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23 Oct 2007 : Column 12WH—continued
Mr. Lewis:
I have two important things to say to the hon. Gentleman. First, for 18 years, was there not a separation of the amount of money that was announced for the NHS, vis-Ã -vis social care? Secondly, is his party committed to spending more money on
social care than this Government have over the next three years, and, if it is, where is that money coming from?
Mr. Stuart: The Minister has one admirable quality, in many areas, and that is consistency. The Conservative party has not run the country for the past 10 years. With respect to the hon. Member for Eccles (Ian Stewart), who mentioned the fact that the basic system was set decades ago, this comprehensive spending review offered the opportunity, with the increase in spending by the Government, to set priorities between social care and health. What have the Government decided to do? This Minister, who promised in this Chamber in January that he would fight for a fair settlement for social care, has delivered a woefully inadequate settlement for social care, which is compounding the situation, where there have been increases in the thresholds for access to care.
Another key question to which I hope that the Minister will return is his assessment of the raising of the thresholds of access to social care. In the east riding, the fear and the feeling is that we will move to a stage where the only people who receive support from adult social care will be those in care homes and those at the most severe end of the critical band. That is the position that we are looking forward to, and it is the direct human result of the failure of the Minister to honour the promise that he made in this Chamber to get a fair deal for social care. If he does not accept the analysis of my right hon. Friend of why that failure has occurred, we need him to explain why it has happened, and not to make party political points about the past and the separation. They might have been in separate strands, but I believe it is fair to say that such a discrepancy between health and social care at a time of such need has not been seen before.
Ian Stewart: Will the hon. Gentleman give way, as he named me?
Mr. Stuart: I shall do so in a moment.
That has been in the context of how the Government have moved forward the policy agenda, in a way that has had broad support across the House, towards merging health and social care. They have taken forward the agenda, and I am happy to congratulate them on doing so, if the Minister is so desperate to have partisan point scoring and credit given. With the support of the Opposition, they have moved forward an agenda of integrating health and social care for exactly the reasons mentioned by my right hon. Friend: people should be able to access services in a seamless way that does not differentiate artificially because of departmental boundaries. We have supported that move and it is in that context that we have the discrepancy in funding between social care and health, and that becomes hard to justify, although we look forward to hearing from the Minister.
Ian Stewart:
It is a bit rich of the hon. Gentleman to accuse others of party political point scoring. He just gave a tour de force in party politics and diminishes the argument for me. Does he not accept that we can acknowledge points in time during the process that have led to the situation in which we find ourselves, which most of us would like to see changed? The single
biggest effect in my city of Salford was when a Conservative Government transferred care from the health service into the community. They did not set the structure up right, and we are now addressing that.
Mr. Stuart: The hon. Gentleman has had several goes, but unfortunately he has not developed his argument.
Ian Stewart: I am happy to have another go.
Mr. Stuart: The hon. Gentleman has had more than his share. He does not seem to have understood—or will not acknowledge—that the comprehensive spending review offers the opportunity to make a shift, or at least to ensure that social care gets the funding that it needs within an integrated health and social care system. That has failed to be done. That is not the fault of a Conservative Government that was last in power 10 years ago, or some other Government four decades ago. The opportunity was there for this Minister to deliver on his promise made in this Chamber earlier this year to get a fair funding settlement for social care. This Minister, this Chancellor of the Exchequer and this Prime Minister have failed to deliver on that, although the opportunity was there.
East Riding of Yorkshire council has been recognised as the top local authority in the country for its stewarding of financial resources. It has demonstrated its commitment to investing in adult social care services with a 6.6 per cent. increase in the adult services budget for 2007-08, significantly higher than most other council services. It has done so because of its commitment—a commitment that I wish that we could see from the Minister—to ensuring decent social care services.
Despite that increase, what is the situation in social care in our area? Because of the increase in the over-85 population in the east riding, which is an increase of more than 400 per annum over a six-year period, the council has had to conduct a review and has decided to remove provision for those with moderate needs. It has also had to put substantial needs into two bands and only those in the upper band will now receive social care services. That was before the comprehensive spending review and its woeful result for social care.
I hope that the Minister will answer my questions and accept that the settlement will lead to a year-on-year cut in adult social care services with an impact not only on the elderly but on those with learning disabilities to boot.
10.25 am
Greg Mulholland (Leeds, North-West) (LD): I want to start by congratulating my hon. Friend the Member for Romsey (Sandra Gidley) on securing this important debate, which could scarcely have come at a more pertinent time. We have had an excellent and interesting debate, which has shown that these issues apply up and down the country and in very different areas.
“The current social care system is in crisis and needs wholesale reform”.
Those are not my words, but a summary of the situation by Age Concern. We are all aware that we have an increasing number of older people in the
population of this country, and yet a decreasing number of people are receiving social care. That is a decreasing number of people receiving care at home, which has fallen by a quarter over the past 10 years, and a decreasing number of care beds in care homes.
We have seen the recent comprehensive spending review, and my hon. Friend, and other hon. Members, powerfully—
Mr. Lewis: Will the hon. Gentleman give way?
Greg Mulholland: Let me make this initial point—hold your horses, and I will let you have a go.
The comprehensive spending review clearly has not delivered enough funds to this important area. Various hon. Members have made it absolutely clear that although the 4 per cent. increase in NHS funding is very welcome, the 1 per cent. increase in social care funding is simply inadequate. The reality is that the vast bulk of the settlement over the subsequent three years is loaded into the third year, but we have a crisis now.
The reality of social care in this country is that services are often of insufficient quality. According to the Commission for Social Care Inspection, only 79 per cent. of homes for older people and 72 per cent. of domiciliary care services meet national minimum standards. Compliance with some critical standards is even lower, as only 65 per cent. of homes for older people meet standards for recruiting staff and 54 per cent. meet standards for safe working practices.
My hon. Friend the Member for Romsey discussed the concern over recent years of local authorities’ rationing care, a point that was also mentioned by the hon. Member for Eccles (Ian Stewart), and the worrying fact that the Local Government Association has admitted that by 2009 not a single local authority will provide social care any longer for those with moderate needs. If we consider those moderate needs—that is a euphemistic phrase—they are the sort of needs that every one of us, individually, would believe should be met for our older people. NHS continuing care does not reach a large majority of those who fulfil the eligibility criteria. Three out of five people, according to Age Concern’s estimates, could miss out on care. We have heard powerful evidence about the postcode lottery, which clearly applies more in social care than in the NHS, which is where the media regularly raise it.
We have heard of the problems with the way in which care homes are funded by local authorities, with the issues of block buying and top-ups, where relatives have to find the difference between what the local authority will pay and the cost of care charged by the home. We have also heard the scandal of people who fund their own care entirely, paying a higher rate than those afforded by the local authority. We cannot allow that to continue.
Mr. Lewis: During the course of the hon. Gentleman’s contribution, will he clarify the Liberal Democrats’ policy on paying for social care?
Greg Mulholland: I shall be delighted to, and I shall come on to it when I finish my synopsis of care in this country.
The personal expenses allowance is £20.45 per week, which is supposed to cover toiletries, personal items and clothes. Can anyone here seriously say that that is enough?
Sandra Gidley: That £20.45 limit has been mentioned by a number of organisations. However, is my hon. Friend aware that residents of homes increasingly have to pay for extra services? Sometimes they are charged for things such as physiotherapy and expected to meet the expense using that money.
Greg Mulholland: My hon. Friend has made a valuable and important point.
I do not think that carers have been mentioned today. They do such an important job and save a huge amount of taxpayers’ money, but, in many areas of the country, they do not have the right or even the option of respite care. I hope that the Minister will touch on that. Although most of this discussion concerns older people, my hon. Friend mentioned children with complex needs. It is important that we bear in mind the needs of all those with disabilities who require care.
Mr. Lewis: We have done a lot for them.
Greg Mulholland: The Minister will have his chance to contribute later. If he wants to intervene, he may, but I would prefer it if he did not chunter throughout my speech.
Mr. Lewis: In presenting these issues, why does the hon. Gentleman not say, during the course of his narrative, that the Government have just announced unprecedented investment in support and respite care for disabled children and their families over the next three years? Why has he missed that out of his speech?
Greg Mulholland: I asked the Minister to clarify what the Government are doing for carers. He has done that and, therefore, does not need to do so in his speech. However, if he wants to make more interventions, I suggest that he does so on the basis of what I am talking about.
On the 2006 Wanless review, the fear is that, once again, the Government are ignoring the advice that they sought, and that this will be Wanless-light, although we accept that the Government have not published their proposals yet—it is important that they say when they will do so. We fear also that the percentage that individuals will be expected to contribute will be considerably less than that proposed by Wanless, which is a real concern.
The other big issue that has been touched on today is the divide between health and social care, and just about every hon. Member has mentioned that today. We must seek to end this rather artificial structural divide. It is difficult to understand why someone who needs care gets it free in a hospital, but not in a care home, and we must address that. However, administratively, I am sure that we would all recognise that the divide causes inefficiencies and, sometimes, contradictions in what clearly are common-sense objectives shared by the two sectors.
Will the Minister comment on the situation in Northern Ireland, where those two sectors are combined? Also, there are examples of good practice, of which he will be
aware, in Herefordshire and, most excitingly, in north-east Lincolnshire, where the new care trust system has been developed. We will watch those developments with interest. We need leadership from the Government, which does not necessarily mean a one-size-fits-all approach. Different local authorities need the ability to introduce different ways of integrating social and health care, and I am sure that we all agree that that is something that we should move towards.
The Minister asked me about the Liberal Democrats’ position on funding. Do the Liberal Democrats believe that the Government have older people’s care as a high enough priority? No! Do we believe that the Government’s current spending plans are sufficient to deal with the crisis? No! Do I believe that the Government are letting down older people in this country? Yes!
Mr. Lewis: What is your policy?
Greg Mulholland: The Liberal Democrats will make older people a higher priority and invest more money than the Government.
Ian Stewart: I would follow the hon. Gentleman’s argument better if he did not just criticise, but said specifically where the money would come from, and on what basis it would be allocated.
Greg Mulholland: We will do that when we publish our manifesto and our policy at the next election. Our policy at the last election was the right one for this Parliament, which has been shown to be the case. Our policy at the next election will be the right one as well, and it would deliver better care for older people than the current Government policy. Will the Minister lay out a clear timetable for the progress of reform, and tell us when we will see the Green Paper and when we can hope for the reforms to be implemented? This crisis needs to be addressed now, and I am afraid that that is not happening.
Will the Minister address concerns expressed by many leading organisations that the funding announced in the comprehensive spending review is weighted in the third year, when it is quite possible that he will no longer be a Minister and when we might not even have this Government? This seems to be a very slow and tardy response to what everyone agrees—including him, I am sure—is an immediate problem that needs swift and decisive reform.
Mr. Bill Olner (in the Chair): Order. That is a comprehensive list of questions to the Minister, which he will answer, if he has the time.
10.36 am
Mr. Stephen O'Brien (Eddisbury) (Con): I am pleased that the hon. Member for Romsey (Sandra Gidley) has secured this debate and congratulate her on doing so. The debate is a little unusual, however, given that she is the Liberal Democrats’ spokesperson for this policy area—at least she was the last time that I checked—and certainly it is a rule within the official Opposition, as opposed to the opposition of her smaller party, not to seek to secure debates on our own subjects. But I shall leave that for the Liberal Democrats.
I am sure that Members on both sides of the House will support me when I say that the contribution of the Liberal Democrats in this debate, as in so many serious debates, avoids any rational approach to policy and costings and treats members of the public as though they have no memories. Let us consider what happened when the Liberal Democrats did something in this policy area in Scotland. Members will be aware of the long waiting lists and the funding shortfall that ran into tens of millions of pounds, caused by the Liberal Democrats, with the support of the then coalition Labour party.
Greg Mulholland: Will the hon. Gentleman give way?
Mr. O'Brien: No. The hon. Gentleman has only just had his chance.
In her speech, the hon. Member for Romsey studiously avoided that matter. I am referring, of course, to the fact that, on 31 October 2006, in this Chamber, during an intervention that I invited her to make, she, the Liberal Democrat’s health spokesperson—
Sandra Gidley: Oh, this is so boring!
Mr. O'Brien: I am not surprised the hon. Lady finds it boring, because we keep on reminding her of this.
One must ensure that this is on the record, the veracity of which is attested to by the fact that I could not use this word were it not inscribed for all time on the pages of Hansard. In that debate, the hon. Lady admitted that she had said that her party’s policy of free personal care was “dishonest”. Furthermore, she admitted that dishonesty is the modus operandi of the Liberal Democrat manifesto writers. It is amazing that she said that. I hope, therefore, that the Minister will not spend too much time addressing the dishonest policy of the Liberal Democrats.
Greg Mulholland: So why are you talking about it?
I hope that the Minister will now give a substantive response to the public’s concerns about the future funding of personal care and, in particular, answer for his Department’s and, arguably, his personal portfolio’s abysmal showing in the comprehensive spending review. The rate of increased funding to the NHS has been reduced by the Government. I note the reduction in the above-inflation funding increase, from 7.5 per cent. for 2004-05 to less than 4 per cent. for the coming three years. We shall wait and see whether the financial control reasserted in the NHS, which continues to run a deficit of £911 million, is anything more than cosmetic.
Furthermore, what the Chancellor advertised as a 4 per cent., above-inflation funding rise amounts to no more than 3.2 per cent. when the Prime Minister’s £2 billion cut to the NHS capital fund is taken into account. The Chancellor sought vainly to dismiss the Conservative party’s prediction of an estimated 3.5 per cent above-inflation rate. It turns out that that really was a conservative estimation of the Government’s cuts.
Financial pressure on the NHS is relevant to the debate. Throughout the sorry saga of the NHS deficit, local authority services have often borne the brunt of PCT cutbacks. In June this year, for instance, London councils alone identified extra pressures amounting to £22 million owing to front-line NHS cuts.
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