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21 Feb 2007 : Column 93WH—continued
First, I shall deal with the contributions by Opposition Members. The hon. Member for Eddisbury
(Mr. O’Brien) always refers to the “failure” of the present Government. Any debate on support for older people must mention the tripling of investment in the national health service and the very generous improvements that have been made. I am referring to the winter fuel allowance, free TV licences, free bus travel and the various other benefits that pensioners get that they were not getting before 1997. The debate also has to be in the context of the public services that we inherited, which, frankly, were a scandal. Older people and vulnerable people disproportionately depend on the quality and range of, and the investment in, public services. We see that if we reflect on what a civilised society is all about.
Therefore, although I accept some of the comments made by hon. Friends, I find it a little difficult to take lectures from the hon. Gentleman. That said, I share his enthusiasm and support for the dedication of people who work in domiciliary care. They work on the front line—at the sharp end—and make a tremendous difference to the quality of many people’s lives.
On the question of direct payments, individual budgets and the “In Control” programme, I have been a great champion of the notion of people power—transferring power from professionals and organisations to those who use services and their families, so that they have control and can shape the services that are being made available to them. We are on the precipice of a radical revolution in the way in which social care is provided. What has happened in the context of direct payments, individual budgets and “In Control” is that much of that has been dealt with from the bottom up; it has been led by the grass roots. There are pioneers out there who are beginning to make that happen. The challenge in the period ahead is to make it the mainstream way in which social care is provided in this country, and we will produce proposals, based on the individual budget pilots, to see how it might be achieved.
Mr. Stephen O’Brien: I accept that the Minister recognises that there has been a bit of a slow start on direct payments, but I hope that he will look at the example of West Sussex, which was drawn to my attention recently, as a great example of where he might be able to accelerate the process.
Mr. Lewis: The hon. Gentleman is right to raise West Sussex. I would add to that Oldham, which is not too far away from his constituency and is doing excellent pioneering work in this field.
The hon. Gentleman referred to the Local Government and Public Involvement in Health Bill. A very important point is that in that Bill, for the first time, we are placing a duty of partnership on primary care trusts with local government. Too often at local level, we are told, the missing partner at the table when it comes to local strategic partnerships and health and well-being in a holistic sense is the local health service. What we have managed to achieve in the Bill—I was heavily involved in that—will make a significant difference, although creating legislation to place on people a duty of co-operation and partnership still requires a willingness at local level for leaders and managers in public services to understand that the best way to achieve their objectives in the modern world is
by co-operating, breaking down organisational boundaries and putting the needs of the local population first.
The hon. Gentleman asked why the provision was in a local government Bill. Frankly, it is because we wanted to get the legislation on the statute book as quickly as possible. There was an option not to include it in the Local Government and Public Involvement in Health Bill. In fact, there was quite a lot of pressure from civil servants not to include it, but the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton), and I wanted to get it on the statute book as a matter of urgency.
The hon. Gentleman must also recognise in the context of the relationship between the NHS and local government that it was only a very short time ago that Christmas pressures were an annual event and bed blocking was normal. That no longer happens in most parts of the country as a result of the relationship between the NHS and local government. In small numbers, it may do, but the notion of an annual crisis and bed blocking as an accepted part of the system has more or less been removed. That is partly a result of the investment that this Government have put in but, to credit people on the ground, it is also a result of much better relationships between local government and the NHS in many areas.
I say gently to the hon. Gentleman that I do not accept the notion of Government cuts. There is a significant debate, to use that term—I shall come to that in a moment—about a shift of resources from hospital-based care to more community-based services. If the Conservative party wishes to go around the country portraying that as cuts, it can, but that is highly irresponsible and disingenuous. In my view, it is extremely misleading for many sections of the population, because any responsible party of government that genuinely believes that more and more people want care closer to home and want to be supported in the community knows that the inevitable consequence of that is a shift of resources from the acute NHS to community-based services. If we are to have debates, let us have mature responsible debates. Let me say very gently to my hon. Friend—or rather the hon. Member for Eddisbury—
Mr. Stephen O’Brien: Stay with “friend.”
Mr. Lewis: If we carry on spending every morning in this Chamber as we have been doing, perhaps we will become honourable friends.
Carers do not like to hear themselves described as a work force, as I think the hon. Gentleman would accept. He referred in his speech to carers as a work force. They are not: they are family members in most cases and sometimes friends. I shall come in a moment to some of the substantive points that he raised about carers.
The hon. Member for Romsey (Sandra Gidley) cares passionately about these issues. She referred to being grumpy in her old age. I think that most Lib Dems will be grumpy in their old age. However, the serious point is that it is all right being decent and honourable, as I believe she is, but politics is about the policies that we put forward and the impression that we give to the
public. My hon. Friend the Member for Stafford (Mr. Kidney) hit the nail on the head: we cannot carry on playing this game with the Liberal Democrats. They no longer claim to believe in free personal care. The hon. Lady said—I have never heard this said in the Chamber before—that she regretted her party misleading the public in the last general election that personal care could be provided on a free basis. She can come out with all the comments and policy suggestions that she likes, but when it comes to testing those policies, the electorate will weigh heavily, at the next election, the suggestion from a Liberal Democrat Front-Bench spokesperson that the Liberal Democrats deliberately misled the British people at the last election.
The hon. Lady said that far more money has been diverted into the NHS. I love the use of that word “diverted”. It is as though it happened by accident and was nothing to do with Labour being elected to government in 1997, our unprecedented level of commitment to the NHS and the near tripling of investment to bring us up to the European average. She said that we have diverted money into the NHS. I ask her to be a little more open about the Government’s clear priority decisions and about where the Liberal Democrats want to put resources.
I am proud that we have chosen to rebuild the health service and much of our public service as a priority by using the benefits of economic growth to invest in the public good. Previous Governments chose to use the benefits of economic growth to cut taxes for people who least needed their taxes cutting and, sadly, to fund mass unemployment as a major part of the public bill.
The hon. Lady and the hon. Member for Eddisbury rightly talked about the issues affecting continuing care. I do not have a date for the hon. Gentleman right now, but I promise that we will make an announcement on national guidance in a matter of weeks, not months. I hope that the guidance will clean up the extremely difficult situation with continuing care. We have had ombudsmen’s judgments and court judgments and there is now a lack of clarity about who is responsible for what. In some areas, local primary care trusts have undoubtedly tried to shunt responsibility on to local authorities when they should have been fulfilling that responsibility. The Government will act to create national guidance. Hopefully, that will help to clarify matters.
The hon. Lady was right when she talked about the changing nature of families. We now have families living not just all over the country, but all over the world. What is the implication of that for the level of support that older and disabled people get and what does it mean for the social care system?
My hon. Friend the Member for Leeds, East talked about Thomas Place, the war veteran hero who lives in his constituency. He was extremely concerned about Mr. Place’s experiences and has a been a great champion and advocate of his by saying that what happened to him was wrong.
My hon. Friend also rightly raised the issue of carers. Millions of heroes in our communities look after older and disabled people on a day-to-day basis. We still have a long way to go to recognise and value their contribution, which will be even greater in the future. However, I say to hon. Members, particularly
my hon. Friends, that we need to contextualise what we say about these matters. In 1999, we were the first Government to introduce a carers grant. Every local authority, every year, gets a significant amount of money to invest specifically in support for carers. That was part of the 1999 national carers strategy, which was the first time that a Government of any colour in this country introduced such a strategy.
Yesterday, the Chancellor joined me in visiting a family in London. We met Gill, an amazing woman who looks after her severely disabled daughter at home. We were privileged to spend time with that family, including Rowan, an 18-year-old young woman with severe learning disabilities, and her 20-year-old sister, Camilla, who has spent most of her life being an amazing young carer. Yesterday, the Chancellor announced that we are to have a national consultation involving carers and carers’ organisations up and down the country to inform the development of a new strategy for carers.
I shall announce, today, the new deal for carers. The new deal is a combination of the emergency respite care funding that has been mentioned, a national advice and information helpline for carers to ensure that they have easy access to information and practical assistance, and an expert carers programme to help carers with practical tasks for which they need support.
Mr. Stephen O'Brien: Does the Minister accept that “announcement” is too big a word given that the scheme has already been announced on the “Today” programme?
Mr. Lewis: I shall ignore that.
In addition to today’s announcement, the Chancellor and the Treasury are undertaking, as part of the comprehensive spending review, a fundamental review of the support that we give to children with disabilities and their families. That is an incredibly important area.
My hon. Friend the Member for Leeds, East expressed his concerns about the privatisation of domiciliary care. The Government have introduced the regulation of that sector, through the Commission for Social Care Inspection, so it is regulated in a way that it was not before. Only last week, I announced that the next wave of social care workers to be formally registered will be domiciliary care workers and managers. That should help to raise standards and quality in the sector.
It was the previous Conservative Government who ring-fenced the money that was transferred from the Department of Health and Social Security to local government and who insisted that about 75 to 80 per cent. of it was spent on the independent sector. That triggered the growth of private sector provision of both domiciliary and residential care, and was driven purely by ideology, not quality of services to individuals.
My hon. Friend also talked about dignity and respect and the way in which people are treated. I have launched a national campaign arguing strongly that we
need to give much greater priority in every care setting—in hospital wards and residential and nursing homes—to older people’s right to be treated with dignity and respect. That is often not about money, but about sensitivity, compassion and the way that different professionals relate to individual older people.
My hon. Friend the Member for Pudsey (Mr. Truswell) asked about the role of the voluntary sector. He is right to say that it plays an increasingly important role in supporting older and disabled people to live independently and have a good and positive quality of life in the community.
My hon. Friend the Member for Stafford spoke with authority and integrity, as he does in any debate to which he makes in this Chamber. His speech was measured, reasonable and fair. I offer to meet him and any other colleagues to discuss the specific situation with residential care homes in Staffordshire. I do not want to mislead people into believing that I can intervene, or would want to, but I certainly want to engage with him and other hon. Members to consider what is happening there.
Mr. Kidney: The staff at one residential home have expressed an interest in trying to run it themselves. Is there support in the Minister’s Department for setting up social enterprises?
Mr. Lewis: We recently created a new social enterprise unit and several social enterprise pathfinders. I am certainly willing to explore with my hon. Friend the possibility of a social enterprise model, if that is appropriate.
I conclude by talking about the big picture. The Government accept that demographic pressures and rising public expectations mean that we need a new and fresh approach to social care. The Treasury acknowledged for the first time, in the November pre-Budget report, that social care is one of the great challenges that now faces this country. It is essential that it is addressed. We continue to negotiate with the Treasury to secure a fair and reasonable settlement as part of the comprehensive spending review, but it will be a very tight settlement.
I have said repeatedly that what we need is not a debate about social care—it is the charities that have been calling for that—but solutions. We need a new settlement between state, citizen and family to reflect those changing demographics and rising expectations. I said that in my statement at yesterday’s Age Concern conference, which was very well received. We need a new settlement, not a debate, and we need to work out what that settlement should look like.
We also need to use existing resources better, including the money that is available for social care that is funnelled through the health service and other local government departments. The money does not come just from the adult social care budget. If we are talking about securing the health and well-being of older people, that includes all of the resources that are spent in local communities. That means properly commissioning services from the third sector where appropriate.
Regeneration (East Lancashire)
11 am
Mr. Greg Pope (Hyndburn) (Lab): I am grateful for the opportunity to raise this important issue. I am also pleased that my hon. Friends the Members for Rossendale and Darwen (Janet Anderson) and for Burnley (Kitty Ussher) are present in the Chamber, as is the hon. Member for Ribble Valley (Mr. Evans). I hope that they will all have the opportunity to make a brief contribution, because I know that they are as concerned as I am about this important issue.
Given that the hon. Member for Ribble Valley is present, I should say in passing that, by rights, I ought to be the Member of Parliament for that constituency. I contested the seat in the 1987 general election, and I think that it was widely acknowledged that I was unfortunate to lose by 22,000 votes—it rained on polling day and it was hard to get the Labour vote out.
Five or six years ago, I raised in a debate the issue of the housing conditions that some of my constituents had to endure. I told the House that the conditions were a disgrace and that they were a badge of shame for various people—those involved in public life; the council, whichever party ran it; the Government and the previous Administration; and, perhaps most of all, myself, as a Member of Parliament. I had tolerated for too long a situation in which people were living in intolerable conditions.
At that time, more than 2,000 houses had been abandoned in my constituency. They were terraced houses that were unfit for human habitation. People could not sell them and had simply walked away from them. In 2000-01, houses changed hands in public houses for less than the cost of a round. In such an environment, unscrupulous private landlords flourished, because they rushed into towns such as Accrington knowing that they could buy up properties for next to nothing and then make a healthy profit out of the housing benefits system. They did not care what sort of people they had as tenants, which added to the spiral of decline.
It was a housing market that had no base on which to build future prosperity. There was no rising equity in most of the property stock in Hyndburn or in other parts of east Lancashire, which meant that there was little financial incentive for home owners to invest in their properties, although there were obviously other incentives. The housing market at that time was not so much stagnant as in a spiral of complete decline.
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