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23 Oct 2007 : Column 18WH—continued


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I shall turn to the direct social care aspects of the comprehensive spending review. The Government made three points, each of which I shall address. They were an increase in overall local authority funding, an increase in direct funding for social care and a Green Paper on long-term care funding. It is disingenuous of the Government to pray in aid the small increase in overall local authority funding—a trick that enables them to announce it many times over in each area of local authority spending. Further, Sir Simon Milton of the Local Government Association called it

That point was powerfully demonstrated by my right hon. Friend the Member for North-West Hampshire (Sir George Young). A mere 1 per cent. increase is inadequate to meet the social services demand pressures, and it exacerbates the inequity between health and social care funding.

The Minister will no doubt tell us once again that direct funding from the Department of Health for social care for older people and support services for carers will increase by £190 million to £1.5 billion by 2010. It should be pointed out that that means an extra £32 million for 2008-09, an extra £88 million for 2009-10 and an extra £190 million for 2010-11, with no promises about what will happen thereafter. Will the funding be ring-fenced for services to older people and carers? Are the increases real or nominal? And, as my right hon. Friend said, is that it?

In the Department’s press release, it said that the money would support personalised budgets, the provision of advocacy and information services and an increased focus on preventive services to support people to live independently and to help 3,000 people with learning disabilities to leave NHS accommodation and live independently. I was particularly intrigued by the first and last claims. On the first, it was my understanding that personalised budgets cost less, rather than more, to administer. On the last claim, will the Minister tell us, first, why it was not completed by April 2004—the target that was set in the White Paper, “Valuing People: A New Strategy for Learning Disability for the 21st Century”? Secondly, is the money distinct from the £175 million of funding that he announced on 9 August to take 1,600 people with learning disabilities out of campus accommodation? It is particularly important to note that the increase in funding in no way approaches the sums needed to deliver an effective and affordable solution to stop people selling their homes to fund their long-term care.

Tony Blair said in his 1997 conference speech:

our children—

Not only have the Labour Government failed to solve that issue, but they have failed ever to address it substantively. Does the Minister agree that the 2005 Labour party manifesto, which promised to

is another Labour broken promise and that it deserves from him similar opprobrium to that which the hon.
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Member for Romsey gave her party’s manifesto claims? In doing so, the Minister must also acknowledge that our fully costed limited liability model at the previous election would have delivered a solution to the problem, that we were the only party ever to put forward a real policy on long-term care funding and that, perhaps, he could learn from us. It is a trend, and something for which he would no doubt gain great popularity with his own Prime Minister, because he seems to enjoy taking whatever policies he hears us put forward.

It would be helpful if the Minister considered what has happened in Kent, which has a Conservative-run county council. The Government’s latest announcement contained a welcome U-turn on individual budgets, embracing health care and social care. Although it was clearly accepted that the Government have failed on social care in the past, the Secretary of State talked about a partnership model. The King’s Fund report, however, made it clear that Kent county council had undertaken a pilot project on the partnership model and that it wanted to do further analysis. However, the report said:

The recent social care announcements are for a 1 per cent. real terms increase in social care budgets in local authorities, the effects of which will be additional charges for adult social services in local authorities throughout the country and a forced increase in council tax. We need individual budgets and the greater efficiency that comes from them. Importantly, the Government should not dismiss the experience of Kent county council’s pilot quite as off-handedly as they have done.

Will the Minister also explain his sad and—I dare say for him—bitter failure to secure anything substantive from the Treasury? He has spent the past 18 months giving the impression to parliamentarians, to stakeholder organisations—we have all spoken to them—and to the public that he will deliver a

He said as much in January, as my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) said in his very powerful speech. On 21 February, the Minister also told us:

On 6 March, he wrote:

And on 17 January, he said:

Further, will the Minister explain to the House what happened to the findings of the review of social care funding, which his predecessor, now the Minister for Borders and Immigration, announced on 30 March
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2006? It was a transparent attempt to fend off the Wanless review, and in announcing it, the then Minister said:

If it really was a

where are its findings and why do we now need a Green Paper, as the Minister has had to announce, which will not have any impact until 2011—well after even this bottling Prime Minister will have been forced to the polls and these Ministers and this Government will be long gone? How long is the long grass into which they have kicked that vital issue?

Without the Minister’s usual rant or statement that he will take no lessons from the Conservatives—after all, the Prime Minister has led the way and announced new policies that are all the result of lessons taken from the Conservatives—will the Minister tell us exactly why he has failed to deliver that which he has promised to the House and to the public?

10.47 am

The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): I congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. It is rather bizarre that as a Front-Bench spokesperson she has secured a debate as a Back Bencher, and that there is a replacement Front Bencher, but do not ask me to explain the Liberal Democrats.

I also congratulate my hon. Friend the Member for Eccles (Ian Stewart) on the way in which he began his contribution. He is right that there is a major demographic change, not only because people are living longer, but because they are developing long-term conditions such as strokes and dementia. He was also right that disabled people now have long and full lives, which is a sign of progress in our society. He also raised the issue of people’s rising expectations of care; they do not want, for example, institutionalised care, but care at home.

For the record, I shall discuss the investment that has been made, because we must ensure that we are clear about the context. Over the past 10 years, overall local government funding has increased by £28.4 billion or 39 per cent. in real terms. The Department of Health allocates a number of specific grants to the 150 local authorities with adult social service responsibilities in England, totalling more than £1 billion, and there is £68 million of capital grants for 2007-08.

The Department has also allocated £60 million for the partnerships for older people projects, £80 million for preventive technology and £60 million for extra care housing in 2006-07 and 2007-08. Since 1999, we have invested just over £1 billion to support carers’ services. As a result, there have been major advances in the care that people receive. Under the comprehensive spending review announcement, local government will receive an average real-terms increase of 1 per cent. per year, which will be worth £2.6 billion a year by 2010-11. In addition, there will be an average increase of 2.3 per
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cent. in real terms per year for direct departmental funding of social care. There will be an additional £2.6 billion by 2010-11 for local government, and almost £200 million additional money for social care provided through the Department.

Mr. Graham Stuart: Will the Minister give way?

Mr. Lewis: I shall not.

I wish to make it clear that the settlement for the Department of Health, at 2.3 per cent., is higher than the average public sector growth of 2.1 per cent. That reflects genuine pressures in the system, and we need to continue to transform the service. The 2.3 per cent. real-terms settlement is in addition to the 1 per cent. settlement for local government, which is about meeting demographic pressures.

I agree with those, including the hon. Members for Romsey and for Wyre Forest (Dr. Taylor), who said that we need a more integrated approach between the NHS at a local level, local government, the voluntary sector and the private sector to create a more integrated health and well-being system in every community. We have made a number of advances towards achieving that, but we still have a long way to go. I point out to the hon. Lady that, in the next three years, the Government will invest unprecedented amounts of money in supporting disabled children and their families for respite care, key workers and transition planning. That has been warmly welcomed by the every disabled child matters coalition.

My hon. Friend raised a number of issues about inequalities in funding and so on. He also talked about the progress that his local authority has made, and I wish to pay tribute to Anne Williams and Maureen Lea for the leadership that they have provided in Salford, and to Anne Williams for the leadership that she is now providing nationally on adult social care.

On the partisan contributions made by Opposition Members, let us be clear that the Liberal Democrats currently do not have a policy on the subject, but they still say in their local leaflets that their policy is free personal care. The hon. Lady said on the record that that was a dishonest promise in their manifesto at the last election. It is completely duplicitous politics. Conservative Members talked of their policy on the funding of social care in their previous manifesto, but it is not their current policy. So the Conservative party does not have a policy on the matter either. Neither of the two Opposition parties is offering to spend more on social care than the Government are committed to spending in the next three years, and neither is committed to a Green Paper on the fundamental long-term reform of social care. That is yet another example of the Government facing up to one of the great challenges that this country faces in future health and well-being issues, which, as my hon. Friend said, is right at the heart of a socially just society.

Mr. Stuart: Will the Minister give way?

Mr. Lewis: I shall not; I am coming to the hon. Gentleman’s points now.

The right hon. Member for North-West Hampshire (Sir George Young) contributes extremely well to making the case for social care, which of course I welcome, but he and the hon. Members for Beverley and Holderness
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(Mr. Stuart) and for Eddisbury (Mr. O'Brien) asked, “Is this it?” Let us be clear: we have a Green Paper committing us to tackling long-term reform; we have a local government settlement of 1 per cent. in real terms; and we have a high real-terms increase in resources through the money that the Department of Health will make available to local government to reform social care in the next three years. We shall announce the details soon, and hon. Members will have answers to all their questions about what improved services that funding will buy.

In addition to all that, the Prime Minister will announce next spring a new deal for carers, building on the record levels of money that this Government have invested in supporting carers in the past 10 years. On 1 October, the Government issued new continuing care guidance to ensure that primary care trusts do not shunt the costs of continuing care on to local authorities. For the first time, we have national guidance. As I have said, the Government are putting record resources into supporting disabled children and their families.

Sandra Gidley: Will the Minister give way?

Hon. Members: Give way!

Mr. Lewis: Hon. Members do not like to hear these messages, but they are going to hear them.

I also wish to mention the appropriate use of resources in the system. There is a local authority—I shall not name it, as I do not wish to embarrass it—that is spending £300,000 on setting up a television station, while it has increased the fees for home care by £300,000. Let us be clear: some decisions being made at a local level about what matters to people need serious scrutiny in relation to local authority prioritisation.

We must all ask why social workers are now spending their whole time as assessors and box tickers rather than doing social work with people. That is not required by any legislation that this Government have passed; it is a result of the community care legislation introduced in the 1990s. When did we ever say that just because people were self-funders, they should be left on their own to navigate the care system by choosing nursing homes or home care? We never said that.

It was this Government who introduced the deferred payment scheme, which means that no elderly person going into care has to sell their home. It is shameful that the Conservative party frightens elderly people by suggesting that old people have to sell their homes when they go into care. This Government changed that and introduced free nursing care, after 18 years when people had to pay for it.

Several hon. Members rose


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Mr. Bill Olner (in the Chair): Order. It is obvious that the Minister is not going to give way, so I would appreciate it if there were no further interventions.

Mr. Lewis: I want all-party consensus on the long-term funding of social care. That is the responsibility of grown-up politicians. We need a new system that redefines what the Government will fund through tax and what individuals are expected to pay. It must be fair and affordable. The current system is not right to meet the demographic challenges that my hon. Friend the Member for Eccles identified, but free care for all is not realistic either. Any politician who says that it is is misleading people. If we unpick the details in Scotland, we see that the system is not really free. Waiting times for services are rocketing, which proves that it is not sustainable, as the Scottish local authorities are saying. We are not wedded to any particular model at this stage. We genuinely want to open the debate to the public, and we want all parties to participate.

The hon. Lady asked what issues we need to examine. In trying to find a new system, we need to consider together what should be available to everybody, wherever they live, and what should be left to local discretion; which elements of the service should be for all, irrespective of their means, and which should be means tested, and what level of assets should trigger full or partial self-funding. Those are the big issues that we must face up to if we are to find consensus on a new settlement on long-term funding. There are no easy solutions or quick-fix wins, and there is nothing that would leave everybody happy and provide a system that is both fair and affordable.

In the new year, we shall announce the process for significant citizens juries and consultation in different parts of the country. We want all political parties to join in the debate and make a contribution, and then we shall produce a Green Paper. We will announce the time scale for that in January. It will identify for the people of this country the scale of the demographic challenge and the range of choices available for meeting it. We will then be clear about the choices that we face and the principles that should underpin them.

This Government are the first to prevent elderly people from having to sell their homes. We introduced free nursing care, and we are facing up to one of the great challenges that face the country. Despite the scale of the tight funding settlement across government, when the details are announced it will be demonstrated that the settlement for social care, to support personal budgets and a shift to prevention, will mean that we can make significant progress on the quality of services for elderly and disabled people and their families in the next three years. We will deal with the long term and put in resources in the short term, and there will begin to be significant reform of services in every local authority, so that carers and older and disabled people have the quality of support and care that they deserve in a civilised society.


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UK Aid (Sudan)

11 am

Mr. Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): I very much welcome the opportunity to debate this important subject. On 10 October, I asked the Prime Minister this question:


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