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17 Jan 2007 : Column 327WH—continued
3.41 pm
Mr. Stephen O'Brien (Eddisbury) (Con):
I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this important and topical debate. He is a tireless campaigner on behalf of his constituents. We regularly hear from him in this Chamber, and he has consistently called the Government to account for the state of social care not only in his county, Shropshire, but across the country. He made a useful reference to the challenge that the Wanless review has set for all of us in political life and to the data that it
published. This is one of the most challenging and known about issues that our political generation have to deal with.
My hon. Friend made a helpful reference to the Sunday Express campaign. Lucy Johnston, one of the journalists in this area, has been working particularly hard. My hon. Friend also covered the rurality and sparsity factor that can affect the provision of residential care. That aspect is notably illustrated by the hon. Members who are taking part in this debate, although it is important to note that some of the most acute problems are also being experienced in inner-city, urban and suburban areas.
I was taken by the compassionate speech made by the right hon. Member for Oxford, East (Mr. Smith). He made good use of the briefing from the Alzheimer’s Society, for which it is to be congratulated. Equally, the speech by my right hon. Friend the Member for North-West Hampshire (Sir George Young) will be one that many will want to return to as this debate unfolds in the coming months and years. He made a compelling case by reference to the local conditions that he encounters in Hampshire, particularly the supply and demand challenges and what is required for the dignity of older people.
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) was able, in his customary trenchant style, to challenge the Minister on a number of areas. Whoever the Government were, we would be calling them to account for the big challenges that now face us all.
This is the second time that the Minister and I have met in Westminster Hall to debate this subject in recent months. That is a mark of its closeness to the hearts of all our constituents, which is unaffected by which party we represent. The Minister was trying to tease out of some of my hon. Friends whether they were articulating party policy while they were standing up to represent their constituents. While we go through a fundamental policy review, it is important to note that the speeches of my right hon. and hon. Friends should all be taken as very worthy submissions to the public services improvement group policy review, co-chaired so ably by the former Secretary of State for Health, my right hon. Friend the Member for Charnwood (Mr. Dorrell), and Baroness Perry, a former chief inspector of schools. I shall certainly forward them a copy of the Official Report of this debate for that purpose.
Long-term care funding is one of the greatest challenges. In the previous debate that I mentioned, which was secured by my hon. Friend the Member for St. Albans (Anne Main), the hon. Member for Romsey (Sandra Gidley), who has of course been able to represent her party again today, branded her party’s policy of so-called free personal care as dishonest—that is not a word normally heard in this Chamber—and effectively suggested that those who write the Liberal Democrat manifestos behave in that way. It was one of the most amazing admissions that I have ever heard in Parliament.
The Minister failed to offer any policy on long-term care funding at that time. The issue has been dodged by the Government. As we know, in 1997, the Prime Minister—then Leader of the Opposition—famously bemoaned the fact that people had to sell their homes to
fund their long-term care. Yet, in power, Labour has failed to introduce any meaningful policy to combat the problem. Moreover, more people are trapped in the blighted situation that the Prime Minister identified, and the threshold has not remotely kept pace with house price inflation in the intervening period, particularly in the areas that are most adversely affected. The Government have not even given a substantive response to the Wanless review of social care.
At the last election, the Conservative party was the only party to offer a real policy of long-term care funding. Labour brazenly promised to
“continue to provide healthcare free in long-term care establishments.”
Health care is NHS care, as everybody knows, and would remain free under the governance of either of the two parties of government on offer in this country.
Mr. Stuart: Is my hon. Friend aware that the closure of beds and community hospitals means that there is an increasing tendency to send patients who are recovering and in need of health care to nursing homes and care homes, where they have to pay for their own recovery? This Government are not even delivering at that basic level.
Mr. O'Brien: The point that my hon. Friend makes only shows the exacerbation of the problem with which we are all seeking to grapple. The Labour manifesto completely failed to address the issues of health and social care costs linked to long-term care. I hope that the Minister will be as candid about those who write his party’s manifesto as the hon. Member for Romsey has been about the people who write her party’s manifesto.
Mr. O'Brien: I think that there is already enough on the record from the hon. Lady.
The only foray that the Labour and Liberal Democrats have made into care funding is the increasingly discredited policy of free personal care that their coalition has introduced in Scotland. I hope that the Minister will take the opportunity to comment on the experience in Scotland, where so much of the provision has been disappointing to say the least. Those who are charged with providing it say that they have not got the money that has been passported for that purpose.
The Government’s failure to solve the problem of the division between health and social care is well documented. The right hon. Member for Darlington (Mr. Milburn) pledged to demolish the “Berlin wall” in 1998, but it took until 2005 for the Minister for Immigration, Citizenship and Nationality, who was then at the Department of Health, to announce a joint White Paper
“designed to deliver integrated health and social care systems”.
That was merged with a health White Paper to produce “Our health, our care, our say”, which contains few substantive measures on closing the gap between health and social care funding. The initiatives that it does suggest are now under threat because of the massive NHS deficits. The temptation to shift costs on
to local authorities has been too hard to resist for many primary care trusts, and the county councils network has expressed grave concern about this area. The impact on Wiltshire county council of the NHS removing £3 million from its income one day before this financial year started was widely reported. In July, the Local Government Association found that seven out of 10 local authorities in areas with an NHS deficit have been affected. It is fair to suggest that the Labour Government have failed to address—let alone solve—the question of how we fund care.
I move on to continuing care funding. During our previous debate I highlighted the shambles in respect of the attitude to NHS continuing care. A new national framework was pledged by the Minister of State, Department for Transport, in December 2004 when he was at the Department of Health. Despite promises that it was due for publication in early 2006, it did not go out to public consultation until June 2006, and the consultation ended on 22 September 2006.
It is worth noting that the Department of Health has a bad habit of holding consultations over the summer months, when people are away. I am sure that the Minister will wish to deny and dispel any idea that such an approach was intended to bury the consultation.
As the right hon. Member for Oxford, East said, the latest national framework newsletter from the Department states that it is currently analysing the contributions received and will publish the Government’s response in due course. It goes on to say that it aims to publish the Government’s response in late 2006 and will publicise the publication via the website and its usual contacts. As it is now 2007, it must be fair to ask the Minister to tell us when the Government will respond and, more pressingly, when the framework will be published. It is now already two years behind schedule.
John Cummings (in the Chair): Order.
Mr. O'Brien: I shall bring my comments to a close, Mr. Cummings, at the end of the slightly shortened time available to me.
It is vital that we have a straight response. We should not overlook the fact that many of the issues tie into the palliative care area, which is also a failed promise in the Labour manifesto. I look forward to the Minister’s response to the challenges faced by all our constituents.
3.50 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate on a public policy issue. I notice that the Conservative party is as split as we are on whether this is a socialist Government, but perhaps we could debate that on another occasion.
I pay tribute to my right hon. Friend the Member for Oxford, East (Mr. Smith), the right hon. Member for North-West Hampshire (Sir George Young) and the hon. Members for Beverley and Holderness (Mr. Stuart) and for Romsey (Sandra Gidley) for trying to engage in some of the serious non-party political points that we must address as we deal with the agenda.
The first point is that older people in this country are entitled to be treated with dignity and respect. They are a generation that worked hard to build this country, and a fundamental sign of a civilised society is the way in which it treats older people. That should unite the House.
My right hon. Friend the Member for Oxford, East referred to the disgraceful report on Merton and Sutton primary care trust and the way in which, at the beginning of the 21st century, people with learning difficulties have been treated in some NHS establishments in that area. We will not tolerate such abuse, non-professionalism and exploitation of people with learning disabilities, and we will certainly take firm action as a consequence of that report. Dignity and respect for older people and also for people with disabilities must be at the heart of a civilised society.
I share the view of hon. Members on both sides of the House that social care needs higher status and greater priority in public policy and debates about the future of this country. I make the point to hon. Members, who did not refer to this, that in the pre-Budget report the Treasury identified social care as one of the great challenges facing this country and one that we have an obligation to address. The Government’s recognition that it is a crucial issue that we must face is an important step forward.
Mr. Stuart: Will the Minister give way?
Mr. Lewis: I will not give way because I do not have enough time. I will try to give way towards the end if I can.
There have been significant major advances with year-on-year, real-terms increases in resources for local government, and improvement in the performance of many adult social services departments, which is a credit to the staff on the front line and the leadership. It is good news that more people are living longer, and that they continue to live in the community rather than in institutions, and consequently have higher quality and fuller lives. However, as hon. Members said, we must face up to real pressures. Demographic challenges are indisputable and undeniable, and we as a society have a responsibility to face up to them. Older people are living longer, and disabled people are living fuller and longer lives. There are also rising expectations in what the public expect from public services and in quality of life.
We welcome the recommendations of Sir Derek Wanless for a sustainable funding model for social care. We do not agree with every detail of his recommendations, but it makes a major contribution to the debate. Wanless rejected the notion of free social care being a desirable or realistic way forward.
We are arguing forcefully—I shall not reveal the details in this debate—with the Treasury about the importance of a good settlement for social care under the comprehensive spending review. Equally important is the need for all politicians, with the public and charitable sector, to engage in a discussion about what a fair new settlement would be for social care and the responsibilities of the state, family members and citizens. We need a new deal to reflect a new settlement
in the demographic realities of the 21st century. We must also be willing to look at reform of social care. It is not just about money. We want more personalised services, and greater control for those who use services and their families, with individual budgets and direct payments. We must do more to raise the status of staff in social care on the front line, and we must look at a greater synergy between the NHS, local government and the voluntary and independent sectors. The hon. Member for Romsey and other hon. Members referred to that.
As my right hon. Friend the Member for Oxford, East said, we must also look at the lessons from the partnerships for older people projects—the POPPS pilots—in which we are focusing resources on preventive, early intervention services in mainstream support for older people to enable them to lead a better quality of life and to make better use of public resources.
I shall not reiterate the points that the hon. Member for Eddisbury (Mr. O'Brien) made about the concession by the hon. Member for Romsey that the Liberal Democrats misled people about free personal care at the general election. That was frankly the most extraordinary admission I have ever heard in the House.
The hon. Member for Shrewsbury and Atcham clearly cares about older people. However, he and his Back-Bench and Front-Bench colleagues are disingenuous about where they stand on the key policy issues concerning older people and their families throughout the country. They are disingenuous because they were the architects of and presided over many of the problems in the current system, and because of the policies that they now advocate in the House. At every opportunity they voted against extra investment for public services and now have an economic policy that would lead to serious cuts in public services.
The hon. Gentleman talked about ring-fencing funding, but the Conservative party says that we should not have ring-fenced pots of money, but should devolve to local level and allow local decision makers to control budgets. He also said that the Government were wrong to prioritise education, and I look forward to him saying that in his election literature at the next general election. Conservative Members want to redirect resources, but they want to redirect them from the poorest and most socially deprived areas to more affluent areas.
The hon. Gentleman said that care services should be free on the NHS, but he knows that much of our debate today was about social care, not NHS care. He said on the one hand that it should be free, and on the other that it is all about thresholds and that he was not advocating free personal care.
The hon. Member for Eddisbury, who speaks for the Conservative party on such issues, questioned the Scottish system and whether it is right. He opposes the Scottish system because it is unrealistically offering free personal care, and it is not working. He is being honest in saying that the Conservative party is not advocating what many commentators and journalists are suggesting—that it should all be free.
Conservative Members oppose service reconfiguration in every community and portray that as cuts, but it is often about redirecting resources from the acute NHS
to investment in social care. The Local Government Association, which is Tory-controlled, said before Christmas that there is enough money in the system, but that it is in the wrong place and that what the Government need to do with local delivery mechanisms is to shift resources from acute NHS care to social care.
All I would say to Conservative Members is that they should engage in an adult and mature debate without misleading people that they are on the side of free, personal care, that they would abolish means testing and that they did not create the current system. They should not imply that, nor that they have not consistently voted against sustained public investment.
On continuing care, Conservative Members are right in saying that we need to clarify the issue as soon as possible; we also need to get it right. We have had ombudsmen’s judgments and court judgments, but it is important when we produce guidance that we get it right so that it creates stability in the system. It is true that on occasions local health organisations have not fulfilled their responsibilities to acknowledge that what is being provided is health, not social, care. We need to ensure that the new guidance reflects that.
Public Infrastructure (London)
4 pm
Mr. Andrew Pelling (Croydon, Central) (Con): I am grateful to Mr. Speaker for his courtesy in granting me the debate, and I thank the Minister for taking time out of her busy diary to respond to it.
At the beginning of every day when I travel to London by public transport, being sufficiently green never to have learned to drive, I come in through Victoria railway station and find many hundreds of my constituents and other commuters waiting outside Victoria underground station. The way that one has to queue to get on to the underground system is a sign that that system is under stress. Further, in the summer, one often travels in temperatures higher than those acceptable for the transportation of live animals in the UK.
Many colleagues think that London is treated far too well in resource terms. I have heard a Member comment in the House that London is a junkie when it comes to the amount of public subsidy and support that it receives from the Government for investment in public transport. I am happy to concede that the Government have been generous in recent years, because in real terms they have at least doubled investment in public transport.
It is important to make the case for further and significant increases in investment in public transport and infrastructure in London. I am keen to obtain from the debate an assurance that the Government understand the points that will be made as the comprehensive spending review is undertaken. Transport for London’s budget and projections have a cut-off point of 2010, and it awaits the results of the CSR.
There has already been a lot of input to the debate on investment in London’s public infrastructure. There has been good work from London First and its publication, “Keeping the UK Competitive”; from the report by the Mayor’s office on investing in London; and from the City of London corporation’s annual report produced by Oxford Economics, “London’s Place in the UK Economy 2006-07”. They all offer good reasons why there should be investment in London’s public infrastructure.
The fundamental point is about the high productivity of London’s economy. Any investment of public funds will secure the highest return on the extra jobs created, because they enjoy the highest productivity rate. There is good value in investing in public infrastructure and in transporting people to those jobs with the highest productivity. Greater London is the only part of the European economy that matches productivity in the United States, and because London has a lower participation rate in its employment market, investors would encounter fewer economic bottlenecks, particularly if extra transport were targeted on London’s deprived areas and combined with effective investment in skills training.
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