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I beg to move,
That this House
recognises the vital support that attendance allowance and disability living allowance provide for people with disabilities;
notes that these benefits are intended to meet the additional costs of living with an impairment or long-term health condition;
further notes with concern that approximately 2.87 million people in the UK who receive disability living allowance or attendance allowance are not eligible for social care services;
acknowledges that some 20,000 individuals have petitioned the Prime Minister and many more have petitioned individual hon. and right hon. Members to ensure that these benefits are secured;
welcomes the Government's announcement that disability living allowance for people under 65 years will not be scrapped;
and urges the Government to ensure that attendance allowance and disability living allowance for people aged 65 years and over are secured and not abolished as part of any future reform of the social care system.
The House will no doubt be aware that the motion is in exactly the same terms as early-day motion 1.
The hon. Gentleman reminds me-I was going to say this anyway-that early-day motion 1 stands in his name and that of 105 other hon. Members. I claim no authorship of the early-day motion, as he will no doubt verify. He composed it no doubt. He might have done so with others, but he did not compose it in direct association with me. None the less, I was happy to sign it, and I and my colleagues agree with it.
I am grateful to the hon. Gentleman for giving way. I am also grateful to the charity Scope, which provided the background. I readily put on the record the fact that Scope is the organisation that helped me. When the vote comes later, I look forward to seeing the 41 Labour MPs who have signed early-day motion 1 voting for what it says in the Lobby.
I am grateful that the hon. Gentleman has provided that confirmation and that he has referred to the cross-party nature of the support for his early-day motion, which is represented by all parties in the House. Because it relates to benefits, which are a United Kingdom matter, Members other than those from England alone have had occasion to sign it.
For some years we have made it clear that we need a consensus about how we can achieve sustainable and high-quality social care for the longer term. We have had years in which reports have come and gone, including the royal commission on long-term care, the long-term care charter, the Wanless report, which was produced for the King's Fund, and the Green Paper, which was published in July. As I made clear to the Secretary of State at this Dispatch Box when he made a statement accompanying the Green Paper on
On page 15 of the Green Paper, the Government said:
"In developing the new system, we think there is a case for drawing some funding streams together to enable us to deliver the new and better care and support system we want to create. We think we should consider integrating some elements of disability benefits, for example Attendance Allowance, to create a new offer for individuals with care and support needs."
When the Green Paper was published, it asked people a number of questions-Members will no doubt recall the questions that were set out in chapter 7-but none of them asked whether the organisations and individuals responding to the Green Paper thought that it was a good idea to transfer attendance allowance and other disability benefits into the funding of the national care service.
I do not know whether a Minister or the Secretary of State wants to let us know about this, but on the face of it, the implication of using attendance allowance as an example of disability benefits-in the plural-in the Green Paper is that other benefits would also be included. We have assumed, as have others, including disability organisations generally, that it would be wholly discriminatory and perverse for the attendance allowance to be withdrawn and incorporated into the funding of the national care service, and for that not to be the case in relation to disability living allowance for those beyond the age of 65. I will continue on the basis that we are essentially talking about those two benefits for that purpose, unless Ministers were to tell us otherwise.
With the exception of the "pay for yourself" option, each option in the Green Paper implies the integration of those disability benefits into the funding of the national care service. Notwithstanding the fact that the Green Paper did not ask a specific question about this, we know that many organisations and individuals who responded highlighted the implication that is set out in the Green Paper and responded to it. I therefore invite the Secretary of State to tell us what proportion of the Green Paper responses received up to
Let me help Ministers on this subject. On the Downing street website, as we now know, there are opportunities to petition the Government on the subject, and 24,000 people have now signed such a petition-the sixth most popular petition on the Prime Minister's website-expressing their opposition to the proposal. The Disability Alliance asked its members whether they supported the proposal to absorb attendance allowance into care budgets, and 93 per cent. said that they did not. The Parkinson's Disease Society asked the same question, and 95 per cent. were opposed. Carers UK asked the same question, and 96 per cent. were opposed.
"We oppose funding the National Care Service from Attendance Allowance...We do not feel that the proposals will provide a system that sufficiently replicates the very important role that Attendance Allowance plays in promoting independence."
I note from the debate on the Queen's Speech in another place that the Minister, when challenged on who supported the options in the Green Paper, quoted Carers UK in a general sense, but not its response to the Green Paper that stated:
"We are concerned and against the proposal to take Attendance Allowance and place it into local care budgets. We believe that this will disenfranchise and impoverish carers and their families."
The Parkinson's Disease Society said in response to the Green Paper that
"our findings warn the Government that scrapping Attendance Allowance and other disability benefits could be detrimental to the independence of people with Parkinson's."
Macmillan Cancer Support said that
"we are strongly opposed to the proposal...to merge the Attendance Allowance funding stream with current social care funding streams to pay for the new National Care Service."
It is important for us to recognise why these organisations feel so strongly about this. The arguments against using this mechanism for funding the care service are compelling, not least because attendance allowance and disability living allowance were not introduced simply to pay for the costs of personal care. They were intended to compensate for the high living costs associated with disability, and not simply to provide for specific care needs.
The White Paper that introduced disability living allowance stated clearly that it was for
"better coverage of assistance with the extra costs of being disabled".
There are also costs that are distinct from, and additional to, social care needs, as described in the Green Paper. That is precisely why disability living allowance and attendance allowance payments have never been calculated on the basis of what is required to provide for social care needs. Rather, they have been calculated on the basis of what might add to the overall cost of disability. They were never intended to provide enough to pay for a professional care service, and it would be wrong to take them as being designed for that purpose. If Ministers were to proceed in the direction indicated in the Green Paper, it would constitute a fundamental change in the purpose and definition of disability benefits.
There is ample evidence of the costs that those benefits go to meet, and they go far beyond being strictly associated with the costs of social care. The Green Paper describes the kind of personal needs involved. They include washing, help with eating and toileting, and so on, but what is provided for and supported by disability benefits goes far beyond that. The benefits are not just spent on direct care services; they have had a big impact on people's lives. They pay for additional heating costs, different diets, and a whole range of support for informal and family carers.
The hon. Gentleman is raising some serious issues in a measured and thoughtful way, but is not that at odds with the way in which his party has approached this issue, in its scaremongering towards existing recipients? I have here a copy of the template for the press release for Conservative party candidates, which carries the words:
"(name), (position)-insert here-voiced (his/her) opposition".
It says that
"an average of £3,400 a year will be snatched away from 2.4 million pensioners".
Can he confirm that that figure refers to the current recipients of those benefits? Is it not the case that the Government have said that that money will not be snatched away?
Of course, the hon. Gentleman has never in his life issued a press release prepared by his own central headquarters. Age UK, which he will acknowledge is an organisation encompassing Age Concern and Help the Aged, has said:
"Without any detail in the public domain people are right to fear the worst".
The problem with that-
No, I am answering Steve Webb. I will come to this point and set it out in detail.
Ministers have said in the Green Paper that, within the national care service, they are proposing to withdraw these benefits from existing recipients and to provide what they describe as equivalent support. However, it is entirely unclear what equivalent support means in this context. The hon. Member for Northavon makes exactly the point that I am making. If one is currently in receipt of disability benefits and what one spends the money on includes-the Disability Alliance has conducted research on this-attending hospital or medical appointments, the cost of transport, support with housework and gardening, higher heating and water bills and a whole range of other things, only 24 per cent. of the money is actually spent on care services as such, so the fact that one is having this income taken away and having personal care services provided does not mean receiving equivalent support-it means receiving something different.
I am grateful to the hon. Gentleman for giving way; he needs a break, as he is not doing very well at the moment-he can check the Hansard. Let me inform the House that existing claimants in receipt of attendance allowance and disability living allowance would see no cash loss in their benefits during a transitional process to a new system. If he were part of a Conservative Government, is he saying that he would never rule out making any changes to AA or DLA for pensioners?
Order. I must say to Mr. Hope that there has been quite a lot of sedentary chuntering taking place. I know that there are strong feelings on these matters, but the effect of this sort of chuntering is to crowd out Back Benchers and I want there to be plenty of time for Back-Bench contributions, which I hope means mercifully brief Front-Bench speeches.
Yes, Mr. Speaker, I shall, of course, be as brief as the argument allows, but I tend to allow Members to make interventions and I am certainly happy to respond to them.
The Minister kept saying yesterday in response to questions that those who are currently entitled to these benefits would, under the Government's proposals, receive the same "cash support", but the amendment to the motion does not say that. It states that
"those receiving the affected benefits at the time of reform would continue to receive an equivalent level of support", which is the same language used in the Green Paper and the same language used by Health Ministers in responses to questions. There is a complete difference between those two things. If it is cash, what is the point of taking away a cash benefit from people in order to give them the cash back? If it is not cash and it is paying for the national care service, our precise point is that there will be a difference between what people use disability benefits to pay for now and what will be provided to them as personal care services under a national care service. There is a major discontinuity between those two things, which Ministers do not seem to understand at all.
Further to the point raised by Steve Webb, it is a full 20 weeks since the publication of the Green Paper and the start of the present campaign on attendance allowance and disability living allowance, so will the hon. Gentleman confirm the rumour that the leader of his party will sack the head of the section for opportunism and scaremongering in Tory party headquarters for tardiness and incompetence?
I am astonished at the meaning or purpose of that intervention. The hon. Gentleman signed early-day motion 1, and what we have tabled for debate on the Order Paper today is couched in exactly the same terms and it seems to me to be perfectly reasonable.
My constituents have a simpler concern than the one about how the Conservatives choose to organise their party. If the Conservatives form a Government, will the hon. Gentleman give an assurance that my elderly and disabled constituents would not be materially worse off? I am more concerned about the sums, however delivered, than the process of delivery, and I am sure that my constituents are, too.
I think the hon. Gentleman is right that people are concerned about that, and I am glad that he also signed the early-day motion, which makes an important point. I do not know why the Government should think that our argument is just about those currently in receipt of attendance allowance and disability living allowance, as we are debating what should be the long-term future of social care. The Green Paper was not about what is going to happen in the next six months, but about what ought to happen in the longer term. I am looking to find out what should happen in the long term for obvious reasons. I am making clear on behalf of my party our belief that the continuation of disability benefits, such as attendance allowance and disability living allowance in their current form, will give current recipients of such benefits and those who will be recipients in the future an opportunity, on a non-means-tested basis, to gain access to cash benefits that will enable them to buy a wide range of services such as informal care, family care, support for travel and support for house improvements on the basis of their own personal choice and control.
I find it astonishing that today is the day on which the Department for Work and Pensions chose to publish a document relating to other disability benefits, entitled "Making choice and control a reality for disabled people". It is clear from that document that the reason the Government did not include attendance allowance, for example, in the "right to control" policy is that it is already a cash benefit. People receiving a cash benefit gain personalisation and choice, but if a Government were to withdraw direct access to that cash benefit and distribute it through the national care service, by definition they would create a lack of personalisation.
I have always considered that to be an agreed common objective. It has been our objective since the 2006 White Paper, and the Government have also moved in the direction of direct payments and personal budgets for social care. More recently, they have moved in the direction that we urged them to follow, which included access to some aspects of health care as part of an overall personal budget. The point is that the budget is a cash budget, and there is an issue over how it should work.
On page 102 of the Green Paper, the Government say:
"We know that disability benefits such as Attendance Allowance are highly valued by the people who receive them, and that they give people control over how they spend their money to meet their care and support needs. However, we also recognise that there are inconsistencies of approach between disability benefits and social care within the current system. This is because the social care and disability benefits systems have developed in isolation from each other and these two largest portions of government care and support expenditure are being allocated on different bases. This can lead to inconsistent and unfair outcomes."
To me, the issue seems perfectly straightforward. If there are two sources of support for people and if one relates to social care and is means-tested while the other is based on an assessment of need, is not means-tested and is in cash form, and if there are inconsistencies between the two in relation to the assessment, what is the answer? The answer is to adopt a common process applying to both the assessment of need for the disability benefits and the assessment of need for access to social care. The answer is not to abolish the cash benefits and combine them in a single system. The Government have said-and it is in the amendment-that there should be a single assessment process; I hope they mean that, as we have agreed, there should be a common assessment process.
"I am sure the right hon. Gentleman will agree that we need national standards-some consistency of assessment. We have long argued for that, and of course there needs to be central Government support, but we do not need a nationalised social care service."-[ Hansard, 14 July 2009; Vol. 496, c. 160.]
That seems to me utterly consistent with the view-which the Government have apparently supported, in rhetoric-that there should be personalisation, that whenever possible there should be cash budgets over which people have more control, and that abolishing access to disability benefits would be a retrograde step.
The hon. Gentleman has been making a powerful point about the advantage of cash benefits in giving individuals control. Does he accept that even if the Government concede that current recipients will continue to receive the cash, there will be a huge loss to future generations who will not receive it?
I agree that it is important to have in mind the longer term, and to bear in mind those who may be recipients of benefit and care support in the future. However, I do not think the Government have said-and they do not say it in the amendment-that current recipients will receive the same cash support. They say they will
"receive an equivalent level of support."
Therefore, unless Ministers are willing to amend their amendment to the motion today, I am afraid that it simply does not answer this point.
My hon. Friend might care to know that Steve Webb is a master of the lurid headline. His website reveals that he has issued press releases entitled:
"Docking alcoholics benefits fundamentally inhumane" and
"New benefits scheme shunting ill onto lower support", as well as the astounding,
"Benefits changes will leave millions without social security".
Therefore, so as far as lurid titles are concerned, the hon. Gentleman obviously knows his stuff.
My hon. Friend makes a very good point better than I could have done.
Part of the argument on this matter is that attendance allowance is effective; it works. The Secretary of State for Work and Pensions said much the same thing last month to the Select Committee on Work and Pensions:
"One of the things we have said is that Attendance Allowance provides very important support for an awful lot of people across the country in a way that they hugely value. In particular it gives people control; it gives them control themselves over the way in which they get support and it is a budget that they can spend themselves."
The universities of Essex and Anglia Ruskin
"found no evidence that Attendance Allowance is paid long term to significant numbers of people who do not have accompanying health problems".
When someone receives both the allowance and care services, the allowance itself is taken into account through the financial assessment.
Those people who use this allowance often do so to save some money to meet higher occasional payments, such as for a wheelchair. An Age UK survey of older people who received attendance allowance found that the allowance supports older people
"to live in their own homes for as long as possible with a reasonable quality of life given their health...it would be no exaggeration to say that Attendance Allowance transforms people's lives."
In summary, people use the attendance allowance and disability living allowance to help them, under their own control, to create a quality of life for themselves that helps them to remain independent. That is precisely in line with the policy we are all trying to pursue. It is clear that if one narrowly focuses only on care needs, we will miss out much that goes to constitute well-being, and there is no health without well-being, and there is no independence, without sustaining people's quality of life.
I am listening carefully to the hon. Gentleman's remarks, and now that he has come to the core of his argument, I have to respond to him. His motion suggests that anybody in receipt of attendance allowance would receive no help from a national care service, and he is repeating that suggestion in the House, whereas in fact we are proposing to replicate the cash control in a new system so as to give people who would receive those benefits the same control and cash in the future. The central plank of the hon. Gentleman's argument is therefore knocked away, and I would be grateful if he would acknowledge that his motion's comments about no help for so many million benefit recipients are simply not true.
I am sorry, but the Secretary of State is completely wrong about that. We are not asserting that people will get no help. We are asserting that existing recipients will not get access to cash benefits in the form in which they currently do, and they will therefore be able to exercise less choice and control because this will be routed through the national care service, which will have its own parameters and will not necessarily enable them to spend that money in the same form as they can now. Ministers have not said in their amendment that current recipients would get cash. Besides, the point is not just about current recipients; it is about future recipients and future reform. The last part of the motion
"urges the Government to ensure that attendance allowance and disability living allowance for people aged 65 years and over are secured and not abolished as part of any future reform of the social care system."
This therefore refers to "future reform."
I am grateful for that clarification, but let me read to the hon. Gentleman from his motion. It
"further notes with concern that approximately 2.87 million people in the UK who receive disability living allowance or attendance allowance are not eligible for social care services".
The crux of his argument is his scurrilous campaign to frighten those people and to suggest that they would receive no support under a national care service. He knows what he is doing-he is raising concern and, frankly, it is gutter politics.
That is rather astonishing, is it not, Mr. Speaker? We have never said anything remotely like that. We always make it absolutely clear that we are opposed to the scrapping of attendance allowance and disability living allowance and their incorporation into the Government's proposed social care service. We want to give people access to cash benefits, personalisation and choice.
Order. I must say to the hon. Gentleman that I have said nothing of the sort.
I apologise, Mr. Speaker. The hon. Gentleman said, in his press release of
"fight against Gordon Brown's plan to scrap benefits for the disabled."
Is it not disgraceful to suggest that anyone is planning to scrap benefits for disabled people?
The Government's Green Paper is clearly intended to propose that disability benefits should be "scrapped", which is the word I used, in order to fund a national care service. That is something that the Government have proposed. I know and respect the hon. Gentleman, but he is trying to find a way not to vote for the early-day motion that he signed.
I have not come to ask the House to endorse my press releases. I have come to ask the House to settle this issue. If it is the Government's view- [ Interruption. ] No, I will not withdraw the motion. The Government should withdraw the amendment, which is clearly flawed, as they are saying that their policy is different from the amendment. If the Government believe that their policy would be consistent with our motion, they should vote for the motion. The debate is on our motion, not on something else.
Does the hon. Gentleman seriously believe that proclaiming that the Government are planning to scrap disabled people's benefits is not causing enormous concern among the most vulnerable individuals and communities in our society? Should he not be ashamed of saying that?
I am not ashamed. We are doing the job that the Government should have done, which is to get out there and explain to people what is in the Green Paper. What is shameful is publishing a Green Paper, at the heart of which is the major proposal of the abolition of cash benefits and their incorporation into funding a care service. The Government are happy to put out a proposal that states, "Would it be a good idea if the Government were to pay a quarter to a third of your care costs upfront?" and people say, "Yeah, that would be a good thing. That would be very nice, thank you." What the Government do not tell them is that, in the process, if they are in receipt of disability benefits, they will lose those benefits in order to pay for it. That is a completely different debate. Fortunately, we have organisations such as Age UK, Carers UK and the Parkinson's Disease Society who went out-we did not do it-and said, "Have you seen what is in the middle of this Green Paper?" They argued against it.
If Roger Berry and the Secretary of State want to put a stop to this now, they simply have to vote for the motion. Then the House will have spoken. There are a range of issues, including the impact on the overall income of pensioners. Some 40 per cent. of all attendance allowance recipients would be living below the Department for Work and Pensions poverty threshold if their disability benefits were removed. As for taking away a cash benefit and providing a care service instead, Ministers talk about equivalent support but they do not talk about equivalent support for future recipients. If the benefits were to be taken away and replaced by the care service, there would be a serious potential impact on the disposable income of many pensioners. Those issues are not explored in the Green Paper. There is no economic modelling associated with the Green Paper and no understanding of what the overall impact on people's disposable incomes would be. There is no evidence about the relationship, in detail, between disability benefit recipients and those who would be the recipients of the national care service so that we can understand the implications for poverty and well being. I am afraid that that simply is not good enough.
The Government's response has been first to deny that they are going to do that, then to get angry and now to engage in abuse. It is like when someone cuts you up when you are driving and then swears at you; first, we get injury from the Government and then insults. It is no good Ministers blaming people's anxieties on us. The organisations that represent disabled people have been at least as voluble as we have been in making this point and in urging the Government to change their policy. We have been clear about the policy that we pursue, but we question whether the Government will be clear. Scrapping disability benefits to pay for the national care service would be a serious mistake and a retrograde step. It would undermine personalisation and control for care users, which they say they are in favour of, and it would undermine family and informal care as opposed to formal and council-arranged care. Members of the House who have followed the consultation on the Green Paper have the right to say no to that. Ministers should accept the motion and move on. That would not be such a big retreat after all the retreats that we have seen in recent months. I say to the Secretary of State, "Just do it. It will only be only painful for today, and tomorrow you will be in a better place as a result." I urge Members on both sides of the House to help the Government to get off this hook. I commend the motion to the House.
I beg to move an amendment to leave out from 'House' to the end of the Question and add:
"welcomes the Government's proposals to create the National Care Service, the first national, universal, entitlement-based system for care and support in England;
notes that the proposals will deliver real benefits to people including wider provision of prevention services, a single needs assessment across England and information, guidance and advice for all;
recognises that in 20 years' time, 1.5 million more people will have care and support needs, whilst the number of people aged over 85 will have doubled;
further notes that around 400,000 people will benefit from enactment of the Personal Care at Home Bill, which contains no proposed changes to disability benefits;
acknowledges that the Government is considering responses to the Big Care Debate consultation before any decisions are made between a range of options for the National Care Service;
understands that changes to disability living allowance for under-65s as part of the introduction of a National Care Service have been ruled out;
and welcomes the reassurance that, if disability benefits for older people were to be reformed as part of the National Care Service, those receiving the affected benefits at the time of reform would continue to receive an equivalent level of support."
Let me begin by saying that I welcome the debate, which deals with a subject that matters greatly to many people in this country. Mr. Lansley and the shadow Secretary of State for Work and Pensions should be thanked for securing the debate, but I cannot stand the simplistic, petty and partisan manner in which the hon. Gentleman introduced it. So far, the approach has been nothing more or less than crude electioneering. The nasty party-the shadow Work and Pensions Secretary knows all about that-is back in all its glory, and it is showing its unpleasant side in the Chamber this afternoon. The debate deserves a higher standard of comment than that which the hon. Gentleman has given today.
I am going to come to that point. Let me say to the hon. Gentleman right now that this debate raises difficult questions. If one seriously intends to embark on a reform of social care in England, one cannot, as Steve Webb rightly said, reduce it to simple press releases that are designed for electioneering, in the crude, simplistic and crass way that the Conservative party seeks to do. The debate deserves better than that and is more complicated than that, and we would expect a better level of engagement from Her Majesty's Opposition than they are offering.
I am listening to the right hon. Gentleman with interest, but I seem to remember that every time there is an election, we knock on pensioners' doors and they confront us saying, "The Labour party has told us that you're going to take away this benefit and that benefit." That is the Government's strategy in every election, so the right hon. Gentleman will forgive me for saying that this is a case of the pot calling the kettle black.
Is that the best the hon. Lady can offer? This is crude electioneering. She has just owned up to it in the House. She has said, "That is what we are doing; you do it, so why can't we do it?" She has let the cat out of the bag.
Let me set out the important context to this debate.
I have already given way to the hon. Gentleman.
Let me set out the important context. Some 61 years ago, the House agreed to the establishment of the national health service to end the unfairness that the people with the greatest needs faced the highest costs and that the people who had the least were in danger of having their needs left unmet. Today, the same unfairness exists in social care. A person who happens to develop dementia in old age, rather than cancer or heart disease, is yet to find the freedom from fear that Nye Bevan promised as the goal of the NHS.
My right hon. Friend has brought us on to the very point that I was going to make. He referred to the difficult issues that the Green Paper raises. Is not one of them that so many elderly people on the standard level of attendance allowance cannot be persuaded to apply for the higher level, even though their needs would certainly make them eligible for it? Is not one of the other difficult issues that so many people with disabilities or incapacities of any kind do not get the care they currently need precisely because of the absence of a national care service? The analogy with the formation of the NHS is absolutely the right one.
My hon. Friend puts it very well. It is because the system has grown in a piecemeal way over the years that it has become confusing and in many ways a lottery. It varies very greatly around the country, according to the eligibility criteria operated by councils and a range of other things. That means that the system is a lottery, and the serious purpose that lies behind the Green Paper is to create a fairer care system for all, in which the people with the greatest needs have those needs met and society as a whole shares the risks and costs of providing that care. In creating such a system, we will provide a better standard and quality of care.
As I said, those who suffer the most face paying the most. It is an enduring unfairness that was not resolved in the post-war settlement, but it becomes more evident and urgent as people increasingly live longer. This House has failed to address the problem, but I do not believe that that can continue. In my view, all parties should commit to reforming social care in England in the next Parliament.
One in five people will need care that costs less than £1,000 during their retirement. One in five will need care that costs more than £50,000. In the worst cases, the sum can exceed £200,000. This cruel lottery leaves us with no way of predicting our risk and makes it hard to protect ourselves against it.
The Secretary of State mentioned England for a second time just now. Does he accept that, if something happened to attendance allowances, that would also affect Scotland, Wales and, potentially, Northern Ireland? Has he decided how that would be dealt with?
The hon. Gentleman will know that social care is devolved, but he is right to point out that any change to attendance allowance, which is a UK benefit, would have implications for Scotland. Of course we would work with colleagues in Scotland, and with the First Secretary, on making progress with any changes.
The current care system is piecemeal and complicated. Many do not know that care is means-tested. People face a battle to access the care that they need. When they succeed, the care can be of a poor quality, but not always. Resources are not channelled to where they are needed the most and, as we all know, carers often do not get the support that they need to make life tolerable and to enable them to provide the care and support that they want to to their loved ones, while also balancing other aspects of their life, such as work.
This much we know, and we know that the problem will become more pressing as the population gets older. When the NHS was created, there were eight working adults for every retired person. Today there are four, and by 2050 that figure will fall to just two. If the system is left unreformed, there are real questions about its sustainability in the long term.
I turn now to the Green Paper that we brought forward in July.
My right hon. Friend is absolutely right to identify the excellent work that carers do. Will he expand on exactly what the Government are doing to provide for carers, who in turn help elderly people to stay in their own homes?
My hon. Friend raises a very important point. In years to come, this will be as important as Sure Start is in helping young mothers with children to balance work and home. That is something that we have discussed in our debates about child care. We must give people looking after elderly relatives quality support that they can draw down when they need it, because that gives them the ability to work and to balance work with caring for their relatives. If we cannot provide that support, there will be an economic consequence for the country.
We have taken steps to support carers, and my Department has made funds available from our budget to support respite care. My hon. Friend is right to raise the issue. A crucial part of any national care service is to provide quality support for carers so that life becomes tolerable and they can carry on with their work and other responsibilities, knowing that there is good-quality support for their loved one when they are not with them. For all those reasons, we brought forward a Green Paper.
Quality is really important to elderly people, and it takes two forms. It relates both to care workers-their training and their capacity to understand people's care needs-and to when care is provided. Care should be given at times convenient for the person receiving it-when they want it rather than when it is convenient for the care agency. Are the Government eager to address and rectify that issue?
My hon. Friend is quite right, and that is why direct payments and personal budgets will lie at the heart of any proposed national care service. We want that level of control at the heart of any reformed system. She is also right to raise the issue of quality. Although there are good examples around the country, and many councils are doing their best, the system is stretched and-if we are honest-it is not systematically providing quality to people across the country. Many people who work in social care earn at or close to the national minimum wage, so in some parts of the country it is difficult to recruit care staff to provide the services that are so desperately needed. For all those reasons, and to put quality at the heart of the work force, we need to pick up the work on strategy in social care being done by the Minister of State, my hon. Friend Phil Hope, who has responsibility for care services. If we can do what we did successfully for the NHS work force, we shall develop a clear career structure, putting money behind training and development to ensure we have a high-quality, motivated work force. For all those reasons, the debate is important and complicated. It cannot be reduced to the level the Conservative party seeks-it is more complicated than that.
We have had a detailed debate on our Green Paper and the consultation has attracted a huge number of replies. Overwhelmingly, people support the principle that the system has to be reformed. The hon. Member for South Cambridgeshire did not say that, but it is what people are telling us. Of course there are difficult views about the nature and shape the reform should take, but people are agreed that worst of all would be to leave the system as it is, with more and more people's needs unmet as we go into a future with an ageing population.
Will my right hon. Friend comment on the key role of qualified social workers in that scenario? They will have the important responsibility of assessing the needs of elderly people and vulnerable disabled adults before considering the care package that is needed. As he knows, social workers do an excellent job but, sadly, they do not get praise for their excellent work.
My hon. Friend is absolutely right. That point came out strongly last week when the social work taskforce reported its conclusions. It pointed out the need to raise the status of social work as a profession and talk up the changes it makes in helping people to live better lives and give them more opportunities. The point was also well made by my hon. Friend, and we have to work hard to make it a reality. Everything in our Green Paper depends on those professional voices in social work. Helping people to unlock the benefits of personalisation and steering them through the system is crucially dependent on a motivated social work profession in adult services. Young people today want to make a difference. One of the biggest differences they can make is to go into social work, be it for children or adults. On both sides of the House, we need to work hard to communicate that message very strongly indeed.
Our Green Paper set out a vision of a national care service that is fairer, simpler and more affordable, underpinned by national rights and entitlements and personalised to individual needs. It set out a system with quality at its heart, whereby people get the care and support that they need. People would know exactly what to expect, what they were entitled to and what they needed to do to get it. The national care service is about helping people to live their lives the way that they want to. It is about putting the person's needs and wishes first, and helping them to keep up relationships with family and friends, to live in their own home for as long as they can and, where possible, to continue to work and contribute to their community.
My right hon. Friend is absolutely right. The two systems are coming together. With the introduction of direct payments, we have seen council support beginning to replicate the benefits system, and the two systems have been slowly merging. Reform would continue and deepen that process, placing individuals with the most need in control of their budget so that they can draw down the support and care that they need. My right hon. Friend is quite right to make that point.
Every citizen would stand to benefit under that new system. As well as helping people who need care, the national care service is about changing the lives of the friends and relations who support them. Many carers in this country have told us about the daily battle they face to get the support that they need, and we want to end that battle by providing a reliable, transparent and accessible system that makes it easier for them to manage their responsibilities. We intend to publish a White Paper in the new year, setting out our proposals for the future of care and support, based on the replies that we have received to our consultation.
I turn now to disability benefits. The current care and support system is provided through a combination of local and central Government funding, personal contributions and benefits. It is complicated, it is not clearly targeted at levels of greatest need and it is not sustainable. In each case, the amounts are increasing. Local government expenditure on adult social care has gone up by more than 50 per cent. since 1997; and the total fees paid by people who use the services have increased significantly over the same period. Today, there are more than 1.5 million recipients of attendance allowance, amounting to expenditure of more than £5 billion a year; and there are more than 790,000 disability living allowance recipients who are over 65 years old, totalling expenditure of some £4 billion a year.
By 2026, we can expect that 1.7 million more adults will need care and support than is the case today, and the cost of disability benefits for the elderly could rise by almost 50 per cent. in real terms. Demographic and financial pressures on that scale cannot easily be met within the current unreformed system, so we have to find a better way to provide support to older and disabled people, and there may be a case for bringing together some disability benefits within adult social care. That is the argument that we are putting forward.
The Opposition's motion refers to people who currently receive disability benefits but are not eligible for social care, and it is true that many people today do not get help from the state towards their care costs. However, that is precisely why this Government are showing leadership and looking at how we can best support care and reform services. As I said in my intervention, it is completely wrong to suggest that all those who currently receive disability benefits but do not receive support from social care services would lose out under a new system. The hon. Member for South Cambridgeshire made a big point of stating that he did not say that, but I am afraid that anybody who has picked up a Conservative party leaflet or a local newspaper recently will have been given a different impression from that which he has given the House this afternoon. He says one thing here and his party's parliamentary candidates say quite another in constituencies throughout the country. If he is serious about this debate, he must get his story straight now. He needs to say here-at that Dispatch Box-the same thing as his candidates say throughout the country. I am afraid that he has been found out today, and he was very helpfully smoked out by Steve Webb.
"And to top it off, unbelievably, they're cutting disability benefits for the oldest and most vulnerable members of our society."
That was the Leader of the Opposition, on "The Blue Blog", on
I agree with my right hon. Friend: it is unbelievable. Conservative councils up and down the country are cutting day centres and nursing homes for older people-cutting social services budgets-and then the Conservatives make that kind of opportunistic statement that comes from a deliberate misreading of the situation in order to give fuel to their candidates in constituencies around the country. Whatever the hon. Member for South Cambridgeshire says today, the reality is what my right hon. Friend has just read out, and it is now on the record for all to see.
It is completely wrong to say that people will lose out under a new system. This is not about using benefits to support the existing system. We want to create a new care and support system that goes beyond that and is fit for the 21st century. We accept that that means we need to carry people with this reform. We also need to protect people in the interim. We have therefore categorically ruled out using disability living allowance for the under-65s. No other decisions about benefit reform have yet been taken. However, we have been absolutely clear that if disability benefits are reformed as part of delivering the national care service, those currently receiving benefit will not lose out financially. To put it simply, there would be no cash losers from this reform. That will remain the case for life. Existing benefits recipients will keep the cash and keep the control-it could not be clearer.
People like disability benefits because they provide a universal entitlement, they provide a cash budget that can be spent on the services that people want, and they support lower-level needs that help people to stay well for longer. Those three principles will all be important features of the new care and support system that we seek to introduce.
May I seek clarification from the Secretary of State? Is he referring to people currently over the age of 65 who are in receipt of benefit or those over the age of 65, who will in due course require benefits? Will they have those benefits secured as well?
The hon. Gentleman is right-I am talking about existing benefit recipients. We are saying that, in future, we propose having a new system of support for people with care needs, but it is not correct to say that that means that support will be withdrawn, which is the argument that the Conservatives are advancing. Our whole aim in this reform is to give more help and support to the people who need it most. We believe that at the moment the money in the system is not properly targeted at those who need most support. That is the difference between our two positions.
"if disability benefits...were to be reformed as part of the National Care Service, those receiving the affected benefits at the time of reform would continue to receive an equivalent level of support."
He has just, in effect, replaced the words,
"an equivalent level of support", with the words, "the same amount in cash"-that is, no cash loss. That is a completely different policy-which one is it?
I am sorry, but "equivalent level of support" is pretty plain-it means no cash losers. It is an equivalent level of support: that could not be clearer. I have said very clearly that people will keep the cash and keep the control. We have said that all along, but the hon. Gentleman has been choosing not to listen because it did not suit the grubby campaign that he has been mounting for the past couple of weeks. We have made this absolutely clear. He may not like it, because it does not suit his purposes, but it could not be clearer.
As I said, the three principles in the benefits system will all be important features of a new care and support system. [ Interruption. ] If the hon. Member for South Cambridgeshire will stop chuntering, let me say that cash payments will be at the heart of a new system. The care services Minister, my hon. Friend the Member for Corby, and I have been saying that every day since we launched the Green Paper. That is what
"an equivalent level of support" means. The hon. Gentleman has chosen not to listen to that because it was inconvenient- [Interruption.]
Order. I apologise for interrupting the Secretary of State, but I must say to Ms Milton that there seems to be a competition among Front-Bench Members for the dubious accolade of chunterer-in-chief. [Interruption.] Order. I do not require any help from Mr. Burns-he is often competing for that accolade himself
Thank you, Mr. Speaker.
The point that the hon. Member for South Cambridgeshire seems to have missed is that we have said all along that cash payments will be part of the new system. I said in response to my right hon. Friend Mrs. McGuire a moment ago that in recent years, we have begun to see a merging of the local authority support system and benefits, with the introduction of direct payments. That is a trend that we want to continue. It is not about giving people's benefits to councils, as the press releases accuse us of. People in the care system are already getting used to getting cash budgets, and the number of people receiving them has risen by 28.9 per cent. over the past year. Including carers, 115,000 people have received them, and our reforms will take the process further. Let me be clear: we will reform disability benefits only if we are certain that the new system can better support the needs of older and disabled people.
The hon. Member for South Cambridgeshire is often good at taking a big position without any reference to what other people in his party say. His whole thesis today was to raise the spectre of the loss of benefits, and he gave the idea that any reform of benefits means somebody losing out and that we cannot possibly raise these issues without trying to cut support. However, I have before me a speech that Mr. Cameron made in Scotland on
"So there are the problems in the benefits system. It is too complex. It does not incentivise work sufficiently. And it relies too much on large government agencies...Our policy review is examining the option of a radical simplification of the benefits package for disabled people. I welcome the principle of Individual Budgets. But I'd like to go much further."
It is unbelievable-he was giving exactly the same argument that we have been mounting, which underpins our Green Paper. [Interruption.] Hear me out, there is more. He went on to back us up even further, saying:
"Instead of the half-dozen different benefits a disabled person can receive-each with its different conditions and its own application form"- [Interruption.]
They are not listening now, are they? He said that
"we should be moving towards a single assessment process, and perhaps even a single benefit."
There it is in black and white, in a speech, the same thing that we are talking about-the simplification of the support system, perhaps through a single benefit. Yet the Conservatives have brought the motion before the House today because, three years on from that, it suits their purposes to issue press releases and frighten disabled and older people up and down the country.
I am still utterly unable to reconcile what the Secretary of State is now saying about the Government's change of policy with what is in the Green Paper. The use of disability benefits to pay for the national care service is intended to back what was clearly one of the preferred options, the partnership model. Page 109 of the Green Paper even has a helpful diagram showing how, under the current system, there is a big shift from people paying for themselves to people getting part of their care free. The Green Paper states that
"those who were on the lowest incomes would continue to get all their care for free."
Is he really telling us that under the national care service as he proposes to introduce it, existing disability benefit recipients will continue to get the exact cash benefit that they currently get, plus their social care free? In that case, where is the money to come from to provide universal care for others?
Can the hon. Gentleman tell me what part of "no cash losers" he does not understand? Interestingly, just as I was coming to a rather sensitive and difficult part of my speech for the Conservatives, he got up and raised a different point. He did not like hearing what I was saying, did he, but he was quick to come back with a red herring. The policy is "no cash losers" and it could not be more simple.
That brings me to the Personal Care at Home Bill. There are still huge challenges in the care and support system. The Green Paper sought people's views on how we resolve those and create a sustainable system for the long term. In our view, those with the greatest needs cannot wait, and we cannot stand still in meeting the challenge of rising costs. Currently, an estimated 80,000 older people in the highest need receive free personal care, but 40,000 pay part of their costs, and 50,000 pay all their costs.
No-I am making progress. Among younger adults, an estimated 90,000 receive free care, while 20 per cent. pay all or part of their own costs, so we want to start now with reform, by helping people to live independently for longer in their own homes for free, which is something they tell us they really want. Our Bill will do just that. It will end the postcode lottery in care for those most vulnerable members of our society. Let us not forget that many have already paid significantly out of their own pockets to fund their own care- [ Interruption. ] The hon. Member for South Cambridgeshire says, "Second Reading on Monday." We are putting forward reforms that support people in their entirety-support for older and disabled people-and I am very sorry that he considers that unimportant.
Does my right hon. Friend remember the scaremongering that took place when our party was introducing the Care Standards Act 2000? We were told that we would drive agencies and care home owners out of business, and that we would not raise standards or improve the quality of care. Some companies went out of business, but they could not provide quality care. The Bill is the next step in the reform of care that will improve life for the elderly and disabled. As such, should not everyone welcome it?
My hon. Friend makes her point very well. The Conservatives have a track record on these issues-a track record of opposing any step forward that has given more dignity to older people, particularly those in residential or nursing care. I remember that on the day we launched the Green Paper in the House, a distinguished Member of the Opposition stood up to complain about the burden of the national minimum wage on care homes and asked whether more could be done to give more deregulation to care homes. Quite frankly, that is their true voice-that is what they have done in their past. When they come here with the pretence of speaking up for older people, I am afraid it just does not wash.
As the Secretary of State has changed the Government's policy this afternoon, I think it would be helpful if the House could understand exactly what he is saying for those existing pensioner recipients of either attendance allowance or disability living allowance. Is he saying that under the Government's proposals, those people will no longer receive attendance allowance or DLA, but instead receive a cash payment? Is he also saying that, as with attendance allowance and DLA, they will be free to spend the payment on whatever they choose, or will they be able to spend it only on the provision of social care?
I do not think the shadow Work and Pensions Secretary has been listening this afternoon, nor do I think she listened yesterday at Work and Pensions questions, when the Under-Secretary of State for Work and Pensions, my hon. Friend Jonathan Shaw, said quite clearly that an equivalent level of support meant no cash losers. She has not been listening to this debate nor indeed did she listen to the debate yesterday.
The right hon. Lady asks if our proposals mean that people can have the control to buy what they need. How many times have I said that this afternoon? The crux of what we are building is the power and control that people get in cash benefits-that is at the heart of the national care service. It could not be clearer and she clearly has not been listening to anything we have said.
We want to go further. In the Personal Care at Home Bill, we want to build a system that does all it can not just to pick up the pieces when people need help, but that has prevention at its heart. We want to invest resources in re-ablement-services to get people back on their feet and to give them intensive support after illness, an operation or a fall, so that they can live independently at home. The hon. Member for South Cambridgeshire is only proposing to help people who end up in residential care. What kind of a vision of the future is that-giving people an incentive to go into residential care? Surely the best way forward for care is to invest in prevention, to give people support to live independently at home and, at all times, to support them to live in their home. That is what they tell us that they want.
Before the Secretary of State finally moves away from the clash of press releases, will he comment on the quote in the Health Service Journal today from a national health service source? Under the headline "NHS to take responsibility for social care", the report outlines the Government's plans to take more responsibility and states:
"Social care is currently provided by local authorities, the majority of which are now Conservative controlled. A move towards greater control of social care by the NHS has been described to HSJ by an NHS source as one way to 'rip the guts out of' Tory-controlled councils."
Will he take the opportunity to condemn that quote and find the NHS source it came from?
Some 1.3 million people work in the NHS, and I cannot be responsible for what all of them say at all times. It is my judgment that, whatever happens, more money from the health budget will have to be spent closer to the line with social care. That is just the way things will have to go, and that is why I am talking about finding resources from within my Department to fund re-ablement services-intense support to get people back on their feet after a vulnerable or low moment in their lives. Because we do not provide such support at the moment, people end up at the door of the NHS or asking for support from local authorities. We want to expand the level of support. We should also be less precious about spending health resources on equipment and telecare to help people to live in their own homes. That is all part of my vision. We have to break down the approach of the past that has said, "The health service pays for this and councils pay for that", and we argue about the bit in the middle. We can no longer sustain that-Alistair Burt is nodding in agreement. The hon. Member for South Cambridgeshire should listen to more distinguished voices on his Back Benches if he wants some good advice about policy. The hon. Member for North-East Bedfordshire has a long track record in these areas.
This is an ambitious vision and it will not happen overnight. It raises complex and difficult questions that this House needs to consider carefully before proceeding with any reform. It cannot be a debate that is reduced to crude electioneering, because that would block out and shout down the debate. That is what we have heard from the Conservatives this afternoon. We have raised the issue of social care and the response from them is to shout it down and frighten people. The Conservatives cannot open up the debate because they do not have the ideas to put into the debate. Let us have a few more ideas and constructive comments, rather than the low politics that we have heard from them this afternoon.
The Prime Minister has committed to making social care our top domestic priority in the next Parliament. That shows that we have the ideas, the courage and the confidence to tackle the big issues that the country faces. I believe that the national care service could be a major social reform that will stand alongside some of the major reforms of the last century. It would be easy to say that it is too difficult. We have been under pressure this afternoon to say that we will drop it all, as the hon. Member for South Cambridgeshire invited me to do at the end of his comments. But we will not do that; we will see this through. If we fail to act, we will make the choices more difficult, the unfairnesses will grow year on year and this post-war generation-it includes people who own their own properties and who will live longer, which is a good thing-will face ever more unfairness than their parents did. These are big challenges. The Government believe that we have the right ideas to address them, and I urge my hon. Friend to oppose the motion.
As we have heard, we are effectively debating early-day motion 1, which was tabled by my hon. Friend Bob Russell after a night spent in a sleeping bag to ensure that he was in the Table Office to table perhaps slightly more than one early-day motion. However, of all the issues that could be brought to the House's attention, he chose this to be the first motion of the new Session, and rightly so. I congratulate him.
The subject of our debate is important, and I am delighted that the Conservatives have put the words in my hon. Friend's motion on the Order Paper. He was quite surprised when I told him last night that they had done so-he was slightly surprised too that they did not tell him directly, but never mind. However, the debate gives us the chance to put to rest, I hope, something that has caused great anxiety among millions of disabled people in Britain.
We have all seen the press release being talked about, and as much as Mr. Lansley might pretend otherwise, it is transparent that the release that he is encouraging his party's candidates to put out is designed to alarm current recipients of the allowances. All the statistics that his office-I assume that it is his office-has inserted into the press release relate to current recipients. It refers to 2.4 million pensioners who are current recipients. It reads: "In (constituency) ,"-fill in the gap-
"this would affect (x) pensioners- (y) who receive Attendance Allowance"- note the present tense-
"and (z) who receive Disability Living Allowance".
It is designed to frighten people.
In a moment.
I hope that the Department will reflect on whether its language in the Green Paper should have been more unambiguous and should not have left the door open to such campaigning. It is helpful that the Secretary of State said clearly this afternoon that there would be no cash losers; that was not the phrase used in the Green Paper. For the avoidance of doubt, and for those 2.4 million people, I shall describe, as faithfully and as accurately as I can, on the strength of the conversations that we have had, what I understand the Government's policy to be. If I get anything wrong, I hope that Ministers will correct me.
The hon. Gentleman has made the exact point that I was going to put to him. The Government have said that people will be guaranteed an equivalent level of support, but that could mean anything. We assumed, as did many vulnerable people, that it meant that people's disability benefits were under threat. Does he agree that the Government themselves have been the main cause of the problem?
As I said, I think, perhaps with the benefit of hindsight, that the wording in the Green paper could have been more unambiguous. The draft press release states:
That rather extends what the Green Paper might have been thought to mean. For the record, however, I shall describe what I think the Government are saying. Under the proposals, existing recipients over pension age of disability benefits-attendance allowance and DLA-will continue to get, first, the same amount of cash; secondly, they will be as free as they are now to spend it on what they like; and, thirdly, if, in addition to those cash benefits, they receive social care from a local authority, that will continue as well. Those are the three strands that I understand are present from what Ministers have said.
That is helpful.
The proposals therefore raise questions for future recipients-that is what I am now talking about-and I hope that Ministers will address some of those questions. For example, if DLA is to remain for under-65s but perhaps not for over-65s, there will be a question about the transition from under to over 65. It is clear from research evidence that DLA is not just a care cost benefit, but a disability cost benefit. Is it not therefore the case that, in the future, if people on DLA who became disabled before pension age go on to the new regime and receive support from a different package-I do not want to say "have it taken away from them"-that will presumably give them potentially less cash after the transition to spend on the other costs associated with their disability? I assume that that would be a consequence of the Government's proposal. Is there not a danger, therefore, that although those individuals' care needs might be fully met in the future, the compensation that society has given over generations for the additional costs of disability would thereby be undermined, because potentially all or a large part of that cash would be put into a bucket for care costs and their ability to meet other, extra disability costs might thereby be constrained? We need to understand the transition from under to over the pension age, compared with the position now. That is the first question that I hope the Minister responding will address.
The second question is about the current role of such benefits in passporting people on to other things. If a person receives attendance allowance, someone will be looking after them 35 hours a week and, in principle, will be passported on to carer's allowance. Could the Minister who responds to the debate say something about how such passporting might work in a world where new recipients receive a care package, but do not necessarily receive the benefits that passport them on to other benefits? One imagines that there are ways around that, but there would be consequences.
We all agree on the importance of cash benefits for personal control, personalisation and dignity. We would all want the cash to make our own choices and not to have the state decide what pattern of services we want. One of my concerns about the Government's proposal is that the new system will inevitably rely more heavily on means-testing than the current one. That is implicit in the Green Paper, which on page 102 describes attendance allowance thus:
"Attendance Allowance is not means-tested, so people get it regardless of how well-off they are."
Of course, that is simply a statement of fact, but why does the Green Paper say that and, by implication, "And this might be thought to be a bad thing. This is not money well spent"? At that point we part company with the Government, because our argument is that attendance allowance and DLA are designed to meet the additional costs of disability and people have those additional costs whether they are rich or poor.
We are talking about a universal benefit for people with disabilities. They will all face a set of additional costs on average, so we as a society compensate them all. Reading between the lines of the Green Paper and suggesting that, although there are additional costs, people who are well off can meet them themselves would be a worrying undermining of that principle. In our view, therefore, a continuing role for a disability benefit that is specifically related to the additional costs of care, but separate from the process for assessment and meeting care needs, is an important part of the system.
I admit that I was rather puzzled by what the hon. Member for South Cambridgeshire said about a single assessment system; his comment struck me as rather odd. At the moment, we have a system in which attendance allowance goes to millions of people who do not get social care services provided by their local authority. In a single assessment system, however, there are only two possible outcomes. Either the outcome is as broad as attendance allowance, in which case we would bring all the people who get social care who do not currently receive the allowance into the system, which would presumably be hugely expensive; or it is as narrow as social care, in which case people would be knocked out of attendance allowance. If neither of those two things is done, the system is not a single system.
I suppose we could have a compromise, whereby a few fewer people receive attendance allowance and a few more people receive social care, but that is not what the hon. Gentleman seemed to be saying. I am therefore slightly confused. We have come not to expect alternative proposals from the Conservative Opposition, but this time there is one on the table, only it seems not to make any sense. If we are talking about a single process of assessment that is different from what we have now, either it is universal and based on need, like attendance allowance, or it is means-tested, like social care, but it is rather hard to see how those can be one, single system.
There is an important question about what I call the non-overlap group-the people who are disabled enough to receive attendance allowance, but who do not get local authority social care. Again, my concern is that either that set of people loses out if attendance allowance goes, or the Government do not save any money, because those people use their attendance allowance to pay for care, and if the allowance was not there, they would rely on local authority provision. The only saving would be achieved be through means-testing, which is a worry. We all know why means-testing happens-we cannot be generous to everyone, so we pick some people-but there is a balance to be struck between universalism and means-testing.
One of my worries about the present Government is that the balance between universal and means-tested benefits in, for example, the pensions system has gone very much in the direction of means-testing. We have on the Front Bench today a former Pensions Minister, who will know that, when there was spare cash, it went into the means-tested areas. That was an understandable choice, but the Minister says that social care needs to look more like the NHS, and one of the hallmarks of the NHS is that we as a society say that people who are sick are entitled to help whether they are rich or poor. In my view, the Government's model seems to be veering in the direction of means-testing, because if we roll attendance allowance into the local authority social care budgets, we will by definition be doing more means-testing. We all get letters from our constituents saying, "I've worked hard and saved hard, but what was the point, because I'm no better off?" If we make social care more means-tested, we will rightly get more of those letters, because needing social care is akin to needing health care; it is the same sort of thing. Our worry about the direction of Government policy is the greater emphasis on means-testing.
That brings us to take-up. We know that take-up, even of the universal disability benefits, is not brilliant. There are plenty of people out there who should be getting attendance allowance or disability living allowance but who are not doing so. If we were to impose a means-testing regime on all that to create a single system, the likelihood of people missing out on the whole lot would increase. In Work and Pensions questions yesterday, a question was asked about the length of the DLA form. The Minister quite properly said that it was a complicated business and that we have to ask a lot of questions if we want to capture everything. If we tried to combine that with a means-tested system of local authority care, I imagine that the barriers would be even greater and we would therefore risk excluding vulnerable people. Having a mixture of the universal system that includes attendance allowance and, ideally, a less means-tested local authority system would create a better balance than what the Government are proposing.
My hon. Friend the Member for Colchester was right to table his early-day motion a few weeks ago. The motion before the House today accurately sets out our position, which is that attendance allowance and DLA for the over-65s have an important part to play in the system. We recognise that the Government have promised equivalent cash support for current recipients, but we believe that those benefits have a long-term future as well. That is where we part company with the Government.
Does my hon. Friend agree that, despite the differences of opinion between Government and Opposition Front Benchers, the fact is that 105 hon. Members from all eight political parties represented in the House, plus independents, have signed the early-day motion? There is no reason why the 39 Labour Members who signed it should not sign up to the motion before the House today, especially as they outnumber the 21 Conservatives and 32 Liberal Democrats. There is no reason why the House should not be united on the motion.
I share my hon. Friend's hope, but I am slightly torn. We are always glad when Members from other parties sign our early-day motions, and the last thing we want is to discourage them from doing so in the future. I take my hon. Friend's point that there is nothing in the motion with which they should have a problem. I was not planning to make a partisan point, but this reminds me that, as of yesterday, when I realised what motion had been tabled for today, I checked to see how many Conservative Members had signed the early-day motion. At that stage, the number was 16. Given the primary importance of the subject, I was rather startled to find that the early-day motion had been signed by only 16 of them-including the hon. Member for South Cambridgeshire and Mrs. May, who presumably knew that this debate was coming. That was rather a surprise. I agree with my hon. Friend, however, that there is nothing in the motion that Labour Members should have any difficulty with.
The key points are that we, corporately-to put it generously-should cease as of now to cause alarm to 2.4 million disabled people, and that the message goes out that their benefits and their rights are protected and will remain intact. By all means, let us have a mature debate about the future, but in our judgment, attendance allowance and DLA will continue to have a specific role to play in the system, by meeting the additional costs that those of us who are fortunate enough not to be disabled do not have. Those costs are incurred regardless of means and those benefits should therefore have a long-term role in the system. Any attempt to make the system more means-tested discourages those who have worked hard and saved hard, and penalises those who have become disabled through no fault of their own. That is the wrong direction to go in.
I hope that this debate will be helpful in placing on the record the reasons why current recipients need not be alarmed, while also allowing us to encourage the Government to think again about the threats to those benefits whose purpose is to meet additional costs that are not met elsewhere in the system and should always be met in any future system.
I hope not to take up my full allocation of time. I have one or two points to raise, not least because I used to be the Minister with responsibility for disabled people and had to deal with some of the early policy issues and discussions about this development.
Perhaps we should be more optimistic about why we are all here today. The justification for the reform of social care is, as the Secretary of State indicated, that we are all living longer and, thanks to medical science, can be kept in our homes longer. That is the good news to start with. The bad news is that although Mr. Lansley, who opened for the Conservative Opposition, said that there was a need for consensus, he then went on to scaremonger about the so-called attempt by a Labour Government to take away disability benefits from nearly 3 million people in Britain. Frankly, that is a disgraceful way to come at the subject, because the reform of social care is an important matter for all of us.
As Steve Webb suggested, we should have a mature debate. [Interruption.] In some ways-I point this out to the Under-Secretary of State for Work and Pensions, my hon. Friend Jonathan Shaw, who is the current Minister with responsibility for disabled people-our approach to pension reform should provide a model. That was about consensus and moving forward on the basis of certain principles. Frankly, however- [Interruption.] I think some Opposition Members should take a degree in chuntering, because they are getting very good at it.
I will not take lessons from an Opposition who, in October this year, said that their solution to social care reform was a one-off payment of £8,000, which would give people no guarantee that they would not have to pay a top-up if their social care costs were more than approximately £26,000. There were no guarantees either to people with a pre-existing health condition that their social care costs would be covered. I declare a vested interest: I wonder whether insulin-dependent diabetics who may have complicated health needs will get the benefits that they require if they pay that £8,000. The Conservative proposal was taken apart by every expert in the field because it was drawn up on the back of an envelope to please a Conservative party conference. I am delighted that my right hon. Friend the Secretary of State for Health clarified that there was absolutely no contradiction between the reform of social care and independence, choice and control for disabled and elderly people.
I think that the Secretary of State has answered that question-today and previously-and we are now in the territory of working out how many semantic angels can dance on the head of a pin. The Secretary of State and the Government have been very clear throughout that there will be no cash changes for individuals.
To colleagues who are having difficulty dealing with the reform of social care or in engaging with a Green Paper consultation, let me explain that there is no independence for an elderly person living on attendance allowance in a local authority that does not see social care as one of its funding priorities. That is not about independence, it does not provide choice and it certainly does not give control. As for my friends in voluntary organisations such as Carers UK and the many others that have been mentioned, I have the utmost respect for them, but I think they know in their heart of hearts that we must have a genuine discussion about how to deal with the demographic time-bomb and the social care time-bomb that we all face. I understand exactly why they are advancing some of the arguments that we have heard today, but they need to become part of the ongoing discussion about how we can reform the system. Even the best of the voluntary organisations need to respond to the conundrum of how we should deal with a social care system in which two people are working for every one person over the age of 65.
I am most grateful to the right hon. Lady. She began by rightly championing the idea of consensus, suggesting that it would be helpful and that the pension process might prove to be a precedent in that regard. Does she accept, however, that although we in the official Opposition have always indicated that we would be receptive, we have never received an invitation even to discuss the issue, let alone an invitation to a round table with Ministers?
Perhaps the hon. Gentleman should reflect on whether the Opposition have made any effort to contribute to the consultation over the past few weeks. [Interruption.] Is the hon. Gentleman saying that they made a formal response to the formal response to the consultation document? I am not sure whether the answer is yes or no.
I think that colleagues sign early-day motions for all sorts of reasons and I do not wish to second-guess the motives of any of my colleagues. The purpose of signing early-day motions is to put on the agenda matters about which Members feel strongly. I do not intend to fall into any trap set by the hon. Gentleman.
As I have said, I believe that genuine discussions must take place with the organisations that represent the needs and ambitions of disabled people. Let me say this to the Government, and I say it with the utmost respect to my colleagues. I welcomed the Secretary of State's comments about cash support, but the Government know that disability benefits, including attendance allowance, are valued and that any proposed changes should be seen in the context of improving the lives of disabled and older people in the future-I recognise that we are talking about the future.
Unusually, I agree with John Mason. Obviously, any discussions must take account of the impact in other parts of the United Kingdom. We must recognise that devolved Administrations will be involved if changes are made to what is currently a United Kingdom-wide benefit. The discussions must be meaningful and robust, and I hope that some of them have already begun.
This is probably the next great social agenda development, and I do not think any of us can run away from it. We cannot change the demography, certainly in the short term. The social care Green Paper sets out the questions, highlights some of the options, and gives people an opportunity to engage in the debate. What we cannot do is run away from that debate. We cannot simply pretend that it is not happening, or we shall have abrogated our responsibility to future generations whose social care needs will have to be met.
I congratulate Mrs. McGuire on saying that she would sit down well within her allotted time, and then sticking to her promise. I shall try to emulate her in that regard.
The right hon. Lady began by saying that the occasion for the debate was good news-the news that more elderly people are living longer-and that we should all celebrate that good news. I entirely agree with her, but the other aspect of the background to the debate is less happy. Although it has been recognised from 1997 onwards, and indeed was recognised by the previous Government-in which, as Secretary of State for Health, I was responsible for these issues-the fact that people are living longer, and have higher expectations for their care in old age, creates a real policy challenge when it comes to paying for the care that, when we are younger, we all want for elderly people and that we want for ourselves as we grow older. The current Government came to office, and the then Prime Minister promised action on this subject, in autumn 1997, yet all we have had are repeated commissions that have, in truth, failed to address the issue.
The most accurate assessment of the issue was provided by the Wanless report, which said that merely to stand still-merely to deliver the same quality of care to elderly people as now-would require the proportion of gross domestic product committed to this area of care to rise from 1.1 per cent. to 1.5 per cent. over the next 15 years, and that that would represent an increase in the cash cost of providing that care of £14 billion. That is how much it would cost merely to stand still. A parallel report by the Commission for Social Care Inspection pointed out that to stand still is not to deliver on our aspirations. The background to our debate is, therefore the fact that for 12 years we have failed to address the question of how we as a society will fund our aspirations for elderly care.
Twelve years on, the Government produced a Green Paper this summer, which is the immediate background to the debate, because it tabled the suggestion that attendance allowance and disability living allowance should be put into the pot to square the circle of paying for this area of care. It also tabled the suggestion that "a National Care Service"-capital N, C and S-should be developed, but it set out almost no details of what such a service should look like, beyond saying that disablement benefits should be part of the funding solution for paying for reshaped care for elderly people.
Since that Green Paper was published, two fundamental conflicts have developed at the heart of policy in this area. They have now started to bubble to the surface, and I want to address those two conflicts this afternoon. My hon. Friend Mr. Lansley has already discussed the first of them: should we develop a policy that is based on a preference for the payment of cash benefits, or one that allows greater flexibility for commissioners of service to provide a package of care that is, in their opinion, tailored to meet the needs of elderly people, but that does not necessarily reflect the wishes of the elderly people themselves?
Does the right hon. Gentleman agree that that option could turn out to be more expensive as well? Often, a friend or family member will visit to care for a few hours and they will incur only the cost of the taxi fare, but if such visits were replaced by the local authority providing paid care for a few hours, that would be much more expensive.
The hon. Gentleman is absolutely right, and what he says is relevant to the point made by my hon. Friend the Member for South Cambridgeshire about the way in which a local authority-commissioned service relates to carers. A local authority-commissioned service runs the risk of being less accurate in meeting what elderly people want and demand of such services, and therefore of being not merely more expensive, but less good value for money. There are therefore many reasons for choosing to have a policy that prefers, accentuates and develops direct payments, rather than officially commissioned services. That is why we passed the direct payments legislation before 1997, and it is why we have supported the development of that concept since. I believe that any move to put disablement benefits into the pot to pay for the national care service would be a big step in the wrong direction.
The Ministers say, "Don't worry about it. Local authorities will still have the same encouragement to pay direct cash payments." Who do they think they are kidding? They are clearly not kidding the next generation of elderly people. I accept entirely that there will be no cash losers in the current generation of benefit recipients, but we are concerned here about the development of policy for the future. I simply do not believe that if we take a system that provides an entitlement to a cash benefit and give that cash to a local authority commissioning body, we will have entrenched or developed the policy of preferring cash payments to commissioned services. It flies in the face of common sense, and particularly so when we all know that we are going into a decade in which there will be severe resource pressure.
Of course, it is true that, against that background-even if the Department of Health does not prefer such an approach-the Treasury is encouraging this policy direction to create more flexibility to free up resources that, in its mind, are now being devoted to a demand-led programme so that it can put those resources at the disposal of a priority-led programme that will be subject to a cash limit in the way that the disablement benefit programme is not. All those reasons should, I believe, commit us to opposing a development of policy that takes an existing demand-led cash payments programme and puts it into a local authority cash-limited priority-led programme. That simply will not deliver the core policy objective that has been consistently developed since before 1997 and, to give them credit, by this Government since 1997 to build up a preference for cash payments over commissioned services. That is one fundamental conflict that I believe to be at the heart of the development of the policy for a national care service.
The other conflict that is equally at the heart of this policy has not yet been raised this afternoon. It is the unresolved conflict caused by the question of whether we are seeking to develop greater local flexibility, local choice and local management of these services or a single national blueprint, rolled out across the country. The Department of Health talks about putting the disablement benefits at the disposal of the national care service in order to fund and develop its vision of a national care service with national assessment, a national entitlement programme and the development, therefore, of a policy that moves social care for the elderly from being a local authority service to a national service on the model of the national health service. The Secretary of State made it entirely explicit that that was the agenda of the Department of Health.
At the same time, in this Chamber, only a few weeks ago, we were debating with the Department for Communities and Local Government the development of the Total Place programme, which embraces the idea that disablement allowances should be put into that programme in order to take funds that are currently determined by a national programme with a national entitlement prescription and to put them at the discretion of local authorities so that they can create a more flexible local model of service delivery that reflects more accurately the local circumstances of individual local authorities.
Which approach are the Government supporting? Are we putting attendance allowances and disablement allowances into the local pot in order to develop a national care service? There is something tautological about taking a national programme and putting it into local authorities in order to develop a national care service. That is a bit like listening to a Frenchman explaining the game of cricket. Are we developing the programme in order to develop a national care service or are we taking these benefits and putting them at the discretion of the local authority in order to develop local flexibility and Total Place? Again, this comes back to a point that I made earlier. Is this about putting those moneys into a cash-limited programme to create greater discretion, as would be the Treasury's agenda, or is it about the national payment of cash benefits according to a national entitlement programme, which would be my preference?
My central point is that, against the background of the Government having failed for 12 years to address the resource challenges in the care of the elderly, they published a Green Paper this summer that said that the solution was the development of a national care service-three words with no policy behind them. That was a good headline, but behind it is an unresolved muddle of unresolved conflicts. All that is unresolved after 12 years of failing to rise to the challenge that was clearly there 12 years ago. Hon. Members need not take my word for that: in 1997, Tony Blair said that it would be a disgrace if this matter were not addressed. Those were his words, not mine.
It is a pleasure to follow Mr. Dorrell, who has raised two fundamental issues. I hope that the Government and others, in their response to the consultation exercise, will consider those issues carefully.
I start from the position of being one of those who signed the early-day motion-and not just yesterday-but I shall be supporting the Government amendment this evening.
The hon. Gentleman may say that, but I have voted against the Government on rare occasions when I felt that there was no alternative and I have not precluded entirely the possibility of my ever doing that again, but I hope that I do not have to. We have had a consultation exercise and the Government's amendment makes it clear that they are considering the responses to that consultation. It is quite wrong for members of the Opposition to say that the Government have decided to stop disability benefits. That is untrue and misleading, and it scares vulnerable people. That is another reason why I shall not vote for the Opposition's motion. We have heard some of the responses to the consultation, and most of us can guess what many of the responses from various organisations have been. Those responses should be treated seriously, and I am sure that they will be, but no decisions have yet been made.
The hon. Gentleman has been around this course several times. He knows this subject exceptionally well and he has a strong reputation in the House on this issue, so is he puzzled that, in dealing with some of the earlier responses to the consultation, the Minister and others have left hanging much of what has raised concerns outside? It appears that attempts are being made to deal with part of that today. If they had been as clear as he suggests, there would not have been the scares that currently involve certain organisations. Could Ministers have not done rather better?
I can answer that in one sentence. People are anxious because others have generated scares outside. Let me speak for myself. I agree with the Government that disability benefits should be seen in the context of a national care service. I, as much as anyone, want a national care service that is similar to the national health service. That is long overdue. As the Government say in their amendment, the national care service is about having a
"national, universal, entitlement-based system for care and support".
The only part of the system that is currently national, universal and entitlement-based is the benefit system-attendance allowance, disability living allowance and other related benefits. My point of departure is this: if our purpose is to create a national care service, I find it strange that the part of the package that we should start considering is the one part of the service that is national, universal and entitlement-based. It would be much more logical, in summary, for attendance allowance, DLA and related national entitlements to be the basis on which we build a national care service.
I welcome the publication of the Green Paper. It addresses a number of the shortcomings of the social care system that deny disabled and older people the right to decent care and support. That is why virtually every disability organisation-Age UK, Age Concern, Help the Aged and many others-has also welcomed it.
It is interesting that, within a few days, the same organisations expressed specific concerns about the future of disability benefits, so I think that we should regard their submissions as pretty sophisticated: they passionately want a national care system, but they have concerns about removing the national entitlements that currently exist through the benefits system.
We all know why things need to be done. As Members of Parliament, we all know that needs are being met insufficiently. Our constituents frequently have unmet needs, and perhaps the same is true for members of our families. At present, local authorities are addressing only the most serious needs, and there are charges. For instance, a constituent wrote to me this week claiming that her charging regime was unfair and unreasonable, and I think that she is correct. In addition, the 6 million carers in our country do not get the kind of support that they should get, and all that is despite the fact that the Government are putting more money than ever into the social care system. I do not think that the Government can be criticised for not providing extra resources. They have done that, but the system itself is not functioning as it should.
As the right hon. Member for Charnwood said, provision varies from local authority to local authority. People who get an assessment for care and support in one local authority but who have the temerity to want to work, or visit relatives, in the next-door local authority have to go through the process all over again. When will that cease? Entitlements are not portable. When are we going to get portable entitlements? A national care system, if it is national, will at least address that problem.
Finally, disabled people are twice as likely to live in poverty as non-disabled people. In such circumstances, therefore, we should be very cautious indeed about considering changes to benefits in a downward direction. Let us not forget that people who receive attendance allowance and DLA are, sadly, some of the poorest in our society.
As I have said, I support the vision of a national care system and national entitlements. I welcome the emphasis in the Green Paper on preventive interventions and on promoting choice and control. As other hon. Members have said, it is the national entitlements that give choice and control at the moment, because people can choose how to spend that money.
I think that resources could be saved if we moved to a national care system, and away from multiple assessments of non-portable entitlements between local authorities. The existing bureaucracy could be reduced in size, and some resources could be saved that should be spent on front-line care and support. Nevertheless, we all know that that is not going to be enough to provide the resources that the social care system needs at present. It will certainly not be enough, given the well-known demographic changes, to ensure the resources that the social care system of the future will need, but I repeat that I do not think that it makes sense to fund the social care system by undermining that part of the benefits system that works most successfully at present.
As Steve Webb has pointed out, many people who receive attendance allowance do not receive any social care support at all. Why should we consider any change to that entitlement, given the possible consequences for those people?
It must also be stated that, as we all know, many people's experiences of local authority social services are not good. I am a former local councillor and I am passionate about local government, but we all know that there are local authorities, for faults that either are not their own-perhaps insufficient resources-or are their own that do not provide the quality service that is needed. When disabled people say to me, "For goodness sake, we must retain AA and DLA", it is often because they cannot bear the possibility that the money would somehow end up under the control of local authorities with their current management of the social care system.
That is not a criticism of individuals who work for local authorities. Many struggle in very difficult circumstances indeed. Many local authorities are quite small, so there is often a real question about how they can provide a comprehensive social care service. I am not criticising individuals-I am simply relaying what we all know: many of our constituents who use local authority social care services are less than enthusiastic about their quality and are, therefore, all the more keen to hang on to national entitlements via the benefits system.
Attendance allowance and DLA are paid directly to individuals regardless of their personal circumstances, such as where they live, which makes the allowances an obviously desirable entitlement. As we have all said, recipients can spend the money as they wish. Those allowances have all the advantages of the individual budget-they are about empowerment, choice and control. The allowances have the important characteristics that we are saying the national care system should have in the future, so we should tamper with them only after we have come up with a very good reason for so doing. At the moment, it does not make much sense to move the part of the system that arguably works most successfully, given what disabled and older people expect from it, and that is why disability organisations, Age Concern and Help the Aged have expressed concerns.
Disability Alliance and the disability consortium-representing between 25 and 30 organisations-oppose the use of existing benefits to fund social care. Disability Alliance said:
"DLA and AA were intended to help with the higher costs of living disabled people and their families experience, and to help tackle the link between disability and poverty. We believe placing either or both of these funds in the pool for Local Authority distribution could cut support and restrict choice and control for many disabled people."
We should listen to what Disability Allowance has to say.
Age Concern and Help the Aged said:
"If the idea to stop AA is taken forward, it will mean that many older people will be worse off than they are now."
Finally, we all recognise that the Institute for Social and Economic Research is an organisation that has no political agenda; it produces reports and analyses by experts in the field. Its response was:
"Since the need for 'care'...is the main criterion governing eligibility for the benefits, it is sometimes assumed that the money is intended to pay for care. On the other hand, the past governments that introduced these benefits made it clear they were intended to contribute to the general extra cost of living faced over the long haul by disabled people and their families-extra heating, special diets, the incidental costs of hospital visits and so on-not necessarily on caring services."
Others have made that point this afternoon. The ISER continued:
"Standard of living indicators suggest that the current benefits do little more than compensate disabled people and their families for the extra costs associated with disability. A reduction in their cash incomes is likely to lead to an increase in deprivation."
The significant additional resources needed for the national care system should come from general taxation. I do not believe that one group of disabled people should be required to pay disproportionately for care and support for another group of disabled people. It is a responsibility that all citizens should share. My concerns, therefore, are that we might end up damaging the most successful part of the current system, which is the national entitlements via the benefit system, and that the proposal may not be fair.
The truth is that we will not know the detail that might be in the White Paper until we see the White Paper. Indeed, a number of questions have been raised, not least by the right hon. Member for Charnwood, to which I suspect we will not get clear answers this afternoon, and I hope that that is for a good reason. I hope that it is because the Government are considering carefully the submissions that were made to the Green Paper as part of the consultation exercise.
Yes, I signed early-day motion 1, and I did so for the simple reason that I agree with it. However, I am afraid that I shall not support the Opposition motion before us, and I shall not do so for two reasons. Sixteen Opposition Members signed the motion, and a number of them did so yesterday. I have great respect for the views of many Opposition Members, and I make no personal comments, but it is not good enough for a political party to use the early-day motion as a bandwagon on which to jump and bash others when three handfuls of its Members actually put their names to the relevant motion. When they also go around making statements, as they have explicitly done, saying that the Government are taking away disability benefits, despite no such decisions having been made, I think that that is outrageous. That was not in the statement of my right hon. Friend the Secretary of State, who was here earlier this afternoon, and I have it in front of me.
So, I shall not support an Opposition motion that has been presented in that way. The Government's amendment explicitly states that no decisions have been made, and I welcome that. It states also that they will take into account the consultation exercise and the submissions that have been made. The Government are not setting out to frighten people, and for that reason I shall support their amendment. That is no guarantee, however, that they can always rely-on every conceivable occasion-on such unqualified support.
These are always good debates in which to take part, and it is a pleasure to follow Roger Berry, who knows and cares about this subject very deeply. I agreed with many of his later remarks, but I shall avoid the difficulties of the politics for a while. It is always, however, a pleasure to listen to him, as it is to listen to the Front Benchers and to my right hon. Friend Mr. Dorrell.
I make two comments based on my time as Minister for Disabled People. Many distinguished colleagues, such as the Under-Secretary of State for Health, Ann Keen, who is sitting on the Government Front Bench now, have followed me into that position. I remember someone asking me to do more as a Minister to ensure that people with disabilities could access polling stations. That happened early on in my time as Minister, and before the meeting I thought, "What's this about? Everybody has the right to vote, you can vote by post, it doesn't really matter if you can't physically go down to the polling station. You've still got the same right to vote. What's the point?" By the end of the meeting, I had got the point: there is a very early conversion for Ministers and Members who are involved with people with disabilities. They realise that, for those with disabilities, one of the most important things is to be able to do the things that everybody else does-without thinking about them, without it being a big deal-and to have the same access to things which everybody else takes for granted.
My second observation is to offer a memory of Nicholas Scott. I know that we are in the heat of battle and that the Secretary of State for Health gets well stuck into such encounters, but if he looks back at some of his previous press releases he may come to see that crass politicking-the phrase that he used-is reflected in them. No doubt it will feature in future press releases, too. Nevertheless, he gave an impression that Opposition Members either had an artificial interest in disability or did not care very much. Well, those who knew Nicholas Scott and worked with him in the House know how unfair that impression is. I remember talking to Nick about the independent living fund, the disability living allowance and other such issues. He said to me: "One of the great things about disability issues is that by and large there is a benevolent ratchet. It does not always proceed at the pace those in the disability lobby would like, but it moves inevitably to a position of greater individual choice and the opportunity to exercise more individual power. That is really important for people with disabilities. There is a process whereby we have moved from a position of giving things to people to their then being able to access them entirely of their own accord." I begin my remarks about the motion on that basis.
I do not dispute with Ministers the difficulty of dealing with this matter, nor the issue of quantum. It will be extremely expensive and difficult to manage this for the future-there is no argument about that. It is of course partly about how much money goes in, but it is also about how that money is applied and who has control over it. Serious questions have been asked about precisely what a national care service might mean, how it might be handled locally, and what power there will be for the individual. Those issues are at the heart of our discussions here and the confusion outside that has led so many individuals, including those from disability organisations, to raise the concerns that they have. No matter what politicians may have added in trying to develop the policy in one way or another, those fears are genuine and worrying. I will turn in a moment to some of the things we have heard today as supposed clarifications of the policy.
Let me quote from a letter from one of my constituents. It was produced at the time when the policy had been announced in the Green Paper and people were not sure where it was going, and it reflects a concern that we now know is met because existing benefit holders will not be affected. Nevertheless, it might just as well have been written today by somebody anticipating what the future may hold. I suspect that most of us have similar letters. My constituent wrote:
"At the moment my husband of 82 who is blind and has other health needs, receives attendance allowance at the highest rate. Taking away this allowance would affect greatly his quality of life. He is a very independent gentleman, one who would find it very difficult to allow people he is not familiar with to provide personal care. Because of the allowance he is able to arrange his own help and feel in control of what needs he wants met and not assessed by what social services consider to be his needs. I feel for an older person who remembers pre war conditions. He is unlikely to access services through a local authority, he feels this is going back to the 'State Control, and Work House mentality'. Going without these provisions would greatly affect his quality of life, and mine as I can pay for someone to sit with him for a break with caring."
On one of the websites that discuss these matters, a gentleman called Mick Hall says:
"My own Dad who has now sadly died fell into this category. His reasoning was two fold: before he became ill and frail he had taken responsibility for his life since he was a young boy. He also feared if he let people in through the door he might be taken off without his consent and placed in what he called in a disparaging manner 'a home.'"
When I spoke today to Yvonne Clark, the excellent chief executive of Carers in Bedfordshire, she reiterated that that fear about loss of control was of major concern to people. We have dealt with that a little bit today, or I think we have, in terms of what the policy is, but I am still not quite sure about that. It is important to know how we have got to where we are, and the Minister who winds up will have to clear up the confusion that appeared to exist before half-past 3 and about where we are now.
The Secretary of State almost used the words, "Read my lips-no cash losers." However, that is not what he was saying on
"There seems to be no coherent back story about how it is going to be funded, what the criteria are, how it interfaces with other aspects of the health and social care system, whether the money allocated will be enough, and if it isn't, what is going to be the price paid by other parts of the care budget".
On the same day, the Secretary of State was quoted in The Independent:
"in suggesting benefits could simply disappear. However, he admitted that the Attendance Allowance could be reformed to pay for broader changes in the future. He added that anyone who lost out would be compensated with an 'equivalent level of support'."
If the phrase "Read my lips-no cash losers" was on his mind then and always had been, and if it was never in any doubt, why did he not make it clear to The Independent that there would not be anyone who would be compensated with an "equivalent level of support", because no one would actually lose out? I am not certain that The Independent was contacted to say, "You've got this wrong".
Even if what the Secretary of State says today is now the Government's position, it deals only with today's benefit recipients. All the letters that my hon. Friend read out are a cogent argument about a policy that affects the next generation independently of today's benefit recipients.
My right hon. Friend makes the obvious point, although until today I would maintain that there was still a reasonable element of confusion about exactly who would be affected. I suspect that there probably still is. If what the Secretary of State has announced today was so blindingly obvious, why was it not made clear when the policy was being discussed, just two or three weeks ago? Why have so many people been disturbed about it? It is not simply a question of politicians making something out of it; it could have been squashed at a very early stage, but it was not, and it was not squashed because the Secretary of State had not developed the policy far enough. I submit that what we have extracted from him today was not in his brief this morning.
The Under-Secretary of State for Work and Pensions, Jonathan Shaw, had a similar opportunity to explain what the policy was in his interview with Disability Now. The magazine asked whether older people would be affected adversely if attendance allowance were abolished under a reformed social care system. The Under-Secretary rightly said:
"The amount would be put into a social budget of the local authority and people would receive care services in the way that they might use their Attendance Allowance to pay for that now."
Again, when the concern was raised there was no suggestion whether that would apply now or in the future. It was left hanging. I suggest that there are real concerns about that matter, so my right hon. and hon. Friends are quite right to have tabled a motion that is widely supported and endorsed by agencies outside.
I must admit that if I had been the Secretary of State this morning, I would have ensured that "no cash losers" was written in pretty clear terms, so that we would not have had these exchanges about what an equivalent amount of support means. The door was left wide open, and I suspect that it has been closed at a very late stage during the course of the day. However, we may get further information about that later.
There is concern about why the change is being made. We know about the difficulties in the amounts of money involved, but then we come to a point raised in the letter from my constituent and by my right hon. Friend the Member for Charnwood. It is how services are provided that matters. One reader of Disability Now wrote:
"The Government seems upset that it doesn't know or control how we're using the money, so it wants to give it to councils so everyone can see who gets what and for what."
That concern about the personal element being taken away is widespread, and the fear is that if the Government do not control it, they do not like it.
Neil Bateman, a welfare rights specialist, has written about the discrepancy in the numbers of those who receive social care and those who receive allowances. That can be interpreted in different ways, but he asked:
"really suggesting that over two and half million people would lose these benefits? Would care services be expanded threefold to provide services instead? Fat chance."
He is picking up on that dilemma. It looks as though there is a gap somewhere, and even from what the Secretary has said today, we are not sure how it is going to be closed.
I shall conclude with one last point. The Minister and Steve Webb, who speaks for the Liberal Democrats, asked whether we know where the benefit money is currently applied, which is very important. I maintain that the Department for Work and Pensions does not know, but it ought to before making changes. I say that because of an excellent DWP working paper-working paper 58 of this year-in which a researcher is given this task:
"A research plan is proposed at the end which looks towards a large-scale survey starting in about two years' time...which will provide some answers to the questions at issue".
The planned research programme will look at how disability benefits are spent and used, which is precisely the information people need before introducing a Green Paper, and certainly before a White Paper. The proposal is for three major studies, which is exactly what colleagues have been discussing today. It states:
"Understanding Society is a general purpose panel survey covering 40,000 households...The survey is likely to offer a crude scale of impairment, adequate income and deprivation data, and a wide range of social participation indicators, without focusing on issues of special relevance to disabled people."
That will be supplemented by a
"longitudinal disability survey...a highly specialised disability survey based on screening of an initial sample of 50,000 individuals."
The document goes on to state:
"The Policy Studies Institute has been commissioned by DWP to develop a methodology for measuring take-up of DLA and AA."
It is intended that two of those surveys will start next year, but for the third, which looks at take-up of DLA and AA,
"There is no current timetable".
If the Department acknowledges that it needs and wants information on how those allowances are spent, why do we not have it before working out a new way to subsume them into a benefit? I maintain that this is perhaps not the right time to do that. It is certainly not the right time to worry those who are going to come on to the benefit about its future. That may not be the right way to use it.
I return to how I started, and the letter from my constituent and what Nick Scott said. Giving individual people with disabilities the power to choose gives them the sense that they can do exactly what everyone else can do, without having to make major changes and without being supplicants and dependent on someone else. If a national care service in any way replaces that sense of individual power with the sense that something is being given to people with disabilities, however well intentioned that is, we will be missing something. We will be losing what Nick and the hon. Member for Kingswood have always fought for and what we care about. The Minister could begin to clarify the matter this evening, but I suspect that he will have to go some distance to convince those who are rightly concerned about a possible change for the worse in the way this ratchet has been working for so long.
It is a real pleasure to follow Alistair Burt, who made a reasoned argument. Of course, I accept none of it, but it was done beautifully.
Care of the elderly was my first love when I completed my nurse training and it has continued for many years, because I believe that a society is judged by the way it treats elderly people and by how we prepare for our lives as we grow older and more dependent. That is what this debate is all about, and I very much welcome it. I am relying not on briefing notes from the Library or from my party, nor am I reading out news releases prepared by the Conservative party for its candidates; rather, I relying on the great good sense of my constituents.
In the later part of the summer, I held a consultation with more than 40 individuals, including people from the caring professions, carers and those who are cared for. It was to their comments on disability that I listened. We came together to discuss the White Paper. It was clear in our conversation that those people were not going crazy about benefits or getting upset or anxious. We were having a conversation because the proposals were undergoing consultation. It was a reasonable, adult, mature conversation between a representative of the Government and those who would be most greatly affected by the proposals, and I very much welcomed it. Following our morning's deliberations, we were able to prepare a submission in response to the Green Paper. I hope that our comments will be taken seriously. I am glad that a solution has not already been offered, apart from the assurances, which were given early on-weeks and weeks ago-about the safeguarding of those benefits.
I know that scaremongering is the reason for today's debate, but I am absolutely delighted about it because it has given me the opportunity, as a Member of Parliament, to engage many more people than I thought I would at the beginning of the consultation. I wrote to many people. I have no interest in what happens to me-this is about the future of older people. Whatever happens at the next general election is of no importance compared with what the future may hold for older people. That is why it is important to have this debate without making silly, snidey remarks to each other.
I was interested to hear Mr. Dorrell, because the 60th anniversary of the NHS was a great opportunity to revisit the arguments that were had when the then Labour Government were determined to introduce it. In his very reasonable way, he tried to explain why many of the proposals are unaffordable-that was the gist of his contribution. I only hope that we do not listen to that argument. I believe we have a responsibility to step up to the plate and to tackle what I believe is one of the biggest omissions in care today-bringing together health and social care, and ensuring that we adequately help people as they become infirm and those with disabilities.
I welcome the debate, and I am now able to correspond with many more people. They made some quite interesting suggestions-they are not out of briefing notes or anything else. I have been assured that the benefits are certainly no longer under consideration, but people ask me why the Opposition, who have produced a news release for the next general election, say they are.
I take issue with that. We are talking about a matter of great concern, and our constituents rightly tell us to explain to the Government why we do not believe in wrapping up those benefits and why a national care service, which is a fantastic innovation, is a good idea, but the campaigning has gone on long beyond when those reassurances were made. That brings into question how that whole campaign has been conducted. That brings that campaign into disrepute, and I hope that none of my hon. Friends will support the Opposition motion tonight.
Two constituents of mine, who suffer from severe disabilities themselves, run two excellent groups in Crawley. First is Mrs. Carslake, who runs the Jackdaw club; last weekend the whole club went to Butlins at Bognor, where they had an excellent time-using their DLA to get out and about. The people in that club understand that it is this Government who are committed to their care in the future. The second is Mrs. Kay Turner, whom I visited at home following some concerns that she raised. She runs the GEMMS club, which looks after people with neurological conditions. The members have discussed the Green Paper and the national care service proposal.
Mrs. Turner made an excellent point to me. She said, "I'm not badly off. I was well before I became ill, and the level of care that I have been able to secure through the DLA has ensured that we have a decent life together. We enjoy each other's company and we do not feel as though we are impoverished." We need to protect such people too. Through the empowerment that the DLA has given that couple, she has managed to keep well in herself and to remain active and engaged with many other people.
This is an issue of trust. I have listened carefully to the contributions from Opposition Members and the undeniable stoking up of anxiety to ensure-
The hon. Lady is making an interesting and well considered argument. Does she agree that the fear generated by the draft press release from the Conservative party makes life even tougher for constituents whose lives are already often difficult?
I am grateful for that intervention, and I agree that the press release will make life tougher for people who will be anxious and concerned by it. Those who blindly follow the party lead and stick their name into a press release and put it out without thought or consideration need to think very carefully. I am very much aware that I have the most marginal seat in the country and I am proud of my 37 majority-and I have the tattoo to prove it. If our opponents issue press releases just to stoke up some concern, that is an issue of trust, and those people should reflect on what they are doing.
It seems to me that this campaign began with a deeply held desire to engage with constituents on the future of social care, but it has been turned into a bandwagon campaign, and that may have something to do with the fact that the Opposition proposal-hastily put together at the party conference-for a one-off payment for those willing to go into residential care, has bombed. There is no question about that. None of my constituents is talking about that proposal-the only game in town is about how we can provide care at home for family members. It is not about people who are well at present signing up to go into a nursing home in the future. There is a connection between those two events that has caused the Conservatives to jump on this bandwagon.
I hope that when we have the Second Reading of the Bill that will be the first step towards the national care service, our constituents will understand that they can trust the proposals and their benefits will not be affected. We need to have a proper debate, as many hon. Members have said today. We cannot go on avoiding the issue of providing care for elderly people with dignity and decency. I hope that after this robust debate today we will be able to make progress and look in detail at how we ensure that everybody can be confident that they will be able to live in a decent, happy and secure home in the future.
The reason for today's debate is the Government's failure to be entirely clear about how they will fund their three proposed options for a national care service in their Green Paper. My hon. Friend Justine Greening pointed out that all of us-at least on this side of the House-have been victims of smear campaigns in elections that we have fought, whether in relation to TV licences, pensions or Sure Start, and now this issue. Our campaign is not a smear campaign and I agree with those hon. Members who have said that the subject is far more serious than that. We should treat it with the respect that it deserves.
If the Government think that they can achieve something in their last six months, let us take them at their word. Let us have that debate on behalf of our vulnerable constituents. Let us proceed with caution, but also with clarity. We need a debate that contains costs and decisions-I hate to break that news to Labour Members. I hope that when he sums up the Minister will answer the question posed by my right hon. Friend Mrs. May about cash benefits. She asked whether, if there are to be no cash losers, the benefits will be available to be spent as people want to spend them.
That is good to know. Earlier, the Secretary of State seemed to be having a Bill Clinton moment, in which we were not sure what the meaning of "is" was, or a Lewis Carroll moment in which the words were to mean what he said they were to mean. Perhaps instead it is one of those irregular verbs from a comedy programme that we all know and love, in which the Minister proposes a policy, we scrutinise it and the people outside think that the Government are in chaos. I would not want anybody to think that.
People receive attendance allowance or DLA because they need it. Many of us have pointed out that those benefits are based on need, not means, and that is an important point. Age Concern, which does great work in Norwich and Norfolk as a whole, as it does across the country, supports those benefits because they help older people to meet the daily living costs of disability. There is no question in anybody's mind that these benefits are undeserved or that they should be tossed around as discretionary options. In fact, they are essential to anybody's idea of social justice.
People in my constituency use those benefits for vital daily activities, such as assistance with washing, dressing or eating. They use them to carry on life in an enjoyable and meaningful way, and we all agree about that-the Minister nods again. A younger constituent came to my surgery on Saturday: he is totally blind, and he uses DLA to get around the city. He is another example of those who use it for enabling activities.
I recently met with carers and I hosted a web chat on Friday for a forum called Chill 4 Us. I spoke online with carers who, day in and day out, give up their time to care for others. Their passion on this issue was clear and powerful. None of them wants to lose DLA and AA because they need and appreciate them greatly as cash benefits. Sadly, however, I got the impression that the only chance they have to say that is through such virtual forums-we were there tapping away. That is one of the difficulties in this debate. It can be very constricting for people who need us to take the subject seriously and treat it with respect and maturity. Quite simply, living with the kind of care needs for which DLA and AA cater is hard and can be expensive. They are needs-based benefits. It is one small piece of help that society can give, so it should hardly be controversial to say, "Let's not abolish something that the elderly, disabled or ill need and value."
I want to highlight the vulnerability that comes with such need. Fooling around with such benefits carries a weighty risk. A younger constituent aged, say, 35 might be able to plan for the future if changes are made to the system now. Many today have mentioned the needs of the future cohort; from what Ministers have said, it seems that today's cohort might be fine. However, the many people who receive DLA or AA after 65 might be less able to accommodate change. In many cases, they have made financial choices for their retirement that leave them and their families little room for manoeuvre. In other cases, people are already living on precarious means-we have heard plenty of figures today-and the abolition, if enacted, could represent a loss of up to £60 a week. That would be serious in many cases.
Some recipients of DLA and AA are physically ill or disabled, and their lives could become severely restricted without that assistance. People suffering from dementia or other mental illnesses, too, are particularly vulnerable to change. Making any changes that affect those social groups is difficult and complex. Getting the change right is paramount, and of course we are all taking that seriously today. However, debating the changes without causing immense anxiety is another thing entirely. The uncertainty generated by the Government's proposals in July's Green Paper has caused enormous concern and distress for people who are already vulnerable. Many Members have recounted what they have heard in their constituencies.
Forgive me for saying this, but it is incumbent on the Government to exercise caution and clarity in their approach. We also need flexibility and personal and local control at the end of whatever proposal emerges. I am sure that no one has an argument with a system that aims to be fair, simple and affordable. That is wonderful. However, we have serious concerns about a system that removes or reduces older people's ability to choose what to do. Choice and control must shine through any reforms that we make to the care system.
By choice and control, we mean the support that people need to choose how they overcome their concerns in their own way. Abolishing AA and DLA is a serious risk to such individual control. I would like a Minister to explain the paradox clearly. If the wording that has rather tortuously been made available still leaves open the option of abolishing AA and DLA, we need to know why the Government think that that maintains choice and control for individuals. That question is still on the table.
I would also like Ministers to explain, even after today's twists and turns, a policy that seeks to reallocate a cash benefit that grant money to people who need it and allows them spend it how they want, and to add it instead to a nationalised system that could simply eat it up through the weight of bureaucracy.
Quite right, as my hon. Friend says.
Let us turn to the ground on which the Government might like the debate to take place. If there are to be no cash losers, why are we talking about abolishing two benefits-or not abolishing them; I may have to grant the Minister that, although I do not think that he is guaranteeing not to abolish them-and replacing them with the same? If there will be no cash losers, and some cash winners or cash neutrals, at the end of the process, why are we having much of this debate at all? That key question, too, is still on the table.
The Green Paper appears to contain a further argument that the aim is to reduce complexity for older people by merging funding streams. The paper states:
"Having two different funding streams means that older people have to apply separately", which can be off-putting. The Green Paper states that there is a case for integrating those streams
"to improve the effectiveness of state funding."
I would like the Minister to explain what kind of state funding can be more effective than meeting the rawest needs of people in a way that gives them power over their own solutions.
I would also like the Minister to acknowledge that, by his own argument for reducing complexity, there is so much more to do to help not only that group of people, but the millions in the UK who despair of ever getting what they deserve from the state. I am talking about the country we live in, where almost daily in the past 12 years, we have had application forms, means tests, quangos, queues and hoops added to every conceivable aspect of the public sector. It is no wonder that we are talking again about a group of people who are vulnerable to change and worried about more burdens being added as they simply try to get on with what they want to do.
To make a constructive point, it is essential to provide good information to people in any new care system. I shall mention one local example. Norwich has several day care centres provided by the local authority. I am sad that the Secretary of State is not here to hear this point, because judging by something he said earlier, I think he knows about it. He will also know that Norfolk county council is consulting on its options and he may know that I, as a local MP, will be standing up for my constituents on those options, rather than playing party politics.
The local authority is facing ever less funding in future, in a period of a staggering national deficit, and a move to personalised budgets. Under the pressure of at least two burdens from national Government, therefore, the council is seeking to focus its limited means on those who need its help the most. In particular, we are talking about dementia needs and so-called re-ablement requirements. Most people have no problem with that. The rub has come as the council has reviewed against its projected future requirements the usage of three day care centres that it runs. The elderly members of at least one of those facilities-the Silver Rooms-in my constituency are extremely anxious about their future. They are frail and some have physical and mental disabilities.
I raise that example not only because, if local facilities are to close, losing AA would in many cases be a double blow for those people, but because their plight illustrates particularly well why a national care service would do well to excel in the provision of good information. If the personalisation of care budgets moves from being a twinkle in a planner's eye to a fully workable, local scheme, my constituents will need to know where they can spend their money. That remains true in a world with or without AA and DLA, and with or without any of the options provided in a national care service. My constituents will want the comfort of knowing that, with their personal budget in hand, their day centre, or whatever they choose to spend their future benefits on, will still be open for business. If a national care service can provide such information and support, that is wonderful. However, if it cannot and only succeeds in removing cash benefits that might be seen as an effective forerunner to personal budgets and gobbling them up in a monster of a scheme that provides no improvement, we really are in trouble.
I emphasise the gravity of getting this right. It is clear that reform of social care is greatly needed. My right hon. Friend Mr. Dorrell referred to the Wanless report. Others will be familiar with the statistics on exactly what we will be facing in 10, 20 or 40 years, when perhaps even I will be retiring. Perhaps more shocking, in a survey conducted by the Department of Health in July, I understand that more than half of those asked thought that the total cost of a residential care home for an elderly person would be £10,000 or less and that more than a quarter assumed that it would be free, so in addition to the demographic bomb going off, we are also battling a problem of public information. People need that information. Any proposals in the Green Paper will not be implemented until 2014, which should give us time to pin down the Secretary of State to some clear language. The Government must act now to alert people to that bomb.
Given that so many people rightly fear for the future of social care and are vulnerable to changes in the system, I want answers to some questions in addition to those put so ably by my hon. Friends. Why would the Government seek to remove an obvious area of stability, in the shape of AA and DLA, for vulnerable people? Why would we seek to abolish the only area of clarity for many people in the care system at present? Why would we do away with a cash benefit that goes where it is most needed? We need a clear definition of "no cash losers". Why would we seek to reduce people's independence and open the door to an unwieldy and ever larger bureaucracy? Finally, before they talk about the serpentine amendments that we have seen today-or afterwards, or indeed during that discussion-will the Government give the proposals in their Green Paper the gravity and maturity of decision that they deserve? Will they be able to emerge from all that and talk about social justice on the other side?
I want to concentrate on the proposal to abolish attendance allowance, apparently now only for new claimants, and disability living allowance for the over-65s. As we know, that would affect 2.4 million vulnerable pensioners, including 1.6 million who currently claim attendance allowance and 800,000 over-65s who are on disability living allowance. However, whatever happens to the current claimants, presumably we are talking about higher numbers in future, so those are the minimum numbers at least.
We have received various reassurances from Ministers in recent weeks and months. They have suggested that people will receive similar services, rather than money. Previously, we were told that
"people will be guaranteed an equivalent level of support".-[ Hansard, 19 November 2009; Vol. 501, c. 241.]
One of the problems in this debate is the lack of clarity about the phrase "equivalent level of support", because frankly it can mean absolutely anything to absolutely anyone. Laura Moffatt said that reassurances had been given, but the first reassurances that I heard were given yesterday, at Department for Work and Pensions questions. I am not sure when she thought she had heard reassurances before that.
Quite a lot of concerns have been expressed, not least today, about some of the statements that have been made and the phrases that have been used. The Secretary of State said that the present system was "not sustainable" and that the cost could rise by 50 per cent. A number of hon. Members, including Mrs. McGuire, have talked about a demographic time bomb, which Chloe Smith also mentioned. I feel that those statements are slightly over the top, because the reality is that we, as a Parliament, and the Government need to set priorities. The question is: what priorities are they to be? If we are saying that the present pot of money that looks after the elderly and vulnerable will continue to be the same pot, despite an increasing number in those groups, I would very much question whether that is the right priority.
Yesterday we received clarification that those already receiving the benefits in question would get
"the same level of cash support."-[ Hansard, 7 December 2009; Vol. 502, c. 6.]
The Secretary of State said today that he had "said it all along" and that there would be no cash losers. However, to reiterate what other Members have said, we did not really hear that, and it might have been helpful if he had said it a bit earlier. Although that statement seems to be reassuring, it still leaves new folk looking ahead and wondering what will happen if they do not receive attendance allowance in future. That seems to go in the opposite direction from the Welfare Reform Act 2009, in which I was involved in the Public Bill Committee. Great play was made of the right to control and all parties agreed on that.
I would like to make a number of points. The first is that attendance allowance and DLA do a lot of good. I should like to quote again-I have quoted from this before-from a paper that I received from SAMH-the Scottish Association for Mental Health. What SAMH says is probably typical of what a lot of similar groups would say. SAMH refers to the 194,000 people of working age in Scotland and the 145,000 over-65s who receive attendance allowance and to the 110,000 older people who receive DLA. The advantages that SAMH quotes are similar to those that we have heard about already this evening:
"For example, people with mental health problems can experience much smaller social networks and can feel isolated and alone. Anxiety may mean that a person feels unable to leave their home by themselves. People can choose to use their DLA to use a taxi to access social activities and cover the costs of an informal carer to provide the additional support and assistance needed. Without this additional support the person could experience greater anxiety and social isolation, increasing the potential of a period of hospitalisation or more intensive and costly community support."
SAMH also says:
"Disability benefits and free personal care enable older people in Scotland to remain independent in the community, providing older people with a personal budget to help with their care and support needs. This could include covering the costs of a friend or family member coming to the home in the morning to help the person get out of bed, prepare meals or do shopping and cleaning. Any changes to disability benefits could affect the provision of this care and support and result in an older person needing more costly forms of social care in the home, or lead to a person moving into residential care if they were not able to manage their household."
It has been said before, but it is worth re-emphasising, that much of the present system involves unpaid carers, of whom we hear a lot, and that the danger of just transferring even the same money to local authority or to any other control is that we will get less of a service.
I enjoyed being involved in the Public Bill Committee on the Welfare Reform Act 2009, in which other Members who are present were also involved. It is worth quoting again from the then Bill and from a clause in the part dealing with the right to control. It said:
"The purpose of this Part is to enable disabled people aged 18 or over to exercise greater choice"- not the present choice, but greater choice-
"in relation to, and greater control over, the way in which relevant services (as defined by section 31) are provided to or for them"
The Government seemed to be saying-and I agree with them-that they wanted to move in the direction of individuals having greater control over the services. However, what we are seeing now is a move towards less control. Nobody has explained to me-perhaps the Minister could explain this evening-exactly how those two things are meant to relate to each other.
Previously I asked-and would like to ask again-what would happen to the money in Scotland, Wales and Northern Ireland. Will it be handed over as a lump sum? Will attendance allowance be based on need or will it be based on the Barnett formula? Will it be open to the devolved Governments to continue with attendance allowance in Scotland and Wales, even when it is eventually phased out in England? I did not quite hear the Secretary of State's earlier answer, but if I understood him correctly, he said that he would brief the devolved Governments. I hope that he would go a little further than just briefing them and enter into a consultation with them on how the proposals might work out.
We have received the assurance that only new claimants will be affected, but that leaves a number of questions about the future. Who will be paying for the protection? Will the money go through the local authority or will it be transitionally protected under the social security system? Will it affect local authority budgets, and what happens if local authorities cannot or will not pay? Is the money inflation proof, or will it not be increased each year in line with inflation and thus gradually reduced in real terms? If that is good enough for existing recipients, why should other disabled elderly people not receive at least the same? We will end up with a two-tier system, and potentially for quite a long time.
What happens to people on the middle or high rate of DLA if they reach 65 after the new system is in place? Will they be protected or will they lose the benefit when they reach 65? The current protection appears to affect those on benefit at the time of change, not afterwards, but if so many people are to be protected, what is the point? Should we not continue with something much closer to the present system? What would the impact be on carer's allowance? It is not particularly generous at the moment, at £53.10, but if it is abolished, what will happen to someone who looks after a person who receives attendance allowance or DLA at the higher or middle rate? Similarly, will there be an impact on pension credit?
Locally, the Labour campaign against me often refers to how often I might vote with the Conservatives, but sometimes it forgets to say that, very occasionally, the Conservatives are right and the Labour party is wrong. I must admit that, in this particular debate, I remain suspicious of the Conservatives' motives. I am suspicious of what they might cut instead, if they are going to protect these benefits. However, it is hard to say that Labour has not moved further to the right of the Conservatives on this issue.
The Government have rightly given undertakings about DLA for the under-65s, and, yesterday, new reassurances that those receiving cash will continue to do so. I suggest, however, that it was cynical to get people this worried in the first place, and then apparently to give ground. In the longer term, how can it be right to change the system to give future claimants less control over their benefits?
I was enjoying the speech made by John Mason, until that last bit. He can rest assured that he can vote with us; he does not have to convince himself that we are right, but he can be absolutely certain that the Government are wrong. It was also a delight almost to follow my hon. Friend Chloe Smith, who demonstrated in her thoughtful speech her clear understanding of and care for her constituents.
My hon. Friend Mr. Lansley set out our case comprehensively and-despite what the Secretary of State said-in a measured, thoughtful way. He exposed the weakness of the Government's case. My right hon. Friend Mr. Dorrell, a former Health Secretary, made a thoughtful and typically well-informed speech that raised a number of important questions.
This debate has exposed a Government who are in disarray and running scared on this issue. The Secretary of State-wherever he happens to be-has today effectively holed his own Green Paper below the water line. We did not think that it held the answers anyway, so, from our point of view, that is welcome, but he has effectively destroyed it. He changed the language today. Up until this morning, when the Government's amendment to the motion repeated the words
"would continue to receive an equivalent level of support",
Ministers had stuck doggedly to that language-not that anyone knew what it meant. Many interpreted it to mean that benefits such as attendance allowance and disability living allowance for those over the age of 65 would be taken away and put into a social care system, leading to less control and independence.
Despite what the Secretary of State said, those concerns were not got up by the Opposition; 105 MPs of all parties have signed early-day motion 1, including 39 Labour Members. I think that I heard Roger Berry correctly when he said that, despite having signed that early-day motion, he was going to vote against exactly the same wording on today's Order Paper, purely because today's motion had been tabled by us. He has a good reputation on these issues, and I think that he let himself down in making that argument.
That was not the reason that I gave. I was angry at the way in which the Opposition have scared a number of elderly and disabled people by making the untrue statement that the Government had already made their decision. They have not, and to say that they have is not worthy of support from anyone.
The hon. Gentleman's intervention is inaccurate. He knows that, outside the House, every single organisation representing disabled people has opposed taking away these national disability benefits. He said that himself. These concerns were not got up by the Opposition. My hon. Friend the Member for South Cambridgeshire quoted the Disability Alliance's survey, which had asked its members whether attendance allowance and other benefits should be taken away, and found that 93 per cent. said no. RADAR, a pan-disability organisation, said:
"RADAR is adamant no one is getting their mitts on vital extra-cost benefits. These benefits are to help meet a wide range of extra costs, not just care, but extra heating, laundry and so on. Take them away and people would lose choice, control and independence and more people would fall into poverty."
There is an almost infinite list of quotes such as that, but I will read out just one more. Leonard Cheshire Disability says that its policy on this issue is that
Those concerns are shared not only by Members on both sides of the House but by all those organisations, so to pretend that they have somehow been got up by the Opposition as part of a scaremongering campaign-
No, I will not give way again. You got it wrong the first time.
What did we hear today from the Secretary of State? As my hon. Friend Alistair Burt said, he effectively said "Read my lips-no cash losers". Some might think that that was all well and good, but there is a problem for the Government. What the Secretary of State-who still has not turned up for the winding-up speeches-said today is not compatible with the amendment that his party tabled to our motion this morning. It is actually closer to our motion than to the amendment. It is also contradicted on a number of occasions by his own Green Paper.
There are three options on page 95 of the Green Paper, which the Government say are their favoured options. They are the partnership model, the insurance model and the comprehensive model. They all use disability benefits to extend care to those who do not get it now. The Secretary of State's saying today that there would effectively be no cash losers rules out all the Government's preferred options in the Green Paper.
On page 61, the Green Paper talks about extending the system so that everyone gets some help. It says that
"we want to consider the different ways in which this could be funded, including through integrating funding from the social care and benefits systems."
That is incompatible with giving everyone who currently gets those benefits the same amount of cash as they are getting now, so that there would be no cash losers.
On page 98, the Green Paper states:
"We want to use the money that is in the system to make sure that everyone who qualifies for care and support will get some help with paying for their care."
However, if care is to be extended to those who do not currently get it, the money will have to come from within the system, which means that it will have to come from those disability benefits. If the Secretary of State is now ruling out touching those benefits, he is ruling out this proposal in the Green Paper. Given that some people are not getting care at the moment, the costs will have to go up. If there are to be no cash losers, that will simply not add up.
On page 103, the Green Paper refers to the King's Fund report, and says that
"if the social care system were able to mostly meet the care needs of people who may currently only be supported through the disability benefits system, there would be less need for some of these benefits, and there might be a case for integrating some disability benefits such as Attendance Allowance into the care and support system."
That is exactly what the Government were proposing, but it is not what the Secretary of State said this afternoon.
On page 104, the Green Paper says:
"We can use the taxpayers' money that is already in the system to provide everyone with some care."
As my hon. Friend the Member for South Cambridgeshire pointed out, page 109 of the Green Paper makes it clear that there will be more people getting social care funding under the national care service than at present. According to the Green Paper, the only place that the money can come from is those disability benefits, as the Government have ruled out funding the increased spending from taxation, which I know is the favoured system of hon. Member for Kingswood.
So the Secretary of State cannot have it both ways. If there are to be no cash losers, this Green Paper is not worth the paper it is printed on. Page 114-Members, especially Labour Members, will be pleased to know that this is the last quote-states:
"The state would put in existing funding from taxes which are used for social care and any disability benefits that were integrated, and would use this to support the costs of everyone's care."
That is not about ensuring that there are no cash losers, or that people could have the money and spend how they wanted to, on supporting their independence and choice; it is about using the money to support the cost of everyone's care. That is clear. None of the preferred options can be reconciled with what the Secretary of State said this afternoon.
My right hon. Friend Mrs. May, the shadow Secretary of State for Work and Pensions, asked an important question. If it is true that there are to be no cash losers, and that people will be able to keep the money, will they be able to spend it as they choose-as they can now-on supporting their independence and choice and enabling them to live the life that they want to live? The Secretary of State, who still is not here, could not-or would not-answer that question. So will the Minister tell us whether people will be able to spend that money as freely as they can now?
The Secretary of State made a point of quoting my right hon. Friend Mr. Cameron, and he was quite right. We support what the Government want to do on extending personalisation. Indeed, the Welfare Reform Bill allows social care funding to be integrated into the right to control only because we pressed for that in this House, although we were opposed by the Government- [ Interruption. ] The Secretary of State has finally joined us. Conservatives in the other place, together with Liberal Democrats and Cross-Bench peers, put together a majority which meant that the Government were forced to table their own amendments, with cross-party support, to do the opposite of what they were going to do when the Bill was in Committee in this House. If anyone looks at the record, they can see that that is exactly right; it is very clear.
The question for the Minister to answer is why until today the Government were sticking to the line that people would be given "an equivalent level of support", which is what it says in the Government amendment, and only now that the Secretary of State effectively said, "Read my lips-no cash losers." As I have comprehensively demonstrated, what the Secretary of State said this afternoon cannot be reconciled with what is in his social care Green Paper; he has effectively holed it below the water line. The Minister needs to answer those questions. He may not wish to answer the Opposition, but he needs to answer his own colleagues, particularly those who signed early-day motion 1. He also needs to answer respected Members of all parties and all those organisations outside the House that are very concerned about the Government's plans. Will he set out just what Government policy now is-what it was this morning, what it was at 4.06 pm when the Secretary of State appeared to change it from the Dispatch Box, which I would like the Minister to confirm, and what it is now? I commend the motion to the House; we look forward with interest to hearing the Minister's defence.
This has been an important debate about what many Members have described as a policy that affects every member of our community. It is one of the most difficult issues we need to grasp, not least because, as we all know, we are living longer. In the next 25 years, the number of 85-year-olds will double, the number of people reaching 100 years will quadruple and the ratio of people in work to people in retirement, as my right hon. Friend Mrs. McGuire said, will become 2:1 rather than 4:1 as it is at present. We thus need a debate about how we shape a new national care service that will meet the demands within our communities and meet the higher expectations people quite rightly have in 2009.
People are rightly no longer willing to be just passive recipients of what they are told is good for them. They want to be involved, they want to be consulted and they want to help shape the future. That is why the Government have set out in the Green Paper the available options so that we can have the big care debate. We have had some 40 formal big care debates and I know that hon. Members have had them in their communities, and we thank them for the contributions they have sent to the Department. I have certainly spoken to a great many people as I have travelled around the country.
We have said clearly that no one currently in receipt of attendance allowance or disability living allowance at the time of reform would be a cash loser. It is also important that alongside these reforms, as referred to by a number of hon. Members, we plan to provide greater power for people to control the public funds that we make available to them from the various funding streams. Within the "right to control" legislation in the Welfare Reform Act 2007, we made provision to cover access to work, the disabled facilities grant, the independent living fund, supported employment and, of course, as Mr. Harper mentioned, adult social care.
I acknowledge that the hon. Gentleman put forward amendments in the debate on the Welfare Reform Bill and that I opposed them. We then had a mature and wider debate in the House of Lords- [Interruption.] If I am to accept the point the hon. Gentleman made in good faith, I hope that we can think about how we should frame this discussion. We are all talking about having a mature debate, so I accept that I opposed that amendment and I accept that in the debate in the other place, the amendment was put forward by my noble Friend Lord McKenzie of Luton and by Baroness Campbell of Surbiton, who commands respect throughout Parliament. She said that the changes we made to accept adult social care were done through co-production and she welcomed the way in which all parties had worked together. That is how we need to approach this issue rather than in the disappointing way in which the hon. Member for Forest of Dean chose to present it on this occasion. He normally does a lot better than that.
In that spirit of reconciliation and unity of purpose, will the Minister explain why he hopes that the 39 signatories to early-day motion 1 will vote against exactly the same motion in a few minutes' time?
I am sure that my colleagues will listen closely to my arguments. The hon. Gentleman mentions the early-day motion, and it is interesting to note that Conservative Members laid great store by it. They have followed Bob Russell in that respect, yet despite that great store, only a paltry 16 of them could bring themselves to sign it until recently, as my hon. Friend Roger Berry quite rightly pointed out.
To return to the point I was making about the benefit streams and adult social care, what distinguishes them is that some are national and some are local; some are national means-tested and some local means-tested. It is our ambition to bring all of those within the ambit of allowing people to choose to spend how they want. A number of hon. Members characterised social care from the local authority as a very constrained way of allowing such flexibility, but I would say that they should find out what people are doing with direct payments from social care.
Let me give hon. Members an example. I recently attended a Mind event where a lady said that she had received direct payments as part of her individual budget. She had a mental health condition and she was using that resource to pay for dance classes, which were not organised by the local authority. By using that money, she found a new way of socialising, she learned to dance and it provided her a springboard on which to find her way back into work. She certainly will be able to continue to have such classes in the future, and I say that clearly-
I will answer the hon. Gentleman's point, if he will allow me. This is an important issue about the transitional arrangements, which several hon. Members raised. Existing claimants of AA and DLA will continue to have the flexibility to spend the resource as they wish. The other important point is that we are providing flexibility in terms of a number of different budget headings for the same reasons that a number of hon. Members put forward to explain why AA and DLA are a good thing. That is happening. Saying that the provision of those resources is "constrained" and characterising it as such is wrong.
May I also say that one of the-
No, I will not give way to the right hon. Gentleman for the moment, because I want to address some important points that were put to me.
I am still not sure that the Minister has answered the question put earlier by my right hon. Friend. He knows that with individual budgets, people cannot spend the money entirely how they want because they have to agree that the spending will meet their care needs. At the moment, DLA and AA can be spent on anything they want, with a completely free choice, so will the Minister confirm that all the money people receive under the new system can be spent exactly how they choose to spend it?
During the transitional arrangements, people in receipt of AA and DLA will, when it comes from the local authority, have that cash sum as well as their flexibility protected-along the lines that hon. Ladies and Gentlemen are inquiring about. I hope that I have now satisfied them on that point.
I did not say that at all. I was referring to the flexibility with which people could spend the resources available to them.
Let me respond to some of the points that have been made. Steve Webb made a thoughtful speech exposing the cynicism with which the Conservative party has been scaremongering around the country with press releases. He also asked important questions about arrangements for the work force. We shall need to address ourselves to some of those details in the White Paper, especially the relationship between disability living allowance and attendance allowance and other benefits. Other Members also mentioned the work force. We have seen progress since the Care Standards Act 2000. At the time of its introduction, 80 per cent. of the 1 million or so work force had no qualifications. We have increased the number of people with qualifications by 20 per cent.
The hon. Member for Northavon referred to carer's allowance in particular. We have been working with carers as well. Many want to work, but find the benefits system confusing. That is why organisations such as the Princess Royal Trust for Carers and Carers UK have welcomed the work of our care partnership managers in Jobcentre Plus. About £20 million has been invested to ensure that they combine all the support mechanisms, ensuring that there is good information for carers so that they can join the labour market.
I am grateful to the Minister. Can he confirm that those whose full social care needs are met by local authorities will also continue to receive their attendance allowance and disability living allowance? Will those allowances be fully protected?
Yes, they will.
My right hon. Friend the Member for Stirling rightly referred to the scaremongering of Conservative Members. She spoke of the need to secure for a consensus of the kind that we secured for pension reform, and I hope that that happens. We saw the beginnings of it in the debate. The right hon. Member for Charnwood spoke of the need for reform, but did not refer to the need to pay for it.
Along with a number of other Members, I set out the issues relating to a changing demography. We need to find the necessary resources. We have included in the Green Paper options that would provide far more support for care than is provided at present. The current system involves ever more constraint, and if we continue as we are, the constraint and means-testing will continue to increase. Our proposals provide some solutions that can be debated throughout the country.
Opposition Members asked about devolution. Of course it is right for us to have discussions with the Scottish and Welsh Assembly Governments. Any settlement under the new system will have to take account of social care and health, which are devolved matters.
I perceived a lack of support for local authorities. I think that they do a very good job, but it was only my hon. Friend the Member for Kingswood who talked of the good work that they do. We often characterise all local authorities by highlighting poor performance. That is why we need a national care service. Disabled people's organisations that support such a service speak of the difference in service from one town to another. They have drawn attention to the need for portability, which does not currently exist, and the struggle that they have to undertake to obtain services. They do not want to have to jump through such hoops again. Our proposals give them the opportunity that they want.
Alistair Burt, a former Minister for disabled people, mentioned Nick Scott. I have heard kind words said about Nick Scott during my travels around the country. The hon. Gentleman will know, however, that next year will mark the 40th anniversary of the Chronically Sick and Disabled Persons Act 1970-the first legislation introduced to provide rights and services for disabled people not just in this country but anywhere in the world-and that that is thanks to the first Minister for disabled people, Lord Morris.
The hon. Gentleman was right to observe that as time has gone on, we have given people more choice and control so that they can be the architects of the support that they receive. Adult social care is an important component of people's independence, which is why we need it to be more available rather than perpetuating the present constraint.
My hon. Friend Laura Moffatt, who brought her professional knowledge to the debate, had held consultations in her constituency. As I have found in my travels around the country, it is interesting to sit down and engage in a calm and clear debate, helping people to understand the demographic issues that the country faces and the need to find solutions.
Chloe Smith made a measured contribution to the debate. She talked of the need for flexibility, and I agreed with what she said. She talked of meeting someone in her constituency who was blind. She will know that the Government have accepted an amendment from my hon. Friend John Robertson which will increase disability living allowance for totally blind people from 2011.
John Mason said that he did not trust the Tories. In 1979, the Tories made no reference to the fact that they would cut pensions when they got into power. I think that buyers will need to be extremely wary. We have heard very little from those on the Tory Front Bench, or indeed from the Tories in general, about what they expect from a future social care system. We have heard nothing about domiciliary care. We have heard some half-baked ideas about residential care, which fell apart from one day to the next and did not stand up to even the slightest scrutiny. Mr. Lansley smiles, but I think that even he acknowledges that.
What did the Tories give pensioners? They gave them 18 months in which to wait for an operation, whereas our party gave them a maximum of 18 weeks. They produced pensioner poverty, whereas our party produced pension credit. We provided bus passes, but all that we have seen from the Tory party is cynicism and scaremongering. They have focused-as they prefer to-on the 3,000 richest estates for which they want to provide tax cuts. I urge my right hon. and hon. Friends to vote for the amendment.
claimed to move the c losure (
Question put forthwith, That the Question be now put.
Question agreed to.
Question put accordingly (
The House proceeded to a Division.
Question accordingly negatived.
Question put forthwith (
Question agreed to.
The Deputy Speaker declared the main Question, as amended, to be agreed to (
That this House welcomes the Government's proposals to create the National Care Service, the first national, universal, entitlement-based system for care and support in England; notes that the proposals will deliver real benefits to people including wider provision of prevention services, a single needs assessment across England and information, guidance and advice for all; recognises that in 20 years' time, 1.5 million more people will have care and support needs, whilst the number of people aged over 85 will have doubled; further notes that around 400,000 people will benefit from enactment of the Personal Care at Home Bill, which contains no proposed changes to disability benefits; acknowledges that the Government is considering responses to the Big Care Debate consultation before any decisions are made between a range of options for the National Care Service; understands that changes to disability living allowance for under-65s as part of the introduction of a National Care Service have been ruled out; and welcomes the reassurance that, if disability benefits for older people were to be reformed as part of the National Care Service, those receiving the affected benefits at the time of reform would continue to receive an equivalent level of support.