail. I am sure that the Secretary of State will be pleased to hear my clarification of an absolutely superb policy that is now being much welcomed by those who care to understand it, in contrast to the rather disappointing tribal political ping-pong with which he tried to de-dignify his speech earlier.
It is enough for older people to make the transition to long-term care without having to worry that their most basic needs, such as food and accommodation, may not be taken into account when they undergo a means test.
The Secretary of State has tempted me to move straight on to the next part of my speech. Whereas the Government's Green Paper offers no firm guarantee that every individual will be able to access care in old age, the Conservatives have already placed a large and, I would argue, innovative brick in the wall of social care reform. Our home protection scheme will enable older people to keep their homes and guarantee their care in older age. Our policy will deliver on the promise that Tony Blair made, but failed to keep, more than 11 years ago. We are looking to build on that policy by rigorously examining the options for domiciliary care, so that older people can preserve their independence for as long as possible.
Despite what the Secretary of State said, picking up on some of the rather less informed comment from when the scheme was put forward, let me make it clear that there will be no perverse incentive or adverse selection, because access to residential care via a local authority will be based on assessments of need alone. We will ensure that, as well as ensuring consistency, by putting in place proper national assessment criteria, so the point about perverse incentives is simply not valid.
Surely that is what happens now. People are assessed for need by the local authority, but when they need to go in to a care home they refuse to, because they do not want to. When the scheme is introduced, there will be an incentive for people to go in to care because they will keep their homes, so if they are assessed for need, they will go in.
The hon. Gentleman seems to misunderstand that we all agree across the House that, above all other things, older people want to maintain their independence, dignity and so forth as best they can. There are no people sitting out there thinking, "I must rush into a residential care home." It is only when the need requires it that it happens, although the local authority might have no incentive to meet that need because of capacity issues.
The hon. Gentleman just said that there was consensus that people want to keep their independence and stay in their own homes. My understanding is that his proposal would offer no additional help to people to do that, so how can he stand there and make that statement? The only support would go to people who moved into residential care.
I was right. The right hon. Gentleman is trying to read out the criticisms that those who are rather embarrassed that they have not been able to attack our proposal successfully are now trying to peddle. The truth is that I am about to come to that very point.
Let me just make sure that the home protection scheme is understood. The whole point is that it is part of the overall approach to care, which has to include domiciliary care, which is not addressed by the right hon. Gentleman's own proposals. The firm guarantee is that our home protection scheme would offer every person the chance to protect their assets and guarantee their care through the option of an one-off payment of around £8,000. All care fees would then be waived for life, should the individual ever need long-term residential care. Unlike the Government's partnership model, this single lump sum, paid for at the age of 65, would cover not only care but food and lodging.
The scheme would also be self-financing, an important factor to consider, given the public deficit. The Government might be refusing to be up front about the funding of their partnership model, but the Conservatives are giving careful thought to the ways in which we can both steward the public finances and deliver long-term care to those who need it. The Government's own insurance model would be priced at £20,000-an unrealistic saving goal for the individual-compared with our £8,000 option, which has been verified by a leading actuarial firm and welcomed by Aviva and the Association of British Insurers. If the Secretary of State wants to study the quotes from the ABI, which has looked at this proposal extensively, I would be more than happy to pass them over to him.
I just want to make sure that I fully understand the proposal that the hon. Gentleman is setting out before the House today. Did he use the term "domiciliary care" in the context of the package that he is proposing? In other words, will domiciliary care be covered by the scheme? If not, how will it be covered? Do the Conservatives have a plan for that?
It does not cover domiciliary care. It covers the Government's failure to honour the promise given by Tony Blair as part of his attempt to get elected in 1997. People are fearful about having to sell their homes when they have to go into residential care, and that is what we have at last addressed.
Let me get on to the other point, which is obviously important, and let me make sure that this is fully understood. The Government's partnership model would require every person who believed that they were in need of care to undergo a means test. Our approach is open to everyone, regardless of their financial circumstances. State-funded care would still be available to those on low incomes, but the majority of people who do not qualify for state-funded care would have the option of guaranteeing that their residential care needs would be met at an affordable cost. At present, all the costs of elderly residential care must be met by the individual if they own just £23,000 or more in assets, including the value of their home. Our home protection scheme would enable everyone to access affordable care.
The affordability of our scheme is based on the principle of sharing the risks together. We want to encourage the public to begin to pool their risk of entering long-term care, so that the cost of care for those who need it is lowered. I note that the Secretary of State has now disappeared; he obviously does not like my answer. An analysis of data from the NHS Information Centre suggests that one in seven people will eventually enter long-term care. The Personal Social Services Research Unit has made a series of projections regarding the future cost of care from the current figure of £26,000. An analysis of these data, carried out in consultation with the King's Fund and with actuarial experts, has led us to the premium price of around £8,000.
It is highly unusual, wholly welcome and totally transparent for an Opposition party to lay out a proposal in such detail, and those who have scrutinised it have clearly been unable to pick holes in it. This demonstrates that we have imaginatively addressed a problem that the Government, led by a Prime Minister who never delivered on his 1997 promise, have signally failed to address. That failure has resulted in people with more than £23,000 of assets remaining fearful that they would have to sell everything in order to pay for the residential care that they need.
As has already been said in the debate, when it comes to care, we realise that we need to fight the cause before we reach the crisis. Prevention is always better than costly cure. Mr. Burstow, who is just leaving the Chamber, raised the point, so he might have waited for the answer. Everything must be people-focused.
I am answering the intervention by the hon. Lady's hon. Friend the Member for Sutton and Cheam, who has chosen to leave the Chamber at the very moment the answer is being given.
Public health has been neglected under this Government: budgets have been raided and specialist staff have been cut, so they cannot begin to talk of joined-up health and social care services until they view public health as a priority. Under a Conservative Government, a new priority will be given to public health reform. There will be a Secretary of State for public health, and local directors of public health with the power to allocate independent ring-fenced-I emphasise ring-fenced-budgets to make effective interventions across the health, local government and social housing sectors to promote independent living for elderly people.
While the Government want to standardise care through their national care service, we want to personalise it. We have our sights set on two areas of technology where local directors of public health will be able to use public health budgets to deliver support systems to enable people to live independently in their own homes and reduce the need for costly, complex interventions.
Telecare is the key to giving patients and families the peace of mind to maintain an independent lifestyle. It provides them with a technology-based system of local monitoring, which identifies risk and monitors need without the use of costly or intrusive observation. A telecare scheme in north-west Surrey showed that this sort of preventive technology could reduce the number of people entering residential care by 11 per cent. in a single year. In Scotland, a new programme provided to 7,900 older people last year achieved savings of £11 million and significant improvements in self-reported quality of life for both elderly people and carers. For too many elderly people in too many areas, these services are not on offer.
I am struck by the hon. Gentleman's comments and my reading of a section of the Green Paper reminds me of some important issues raised by a local Age Concern group in my constituency. It pointed out that prevention is not just about the practical issues, as it is often about emotional support. That is what allows people to live independently. Depression is often unreported in elderly people. Day care services, visiting services and listening ears, with people making face-to-face visits, are just as important as the really practical things.
I could not agree more with the hon. Lady. Any of us familiar with these issues in our own families are fully aware that the contact of counsellors or other people of good will-perhaps those with some professional abilities not just to be good listeners, but advisers who can hold people's hands through the labyrinthine process of accessing their necessary support and care needs-is just as vital for the mental and emotional stability of elderly people. I understand absolutely the views expressed by that local group and those requirements must be met as part of the domiciliary care package.
That is why, in addition to the telecare that I mentioned, we need to look at home adaptations, which allow people's living environments to be tailored to their care needs so that injuries are prevented and people can stay in their homes for longer. Around half of people over 80 have a fall at least once a year, many occurring in the home. Many of those falls are easily preventable with the right home adaptations in place.
The final important group to consider is carers. Despite the vital work they do in caring for relatives and friends, our carers have suffered from serious neglect. Last year, the Prime Minister himself pledged £150 million for the carers strategy, with £50 million to be disbursed this financial year, mainly to support respite care. Only two weeks ago, as the hon. Member for Sutton and Cheam mentioned, the Princess Royal Trust for Carers reported that up to £40 million of it has gone missing-soaked up in local primary care trust bureaucracy. The Secretary of State's answer is that we MPs should press our PCTs on that, as it is not for him to impose from the top. When central money is being used to spur action, it is vital to know where that money has gone and to have some means to account for it.
The Green Paper makes little mention of carers' needs or the problems of the funding system, so it is time for a change of approach. In his very first statement of Conservative aims and values in a document called "Built to Last", my right hon. Friend Mr. Cameron, the Leader of the Opposition, committed to better rights to flexible working and respite care for carers. Again, it is a matter of giving people more independence and freedom over their use of social services so that we as a country and the Government in office provide public services that are responsive to people's needs and preferences rather than just a "system".
We know that local authority investment in home adaptation primarily benefits the NHS through reduced hospital admission costs and benefits individuals by providing security in the home. We know that NHS investment in telecare benefits local authorities by reducing their domiciliary care costs and enables individuals to have greater involvement in their care. We also want to know why these projects are not being more widely encouraged and promoted. The Commission for Social Care Inspection's final report found that innovative solutions such as joint council-NHS commissioning and the use of personal budgeting were still the
"exception rather than the norm".
We will require PCTs to promote joint working with local authorities, which will mean budget-pooling and joint commissioning. When the prize is independence, security and dignity for our elderly population and peace of mind for relatives, the bureaucratic barriers that stand in the way must be removed. That would also help to deliver on the quality agenda mentioned by my hon. Friend the Member for Rugby and Kenilworth in an intervention.
These are the final questions that the Secretary of State must answer. What action will the Government take in response to the consultation that ends on
Above all-we have often said that this would be very welcome-when will the Government, rather than engaging in what is often rather disappointing ping-pong across the Dispatch Box and elsewhere, invite any Member of the Opposition to go into their office and talk to them, even if it has to be on private terms, as an earnest of the attempts that they say they are making to build a consensus? So far no such invitation has been offered, although we have made clear that we are open to discussion on what kind of consensus might be built. Given that that has worked to a degree in the pensions arena, there is no reason why it should not work in the social care arena, but it takes a willing Government to cease to be tribal and try to build a genuine consensus.
The question facing the public is a simple one. Can the Government be trusted to deliver social care reform that is so desperately needed? The answer is also simple. The Government's threatened actions will threaten the most vulnerable, whereas we will oppose any measures to cut attendance allowance. Their inaction on residential care will loosen the grip of every older person on his or her assets and home, which is a real fear for such people. Our home protection scheme and our plan for home adaptations will offer older people security and certainty in old age. The Government's uncosted proposals place an unprecedented burden on our public finances, whereas we will confront the issues of funding head on. They have chosen to prolong the status quo, whereas we will choose the necessary change.
I hope that the Government will realise that consensus would be better than this, but until they invite us in, we must continue to make our arguments and make them strongly.
It is a pleasure to serve under your chairmanship, Madam Deputy Speaker, not least because of your long-standing experience, interest and indeed work in this area.
I want to present a brief analysis of why the issue that we are debating is so vital to us, and why it is so vital for us to crack it in an appropriate way, in the next Parliament at the latest. I also want to make some comments on the proposals in the Green Paper, which I hope Ministers will accept as constructive criticism.
The issue of what we now call social care-whether it involves younger people with disabilities of various kinds or suffering from mental ill health, including schizophrenia, or, as is more common, the care of frail elderly people-is one of those issues in politics which are a matter much more for people's agendas and family discussions than for what we often call the political class. It is far more important than Governments and Parliaments have given it credit for over the past 20 years. Within the extended families of which we are so well aware, there will be extensive discussions and great concern about, for instance, what will happen to a person with Down's syndrome when she is no longer a child but is becoming an adult. More typically, there may be concern about someone with dementia, perhaps Alzheimer's, when residential care looms. There may be serious problems involving mental ill health, often affecting remarkably young men, and I mentioned schizophrenia earlier. It is about time that Parliament and Government got a grip on the issue because people "out there" are concerned about it and are impatient for action. Within that, the financing of long-term care is most obviously the unfinished business of the post-war welfare state. We need to sort this out in the next Parliament.
Much has been said about the ageing of our population. Reflecting on this for the first time in a few years, given other interests that I have been pursuing, I think that there are three trends in terms of the ageing population, not just two. One is the ageing of the whole population. We can cite the ratios between those of working age and those who are retired and we have known about them for a long time. We have also known for a long time about the second phenomenon, namely the ageing of the elderly population. It is not so much an issue about those in their 60s or 70s; they may well be an issue for the pensions debate. But more people are living into their late 70s and 80s, which is why this is a crucial area for health and social care.
In 2008 almost 2.8 million were people aged 80 or over. By 2018, it will be 3.5 million. By 2033, according to Office for National Statistics estimates, it could be as many as 5.7 million people, which will be about 8 per cent. of the population.
There is also a third trend that we should note: the ageing of the very elderly population. Far more people will now live into their 90s and far more will get the equivalent of the Queen's telegram-given the demography, it could be from the Queen herself-in 10 or 20 years' time. In 2008 there were 97,000 people aged over 95. By 2033-not so far away-there could be 464,000 people over the age of 95, representing about a fivefold increase during that relatively brief period.
We need to think carefully about the "so what?" question. What are the implications? I have always thought that we should not immediately get into a debate about frailty, health care and social care when we speak about demography. We should applaud the fact that we now live in a society in which people will have a decent lifespan. I remember my professor at the LSE, the great Richard Titmuss, writing an essay about why we thought of the "problem" of ageing. The problem, he thought, was when people died in infancy or before they could retire. There is an ageism in society that we need to confront and there is a paradox: as our population grows more elderly, ageism becomes more rife. We need to confront that ism.
However, we must acknowledge a grim reality- the correlation, although it is not an inevitable one, between disabilities and illnesses of different kinds and an ageing society. There are different indicators in terms of different conditions and different levels of mental and physical disability. Let me give one indicator in relation to dementia. Research from the Alzheimer's Society, of which I have the pleasure to be a vice-president, shows that there are 700,000 people with dementia in the UK today. Of those, 62 per cent. are thought to have Alzheimer's disease itself but, given the figures I have mentioned and the growing numbers of elderly people, the society estimates that by 2021 the total number with dementia in the UK could be 940,000, or almost 1 million people. The number could rise again to 1.7 million by 2051, and that is one of the reasons why we need to pursue the science and research on Alzheimer's: to see whether, with this illness, as with so many others, the scientific and medical communities can start to make an impact. However, that one indicator shows the seriousness of the issue we are talking about today.
The figures I have just cited mean that in all of our constituencies there will be many hundreds of our citizens with dementias of different kinds. The Alzheimer's Society estimate for my constituency is that some 900 people are suffering from dementia. For those who reach the age of 80 or over, there is a one in five risk of dementia. That illustrates the scale of the problem. That level of risk raises issues in respect of how we insure against this, and gets us into the debate about the financial options, which I will come on to shortly.
There are huge implications for all of us in the demography and the epidemiology of some of these issues. There are certainly huge implications for social policy and public spending. I doubt whether we can seek to constrain public spending in this area over the next five or 10 years; if we are to match the scale of the need, it obviously has to be increased. There are also huge implications for families and extended families, and particularly for those husbands and wives or partners, sons and daughters and all the rest of the family and friends and neighbours who become what we now refer to as the carers.
The Green Paper is an important document, and the fact that the Secretary of State is here sends a signal about the seriousness of the issue it addresses, because, regardless of what it says on the plaque in Whitehall, he is actually the head of a Department of health and social care. That is the reality. For too long, the care bit has been merely one division, although an important one, of a great Department. It is often the big health issues-sometimes crises-that take up all the attention. I am therefore pleased that the Secretary of State is giving so much attention to this other area. My comments are offered in the spirit of constructive criticism, and I am sure that he and his Ministers will take them in that way-although they have not heard them all yet.
The Green Paper makes some important comments on entitlement. It acknowledges a truth that is universally observed by us: there are great variations across the country, from local authority to local authority, in the provision of care. As it says, that is not good enough. We need to move towards a greater system of universal entitlement, so that if people move-as they often do when they are frail-they will not find in the new area a totally different system from the one they were used to. I say that because people do not like the idea of a postcode lottery. In some of our debates on these kinds of topics there is a fashion for localism. I am not against localism in terms of innovation, trying out different things and responding to particular local needs, but in this sphere we need to blend the concept of localism with that of national entitlement.
The Green Paper contains some interesting proposals on assessment. Page 10 states:
"You will only need to have one assessment of your needs to gain access to a whole range of care and support services."
I welcome that, and I ask the Minister who will respond to the debate to say more about it. How broadly might that assessment range? When I was Minister with responsibility for pensions, based in the building in which the Minister lives and works-I suspect he lives there for a lot of the time, and he certainly works there-we were developing and rolling out the new Pension Service, including, importantly, the local pension service that performs so many domiciliary visits and assessments of not just the obvious things, such as pension credit issues, but energy efficiency programmes and so on. I do not want to push this too far because people need expertise to conduct assessments in the field of social care, but has the Minister been in talks with the Pension Service and the Minister with responsibility for pensions to see whether there could be a more joined-up approach to these assessments? One of the problems in this field is that once the welfare state is introduced into the life of someone with great frailty, there can simply be too many assessments, so could he say more about that?
The principle behind the assessments for attendance allowance and disability living allowance is self-assessment, in that the applicant fills in the form. Presumably, any new system would require the involvement of some professional help, so there might be a difference in principle in any new system.
That is an interesting and difficult point. When people can simply provide information by themselves or with the help of a relative, through a computer, that is often convenient, but a fellow human being will often be needed to assess a situation properly. The Minister will doubtless be able to respond to that point when he addresses my related point.
My second point deals with effective care in the community-or home support. I shall discuss residential care in a moment. We all know-we have touched on this in the discussion about assessments-that we need to address issues associated with housing, which are so crucial in effective community care, with social service support, with health support and with other forms of support. As something of a student of these things, I noticed that the Green Paper says that we need more joined-up working. We all put our hands up to agree with that. It states:
"One way of doing this is through better joined-up working between health, housing and social care services and between social care and the disability benefits system."
It continues rather boldly by stating:
"Services will be fully joined up between the NHS and the new National Care Service."
The following paragraph states:
"This does not necessarily need to involve structural change."
I do not believe that it does, but will the Minister say more about that?
I suppose that I am trying to put the Minister on the spot, but I do so seriously. If I had had time, Madam Deputy Speaker-you will be aware of some of this documentation-I would have been able to find similar phrases in important state documents about health and social care going back at least 30 years. I would probably find such statements even in the White Paper on growing old produced by a previous Conservative Government. I know, as a student of this subject and from my ministerial experience, that it is one thing for the civil service to draft such fine prose and for Ministers to recite it-I have done that myself-but it is very difficult to make it happen in practice. This is the old story about the lever being pulled in Whitehall and sometimes our assuming that things are happening in the locality when that is not necessarily true.
There is now lots of super practice of joined-up work, particularly between the health and social services, on which to draw. However, I wish briefly to detail my experience as an Education Minister, when my Government introduced the Connexions service. I remember talking to my hon. Friend Phil Hope-he is a Minister now, but he was a Back Bencher then-about that. I waxed lyrical about the importance of the Connexions service for young people and about how we were going to overcome barriers and join up agencies. Did that happen in the field? Sometimes it did, but often it did not. I challenge the Minister, in a friendly way, to prove to me that his fine prose is not just the usual fine prose and that the Department has serious ideas on how its approach will work in future.
I share the right hon. Gentleman's scepticism about how easy it is to join things up. I do not know how much thought he has given to this, but does he think that one way of doing that might be through the personalisation agenda? The Government are in favour of that and my hon. Friend Mr. O'Brien spoke about it forcefully. It is one option, whereby we would make more of the money from different funding sources-from different Departments-go into the hands of the individuals, and those individuals would then spend it. That might be the most successful way to join up effectively the services that they receive and the outcomes they obtain.
I agree with the hon. Gentleman that that is one way through this. We could use empowerment, by giving more of a say-more of the budget-to the individual herself or himself. Another way through would be to be more radical about trying to pool budgets across agencies. Some such pooling goes on in health and social care. I think that the Cabinet Secretary, Sir Gus O'Donnell, has recently spoken about that happening at a more macro-level, and it is an interesting idea. In other words, instead of public spending simply relating to the Whitehall furniture or the local furniture of Departments and so on, we say, "Here is a larger sum of money than we provide at the moment to crack this problem." We need to experiment with that in the future as we enter difficult times with public expenditure in a range of areas. I want the Minister to comment on this. The issue about joined-up working, which an earlier Labour Government called the joint approach to social policy-everyone has had a go at trying to make it work-is that achieving it is like finding the holy grail. It is very difficult but well worth the effort.
My third point is about carers. We have all acknowledged their importance. There are nearly 5 million to 6 million of them, some caring, I am almost tempted to say, too much. Some are caring almost around the clock-and some for more than 50 hours-until sometimes they drop because the fatigue and stress are too much. I want gently to say to the Ministers that I think the provisions in the Green Paper on the treatment of carers are a bit feeble. It looks to me a bit like they have been added on-when I was a civil servant in the Home Office many years ago, somebody referred to it as "joining up with a staple," although I think that there are now electronic ways of joining up a document. I was disappointed that carers were not more central to the analysis. I know that the Government have done a great deal on carers-more than any other Government-and that there has been a recent statement on the issue, but I would like to have seen the subject more central to the analysis, because the choices about how to provide care and the difficult decisions about residential care are ones that the carer and the wider family have to take as well as the cared-for person.
I am not sure whether the Green Paper mentioned carer's assessments at all-if it did, forgive me, but they certainly were not central to it. I speak with a vested interest as the promoter under a Conservative Government of a private Member's Bill that became the Carers (Recognition and Services) Act 1995-the first Act, with all-party support, to enable the carer to have her or his own needs assessed. That is important and we should have heard something about it in the Green Paper.
On carers, may I also pick up another important issue that is mentioned? Perhaps increasingly-and certainly numerically-lots of carers are workers and employees. We have heard how they might also be parents or grandparents. That all adds to the busyness of the life of the British carer. The Government have done a lot in terms of what some people might call the work-life balance-or the employment-care balance-and I urge the Department of Health to push at that door. There will always be at least one other Department, which I know quite well, that will resist that, urged on by certain business interests, but we need to recognise that a modern economy and a modern society have to allow for the fact that people have a dual role as workers or parents of young children while also caring for elderly parents. Some 3 million people combine work and care and I am advised by the statisticians that that is some 12 per cent. of our work force. It is no mean issue.
Finally, I want to talk about the most difficult issue, which is the financing of long-term care. I have referred to it, not terribly originally-others have called it this-as the obvious unfinished business of the modern welfare state. We had a royal commission some 10 years ago, and a minority report was produced. It was an interesting document, but, to be blunt, the Government then parked it in the "too difficult" box. I am pleased that these Ministers are returning to it-[Hon. Members: "Or going."] I see that the Secretary of State is leaving-it is not that difficult an issue. However, I know that Secretaries of State have many things in their crowded diaries. Government and Parliament may have found the issue too difficult, but avoiding it actually left the people needing care and the carers themselves facing difficulties. Some of that care is difficult, and some of the issues that those people face are difficult, but unlike Parliaments and Governments, they have not been able to avoid them for 10 years.
On the Green Paper's analysis of financing long-term care, my assessment is, two cheers for the Green Paper. It advances the debate, and one option could see us through into the future. However, I must echo what one or two colleagues from all parts of the House have said. As a Daily Mail columnist might ask, "Why, oh why have you rejected what you call the taxation option?" I simply do not understand. Although I would not advocate a taxation option, I would look seriously at the pros and, no doubt, cons of a social insurance option-or what we now call a national insurance option.
To dangle that option before the public, while talking about its advantages and how many people rather like it, but then to reject it, was, to be honest, slightly strange. On page 116, however, the Green Paper states:
"During the engagement process, many people told us that they thought an NHS-style system, where the full costs of care and support were met through taxation...would be the fairest option."
It goes on:
"This would require a significant increase in the tax... For this reason we have ruled out this option."
Then, unless I have misunderstood the sequence of the Green Paper, it states:
"The advantage of this system is that it would be universal, and would probably be the simplest and most easily understandable way of funding care and support."
It is almost as if two hands wrote that section of the Green Paper, and I am bound to say that I see the cold, grey hand of the Treasury all over it. That option should not necessarily be the way ahead, but it requires serious study.
The Secretary of State talked about Beveridge, but I thought that, for my colleagues who are students of Beveridge, he was getting into trouble. After all, when Beveridge studied the risks and needs facing society then, and the likely risks and needs in the future, he thought that they were essentially insurable. One had a real risk-if I can use the world "risk"-of becoming old, so one needed a retirement pension. There was always the risk of unemployment, sickness and death, so a social insurance system was the fairest way ahead.
I look at those on the Liberal Benches and wonder, "May I refer to Beveridge as the last great Liberal?" [ Interruption. ] I am glad that they are still awake. He was certainly a great Liberal, and my guess is that, if back then the demography was going to mean that huge numbers of people faced frailty, he would have wrapped up care in his social insurance system. I do not really understand Ministers' argument that to do so now would be a burden on employees. Yes, it would, and I understand the immediate argument that many constituents feel they pay too much tax, and that there are burdens. We would therefore have to be careful, but, before we say that employees should not have to carry that burden, we should note that they do so with pensions. Otherwise, the argument would amount to an attack on our pension arrangements. I suppose that national insurance is really how we pay for our national health service, too.
I therefore urge the Government to reopen that idea, as an option, because it is a serious one. After all, the Secretary of State talked about the current economic difficulties, but we are presumably trying to fashion a system that is fit for purpose for 30, 40 or 50 years. Beveridge, in 1942, and those who became the Labour Government in 1945 had the vision and the courage to go for a, no doubt, expensive welfare state based around social insurance-and that was in 1942, when we had some economic difficulties and, if I remember my history, some difficulties with our European partners at that time. So are we really saying that, at the beginning of the 21st century, that idea is too difficult even to consider as a proper option?
I very much agree with what my right hon. Friend is saying. I think that Beveridge, or the National Insurance Act 1948, set capital limits on ownership. However, the amount of capital that someone had to have was, in today's terms, absolutely enormous, so it covered only a tiny fraction of the richest parts of the population. If that were applied today, everyone would accept it; the problem is that the capital limits are far too low and affect millions of ordinary people.
Yes, that is helpful. Going for a social insurance option would not necessarily guarantee universal free care-a proportion could still be affected under the kind of arrangement that my hon. Friend has advocated. If we are consulting and thinking this through for a White Paper, that option should be there on the table.
I am grateful to the right hon. Gentleman. He referred to taxation paying for pensions. This is not just a matter of practicality-there is something more fundamental to do with that terrible phrase, "cross-generational solidarity." That point is in danger of being lost, I think.
Of course. Unlike the era of Beveridge and another great Liberal-I am being polite today- [ Interruption. ] I am referring to Lloyd George; this is, after all, the centenary of his introducing the old age pension, is it not? [ Interruption. ] Perhaps we could have a Lib-Lab pact-you never know.
Well, he is a liberal with a small "l".
Unlike that era, we are now, demographically, in a situation where people might not only be retired for 30 or so years of their lives but, because of developments in higher and further education, be in education for 20 or 25 years. The issue that we are confronting is how to afford all the things we want in our social policies-both when people are young and when they are old-given that their working life will probably be only half their lifespan. Therefore, the idea that one way or another we should set aside more money during our working lives, whether through social insurance, private insurance or whatever, to pay for frailty, is not such an extraordinary one.
I want to comment briefly on the two options in the Green Paper. First is the insurance option whereby, if I have understood the proposal, someone would be entitled to a share of costs in return for a one-off payment of perhaps £20,000 to £25,000. I put it to the Minister-it is recognised in the Green Paper-that surely one of the great problems with that is that large numbers of people would opt out. I am not saying that they should opt out, but faced with a situation where they are thinking that it is a lottery with a one in five chance that it might be needed, surely many would do so. The amount of the population insured would then become rather problematic.
The Government's second option is the comprehensive option, of which I am much more in favour. It gets over the problem of people opting out because it is compulsory-let us use the C-word, although some would call it the nanny state. However, if we are serious about an insurance model, we need to ensure that everyone who could afford to pay would do so. Of course some people-ultimately the lucky ones, really-would get nothing out of it because they would not have any debilitating conditions and might die suddenly in their 80s. However, that is a bit like the national insurance system, and I do not feel that I have been tricked because I have not received unemployment benefit. I am rather pleased that I have not, and I look to the good people of Croydon, North to ensure that that continues, at least into the foreseeable future.
I end with three questions for the Minister about the comprehensive option. First, how do we cover younger disabled people, given that this is very much a case of something being triggered at age 65? Secondly, how would it work with different cohorts? I can see that someone reaching the age of 65 might pay a certain sum of money, one way or another, but what about the current 80-year-old-how would it affect her? Would there be some sort of phasing in?
Finally, following the Prime Minister's statement at the Labour party conference, which I welcomed, about free home care for those in the most critical need-I think that was the phrase-can the Minister say more about that? How does it relate to residential care? If somebody was getting free home care during their final months at home, and then the time came when they needed to go into residential care, perhaps for only a few months before coming back home or perhaps for ever, would that free care go with them? If not, would not a new unfairness be created there?
I am grateful to the House for its patience.
I am pleased to take part in the debate, and after the rather bad-tempered exchange at the Dispatch Box, I shall make it clear that I was asked speak on behalf of my party today and am very happy to do so. I am not apologising for anybody, and I will be here for the beginning, middle and end of the debate, although I might pop out for a cup of tea a little later if permitted.
Here we are once again talking about the hugely important national issue of social care-talking again, rather than discussing concrete policies. Therein lies the frustration with how it has been handled over the past four years and indeed over the past few Parliaments. I will say one thing for the Government, which is that the Green Paper process and the current consultation process are entirely the right way to deal with this complex issue. The problem is that now is entirely the wrong time to put that process in place.
Much is made of the well known conference speech by Tony Blair in 1997, but even more significantly, on
"The present situation cannot go on much longer. People are entitled to security and dignity in their old age, so we must find a way in which to fund long-term care which is fair and affordable both for the individual and for the taxpayer."-[ Hansard, 4 December 1997; Vol. 302, c. 490.]
Here we are 12 years on, and the rhetoric from the Government is absolutely identical.
Like many people, I like the style and the refreshing openness of the new Secretary of State, but he and the other Ministers have to take it on the chin that this has been a spectacular area of failure throughout the course of this Government's time in power. [Interruption.] If the Minister of State, Phil Hope, wishes to intervene he is welcome to do so, but it is extraordinary that he can sit there and chunter when the Secretary of State himself has acknowledged today that the system is unfair, unclear and ineffective. I would not like to defend this Government's record on care, and I look forward to hearing him do so later.
The Secretary of State is right that the way to deal with this issue is through consensus, working through the complexities and building a coalition across the political divide and with the many organisations that do wonderful work for older people, those with certain conditions and others. It is right to bring them together in a consultation about what should happen. However, the Government are now simply saying that that is a matter for the next Government, and that the current process is about obliging the next Government to act. That is disappointing and unacceptable.
We have to accept where we are and the fact that there has to be a move towards a form of consensus, because this is such a difficult issue. I regret the announcements by both the other parties of their partial policies that do nothing to take us forward to that consensus. Let us consider the problems-again, the Secretary of State gave an honest description of the failings of the current system and the reasons for change. The system is clearly underfunded, patently unfair and so unclear that, in many cases, people are not sure to what they are entitled or how to claim support and care.
The quality of care in the current system is variable and, in some cases, unacceptably low. Too many older people who could remain in the community cost-effectively are admitted to residential care against their wishes. There is concern about the unfairness of a system in which eligibility rules for free NHS continuing care are not applied consistently even throughout England, never mind Wales and Scotland, leading to a postcode lottery-I do not like the term-for those with intensive needs.
Absolutely not. I was saying that there is not even consistently adequate care. I think that we all agree that we must reach a stage whereby all those who need care receive an adequate minimum level of care and know what the state will and will not provide and what they have to provide for themselves.
As the hon. Gentleman probably knows, our policy is to move towards a system-originally derived from Wanless and central to one of the options in the Green Paper-of minimum entitlement, on which people can rely. Beyond that, it is for local councils to retain the power to deliver services, hopefully in a much more joined-up way with local health boards, which will be elected under a Liberal Democrat Government. Moving towards a system of universal basic support, whatever that may be, is central to the Green Paper. The debate and the consultation are about that.
Will the hon. Gentleman say a little about his party's view of the personalisation agenda? His comments about entitlement refer to available resources, but the shape of services locally will depend to some extent on individuals' decisions about how to spend their budgets.
We entirely support the personalisation agenda-we have made that clear all along. Services are best when they are suited to individual needs.
I want to mention briefly the important issue that many groups have raised: the potential changes to benefit. I welcome the fact that the Secretary of State has clarified the position on DLA for under-65s, but I echo the worry that that has caused even more concern among older people and older people's groups about the future of the benefit on which they rely. As soon as people hit that arbitrary 65, they are no longer regarded as a carer or eligible for specific benefits-they have to rely on the state pension. The sooner we can get clarity from the Government about that and, indeed, about attendance allowance, the better.
Let me deal with the two policy announcements that were made suddenly during the party conference season. How far from the idea of consultation and consensus could that possibly be? I am afraid that the two policies seemed more like the first pages of election manifestos than a serious attempt by the Government to work within their Green Paper framework. There is nothing seriously wrong with some of the ideas proposed by the Government and the Opposition, but they must admit that the policies announced by both are partial, would help only a small number of the people who are affected in the wide and complex sphere of social care-
Indeed. It is welcome that at least we now have something from the Conservatives, having had radio silence from them for many years, apart from barbed comments across the Dispatch Box. At least they now have a policy to discuss, even if it is criticised.
It is a little rich for Mr. O'Brien to sit there chuntering when all the Conservatives have is a partial policy that would help a very small number of well-off people. Let us be clear about that. The only people who will be helped by that rather odd contribution from the Conservatives are those who can afford to pay a lump sum of £8,000 at that stage. That may help a few of the people who the Conservatives think are more likely to vote for them at the next election, but if they seriously think that that is any kind of contribution to this important debate, it probably would have been better for them to have carried on saying absolutely nothing at all.
Does the hon. Gentleman agree that the very fact that the Conservatives call their scheme a "home protection scheme" shows where their minds are? Their policy is about protecting the home, not about delivering quality care for the elderly people of this country. [Interruption.]
Mr. Anderson is right. I have heard a lot from the hon. Member for Eddisbury in debates in this House and outside, and it is extraordinary for him seriously to suggest that his policy will do anything on the wider, important issue of keeping people in their homes. I found it extraordinary that when he was challenged on the Conservative policy for the millions of people who need but are currently not getting care, he wandered off and started talking about public health. I do not imagine that I was the only one in the House who was a little confused by that. The Conservatives might think that announcing that they will have a Minister for public health is exciting, but it has no relevance to today's debate.
The Green Paper and the Prime Minister's speech are regrettable announcements. Of course it is important to deal with those who have the most critical needs, as the Prime Minister said in his speech, but the Government must also acknowledge that people with lesser needs all too often miss out because of the pressure on local councils, which have to change their eligibility criteria.
I welcome the fact that the first substantive Government policy announcement on the issue since the Green Paper commits new money. It is not a huge amount, but it is reasonably substantial. If we are to have a consensus, for which the Secretary of State stressed the need, it must start with one very simple premise: there must be more Government investment and money. We can discuss how much that should be and of course, in the recession, we should talk about how much the Government can afford-to echo the comments of Kelvin Hopkins, we should talk about priorities and overall Government spending commitments-but any serious policy to deal with this important area of care must commit new money. I welcome the fact that the Government have at least done that, but I wonder whether that will be all that is included in the Labour party manifesto at the next election.
The Liberal Democrats acknowledge that there is a need for more investment. Any policy that does not deal with that is simply not credible. I look forward to seeing whether the Conservatives acknowledge that too, because all the experts and reports, including Government reports, and all organisations involved, stress that there must be more investment. Any party that does not do that-Help the Aged and Age Concern have said this explicitly-is not a party to which older people should turn.
Other hon. Members have mentioned the important subject of carers. I cannot put it better than Malcolm Wicks when he said that the mention of carers in the Green Paper is a little feeble, and that carers are not at the core of its approach. I accept that it is a cross-departmental issue in the sense that theoretically carers and their benefits come under the remit of the Department for Work and Pensions, and that this is a health debate, but we need more joined-up thinking to recognise the extraordinary contribution that Britain's carers make. It is too awful to contemplate what would happen to many of those in need of social care without the contribution of those millions of people, many of them elderly themselves. It has been estimated that the annual contribution to society by carers is worth more than £87 billion-more than the entire NHS budget-but carer's allowance is still at a level that does nothing to recognise that contribution or the loss of income that carers often face because they take on those responsibilities.
While there have been some important local initiatives-I have had the pleasure of visiting many of them-not enough support, advice and respite is offered to many carers. I reiterate the point made by my hon. Friend Mr. Burstow about the real concern that the £150 million earmarked for carers is not getting through. I ask the Minister to look at that and provide reassurance that the money is getting to the people whom it is designed to help.
I also wish to raise the issue of personal expense allowance. The Conservatives have talked about this issue, and it is important, because we do not want people to have to sell their homes and we must do all that we can to support people to live in their own homes. However, we must also ensure that people in residential care have a standard of living that allows them to live out their later years in dignity, as we would want our own relatives to be able to do. The expense allowance is not currently set at a level to allow that, and that needs to be looked at.
As a member of the all-party parliamentary group on dementia-the chair of the group, Jeremy Wright, is no longer in his place-I could not end my comments without raising that issue. There is a real crisis, given the number of people who suffer, and will suffer, from the set of awful conditions that come under the dementia umbrella; it is forecast to rise to more than 1 million by 2025, which is not very far away. It is frustrating that the Green Paper is not clear about how much the focus will be on dealing with the particular and additional care needs of those who suffer from forms of dementia and their families, many of whom are carers themselves.
Over the last year or so, I have been pleased to work with the Alzheimer's Research Trust and the author Terry Pratchett to call for more research into dementia. I appreciate that that comes under a different Department. There are real possibilities if we invest significant money in preventing some of those conditions, especially if more people can be enabled to carry on living independent lives. I ask for more joined-up thinking on the approach to dementia, so that more research is at the heart of the overall process, as well as a focus on the care needs of people with dementia.
I, and my colleagues on the Liberal Democrat Benches, fully accept that we need to work together. I made my criticisms of the Government at the beginning of my speech; but now it is important to move forward. Whoever the Government after the next election-be it a Liberal Democrat one, a minority Labour one or possibly even the Conservatives in coalition with the nationalists, to which I think the right hon. Member for Croydon, North alluded-from next summer they will have to make this an absolutely top priority as part of their programme for the next Parliament. We do not want to go into the election after next with people saying, "Yes we will do wonderful things in the future." We have had that for the past 12 and a half years.
We need a consensus and to start by agreeing that any reform, however funded, must involve increased Government investment. We need a fairer and clearer system that is easier for people to access and understand. We need a complete overhaul of the care system in this country. We need a system that will ensure support for those who currently are not getting it even though they need help-unfortunately, many are in that situation. We need a system that does not punish people for saving and being thrifty throughout their lives. We need a system that means that people are not forced to sell their homes in the way that too many are still forced. We need a system that is focused a little more on preventive services.
As the hon. Gentleman knows, we have committed to a form of the Wanless partnership model, and we are very clear that we believe that that is the right approach for moving forward to a system in which everyone receives an entitlement that they can know and understand. The hon. Member for Luton, North will not agree, but my party believes that both the state and individuals have to contribute. The question for the debate and consultation is by how much. That does not rule out considering increasing taxation; I echo comments that people taking part in the consultation should be allowed to consider that.
We believe that we need a system that supports carers better and better represents their enormous contribution to society. We also believe that we need a system that finally starts to break down the social care and health divide, to which hon. Members have alluded. That is unfinished business in the NHS and the system as a whole, and it needs to be addressed. The Liberal Democrats are committed to a consensus, which is why we did not launch any partial policies at our party conference. We need to have comprehensive solutions that will deal with the system. It will not be easy. We should have been having this discussion two, five or 10 years ago, but we are having it now.
Whoever are in government after the next the election, the Liberal Democrats will play their part in moving forwards to a social care system that, finally, is fit for the end of the 20th century-never mind the one that we really need, which is for the 21st century. In that society, older people will finally be able to live out the remainder of their lives, knowing what their entitlements are, what they can and should receive and where to go for support, and knowing that, whether they are in residential care or their own homes, they will be supported and appreciated by successive Governments in this country.
I have had an interest in this subject for many years, particularly as an acute nurse who cared for people who then became well, or as well as they could, and had to return home, but who then often found that the services that they received were not of a standard that did justice to a fantastic NHS.I am delighted that we now have the opportunity to consult with our constituents on how best to move forward on shaping the future of social care.
I decided to trust my constituents. I said, "Why don't we have a conference to bring together carers"-that fantastic band of people who care for others-"and those for whom they care?", because they are an important element of this debate. "Why don't we bring them together with those who are in charge of adult services, those who look after people from organisations such as Mind and Age Concern, and social care workers, who do an amazing job, day to day, keeping people in their own homes? Let's gather together 50 people who genuinely have an interest in the debate." I do not care how this debate today came about or why we have decided to have it; I am just very glad that we are having it and that we can raise such matters on the Floor of the House, because I want to ensure that the views of my constituents get through.
I thank my hon. Friend the Minister, who has responsibility for social care services, for the time that he took to greet my constituents and for the care and the honesty with which he engaged with them to make them feel that they were part of the consultation, for we are talking about a Green Paper. That is the important thing that we need to understand, and there are options that need to be discussed. That is why I said that it was important that I trusted my constituents to look at the Green Paper in that light and to consider the options; and, as good people will, they came up with even more thing for Ministers to consider. I would like to put those forward.
I will not reiterate why we are having this debate. We know that the demographics of this country are changing. However, I agree with my right hon. Friend Malcolm Wicks that knowing that most people will live into their retirement is a good problem to have and one that we should celebrate. We need to ensure that that retirement is happy and dignified. That is why I believe that many of the proposals in the Green Paper will secure the future for people.
I thought carefully about how we should try to pull all those thoughts together, because it is difficult when there are 50 lively people in a room who just want to get their views across. We therefore decided to put the questions that were posed in the Green Paper to them, to try to give some structure and a sense of purpose to the meeting. However, there were undoubtedly further issues to be raised. The first question raised in the Green Paper is how we build a national care service. My constituents felt very much that it was important to have a national standard that we can use as a benchmark for how local authorities roll out care in a way that is suited to people. Personalised care is incredibly important to people, but understanding that there is a quality standard in place was crucial to our debate. Indeed, I was so pleased that everyone who spoke knew that we needed to concentrate on the quality of the service.
When I received the Unison briefing on the proposals in the Green Paper, it was interesting to see how much my constituents and carers echoed its views on ensuring that people are properly trained, so that, in whatever service they are in and however it looks, they have the necessary employment laws to back them up and that they receive the education and training that they need. However, that cannot be done on the cheap.
I thank my hon. Friend for his intervention. There was indeed a sense of concern about that. Although people were keen to have their own care sorted and to feel that they were in the driving seat, there was also a great sense that we need the Government and the NHS to be involved to ensure standards and quality. In that respect, I utterly agree with my hon. Friend.
When everyone came together at that conference, it was interesting to see a care worker sitting opposite the adult care services manager and alongside a carer as they tried to thrash out how we should create a national care service. It was stunning to see how much agreement there was among those people on how we should move forward. There was a tremendous sense of the future as they considered the document. One question that was asked was, "What will happen if we are not able to achieve this in this Parliament? Would the system be dismantled in the future? Can we afford to have a sense of hope for a decent social care network and a strategy for the future, or might the system be dismantled?" There is a great sense of insecurity about these things being promised and it being impossible to deliver them, and we need to be able to offer people a sense of security about the future.
I think I know what the hon. Lady is alluding to, and I am sure that the Minister will say more about personalisation later. We have certainly always made it clear that we are very committed to ensuring that individuals have control over their services, so her constituents need have no worries. Whoever forms the next Government, personalisation will be very much on the cards and will continue to be part of the forward strategy.
I am grateful to the hon. Gentleman for his intervention. I suspect, however, that my constituents were also worried that they might be saddled with a scheme that would cover them only if they went into a nursing home if they had paid a contribution of £8,000, rather than a system that would cover all people, whatever their needs. I suspect that they will have real concerns about that. I hear what the hon. Gentleman is saying about personalised care, and that is something that the Government support, with all the provisos on quality, education and employment standards set out by my right hon. Friend the Member for Croydon, North. We must ensure that this is done properly; it cannot be done on the cheap. That is why Labour Members are having a proper debate about this. We must ensure that people understand that this cannot be done without a contribution, perhaps through taxation.
In those discussions in my constituency, it was interesting that people really tried to understand the situation. I sincerely hope that we go for a comprehensive system, as that is what my constituents want. They said unanimously that the comprehensive system was the way forward. If they were to choose a method that involved a one-off payment, that would be their choice. They also asked what was going happen about setting up the system now, and whether they could plan for the future. There was a degree of ambiguity involved. Should this be a system in which they could make their contribution by paying a capped social insurance premium over a period of time, or could that be achieved by a one-off payment? I was really impressed by the way in which they held those discussions.
I admire my hon. Friend for the consultation process that she has held. If I were to put my view to her constituents-or perhaps to my own-that the best system would be a professional public service, with fully trained public servants employed on an accountable basis, available to everyone, would they not have preferred that?
I thank my hon. Friend for that contribution. I suspect that if that question were put directly to my constituents, they would say yes. They were very pleased about the statement from my right hon. Friend the Secretary of State for Health about the NHS being the preferred provider, in whatever sphere. I suspect that that is true. There will be no elimination of the private sector in health. As the preferred provider, however, there is no doubt that the NHS offers security in the future. There is nothing better than knowing that the system is fully funded. That is why we are having a bit of a strange debate here, as it is all about genuinely looking at what will never be a cheap option, but one that should be fair, equitable and allow everyone access to care without having to sell their home. Even in the short time available during that morning conference, my constituents were beginning to understand how to implement and pay for such a service. That showed me that they believed that the proposed strategy was the right way forward.
I am deeply grateful that one problem has been eliminated from our considerations. I would not have liked standing up to express my concern about the loss of disability living allowance for people up to the age of 65; I am delighted that I do not have to do that now. As we know, there is still a debate about the payment of attendance allowance to the over-65s, but, none the less, we need to continue to consider such important matters.
One great shortcoming that people identified was the lack of information about available services; people felt that such communication should be very much a part of a national care service. Part of the difficulty they identified is that those most empowered with the ability to find out what is available always seem to get it. The service must offer proper outreach; it must be able to contact people and to offer the care. We are asking a lot of this service, to say the least, but I do not believe that we need to be mealy-mouthed about it. This is our opportunity to be bold about social care. If we are going to ask people to make a contribution, the service must, frankly, be beyond anything we have ever known in the sphere of social care.
I pay tribute to those working in social care, because I know that they are doing their very best on constrained budgets. We have already talked about demographics and the fact that people are living longer, which means that more and more care must be provided. None the less, if we give people the tools to do the job they wish to do in the way they wish to do it and in a professional manner, I certainly believe that the service they provide will be incredibly special.
Interestingly, people attending the conference also had a sense that we had a personal responsibility for our own health in older age. They were very keen that social care offered the means to overcome health inequality by ensuring that pensioners had access to health checks and took responsibility for their own health through exercise. I think that that is an incredible change. Very often in the past, I think, the NHS was viewed simply as a giver of care, but that sentiment has changed absolutely, particularly in Crawley where we have the "Wellbeing" programme. That programme offers people the opportunity to exercise, to assess their diet and to enjoy different activities in order to allow them to take responsibility for their own health. We know how much that can prevent ill health later on in life.
The conference was very clear in what it wanted to put to the Minister. He spent a long time with us, but even more points were raised after he left. I could not stop people talking, as there were other things that they wanted to say. They were particularly pleased their points appeared to be taken seriously by the Minister. They are also pleased to know that I have had this further opportunity to press their points to the Minister today.
We are looking at a system that could be fair and it could certainly be the best in the world if we managed to set up a national care service that prolonged people's active lives. That is what the service is in the business of doing-making sure that people keep well and are able to remain in their own homes. There is little point in offering a strategy that helps those who are going into nursing homes when it is undoubtedly the case that the overwhelming majority need to remain in their own homes. That is an absolute given. We must ensure that people can receive the care, help and love that they need in order to remain at home.
We shall have to tackle all those matters without imposing undue stress and strain during what will undoubtedly be difficult years while we put the public finances back in order. Anyone who does not accept that is living in cloud cuckoo land. We cannot offer the world without requiring any contribution from those who would benefit from the service that we are providing, either through taxation or through a system of giving. Either way, we shall have to pay.
When we discussed the issue at the conference, I was a bit cheeky and asked people to say whether or not they were taxpayers. There was an absolute divide between taxpayers and non-taxpayers over who should contribute. I believe that we should consider a taxation system, but that we should also consider how we can help others to make a contribution to ease the burden. It need not be an either/or system.
I thank my hon. Friend-I think-for his intervention. I hear what he says.
Without question, my constituents chose the comprehensive system as being the fairest and most equitable. Crucially, they also felt that it was the most sustainable. We know exactly where a system allowing people to opt in or out would lead us. People who wanted to keep their homes would choose to make a contribution of, say, £20,000 in order to do so, leaving everyone else behind. I firmly reject that system, and I am glad to say that my constituents do as well.
We are being presented with an exciting opportunity. I sincerely hope what has been said today and by our constituents will be taken seriously. Today there has been a real sense that we have been given a chance to get the system right. The issue has never been tackled as well as it is tackled in the Green Paper. We have an opportunity to move forward, and to ensure that our constituents, and we ourselves-for I think that, as we grow older, we should declare an interest-enjoy security in old age, along with the care and dignity that older people so richly deserve.
I intend to focus on people receiving care in the community rather than on the part of the Green Paper that deals with residential care, because, important though residential care is, it has already been mentioned a good deal. There are aspects of care in the community that give me cause for concern, and I hope that the Minister will cast some light on them when he responds.
Page 97 of the Green Paper refers to the cost of care for people who are disabled early in their lives. It states:
"People who are disabled when they are born, or who become disabled during their working lives"- presumably, during the early part of their working lives-
"are likely to have lower incomes and so will struggle to meet the cost of their care and support. At present, most people who are in this position will have their care and support funded by the state, because they are on low incomes. We envisage that this would continue."
That sounds very encouraging and reassuring, but the Green Paper seems to contain conflicting information about how people receiving certain benefits would be affected. The Minister dealt with the question of disability living allowance, and I am delighted about that, but we have not yet been told what will happen to DLA recipients aged over 65, or to the people with lifelong disabilities whom I mentioned in an intervention on my hon. Friend Mr. O'Brien-namely, those on severe disablement allowance. Since the paper was published, I, like many MPs, have received correspondence from constituents on all those benefits who have been extremely unsettled by their reading of the Green Paper as to how they as individuals might be affected.
The Green Paper mentions what will happen to people when their services are based on personal circumstances, but also states:
"Your money will be spent wisely and everyone who qualifies for care and support from the state will get some help meeting the cost of care and support needs.
You will be able to get help with paying for your care and support needs, and your money will be used wisely to fund a care and support system that is fair and sustainable."
I can see a slight conflict there. On the one hand, they are being told that their money will be individualised and personalised; on the other, they are told that it
"will be used wisely to fund a care and support system that is fair and sustainable."
That brings me to the initial concern I felt on reading the paper, which is the focus on universal assessment for entitlement to universal entitlements. I would be grateful if the Minister could confirm that I am not misinterpreting the paper. Those people over 65 on attendance allowance think they will lose that benefit, which will go into a pool and the money will then be "used wisely" by a centralised state. The state will transfer the funding through local social services to avoid a problem the paper has not got to grips with: the system of assessment of need by social services. I would like to try to get to grips with it here.
We want to fulfil people's needs as individuals, whether they are the over-65s on attendance allowance, younger adults on disability living allowance, or-as mentioned earlier in the debate-those who have needs but at the moment do not quality for any recognised benefit at all. There are many of them. We all see from our casework young adults who fight to get DLA and quite clearly should get it, but somehow do not tick the right boxes. Among that group, I would particularly identify people with chronic and ongoing mental health conditions, people on the autistic spectrum and people who do not tick the right boxes at the moment.
The hon. Lady talks about ticking boxes. I have had two cases recently in my surgery involving people who have been interviewed by a doctor on behalf of the Department of Work and Pensions and told that they are fit to work when they clearly are not. They have then looked at their form and found that the doctor has lied: the individual has said that they cannot do something and the doctor has put down that they can. Some of the medical practitioners are telling lies when filling in forms.
I am grateful to the hon. Gentleman, as I was just coming to what is now regarded in this country as a universal assessment of the ability to work. Only this week I have had two cases that I am taking up and which I think are quite appalling. All of us in all parts of the House understand that there are a number of people on long-term sickness benefits who could be assisted to get back into work. In my constituency, a great many want that assistance and want to get back into paid employment, but we must understand that does not necessarily mean full-time work; it may also mean some progression into work that is suitable for them. It is not just about retraining but about a range of other things to enable the individual to take their place, either again or the first time, in the workplace.
Following on from the hon. Gentleman's comments, let me highlight what universal assessment means. There is a lady who has worked full time for many years who has had a mastectomy as a result of breast cancer. Her clinicians say she is not ready to go back to work full time. She has had extensive chemotherapy and radiotherapy. She was required to attend for an assessment, at which she was asked to raise her arms above her head; as she was able to do so, she was told, "Okay, you're ready for full-time work"-with no mention of her possibly being able to go back on a part-time basis. Anybody who knows how draining chemotherapy and radiotherapy are on the system will know this is not just about asking, "Can you raise your arms above your head and start work full time on Monday?" She wants to return to work, but this is about gradually reintroducing her into the workplace. Her clinicians have said she might be ready to go back part time, but that she needs to do this gradually because she naturally gets tired very quickly, but that possibility has been totally dismissed.
Another case I have dealt with is really quite tragic. A young girl in her 20s has had a tumour which has ravaged one side of her face, and she has had to have aggressive surgery to stop the spread of the tumour. She will need at least two or three more sessions of major surgery to help to rebuild her face, following the necessary removal of half of it in order to save her life. This young woman is single. She had her own home, which she lost as a result of being out of work while having this long-term surgery. Thankfully, she has now got a home of her own again. The comments made to her when turns up to these back-to-work interviews are outrageous. They are totally insensitive to a young woman who has gone through what I have described. The interviewers do not seem to take into account the emotional damage done to somebody in such circumstances.
In assessing people's disability and how it impacts on their ability to manage their lives-perhaps with a little, or a lot of, support-we must look at the person as a whole. That is why individual plans and packages can triumph over the concept of the universal standard, where there is a tick box and someone's circumstances might not happen to lead to it being ticked or the person conducting the assessment not seeing the right category printed in terms. Further, I would not be happy for there just to be a list of conditions. As we all know, there are levels in respect of many medical conditions, and individuals can be affected very differently by them. For some, a condition can considerably hamper their ability to look after themselves, whereas others might be able to cope with a little help. This notion of universality therefore worries me enormously, because it means there will be winners and losers, and the losers will be those who are least able to make their case.
I commend the hon. Lady for making her points so very powerfully. Does she agree that there is insufficient acknowledgement both of mental health conditions and the fluctuations of many conditions both physical and mental, and that they are simply not taken into account in current assessments?
The hon. Gentleman is absolutely right. I am sure the House has become fed up with me going on about these two issues, and particularly mental health and the autistic spectrum. Such conditions do not fit neatly into any identified national criteria. They are very difficult to assess, and because people's conditions can fluctuate, on one day they might pass a test and some might think, "There isn't much wrong here," but they can deteriorate very rapidly, or circumstances can affect them and make them deteriorate very rapidly. I thus find the one-size-fits-all attitude to providing for the most vulnerable in society worrying, and I hope the Minister will reassure me on this. I know that he has a great deal of knowledge of these matters, and certainly of the autistic spectrum as he has taken the Autism Bill through the House with many of us who have an interest in the subject.
I want now to talk a little about those at the other end of the age spectrum: the elderly. I have mentioned my concern about their being denied disability living allowance, but there is another problem in respect of the elderly. I agree that old age is marvellous-I have been to two 100th birthday parties in my lifetime; this has been in the past few years because as a child one did not trot round going to 100th birthday parties-and the fact that people are living longer, which we can all observe, is to be celebrated. However, this is again about balance and a realisation of what comes with really old age.
Frailty, which might not necessarily involve a diagnosis of any particular condition or illness of which everyone is aware, has an impact on the individual. It affects their physical ability and their mental ability. Nobody ever really thinks they are going to get so old that they cannot do things for themselves, so there is a mental impact to consider.
Loneliness has been mentioned, and social isolation has a huge impact on older people. I represent a rural seat, where one sees a lot of this; some people still live in isolated conditions and do not have the usual arrangement whereby neighbours live right next door. In this universal system, how are these people who are as entitled-and we are talking about entitlement-to get the right help and support as those who live in the larger, urban conurbations, to be treated as individuals, and how are their needs to be met? When I read the document, I worry that they have not been thought of and that they will get left behind.
I serve on the Public Accounts Committee. The Minister will know that in recent years the National Audit Office has put before the PAC reports on very important subjects. We had an excellent report on dementia, another on stroke services and a more recent one on autism-another one, on rheumatoid arthritis, is coming up. Common themes run all the way through all those reports, but the one that perhaps emerges the strongest is the inability of Government Departments and local government departments to work together when they need to do so-for example, in health and social service. They work in silos.
We have heard a little this afternoon about the need for services to work together to provide a holistic approach for the individual, but I must tell the Minister that that will require more than everybody just standing up and saying, "We need to do this." If there is a need for any national structure, it is in this sphere. A national structure is not about saying, "Fred Bloggs in one part of the country will receive this." I would rather somebody more local to Fred Bloggs decided what he needed, based on how he presents at any given moment in time. If there is indeed a role for national structures, it is for the Government to examine carefully what needs to be done to ensure, from the top, that we have a system whereby Departments, including the Department for Work and Pensions, work together with social services, local Jobcentre Plus branches and the housing departments. All those public sector bodies that can deliver the solution to an individual's needs now require more than just having their heads knocked together. There needs to be an imperative from the top that makes all this happen.
I realise that it is difficult; we all understand about budgets. One of the weaknesses in any system aiming to resolve these problems is that if one puts a little bit of money into this year's budget to resolve a problem at the lower end, be it dementia, autism or something else, people feel that it should have been spent on the "higher" needs. Yet if it is not put into this year's budget, somewhere along the line, perhaps even a few years later, the problem will turn into a massive call on the public sector purse because it will have turned into a crisis.
Let us consider the economic point of view. All the reports that the PAC has seen relating to health have shown a very clear benefit to the public purse to be had from doing things the right way. I know it sounds hard when a politician talks just about the economics, because of course every one of those reports contains the human interest issue; each one deals with the impact on people's everyday lives. When the Minister winds up, will he give me reassurance and clarity on that point? I believe that the way forward, particularly with care in the community, is to have people's needs properly addressed.
I would not want to see the bar being raised yet again for the eligibility assessment, particularly when we talk about how this is to be financed. The bar could simply be raised, which would exclude more people at the bottom in order to provide for those at the top. It might sound a logical argument to provide for the most needy-of course it does, and that has to be done. However, it is quite interesting and surprising-this applies all around the country and not just in my part of Devon-to see how many social services departments settle out of court when, very occasionally, somebody challenges the statutory services through the courts or even starts the process of legal action, in order to obtain their legal rights. That tells us something. It tells us that the authorities know they are not fulfilling their role as they should, properly identifying needs and coming to an agreement to fund a package that will meet the needs of the individual.
Finally, I am a great fan of direct payments. I have some personal knowledge of them within my family, but the way the system has been introduced around the country beggars belief. In some areas, it has been done in the most simplistic way as far as the user of the service is concerned. I will name an authority that I think is an exemplar in this regard: the unitary authority in Bournemouth, which is not in my constituency but is an authority with which I am familiar. When it first set up direct payments, it made quite sure that when people employed someone, all the necessary paperwork and administration were in place and simple to follow. It has a helpline for the people who use the system and the forms are extremely simple and straightforward. The authority did a lot of research and did it before people started to use the system.
If such a thing can happen in one area of the country, why do authorities not share the information with each other? Instead, we have seen some authorities whip away the services from those who were receiving them directly from the local authority before they had decided how to get them on to a direct payment system. It totally backfired and caused the most terrible anxiety to people and their carers.
If we want to take a top-down approach, let us take exemplars of best practice and let the Government make it their business to ensure they are spread throughout the country so that people can see how to do it properly. Let us not have the Government or a national system telling individuals from the top down what is needed in their package or who is going to deliver it. We need that freedom so that people's packages can be tailored to their individual needs. Taking that away from them will be a retrograde step.
As Parliamentary Private Secretary to the Minister of State, Ministry of Defence, my hon. Friend Bill Rammell, I have had quite a tough week. I have sat through Adjournment debates, statements, an Opposition day debate yesterday afternoon and a Westminster Hall debate. If I stand back from the issues being discussed, I can see that what was really important and what made it a huge experience for me was listening to people across all this House who had true, real-life experience of what we were talking about. They were people who had served in the forces. Today's Opposition Whip, Mr. Dunne, spoke yesterday about his experience in the reserves-I believe in the naval reserve. Those people knew the real world that they had come from.
I want to speak from my experience as someone who worked as a care worker; 20 years ago this month, I fell into care work by mistake. I had been made redundant as a coal miner, which I had been for 20 years, and I was looking for something to fill my time in the short break before I picked up something else. I went for a 13-week part-time contract at Newcastle city council as a care services driver and 16 years later I left to come and work in this place. But the importance of the story is not why I went there and stayed there. I was fortunate that I went to work in a place that was built by two visionaries: Jeremy Beecham, the leader of Newcastle city council; and a gentleman who is no longer with us, Brian Roycroft, who was the director of social services and, in fact, the leader of social services directors across the country. In the mid-80s, they purpose-built a building in Newcastle called the Minories project, which was constructed to deliver real care in the community. The place was expensive, but it was quality. It included sheltered housing, and the people who lived there had access, as and when they needed it, to staff who worked in another part of the building. It had a respite centre with 16 beds, which meant that over a 10-week period 160 people could stay, giving their families some relief while we looked after them and saw to their needs.
The building had a restaurant that was open to the public, and people over 65-years-old right across Newcastle could go there and meet their old friends. It was a real place that really worked. It had a day centre that was second to none, and we even had our own bus-a 1970s Mercedes bus, which I loved driving. If I live until I am 90, I shall never, ever forget the pleasure that I used to get from driving that bus and seeing a particular old lady called Florrie, who used to look out of the window, with the sunshine in her eyes. The only thing was that she could not see, because she was totally blind, but the look of pleasure on that lady's face will stay with me as long as I live. Memories like that represent the real experience of people who work in care.
I went from being a man working the coalface in March 1989 to being a man standing with a doctor in March 1990, helping to put a prolapsed womb back into a 91-year-old lady. It was totally different, but that is the real work that carers have to do, day-in, day-out, 365 days a year. I want to put on the record my appreciation of the work that they do, whether they are professional carers or carers who help their family or friends. The real joy of that job was the total appreciation that we got from people after doing something as simple as cutting up their food, fastening their laces or helping them go to the toilet-things that we all take for granted, but things that, sadly, they were no longer able to do. But we had to do that work, and it was a privilege to do it.
The great thing that made that building work was that it had a good number of staff. It was a very staff-intensive unit, but because of that it worked. Sadly, however, because it was the early 1990s, we also had to face the reality of the budget constraints that our authority was working under. It was being told that it had to put a price-not a value-on care, and the price of the care that we delivered was, sadly, not in line with the price that the private sector delivered. That is hardly unusual, when we consider that legislation at the time said that there was a £50 disincentive on each bed in a public home as opposed to in a private home. We started off with that loss. If we then consider that staffing and training levels were lower in the private sector, and that their terms and conditions were much lower, we see that it was obvious that the public sector, on a purely comparative basis, could not compete.
We, as an authority, tried to set up an employee share option plan, which would have taken the homes out of direct public ownership and into an arm's-length body that the staff would run. I was unhappy with the plan ideologically, but practically we tried to pursue it. Despite that, the plug was pulled by the then Secretary of State for Social Security. He did not believe that the plan went far enough into the private sector, and the reality was that 25 homes closed in Newcastle and we were left with a rump of four. Home care workers had to pick up the pieces, but at the same time there were too many people to look after. The circle was squared by a change in the criteria for accessibility to care. The criteria for vulnerability and frailty were increased, as was the age level, and people could not access care. Those choices were enforced; they made people such as Brian Roycroft and Jeremy Beecham despair; and they made the staff and the families we took care of despair. So the truth is that, with the piece of work that we are all talking about today, we have the chance to rectify some of those mistakes.
As I said to the Conservative spokesman, the position we reached in the mid-1990s was the result of a programme of 16 years before, from 1979 onwards, when the people of this country made a choice that they wanted tax cuts. The Conservative party delivered those tax cuts, but one cannot give tax cuts and keep on giving quality services-it does not work. If the money is not there, the service cannot be delivered in the way that the people of this country deserve. There was less money to spend, so there was less money to be given out for care services, as well as for other areas.
The policy was also, clearly, ideologically driven. It was not a mistake that care homes were closed-it was direct destruction of the public sector. In the same way, it was not a mistake that public transport was taken away from council ownership and put into the private sector, or that council housing was taken out of the remit of councils. We had two choices back then, and now we have a chance to move forward and make choices in the other direction.
Since 1997, we have seen some improvements. For example, there have been huge improvements in how we look after people at work. The national minimum wage has been a huge positive for people working in the care sector. We now give people guaranteed holidays, people have better maternity rights and paternity rights, and to some extent we have levelled the playing field between private and public sector provision. We have increased resources and support to local authorities and the national health service, and we have supported and developed independent providers. There have been positive changes to training, skills and the registration of staff, so that caring is seen as a professional job.
All that has been important, but it has not been enough. The sad reality is that underneath it all, as Greg Mulholland said, we are under-resourced. That is the nettle that we have to grasp, whether we like it or not. My hon. Friend Laura Moffatt said that care cannot be done on the cheap. In fact, low-cost, nasty, inefficient, unsafe and dangerous care can be done on the cheap, but quality care cannot be done on the cheap. We need to realise that.
I am sad that John Mason has left the Chamber, because I thought that he would engage in a debate about what has been done in Scotland, where the introduction of free care has been accepted. I believe that there have been problems and that there is debate between the Scottish Executive and local authorities about who picks up the tab. The royal commission came up with some positive views. If we, as the United Kingdom Parliament, had taken up the challenge back then, the problems that have arisen in Scotland would not have been an issue. We could have said, "We'll provide for this need across the whole United Kingdom, and we'll do it in a way that avoids these potential problems." It is a shame that that did not happen.
We have a national health service that ensures that someone who is out walking and gets run over by a bus will be taken to a hospital and looked after. But if someone cannot look after themselves, not because they have been run over by a bus but because they cannot go to the toilet on their own, fasten their shoelaces or feed themselves, they are told, "Sorry, you need to sell your house and give us everything you've got except £16,000." I cannot for the life of me see why that is; it is not fair.
This Government, to their credit, went to the people of this country with a 1 per cent. increase in national insurance contributions, directly to support improvements to the health service. I do not recall anyone-perhaps the Conservatives; I am not sure as I was not here at the time-opposing that. The public never complained about it: they said it was a good thing to do, and that was proven. I believe that we should be looking at doing that again. It is nearly a year since we had a 2.5 per cent. VAT cut, which apparently amounts to £12.5 million. Just think-if we put 0.5 per cent. on VAT, that would create £2.5 billion. Perhaps my sums are wrong; if so, someone brighter than me can put me right. That is the sort of mental attitude that this House must have in saying that there are ways to square the circle but they will have a cost.
I want to focus a little on the Tory proposals. I am sceptical, but genuinely interested, and I want to try to work out what the Tories have brought forward. The £8,000 proposal is worth looking at, if taken as a purely mathematical argument. I understand that they said at their conference that if five people pay £8,000, one person gets two years of care out of that £40,000, and the other four will not need it. How many people will have to pay before it becomes effective? Will it be five, 50, 5,000 or 50,000? If people do not buy into the scheme, it will not get off the ground, and what will we be able to do in the meantime? There have also been rafts of reports that the costs are being underestimated as they will be not £20,000 but £26,000 a year, and that the average stay will be three and a half years rather than two. If that is the case, the figures will obviously be inflated.
As I said to Mr. O'Brien, I believe that people will go into care earlier in future. When people are assessed now and told, "You should be in care", they say, "I am not going into care". They go into care at the last moment because of the pernicious impact of losing their home and not being able to leave it to their children, which is understandable. In future, if they realise they need care, they will say, "Yes, I will go in early, because my home is now safe". However we square the circle, people will go into care earlier and stay in longer. They will get the care they need at the front end rather than have to go in when they are on their last legs. The average period in care will be much longer.
If those people were self-funding, would they not be subject to assessment to see whether they needed to go into care? They could not just go in voluntarily without a full medical need to be admitted.
I agree absolutely. They would need medical, social and financial assessments, but my point is that that happens now and people are told, "The best place for you is in care". They say, "I know that, but I am not going in." In future, they will say, "I will go in, because my family is going to keep my home." There will be an incentive, whereas there is a disincentive at the moment because they want to protect the assets that they want to leave to their children. To a certain extent that is why we are having this debate, and the Opposition should bear that in mind and address it. The hon. Member for Leeds, North-West spoke about consensus, and if we are having a genuine debate a consensus has to be hammered out. We need much more data to show whether the £8,000 proposal is a runner.
The proposal is a private insurance scheme. I do not know whether private insurers will be full of the milk of human kindness all of a sudden and say, "We will run the scheme free". It hardly seems likely of a company such as Aviva, which has just announced almost £3 billion of profits. It might say, "We can afford to absorb this; we will do it for nothing", but I doubt it very much.
The crux of the matter is that some people will not be able to find £8,000, some people will choose not to pay it and some will not have a pension lump sum. Why say to someone, "On the day you retire, give us £8,000"? Why not say, "Give us £3 a week for 50 years while you are at work"? That is how we fund the national health service and most of the public services in this country. It is how we should have been funding care for the past three decades and how we should fund it going forward-it is called collectivism.
We have good quality caring staff who put a lot of trust in us to find a way forward for them. That is the whole team-ancillary workers, home care workers, domestics working in homes, social workers and people classed as backroom staff who do the paperwork and ensure that things are right and proper. They need to know that they are in a service worth working in. They are professionals and we need to treat them as such. We need to respect them and reward them in a way that clearly has not happened in the past.
The royal commission reported that we should pursue various things. Ministers said that the report did not get consensus, but I can inform them that when it came out, I was the chair of the policy committee for the trade union, Unison. We set up the right to care group, which involved campaign groups including one of the main ones, led by Claire Rayner, user groups, carers and workers. The group was clear that the best way to address the problem was for the service to be directly funded by tax. If we had done that then, it would have been embedded in the culture of this country by now and we would not have been having this debate. If we had bitten the bullet at the beginning of this century, the Opposition would have seen the system work and been converted in the same way as on the minimum wage and the other positive things that we have done. We should go for the fully funded option and, if we cannot do that, we must ensure that it plays a huge part in future.
We have been here before and we did not make the right choices. We must now make the right choices-it is the mark of a civilised society. The shadow Chancellor said in his speech at conference, "We're all in this together." The Conservative party's programmes are not about us all being in this together, but about us all being individuals. I believe that we are in this together because none of us knows where we will end up if we are fortunate enough to live into old age. We should provide collectively.
In the past three decades, we have failed to provide for the people of this country. It was interesting to hear the hon. Member for Eddisbury describe how he is trying realise Tony Blair's promises. I lived about 10 miles from Tony Blair for 25 years, though politically we are probably a million miles apart. However, I agreed with him when he said that we are best when we are bold. I say to my hon. Friend on the Front Bench, "Be bold, comrade."
Order. There is plenty of time left for Back-Bench contributions before the Minister of State winds up, but I hope that the Member who has the floor will have regard to the fact that others also wish to contribute and do not want their contributions to be unreasonably squeezed.
I am grateful for that guidance, Mr. Speaker, and I will endeavour to live by it.
First, I want to say something in response to the way in which the Secretary of State opened the debate. Given that he began with some rather cheap remarks about my hon. Friend the shadow Secretary of State and that he said that the subject of the debate was the most important in his in-tray, it is extraordinary that he left at 3.24 and has not stayed to the end.
On a happier note, I listened carefully to the remarks of Malcolm Wicks about our ageing society and the comments of my hon. Friend Angela Browning about the number of people in our society who are over 100. That reminds me that this year on
Given that I do not have much time and that I want other hon. Members to have an opportunity to speak, I shall focus specifically on the benefits in the Green Paper, to which several hon. Members referred, that cause our constituents concern. The Green Paper mentions attendance allowance, which, according to the Library briefing, is the main social security benefit that goes to people over 65. Although one cannot apply for disability living allowance once one is 65 or over, it continues after 65 for those who are already getting it. It is worth spending a moment on those allowances.
Two rates of attendance allowance currently apply. The lower rate is £47.10 and the higher rate is £70.35 a week. They are significant amounts. I am sure that many who receive them would say that they are not high enough, but they are significant amounts that make a significant difference to the quality of people's lives. They are based on need and not means-tested using income or capital. They are tax free and non-contributory. They are therefore very different in nature from the social care support that one receives through a local authority, which is means-tested. That is one of the reasons for the debate.
Given that the Secretary of State mentioned DLA, it is worth noting that whereas attendance allowance has only a care component, assessed on personal care needs, DLA has a care component and a mobility component. For many people, the mobility component, which under the higher rate is enough to fund a car through the Motability scheme, makes a huge difference. It sometimes makes the difference between a person being independent or otherwise. Will the Minister refer to that in his remarks?
Those benefits are quite distinctive, because if someone meets the conditions and receives them, they can spend the money as they choose. Effectively, it gives them all the advantages of an individual budget. In a sense, attendance allowance and disability living allowance are individual budgets par excellence, because the funds go to the individual, who can then decide how best to spend them. The concern of many organisations and disabled people is that if the allowances were effectively folded into the social care system, the funds would become means-tested, cash-limited and rationed.
My hon. Friend the Member for Tiverton and Honiton gave some examples of how that could be damaging, and I am pleased that my hon. Friend Mr. O'Brien, who speaks for the Conservatives on these matters, made it very clear that we are not tempted to go down that road. In the time that the Minister has available, which I know is increasingly compressed, will he dwell on how the proposals to fold attendance allowance and other disability benefits into the social care system seem to be a step in the opposite direction from the welcome moves and his agenda towards a more personalised approach?
We are saying to local authorities, "We want you to assess people and agree on an amount of financial support, and ensure either that they have the opportunity to take the money in cash to spend themselves or that you continue to provide the services while allowing the individual to be in the driving seat about what the services look like," yet folding benefits that people already receive and control into the local authority system takes us in the opposite direction. The Minister will know as well as I do that getting the personalised approach working and getting local authorities to adopt it with enthusiasm is not as easy as it ought to be. Anything that takes us in the opposite direction is not to be welcomed.
It is worth remembering that a significant number of people get those benefits. As of February this year, nearly 1.6 million people receive attendance allowance, and almost 1 million people above pension age-65 years-get disability living allowance. If we add those numbers and divide the sum by the number of parliamentary constituencies, we see that every hon. Member has on average 4,000 over-65s who get one or other allowance. That is a significant number of people who may be concerned about the proposals in the Green Paper.
I draw the Minister's attention to what the Secretary of State said at the beginning of the debate. He said that, often, talk of change is unsettling for people, which indeed it is. That is not a reason for not changing something, but the unsettling nature of change is made worse when the Government's intentions are not clear, so will the Minister clear up this matter? On
"All the models that" the Government
"have done have not included DLA...DLA is not under threat and people can be very happy."
"are considering all disability benefits."-[ Hansard, House of Lords, 13 October 2009; Vol. 713, c. 112.]
However, the Secretary of State told a conference of directors of adult social services in Harrogate that he wanted to close down the controversy over DLA and made it clear that the Government had ruled out any suggestion that DLA for under-65s would be brought into the new national care service. Given that the Minister said that DLA was not being considered, that his colleague in the other place said that it was, and that the Secretary of State implicitly accepted that it was being considered because he ruled it out for the under-65s, I do not think that the Government have been very clear. That is partly why people find change unsettling. They are given mixed messages and they do not know what is going on.
It is also worth asking what would happen to carer's allowance in those circumstances. Some 500,000 people receive carer's allowance, but in order to qualify for it a claimant must be caring for a disabled person. The definition of a disabled person in that instance is someone who receives the middle or higher rate care component of disability living allowance, or attendance allowance-or, in a smaller number of cases, constant attendance allowance paid with a war or industrial disablement pension. If changes are made to attendance allowance, they could have an impact on whether someone is entitled to carer's allowance. The Minister needs to set people's minds at rest about whether the changes in attendance allowance will trigger changes in entitlement to carer's allowances.
Many people receive carer's allowances for caring for people who receive attendance allowance, because they need regular and substantial care-more than 35 hours a week-so there would be several knock-on effects on people's income if changes were made to attendance allowances.
The hon. Gentleman makes a sensible point that supports what I have said.
Many groups that represent disabled people are very concerned about the proposals and have submitted responses to the consultation. For example, the Royal National Institute of Blind People and Action for Blind People have said that they are strongly opposed to the loss of attendance allowance. RADAR has said that it is
"adamant that no one is getting their mitts on vital extra-cost benefits".
It makes the point that such benefits are designed to help to meet the extra costs of being disabled and needing such care, and that people would lose choice, control and independence if they were removed.
Leonard Cheshire Disability also opposes any moves to take the DLA care component and attendance allowance into broader social care funding. The National Autistic Society is very concerned about the proposals, as is Age Concern. So a broad spread of organisations that work in the field are very concerned.
Neil Bateman, a welfare rights specialist who writes for the website communitycare.co.uk, makes the point:
"The AA/DLA recipient...decides what to spend the money on...the core principle behind Individual Budgets, whereas transferring AA/DLA to social care...would involve extending bureaucratic control over people's lives, undermining the new philosophy of individualisation and choice."
That is exactly the point that I made earlier. The Government need to think again about this change. The Secretary of State has gone some way by ruling out changing DLA for those under 65, but that still leaves more than 1 million over 65 and a significant number on attendance allowance with concerns that have not been allayed.
The issue of devolution and the impact on the benefits system has been mentioned. The very good Library paper for this debate points out:
"Social security is a reserved matter in Great Britain and a single body of legislation applies across England, Wales and Scotland. Any move to change the benefits rules in England alone would...be a significant departure".
That is of especial interest and concern to me, because I represent a constituency that borders Wales. For example, we no longer have a national health service across the UK: we have four different health services with different policies and different ways of dealing with challenges. A national care service would really be an England care service, which would deliver care in England, not across the UK. For people who live towards the southern end of my constituency, in Sedbury or Beachley for example, the nearest town is Chepstow, which is in Wales, and I would not want them to face artificial restrictions on the best option for them because that would involve crossing a border within the UK. Equally, somebody living in Wales with a service to be delivered in England would be restricted. That would be a retrograde step and not one that we should support.
The Minister knows that I am concerned about that matter, because I asked him a question at Health questions a couple of weeks ago. New information has come into my hands since then. I drew his attention to the fact that there had been a Green or White Paper-I forget which-on this in May 2008 that had talked about the impact on the devolved parts of the United Kingdom and the necessity to talk to the Scottish Government and the Welsh Assembly Government. He kind of indicated that that might have happened. I asked him about it, and I think that he said that those discussions were taking place.
I received a briefing for this debate from the Scottish Association for Mental Health. According to that association, the Scottish Government reported as late as
It would be helpful if the Minister could indicate whether those discussions are now under way-whether at official or ministerial level-or, if they are not, when they will start. If they are under way, will he indicate where they have got to? We must ensure that we do not make changes to the UK-wide benefits system that will affect different parts of the United Kingdom without having had those conversations. That might leave people in the lurch, as my hon. Friend the Member for Tiverton and Honiton suggested has happened in other local authority areas.
There are real concerns about the impact on benefits which affect, as I said, on average 4,000 people in every constituency in the United Kingdom. That will concentrate the minds of hon. Members on both sides of the House as we approach the general election. There are also other issues that have not really come up about the impact on the devolved parts of the United Kingdom. I know that the Minister will be short on time, but if he can at least touch on those points, I would be most grateful.
I am delighted that we are having this important debate. The Secretary of State was right when he identified that the matter before us will pose an important challenge in the next Parliament for whoever find themselves in Government. The question is whether we can build a consensus this side of the general election. Although this debate has many threads that could be pulled together to create a consensus, the environment in which we are having the debate-with a general election not far off-probably makes it impossible this side of the general election to reach that final consensus. Whoever is in government after the election, however, will need to drive quickly and forcefully to deliver a consensus, because if we do not have it, we will be talking about this matter again and again in a decade, but still have made no further progress.
In an intervention on the Secretary of State, I referred to the consultation process. My local authority-the London borough of Sutton-has participated in that and organised two events with carers groups, carers themselves, people in receipt of care and various providers. It came up with five key findings in a 16-page report that will be winging its way to the Department. I picked up a draft this morning. The findings were that people
"preferred local to national (local flexibility with national assessment and minimum standards)...wanted a simple, transparent system that ends the 'post-code' lottery...preferred comprehensive over partnership and insurance (there was a distrust in insurance)...were interested in discussing taxation as an option" and
"wanted more information on the subject generally".
The last point is particularly germane to our debate. There is a huge level of ignorance about social care until people enter the system or encounter it vicariously through a relative's experience. Until that happens, most people do not know what the system is about. I would therefore greatly support anything that can be done to raise awareness or ensure that social care is a central issue at the next general election.
Mr. Anderson talked about the rationing of care, in effect, through the use of eligibility criteria. Although there have been welcome changes in that respect over the past 10 years, I am also proud that my local authority, the London borough of Sutton, which has been under Lib-Dem control for the past 23 years, has managed to sustain its eligibility criteria in the "moderate" band. That ought not to go unmentioned, as only a handful of London boroughs still do that.
Quality of care has been referred to in this debate in a number of ways. I want to pick up on two or three points that illustrate why we need to strive to do more to address concerns about quality. In their briefings for this debate, both the Parkinson's Disease Society and the Alzheimer's Society reported concerns about the quality of care and, in particular, the lack of social activities in residential care. People are left to receive care passively and, although routine tasks are performed, they do not receive the emotional support and engagement that comes through social activity. There is also a crying need for more training, particularly on dementia.
One subject that is a particular concern for me, and which I also think is a marker of quality of care, is the inappropriate-and I would go so far as to say abusive-use of antipsychotic drugs in residential settings. Not only do they bring people's lives to an end prematurely, but in some cases they kill people. The evidence has mounted over the years. I hope that Professor Sube Banerjee's report, which I am told is to be published next month, will not just be published, but generate genuine action from the Government.
There has also been a lot of talk about home care, which is undoubtedly an important component of what we want to see happen. However, home care can become as isolating and institutionalising as residential care if it is not well delivered. There are plenty of documented cases and audit reports demonstrating that. Again, training is an essential part of that, particularly in manual handling. We need to avoid having a revolving door of poorly paid and poorly trained staff or a succession of ever-changing faces coming in and providing brief care interventions. We also need to avoid having to chase people to get them there in the first place.
Reference has been made to telecare. I have seen it being developed and delivered in many parts of the country. It undoubtedly has a contribution to make, but it cannot be a substitute for emotional support or that human touch and kindness. If telecare is a substitute for those things, what has it become? It has become little more than the electronic tagging of the elderly.
The central debate is about funding and how we pay for care. When we address the care of the elderly part of our population, we must keep in mind dementia and the fact that two thirds of those in care homes suffer from it. The bills that they face are huge. Some would describe them as a tax on dementia-indeed, the Alzheimer's Society labels them as such. We therefore need to design a system in which the risk is fairly shared across society, find ways of removing barriers to accessing to capital-the figure of £1 trillion for the assets that the over-65s owned before the recession is not to be ignored in this debate-and ensure that people can access financial services in contributing to the costs of their care.
However, the silence in the Green Paper on the means test thresholds and the overall funding levels makes the whole thing ring rather hollow. Without those, it is hard to judge what the intention or purpose behind the design of the system will be. One way in which the Government clearly hope to try to redirect resources is through the change to attendance allowance and disability living allowance. Although I welcome what has been said about disability living allowance in respect of the under-65s, there are still question marks over the rest.
Let us be clear: DLA and attendance allowance are the perfect direct payments, because they maximise individuals' personal choice and control over how they use the resources that they receive. They are based on need and are not means-tested. We need to understand the consequences of folding them up into social care budgets. One of the consequences, as we have just heard, is the possibility of breaking the link to the carer's benefits and possibly making it harder for that benefit to be paid at all. I therefore hope that we do not go down that path.
My hon. Friend Greg Mulholland mentioned the personal expenses allowance. In the past, there was a promise of a consultation on that, and the Green Paper would have been an ideal opportunity at least to ask whether the allowance was fit for purpose and sufficient. Anyone who goes into residential care and is funded by the state will find that the state takes most of their money away from them. They are handed back only £21.15 a week to meet all their personal costs. Frankly, that is not enough to give anyone a reasonable quality of life, to give them the right to buy a present for their grandson, to have a decent haircut, or whatever else they might need. The Joseph Rowntree Foundation suggests that at least £40 is necessary to give any justice to those people in residential care.
The national care service seems to be the centrepiece of the Green Paper, but what is it really going to be? Will it be a virtual organisation, or will it become a real one? It is not entirely clear what is intended. If it is about providing a national framework of eligibility, that is welcome. If it is about greater clarity and the portability of care packages, that is welcome, too. It is important to recognise, however, that concerns have been expressed about how national eligibility criteria will be made to stick around the country. Those concerns emerged from the consultations in Sutton. How can we create assessment tools that will guarantee consistency of approach? We have seen, as the continuing care framework was rolled out across the country, that there are clearly inconsistencies between one part of the country and another.
Malcolm Wicks talked about joined-up assessments, and he was absolutely right. That leads me to ask another question of the Minister: whatever happened to the single assessment process? It was trumpeted in 2002, when the national service framework for older people was launched. It was going to provide the way of ensuring that people were not put through endless, untimely assessment processes; only one process would be needed. That did not happen. Surely that process needs to be revisited if we are to have an assessment tool that really delivers.
I have said already that I welcome the portability of care packages, which is mentioned in the Green Paper. I also welcome the recognition of the value of advice and information for all, and of how empowering that can be for individuals. There is, however, a question mark over whether there is enough recognition of the differing capacities of individuals and families to navigate their way through the system. That does not seem to have been reflected in any discussion about advocacy or about how we tailor support for families so that the system really delivers for everyone.
I speak to constituents who have experienced direct payments, and Angela Browning demonstrated graphically how we can learn from experience around the country in that regard. People have been turned into book-keepers and diary-keepers; they have effectively become the brokers of the system when they really wanted to be a carer. In some ways, direct payment takes that away from them and gives them something else which they have not signed up for. We need clarity about advocacy.
It is also important to make it clear, when designing a new system fit for the 21st century, that human rights are a strong and resilient thread running through all of it. In a rights-based, entitlements-based system, the individual can ultimately force the joining up of services-through the courts if necessary-and ensure that they are wrapped around to fit them, rather than the other way round.
I welcome what the Secretary of State said earlier about the need to root out ageism by 2012. That is long overdue, but very welcome. We should not have arbitrary age bars or differential charges for services. How can the charges for someone in a young adult care facility be massively higher than those for someone in a residential care home for the elderly? What is it that those elderly people are not entitled to that results in their care costs being so much lower than those for younger people?
That brings me to carers, to whom I referred in an intervention. Carers should be part of the Green Paper and should be enshrined in the principles of the national care service. Just last week, I attended the annual review of the Sutton carers centre, which covers 19,000 carers in the London borough of Sutton. I heard some very inspirational presentations given by local carers there-and by Jill Pay, who I understand is on the Standing Commission on Carers. These are ordinary people doing exceptional things, and we all know that their own health and well-being often suffer as a result of taking on caring responsibilities. Reference has been made to the £53.10 carer's benefit. What we need is a timetable that delivers a significant enhancement to that benefit, well before the 2018 target set in the Government's carers strategy.
We also need transparency and accountability regarding the £150 million that the Secretary of State has put into caring services through the NHS. When I raised the matter in a debate in June, the Minister told me that I should go and ask my primary care trust. I did just that. Three months and endless e-mails later, I received a letter yesterday. Let me read what it said at the end:
"NHS Sutton and Merton was expecting these resources to be allocated specifically, and not as part of general growth allocations. However, it only became clear in April 2009 that the funds were actually included in general growth which the PCT had already committed some 4 months earlier in the Strategic Plan."
The money is not going where it was intended, irrespective of whether or not the Minister tells us it is. I hope that he will say more in his summing-up speech about how we will be able to track this in the future. I am not talking about ring-fencing; the Minister should not go down that path. I am not in interested in that; I am interested in local accountability for how the money is spent. At the moment, on the basis of the behaviour of my PCT and many others, that is not demonstrable.
To conclude, I hope that the Green Paper will not only provide better care and support, but be a driver for law reform. We need a comprehensive new social care Act that brings together all the carers legislation passed piecemeal over the last decade. It should update the legislation, remove the last vestiges of the Poor Law that are still part of our system and deliver the safeguarding, security and decency of care that all our citizens deserve. With that, I look forward to seeing the White Paper, but rather than delivering anything, it might be a first shot in the general election. After that election, whoever sits on the Treasury Bench will have to build a real consensus, which is what all our constituents want.
I will endeavour to be fairly brief. The Green Paper is concerned with care in England. My hon. Friend John Mason speaks for Scotland, and I speak for Plaid Cymru and Wales. In the past, I have resisted intervening in debates on care in England, despite the strong temptation.
Our main concern-and that of constituents in Wales and Scotland-is the particular worry about attendance allowance and disability living allowance. There has been some confusion over the last few months, some of which was cleared by the announcement on DLA for the under-65s. That still leaves the concern I expressed earlier about over-65s, particularly those in Wales and Scotland, given the devolved nature of care, social care and health services.
I had a close look at the Green Paper. I see that everyone on the front page is smiling, and, rather alarmingly, so is the Prime Minister on page 2, but perhaps they are all smiling at the DLA announcements-so there we are.
About 115,000 people in Wales have a right to attendance allowance, 80,000 of them at the higher rate. They, including 2,370 in my own Caernarfon constituency, value it as a targeted and dependable source of help. Since its inception, it has provided a way of promoting and enabling autonomy, just as the mobility allowance provided a way of addressing the needs of disabled people living out in the community. That was also the principle behind the groundbreaking moves in the '70s and '80s, particularly in Wales, to shut large institutions under the "All Wales strategy for mental handicap", as it was called at the time-something I was intimately involved in as a young social worker.
Attendance allowance helps people to be independent. There nothing wrong with being dependent. There is nothing dishonourable about it. However, the direction of social policy over the past 30 years has been towards autonomy, choice and enhanced independence for those who, in darker decades, might never have seen the outside of an institution. I therefore consider the current move to be a step in the wrong direction.
Given that the provision of care in Scotland and Wales is the responsibility of the devolved Administrations, I hope that the Minister will explain what will happen in Scotland and Wales if attendance allowance is, as it were, taken in-house throughout the United Kingdom. Will the Scotland and Wales element be transferred to the Welsh Assembly and the Scottish Parliament as a block grant for them to administer? That would be something of a constitutional novelty. Will the Welsh Assembly, for example, be able to administer an attendance allowance for Wales on the basis of the old system, or will it just spend the money on health and social services in Wales in the normal manner?
I will, although I am loth to do so given the pressure of time.
I am grateful to the hon. Gentleman. He has reminded us of a comment made by Malcolm Wicks about joined up-government, not just in Westminster but throughout the United Kingdom. It is essential for conversations between the Westminster Government and the devolved Governments to take place at an early stage.
That is a very good point. I would certainly like the Welsh Assembly Government to take more responsibility for attendance allowance, although, as I have said, that would be a constitutional novelty.
I think that we need some answers from the Government before we take this much further, because there is a real fear in Wales and Scotland that DLA and attendance allowance will disappear, and we are unclear about what will take their place.
We have had an important-indeed, I would say crucial-debate on the Government's proposal to create a national care service for older and disabled people. Members have spoken with great passion and considerable knowledge. We have heard from former Ministers, and from Members with personal and constituency experiences. I shall take each of the contributions as a submission to the Green Paper consultation, which will boost the numbers.
In opening the debate, my right hon. Friend the Secretary of State spelled out the need for change. My right hon. Friend Malcolm Wicks and Mr. O'Brien rehearsed some of the core arguments about the change in demography. For me, a key fact is that there will be 1.7 million more people needing care in the future. Is the current system of care provision able to cater for that? The Government's conclusion, and one of the drivers behind the decision to change the system into a national care service, is that it is not, and that we need to find ways of responding to that.
Another key issue is the anger that I have heard expressed up and down the country at the unfairness of the means test, which forces people to use their savings or sell their homes to pay for their own care. That was mentioned by my hon. Friend Mr. Anderson. People are also worried about the quality of care services. I think that every Member referred to that. People are worried not only about whether they will be cared for well, but about whether the standard of care will vary according to where they live. Many are worried about the postcode lottery. Adults with disabilities are particularly worried about a variation between care assessments in different parts of the country. They do not feel confident that their care needs would be met if they moved to another area.
In proposing a national care service, we have used the building blocks of much of the very good work that has already been done throughout the country over the last four or five years. I must directly contradict claims by some Members on both sides of the House that we did nothing during those years and then suddenly embarked on consultation about a Green Paper. I remind them that it was back in 2007 that we launched "Putting People First", which received huge support across the country. Local authorities, the health service, third sector organisations and the private sector signed up to the agenda for the transformation of care services. We set aside an additional £520 million for local authorities to personalise social care services in the way that every Member here wants. Most councils are now getting more than £1 million each to support the agenda during the period 2008-11. That is a major building block as we aspire to create a national care service.
Many Members mentioned carers and the importance of recognising their contribution in caring for a loved one. The carers strategy, published in 2008, is a 10-year programme to help to ensure that carers get increased care and control and can have a life outside of caring, which is what they aspire to and what we aspire to on their behalf. I understand the criticisms, repeated today, about the money being delivered by the primary care trusts that have received extra cash, for example for respite care. I will be meeting the Princess Royal Trust for Carers, with senior NHS officials, to discuss how we might take this forward.
I find it difficult to accept criticism from the Conservative party about that issue as it voted against the extra money going into the health service in the first place. It now criticises us for the fact that the health service may not be giving the money out as it would have hoped. I cannot accept that and I find its position to be a little hypocritical.
Others have mentioned the importance of services for people with disabilities. I want to remind the House that another key building block that we put in place to create a national care service was Valuing People Now, our three-year strategy to transform the lives of those with learning disabilities and improve the quality of and their access to local public services. I was disappointed when Sarah Teather criticised the Green Paper for not addressing the needs of adults with learning disabilities, as the whole of the Green Paper is about adults with disabilities, including learning disabilities. Many of the features of the service that they will receive are captured in the Green Paper. We also have a specific strategy to drive forward in particular services for adults with learning disabilities.
Many Members have mentioned dementia as being a key pressure at the moment and one that is likely to grow because of the demographic changes. My right hon. Friend the Member for Croydon, North made that point. We have our national dementia strategy, published in February. It talks about earlier diagnosis and earlier intervention, which is a key part of how we help people to live well with dementia as well as providing new services. I visited my right hon. Friend's constituency where there is a very good memory clinic-one of the forerunners of the national dementia strategy, it is a model of good practice that we would like to be replicated across the country.
Mental health has been mentioned. We have just completed our consultation on New Horizons, a major shared vision for mental health for the future, whose twin aims are to improve mental health services generally but also, specifically, to improve the mental well-being of the population as a whole.
We also have the national strategy on adults with autism. Angela Browning was gracious in recognising the contribution of the Government in creating a statutory basis for that in a Bill that I think will receive Royal Assent in a few days. I am certain that it will. It is a landmark for the care and support of adults with autism.
We also have our Dignity in Care campaign. Not a single Member mentioned that, which is why I mention it now. It is another key building block in driving change forward from the bottom up. Ten thousand individuals have now identified themselves as dignity champions in residential care homes, domiciliary care, the NHS, local authorities, the third sector and private sector organisations. They are all committed to playing their part in taking forward what I regard as a social movement to put dignity at the heart of care.
More recently, we published the social care workforce strategy. My hon. Friend Laura Moffatt was a model for how we might undertake consultations in our constituencies with individuals and groups on such proposals. From today, I would encourage every MP to spend the next two weeks-we still have another fortnight before the closing date-talking to local carers organisations and user groups, as well as third sector and private sector care providers and local authorities. We must ensure that everybody is fully engaged in this debate. Members should be leaders and shapers of the debate in their constituencies, because it is very important. The Prime Minister recently announced that from October 2010 people with the greatest needs will be offered free personal care in their own homes, which is a major step forward in creating an integrated national care service for the future. We are working through the detailed modelling of how that will work, but it is of central importance and a building block towards achieving a national care service.
We must work through each and every one of these strategies and bring them together. Each of them is good in its own right but, because of the concerns that have been raised, we all know that in order to meet the needs of both carers and the users of care in our constituencies we have to reform and reshape the whole system, as well as put in place and improve the individual components. Many Members have highlighted the key features of the national care service, and I think the public should start to expect them as an entitlement. Those features include services that enable people to live longer in their own homes, and prevention-that has been a theme throughout the afternoon. This will give carers support, and also peace of mind that the person they are caring for-perhaps a family member-is being looked after, such as through telecare or telehealth. I disagree with the sweeping criticism made by Mr. Burstow; I think telecare and telehealth have an important role to play in helping people, alongside other measures.
I understand why the hon. Gentleman wants to intervene, but I am sure he will understand that I do not have much time. Let me just say that I do not think we should dismiss these measures too readily.
The idea of a national assessment of a person's care needs based on the aspirations they themselves have about their way of life and independence was raised. I want to reassure the hon. Member for Tiverton and Honiton that that is exactly what we want from a consistent and national system of care. It will of course be delivered locally, but to a pattern and a set approach that will allow people to have consistency of care in different parts of the country. It will not impose a system that negates individual needs and local distinctiveness; rather it will reinforce the needs of the individual and in a way that does not lead to different outcomes in different parts of the country. I hope that reassurance is sufficient.
The disability movement in this country has been championing real portability, and wants that to be the outcome of the care needs assessment. I am delighted that the national care service will be a major achievement for the disability movement in this country.
I agree about portability and the disability movement, but what is important to note is that this is not a national care service, but an England care service. We must not get more portability within England and then make the borders between Wales and Scotland real barriers to people who might want to move about our United Kingdom.
I will make this point now, although I was going to come on to address the contribution of Hywel Williams as well as that which of Mr. Harper made from the Back Benches-it is confusing that he is now sitting on the Front Bench. Officials met colleagues from the devolved Administrations and territorial offices to discuss the content of the Green Paper before publication in July this year. Officials have been in regular contact since then with all devolved Administrations. We have been holding various meetings since the publication, and a further series of meetings is planned to ensure a co-ordinated approach and to take into account the very real and understandable concerns Members have raised.
Members have asked about the extent to which social care and health care services can be joined up. My right hon. Friend the Member for Croydon, North made a particular point about that in relation to housing. This is not just warm words in a paper; it is practical action that we know can happen, whether through joint strategic needs assessments or joint commissioning processes. We also have some structural changes. There are eight care trusts, for example. Each of these models is being tried. Some are better than others. There is not a one-size-fits-all attitude. Indeed, we now have a range of integrated care pilots. I am unsure whether my right hon. Friend has come across them, but they were launched recently. The clue to what they are about is in the title; they offer integrated care. Issues being looked at in 16 localities include integrated care for people with dementia and the elderly, end-of-life care and care for people with long-term conditions, fluctuating conditions or mental health conditions. So we are taking practical steps to find out, through practice-through making it happen-how we can do this better.
Providing more information and advice is another key feature of the approach; it could be said to be an entitlement that people should expect from a national care service. People and their families should know what care, support and choices are available and how they can properly access them. We need to be able to reach out into the community to those who might not be accessing services under the current system.
Yes, this country has some excellent examples of support for advocacy, particularly among the user-led organisations; there are many varieties of this. We are funding the development of a range of user-led organisations up and down the country, and I have met such organisations. The one that I can remember most vividly is the Essex Coalition of Disabled People: not only are its people advocates, but they manage the direct payments system for many disabled people in Essex who use it-those disabled people find that things work very well. That coalition is run by disabled people for disabled people, and it provides a successful advocacy system too. Advocacy would need to be a part of any future national care service.
The idea of personalised care and support is crucial. The word "personalisation" runs through the whole of the Green Paper. It is about giving people choice over the care that they receive; giving people control over their care and when and how they receive it; and genuinely enabling people to live the independent lives that they want to lead. This personalisation should apply not only to care provided in people's own homes, but to residential care. The point has been made, not least by the hon. Member for Sutton and Cheam, that we need to ensure that in residential care settings people are given personalised care. I can remember visiting one residential care home where two residents in their 80s had got married. They were living ordinary lives and doing things that other people do, such as having relationships. That is the right way forward.
The key theme that every Member's contribution has touched on is fair funding. We know that all the options will have their advantages and disadvantages-in fact, we spell them out in the Green Paper to encourage the widest debate possible, as people understand how we could have funding that is sustainable for the longer term. A number of hon. Members, not all of whom are still in the Chamber, have reflected on the value of general taxation as a route for funding a national care service. May I emphasise that a lot of care is funded through general taxation right now? That is what is being delivered at the moment. We know that more resources are being put in from general taxation to fund the care system, of which the free personal care announced by the Prime Minister is the latest example.
I have a key question to ask hon. Members, including my hon. Friends the Members for Blaydon and for Luton, North (Kelvin Hopkins), who commented on this: given the demographic change that will take place-there are four people of working age to every pensioner now, but that will become two in the future-would it be fair between the generations to place all the burden of paying for older people's care on people of working age? The system would have to be not only fair between the generations-I have met many people who feel it would not be-but sustainable. Can it actually work in practice, or would the level of the tax burden on the working age population be so high as to be unacceptable?
The Minister has obviously made the assumption that the only way to pay for this is out of income tax. However, people carry on paying tax long after they have retired; everybody pays VAT every day of the week. I made the point in my contribution that one possible approach would be to have a 0.5 per cent. rise in VAT, which would put £2.5 billion directly into the care budget.
All I can say to my hon. Friend is that we are listening hard to what everybody has to say about the way forward. I have tried to explain why the models that we have proposed are sustainable in the longer term-over decades of an ageing society-but we welcome any thoughts that people have and any contributions that they wish to make.
I wish to try to address some of the misconceptions that are inevitable when a debate of this kind is generated. First, I wish to say that this is a Green Paper for all adults; although the media may have portrayed it as a social care Green Paper that is just for older people, it is not-it is for adults with disabilities too. We are keen to ensure that we have a national care service that rightly provides the choice, control and independent lives that adults with disabilities rightly expect. I hope to hear more about that from their organisations in the future.
Secondly-I think this is a fair criticism-it was said that in some ways we have not placed families and carers at the heart of a new system for care in the future. I can see the reasons for that criticism of the Green Paper, but I want to say today that we do see families and carers as being at the very heart of the system. The purpose of a care service has to be to provide the support, choice and services that individuals need and that they can access in order to their lives as individuals with somebody caring for them with their families and relatives. Some people, of course, do not have carers, families and relatives around them. The care service needs to meet their needs, too, but we need to ensure that, as Greg Mulholland said, the care service gives support to carers and families, who are at the heart of what a care system should be about.
On benefits and attendance allowance, which were mentioned by many hon. Members, let me make it clear that we are still keen to receive views on the case that was made by the King's Fund, Wanless and others to bring together some elements of disability benefits, such as attendance allowance, with the funding of care to provide a better, targeted system of care and support that will benefit everyone in need of care. I recognise some of the detailed points about the fact that attendance allowance and the DLA can be gateway benefits to other benefits, and that any change to the system will therefore need to take that into account. I am keen to get all of that right. I was pleased that the hon. Member for Forest of Dean described attendance allowance and DLA as being folded into a care system that gets reshaped and redistributed, rather than as being cut, which is how others have been portraying it. It quite clearly is not a cut.
Whatever the outcome of the consultation, the principle will continue to be that people receiving any of the relevant benefits at the time of reform will receive an equivalent level of support and protection under a new and better care and support system. We are going to make changes to disability benefits only if we are certain that by doing so we can better support the care needs of older and disabled people.
To pick up on the point about the cash that one gets as an attendance allowance, our intention is that the care and support that people will get in the future will be in the form of a personal budget that can be provided in cash for anybody who wants it that way. We want to see that feature driving forward as we develop our national care service. Although I am sure that that will not have assuaged all the concerns that have been raised today, I hope that those reassurances will help individual concerns.
I will not take the time of the House by reflecting for too long on the Government's concerns about the views expressed by the Conservatives and its way forward. My view is that the Opposition simply do not get it. A few weeks ago, they announced their scheme for a voluntary payment of £8,000 to provide residential care for those who choose it. We now understand that that scheme will exclude people with any pre-existing health conditions, so the number of those who would enter the scheme-let alone the number who would voluntarily choose to do so-is so small that it becomes a scheme for very few people, which completely ignores the needs of the many. Indeed, nine out of 10 people are not cared for in residential care-they are cared for in their own homes. That is why we have gone down the route of the free personal care scheme as a major building block for a new national care service.
Although I do not know the details, last week Mr. Lansley, who speaks for the Opposition on these matters, announced the creation of what appeared to be 153 new local quangos called public health boards, which would just be another layer of bureaucracy and complexity of funding, which already bedevil the system. I fail to see how a party that talks publicly about cutting bureaucracy and waste can immediately create a massive new wasteful bureaucracy, but that is for it to defend.
In drawing this debate to a close, I am delighted to say that the careandsupport.direct.gov.uk website has had 90,000 hits. Will hon. Members please encourage all their constituents to take part-if Members have their own website, I ask them please to add a link to the site from theirs-and to get engaged in the debate? Let us learn from the inspirational example of my hon. Friend the Member for Crawley who held a debate in her constituency. Let us meet local organisations. The job is clear. I want to build an unstoppable momentum for reform that will represent the biggest step forward for social justice in decades and improve millions of lives. Let us together create a national care service of which we can all be proud.
Question put and agreed to.
That this House has considered the matter of the Social Care Green Paper.