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Social Care

Part of the debate – in the House of Commons at 5:13 pm on 25th February 2020.

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Photo of Anne Marie Morris Anne Marie Morris Conservative, Newton Abbot 5:13 pm, 25th February 2020

Thank you very much, Mr Deputy Speaker.

Devon is a wonderful place for people to come and retire, and as a consequence we have many older people. According to Age UK, we have 39,853 individuals over 65 who have unmet social care needs, and in my own constituency the figure is 3,614. We know that there is a problem. It is not just in my constituency, and it is not just in Devon. I think that there is already a strong chord of agreement in the House that this is no longer about talking, but about action.

Those listening will expect us to act for them. They will not expect us to get involved in political wrangles. We have already had political wrangles over Brexit, and look where that got us: three years of inactivity. This Government have a majority, and with that comes a responsibility to finally resolve this social care problem. We have to find a solution. No more reports. No more royal commissions. We have had Sutherland, Wanless and Dilnot, and no Government who commissioned any of those reports have accepted all their recommendations. What would be the point of another one? The Care Act 2014 was a great start, but part two has not been implemented. Frankly, I do not think it ever will be. The reason? It is not affordable. Certainly, how we would afford it has not been thought through.

What is the barrier to all this? Why do Governments of every colour fail to deliver? First, there is a reluctance to ’fess up and actually admit how much this is going to cost. Secondly, there is disagreement across the House as to exactly how that cost can be met. We have already seen examples of that in the contributions today. Even if we could agree, there are other things that need to be sorted out, as my hon. Friend Jackie Doyle-Price mentioned. We need to agree as a nation on the standard of care that should be delivered. We are not there yet. Even LaingBuisson, which has set many of the standards, has not done that.

We need to accept personal responsibility to maintain and improve our own health. We do not yet do that. We need to reduce our own care needs, or at the very least delay them. We need to consider developing community resilience. Families are often widespread, and we need to take responsibility for our neighbours and plan together for our wellbeing. We need to drive forward a wellness and wellbeing agenda, which is much more a public health agenda. Too much time is spent on illness, and not on wellness. We need to change our mindset with regard to old age, and I would certainly recommend reading “Extra Time: 10 lessons for an ageing world” by Camilla Cavendish. Being old does not necessarily mean that we are past it and falling off our perch.

What is the roadmap to change? For me, first, we need to define what “good” looks like to the recipient. Secondly, we need to decide what resources we need to provide that. Thirdly, we must develop a proper training and recruitment plan, and motivate our staff. Fourthly, we need to evaluate the adequacy of the existing infrastructure for care delivery. Do we have the right model? No, I do not think so. The earlier references to housing were well made in that regard. Fifthly, we need to look at integrating not just health and care but the whole IT strategy and housing strategy. There is much more work to be done on that. Sixthly, we must bite the bullet and decide which of the nine funding models—because there are nine—suggested in the various reviews we are going to use. There will be a degree of mix and match, but we have to make a decision.

So, that is for the long term. In the short term, we need a fix, and it is not just about money. We need to ask the Care Quality Commission to set the minimum funding levels that we will expect local government to pay for the care of any client, and central Government should be obligated to pay for that. We must make local authorities accountable for both the quality and quantity of care provided. They are not at the moment, and we know that there is a bit of a postcode lottery. We must make the NHS and local authorities equally and jointly accountable for the health and care delivered in the home and in care settings. That is not the case now. I do not ever want to hear a clinical commissioning group telling me, when it is talking about closing one of my local community care hospitals when we have no nursing care in the area, that it is not the CCG’s problem but the problem of the local authority. That is not acceptable, and it is not responsible.

We also need to put in place a full review of nursing care outside NHS provider institutions, and provide ring-fenced capital funding to deal with it. We need to stop the practice of putting people who should be receiving nursing care into residential care homes. That is not responsible; it is not right for the care home or for the client. We must stop caring for dementia patients in hospitals. That is completely wrong. It is not right for their care and not right for them in the long term. We need to create the right provision.

I am afraid that we also need to increase general taxation and report annually as to how that money, which should be ring-fenced, is being spent. I believe that those who are working should carry on paying national insurance contributions even past retirement. I take the point about the older generation who have retired contributing, and that needs to be taken into account. We should raise the level of personal funds that an individual may keep before they contribute. I think it should be raised to £100,000, and we need to cost that. We need to include more people with lesser care needs in the state-funded system, and, as has been discussed, we need to develop a funding model with the private care sector and the insurance sector that combines personal and state contributions to care costs, looking at compulsory savings and risk-sharing mechanisms.

We have made a promise to the British people, and we must keep it. Now is the time for action. No more talk, no more reports and no more commissions. This is the time for this Government, who have a majority, to deliver.