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Mr. Lewis:
It is not generally known that, in 1999, the Government introduced the notion of deferred payment, whereby older people do not have to sell their home if they go into care. It is not totally clear how many people are taking up the opportunity to use the deferred payment scheme. I have to say to the hon. Gentleman that, in fact, he got his timeframe right. Between 1979 and 1997, there was no attempt to do anything about the means-tested system. In contrast to the NHS, social care has been means-tested since 1948, but nothing was done about that between 1979 and 1997, so we will not take lectures from the hon. Gentleman about the inevitable consequences of a means-tested system— [ Interruption. ] I will answer his second question. Members of the House are aware that, if we examine the detail of what is happening in Scotland, we see that care is not free. People still have to pay for housing and for food. Also, services are being rationed, which means that people are having to wait for increasingly long periods of time to access care. Scottish local authorities are saying that the current position is entirely unsustainable. Politicians
may shroud-wave and make offers that appear attractive, but in reality, the result is the provision of inadequate services.
As part of the debate over the next six months leading up to the Green Paper, let us have an honest and serious discussion about the respective responsibilities of the state, the family and the individual for paying for care, bearing in mind that there are no easy options in regard to fairness and sustainability. The people for whom I feel most sorry under the current system are those who work hard, play by the rules and do the right thing, and who are neither rich nor poor. There is a sense of injustice and unfairness among those people at the way in which decisions are made about means-testing.
I am also anxious to put right the situation in which people who fund their own care are left alone to make difficult decisions about choosing their care and where to go for advice and support. In my view, self-funders should be entitled to a much greater level of protection and help than they get at the moment, but let us not pretend that there are any easy answers or easy solutions.
Mr. Kidney: On the subject of the need for a debate, will my hon. Friend accept my praise for him in bringing this matter to the fore so that we can have a great public debate on such a big policy issue? Does he agree that there is a role for the media to help in this regard? Will he give credit to the BBC for its recent in-depth and deliberative coverage of these issues, which has tried to include everybody in the debate?
Mr. Lewis: I thank my hon. Friend for his kind comments on my contribution. Other hon. Members, some of whom are in the Chamber today, have made a major contribution over the years to ensuring that social care has been given a greater level of priority. That requirement is still desperately needed in view of the changing nature of society. Of course it is helpful when the media engage in this debate in a positive, constructive, honest and balanced way. Some of the recent coverage has been very balanced. Let us consider, for example, the way in which the “Today” programme reported the lady who went under cover in care homes. Some people were concerned about the ethics of her going under cover, which is a different debate, but that coverage was incredibly balanced. She was encouraged to talk about the positive and good things as well as to highlight the negative experiences that she had in residential and nursing care. All too often we do not present a balanced view. For example, hundreds of thousands of low-paid low-skilled workers work in the care system. They do a tremendous job on the front line of providing care in very difficult circumstances. Yet we always present this industry—this care sector—in the deficit model, in a negative way. Of course, there are massive problems. We only need to listen to the experiences of older people and their families to know that all too often the system does not respond to their needs in the way in which they have the right to expect. Equally, however, we should have a balance to the debate. I welcome the fact that sections of the media are starting to ensure that the debate is far more balanced.
In my view, the care system does not function in a vacuum from the rest of society. We have deeply cultural and attitudinal issues to address about how we
treat older people in our communities and society. In the same way as we recognise that investing in children and young people will determine the future of our country, we must also recognise that the way in which we treat older people will determine the character of our country in the future.
We should also remember that older people are not simply passive recipients of care. They increasingly have the ability to make a massive contribution to their communities and families and to our society. It is incredibly important that we have an adult, mature debate about the issue, which poses one of the greatest challenges that we face.
It is also important to reflect on some of the progress that has been made over the past few years. This is the first Government to introduce a serious set of national minimum standards backed up by inspection and regulation. The consequence of that has been a significant improvement in the number of providers of residential and nursing care and of domiciliary services that meet minimum standards. That would not have happened without the dreadful word “regulation”. All too often, regulation is presented as a bad thing, but it has begun to make a real difference in the sector. As we develop the new regulator, bringing together health and social care regulation and inspection, it is important that we continue to use that system to help us to raise standards.
Kelvin Hopkins: I agree entirely about the need for regulation. Indeed, a number of recent reports have shown that regulation clearly has been inadequate because standards have not been good enough and people have been suffering. However, the Government have proposed light-touch, risk-based regulation instead of rigorous inspection. Does that not pose a risk that the regulation will not be good enough?
Mr. Lewis: I do not agree. There are a number of ways in which we influence the quality of care that older people and others experience. One of them is inspection and regulation; the other is the commissioning decisions that are made by local authorities or the NHS. Frankly, they should not be commissioning with either poor providers or even, on occasion, those providers that can meet only minimum standards. World-class commissioning is about ensuring that we organise services from those care homes and day care and domiciliary care services that offer people a high standard of care.
The other important element is to ensure that individuals and families feel sufficiently empowered to complain and raise concerns if they are not getting the care that they need. Communities also need to take responsibility for ensuring that we treat older people in a positive manner. That becomes even more important as more and more people remain within their own homes. It would not be appropriate to send inspectors and regulators into people’s homes, but equally there is an argument for saying that there is a vulnerability and risk to consider that requires us to think differently about the relationship between the state, the family and the individual. We must not make the mistake of believing that the only way to protect older people in this context is through the inspection and regulatory framework, although it is incredibly important.
We have also introduced free nursing care for the first time. I mentioned the deferred payment scheme. It was this Government in 1999 who introduced the first ever national carers strategy. Since then, we have given every local authority a specific annual carers grant to expand respite care and to give better information and better emotional support to carers. There was a period in this country when there was a denial in public policy terms of the contribution and role that carers make. The fact is that carers have distinct needs as opposed to the needs of the people for whom they care. Six years ago we also launched Valuing People, to ensure that people with learning disabilities have the same life chances that many other citizens take for granted, whether it be a home of their own, a job or the opportunity to have a decent quality of social leisure life.
Last year, I introduced a new national framework for continuing care. There were concerns about a postcode lottery across the country whereby some primary care trusts were not accepting their responsibilities in terms of recognising that people have nursing care needs as opposed to social care needs. That national framework has begun to make a difference to people’s ability to access continuing care funding.
This Government introduced a specific grant to stimulate the use of telecare. One issue that does not get sufficient attention in the debate on social care is the potential of modern technology to support people to have a more independent high-quality life, particularly within their own homes. We are seeing across the country a significant expansion in the utilisation of telecare to support people, but we have a long way to go. It is important to encourage and stimulate innovation because we are still pretty weak in terms of innovative development of services and innovative approaches.
We also introduced the General Social Care Council to register social workers who move on to domiciliary care agencies so that professional standards are maintained and monitored. Skills for Care ensures that we invest significant amounts in a difficult environment, which has a low-skilled, low-paid work force, to get people who work on the front line of care services to at least level 2 qualifications and beyond.
There has been an improvement in integration between health services, local government and the voluntary sector in some communities, although we still have a long way to go in the terms of the so-called Berlin wall between health and local government. I hope that we will be able to make more significant and rapid progress in the future.
Our White Paper “Our health, our care, our say: a new direction for community services”, for the first time commits us to a vision of integrated personalised preventive services. We should not forget in the context of a debate about how we treat older people in our country that older people have been the major beneficiaries of the slashed waiting times and waiting lists for the national health service. That point is frequently not made. Older people used to be made to wait for years for the treatment of health conditions, such as hip replacements and cataract operations, that affect people’s ability on a day-to-day basis to have a decent quality of life. I am proud that as a result of the decisions taken and the targets set, the Government
have been able slash waiting lists. We will achieve the historic objective by the end of this year of a maximum wait for most treatments of 18 weeks. We should not forget that the major users of the NHS are older people. They have benefited significantly in terms of their independence and health as a result of our policy and the investment that has come directly from the Government.
There has been a major expansion of community-based mental health services. We all know that of course it was right to close those institutions down and to give people the chance to live dignified, decent lives within the community. Anyone who spent time as I did in those dreadful long-stay mental handicap hospitals, where people were shut away from society for 40 years, will know that it was the right thing to do. The Conservative party embarked on that programme when in government, and I pay tribute to it for that. The only problem was that the Conservatives did not transfer adequate resources specifically to people with mental health problems within the community, so many of them were left in vulnerable positions, not having proper and adequate support. I am proud of the fact that we have significantly expanded mental health services in the community, although we have a long way to go.
With regard to the controversy about the new GP contract, one of the other benefits that does not often get referred to is the fact that for the first time we incentivised GPs to take responsibility for the management of long-term conditions. That is another major advance. We should bear in mind that an ageing society is not the only challenge that we face. A major challenge is the number of people who are living longer with long-term conditions developed earlier in life, when they are in their forties and fifties, and making GPs responsible for managing such conditions and taking them seriously is an important way of preventing those people from deteriorating further.
This year’s programme of reform and other activities is probably the busiest and the most significant for 20 years. Since April, the Putting People First transformation scheme has been delivered in every local authority area, supported by half a billion pounds of Government funding over three years. It focuses on a shift from the present system, which tends to support people only when they become very ill or very dependent, to a system based on prevention and early intervention. The aim is to offer decent information, advice and, where appropriate, advocacy to everyone, including people who fund their own care.
One of the unintended consequences of the community care legislation of the early 1990s was that people who went to their local authority and said that they had assets or means of £21,000 were told “You’re on your own: there is no help for you here”. It is crucial for us to ensure that those people have access to high-quality information and advice on difficult decisions relating to care and support for themselves or family members.
Jeremy Wright (Rugby and Kenilworth) (Con):
Of course information should be available to self-funders. As the Minister knows, they often end up on the doorstep of the voluntary sector, which does a fantastic job in pointing them in the right direction. Does he
think there is any scope for the Government to do more to help that sector to provide advice, rather than providing it directly?
Mr. Lewis: This Government have invested more money in public service and improving the quality of life in local communities than any other Government in living memory, but I agree that the voluntary sector is a major part of the solution. In the past, I have been critical of local government and NHS commissioners who reach for conventional, traditional solutions rather than using the voluntary, community-based organisations that are sometimes far better placed to provide advocacy and contact sections of communities that are hard to reach, such as members of the black and ethnic-minority community and people who do not feel comfortable about using traditional services because of their faith or culture.
Voluntary and community organisations have a crucial role. For many older people, the real issue may be not a need for hard-edged personal care but loneliness and isolation, and the voluntary sector is often in the best position to offer them activities and support. All too often, however, statutory agencies are not commissioning with the third sector as we would wish them to. Despite the unprecedented amount invested in the sector over the past 10 years, it could do more, and in many localities the relationship between it and the statutory agencies could be more satisfactory.
Voluntary organisations have every right to complain about the need for longer-term funding, which currently means knowing only one year at a time how much they will receive, but, arguably for the first time, local government and, within a couple of months, the NHS are to benefit from three-year settlements. That means that there is no longer any excuse for those organisations not to enter into longer-term funding arrangements with the third sector and put the principles of the compact into practice.
Mr. David Drew (Stroud) (Lab/Co-op): I am sure that my hon. Friend is going to mention direct payments, which have been a great success in Gloucestershire. Carers and others in the voluntary sector set up an organisation to act as gatekeeper with the local authority and ensure that proper use was being made of the payments. However, because they had “professionalised” themselves, the local authority forced them to tender for moneys, and lo and behold, they lost the tender. That was a huge knock back. Will my hon. Friend work with his colleagues in the Department for Communities and Local Government to encourage the voluntary sector locally to make the best use of resources, and not to be overtaken by outside organisations?
Mr. Lewis: I entirely agree. I was, in fact, going to say something about personal budgets and direct payments. Obviously my hon. Friend can read my mind, which is usually not a very pleasant experience.
At present direct payments are used by a relatively small, albeit increasing, number of people. We have made clear that we want the vast majority of adults to have personal budgets within the next three years. We want people to have maximum control and power over their own care and support, because we believe in the right to self-determination. Some people will need a
significant amount of help to exercise that control and power over their lives, but in principle that is our direction of travel, and we want it to become the norm.
The Government must work with, in particular, local authorities to ensure that the necessary support systems are there to enable people to use direct payments and personal budgets to maximum effect. We encourage the pooling of personal budgets and the bureaucracy that is necessary to make control and choice possible. Our role is to clarify and encourage best practice, and to support local government in the delivery of what is arguably one of the most radical pioneering public service reforms that the country has ever seen.
Dr. Stephen Ladyman (South Thanet) (Lab): Does my hon. Friend agree that we should not underestimate the number, and the type, of people who can use personal budgets? In Wigan I met a man with severe learning difficulties who, with help and the use of a life map, was able to express the way in which he wanted to lead his life, and who, through the use of direct payments, was able to leave residential accommodation and live an independent life in his own flat, despite his severe disabilities.
Mr. Lewis: As ever, I agree with my hon. Friend. I pay tribute to the work that he did when he was doing my job. He initiated much of the pioneering work that has made direct payments a mainstream part of the social care agenda.
Some people hold the ideological view that certain members of society, to whom they attach labels, cannot exercise control or self-determination, and the state should not put them in a position that suggests that they can. That is not consistent with the views of our party or our Government, although of course there are people who will need a massive amount of help to exercise control and choice.
I shall never forget attending a conference, before I had been doing this job for long, where an individual with learning disabilities stood up at the back of the room and said “Minister, I want a life, not a service.”
That individual was making the point, “I am fed up with this collection of agencies and organisations fishing around in my life. Give me a budget, give me the opportunity to exercise control and articulate my needs, and then I can have the quality of life that I really want.” All the evidence shows that where people do have that level of control and choice, two things happen: first, they get much better outcomes and quality of life than under the existing, traditional way of doing things; secondly, we get better value for money. It is a win, win. This is incredibly complex because it is a new system that requires a lot of thought, but I am absolutely convinced that giving people control and choice through personal budgets and, where appropriate, direct payments is the right thing to do from a values point of view and a quality-of-life point of view.
I must now make some progress, Mr. Deputy Speaker. Let me rattle through the other changes that we are making this year.
Mr. Andrew Lansley (South Cambridgeshire) (Con): Will the Minister give way?
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