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It seems that the policy has been quietly dropped by the latest Liberal Democrat leader, the right hon. Member for Sheffield, Hallam (Mr. Clegg). Many weeks after it was originally said that it had been dropped, it has also finally been dropped from the Lib Dem website. The Liberal Democrat spokesman will no doubt tell the House that the Lib Dems have committed to a “care guarantee” based on Wanless’s partnership model, along with a £2 billion price tag. It
is fair to say, however, that until the Liberals have said what each person might be guaranteed and given an indication as to where the money will come from, the House need not be detained by giving the proposal any credence. It is interesting to note that the Minister said that the free personal care that was offered in Scotland had never been deliverable, let alone delivered, because of the disparities between local authority provision in Scotland and because it completely omitted the so-called hotel costs of accommodation and food. As there was a combined Labour-Liberal Administration at the time, I am sure that the lesson has been taken to heart that that policy could not be afforded. That is another element in building the consensus that has at last been arrived at.
We need to find a way forward on carers, on whom the Minister spent a little time in his speech. There are about 6 million carers in the UK, and more than three in five of us will become carers at some time in our lives. Too often, carers bear the brunt of inadequate provision of care and support, and they are among those who are suffering most because of the Government’s prevarication on reform. In its helpful briefing for this debate, Help the Aged calls for carers to be supported as an integral part of the care and support system. I pay tribute to the work of Carers UK and many other partners of carers week, which takes place next week. We are still waiting for the new deal for carers; I think that the Minister said that it will be delivered relatively shortly.
It is important to recognise that carers have become very concerned about the changes made to service provision and regular respite care, particularly locally, through changes to the carers grant. I make a distinction between the announcement on emergency respite care and the need for regular predicted respite care, which remains of serious concern to many carers. Carers suffer most because of squeezes by councils on eligibility criteria. We are therefore looking seriously at how carers can be included as part of the original assessment of the care needs package of the cared-for person. We need to include a recognition of the effects on the social and other aspects of the carer community. That may be a pointer in terms of the consensus that is being developed across the parties and across the House.
This applies equally to the grave concerns that we all share about young carers. In 2001, the census found that there were approximately 175,000 young carers in the UK, although that figure is believed to be higher by those working in the field. The average age of young carers is 12. One in three regularly misses school and one in four has no external support. That has led to tragedies such as that of Deanne Asamoah. Those of us who understand and are concerned about this issue know that there is a need to support young carers, not ban them. It is important that it is part of a family’s choice, and often the young person’s choice, that they wish to care for a parent, grandparent or other relation. The needs of young carers should be part of the original care assessment, as I said in relation to carers generally. When making the assessment of the cared-for person, there must be clarity about the needs of the young person and those must be taken into account in assessing the package of support that is required.
Mr. Lewis: I agree entirely with what the hon. Gentleman said about young carers. Does he welcome the fact that in the bundle of papers he referred to, there is, for the first time, a requirement on adult services to ensure that, as a result of the decisions that they make about an adult, no child or young person is left inappropriately caring for a parent? He is right to say that we cannot stop children and young people loving a parent who has an illness, and nor should we, but no child should have their childhood stolen through being asked to take on inappropriate responsibilities. Does he welcome the fact that in the bundle of papers he dismissed earlier, we call on adult services to ensure that that never happens to any child or young person?
Mr. O'Brien: I certainly acknowledge that there is a call. The issue has been support in resource terms to ensure that it happens. That support has not been translated into what is happening on the ground, which is why the matter has caused concern throughout the House and has been the subject of some debate. It is important that we try hard to maintain the consensus on young carers and carers in general, because the regularity of respite care is important to the health and welfare of carers, who are ultimately the people who will be able to deliver the best care.
Mr. Lewis: Will the hon. Gentleman give way?
Mr. O'Brien: No, I think I have given way generously to the Minister. There will be a chance at the end of the debate for him to put anything he wants to on the record.
Mr. O'Brien: I am going to move on because I think that the Minister has had more than a fair chance.
We must also tackle the issue of dignity. On Tuesday, the Commission for Social Care Inspection report on dignity for those in dementia care identified that only a quarter of the care homes inspected had detailed care plans that gave guidance about the residents’ preferences for care. CSCI issued statutory requirements to half the care homes, detailing actions that they had to take to improve care provision, and an astonishing one in five were given requirements on maintaining people’s privacy and dignity. It is clear that that is simply not good enough, but at the same time, we must praise and celebrate much of the good work that goes on in care homes, carried out by people who give such a lot of professional support.
The problem is not limited to the social care sector. The Healthcare Commission’s report, “Caring for Dignity”, which was published in September last year, looked at 23 trusts at high risk of non-compliance with dignity standards. The report noted that the profile of dignity had been raised in the NHS, and I am sure that the whole House will wish Sir Michael Parkinson well in his role as the dignity ambassador. Raising the profile is one thing, and concrete action is another. The Healthcare Commission noted serious failures of non-compliance, most often due to failure in providing single-sex accommodation. In addition, most trusts found it difficult to engage with patients with dementia and inadequate arrangements were made for uninterrupted meal-time environments.
As we know, the Healthcare Commission’s most recent in-patient survey, published on 12 May, showed that one in four patients had to share a sleeping area with people of the opposite sex when first admitted to a hospital ward, and that one in five had to share a sleeping area with the opposite sex when moved to a second ward. Nearly a third of patients had to use the same bathroom or shower area as the opposite sex. The survey also highlighted malnutrition, with one in five patients not given enough help to eat their meals. It is important for the House to note that those failures are not primarily the fault of front-line care staff—far from it—or hospital managers. It is a question of the gulf between the words that are spoken and the ability to translate them into action.
Mr. Lewis: Does the hon. Gentleman welcome the fact that in the NHS operating framework for this year, it is made clear to NHS managers that minimising mixed-sex accommodation has to be a top priority? Does he also welcome the fact that the director general of Age Concern, Gordon Lishman, is overseeing an action plan to improve nutrition in the health and social care system? Finally, does the hon. Gentleman’s party have any policies at all on how we will enhance support for carers in our society?
Mr. O'Brien: The Under-Secretary was right to say that Age Concern referred to malnutrition and I am glad to note the important work that will help tackle the problem. However, the problem emerged in responses to a series of parliamentary questions, which I tabled. The Government eventually gave the information, which showed a seriously adverse move, I think from 10 to 11 per cent., in the proportion of those going into hospital who left more malnourished. Government figures acknowledge that. It is interesting that Gordon Lishman said:
“What we need is not just a discussion but a timetable for action. These problems have been with us since Labour came to power”.
The Under-Secretary needs to be careful about whom he prays in aid.
Mixed-sex wards cause “indignity” and “distress”—a quote from Tony Blair in 1996. He said:
“Is it beyond the collective wit of the Government and the health administrators to deal with that problem? It is a question not just of money, but of political will.”—[ Official Report, 19 November 1996; Vol. 285, c. 832.]
Yet the Government have reneged on their promise to end such wards, although the Secretary of State attempted to make a weaselly distinction between mixed-sex wards and mixed-sex accommodation. The Under-Secretary was rightly keen to identify dignity as central to many of the arguments about social care, but we must consider the Government’s track record.
The Under-Secretary also rightly identified the importance of individual budgets for older and disabled people. We look forward to the publication later this year of the Green Paper on the individual budget pilot programme, which finished at the end of last year. We accept that individual budgets are key to giving more control to individuals. The Institute for Public Policy Research report, “Just Care?”, which was published last week, called for joined-up services and consideration of the community and family context of care, a greater
voice for the community, clarity in outcomes and supporting individual choice through budgetary control of services.
Oldham is a pilot site for the Department’s individualised budget scheme and a “total transformation” site for In Control. To date, the pilot scheme has made an 8 per cent. saving in the overall budget. In the feedback from participants, 86 per cent. reported an improved quality of life, 56 per cent. said that opportunities to take part and contribute to their community were increased, 72 per cent. reported greater choice and control over their lives and 74 per cent. said that they had more dignity in their support. People should be able to take charge of their care and not be forced into accepting “one size fits all”. Direct payments and individual budgets do not simply deliver savings—far from it—but give people the freedom to take charge of their lives and design their care services around their individual needs. It is vital to acknowledge that, although individual budgets and direct payments are no answer in themselves, they are positive when appropriate and should be encouraged.
Tightening the eligibility criteria has also caused great concern. As was pointed out earlier, yesterday evening, I attended the launch of the National Centre for Independent Living’s report for the Coalition on Charging, entitled “Charging into Poverty?” It states that rising care charges put older people and disabled people at risk of not being able to afford to eat, heat their homes, wash or get essential support. It found that 80 per cent. of those surveyed who no longer use care services said that charges contributed to their decision to stop their support. A fifth of those surveyed who currently use support suggested that they would stop if charges increased further, and 29 per cent. of respondents did not feel that their essential expenditure on impairment and health conditions was taken into account in financial assessments for paying charges. That means that they have to choose between essential support and equally essential food, heating and utility bills. Nearly three quarters of those surveyed believe that the Government should think about the charges that people pay for support at home in adult care reform plans.
The Coalition on Charging is calling on the Government to conduct a thorough review of the impact of care charges from 2008 and for those issues to be addressed in adult care reform in England. We await the outcome of the eligibility criteria review from the Commission for Social Care Inspection, which the Under-Secretary mentioned, in relation to a power that I hope that the Health and Social Care Bill will not remove. We discussed that with the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), in Committee and we hope that that power will not be temporarily suspended until the next general election. The continuing operation of CSCI and its successor, the Care Quality Commission, will be an advantage for all.
Often, the most vulnerable people affected by the various issues in long-term care and care for the elderly are the low earners and those subject to the means test. The Resolution Foundation, headed by the former special adviser to the right hon. Member for Sheffield, Brightside (Mr. Blunkett), has done some work on the
impact of care charges, particularly the means test, on low earners in the UK. There are 15 million low earners in this country, 3 million of whom are over 65. Low earners are 25 per cent. more likely to be carers. They find the system complex, inaccessible and unfair, and have found it difficult to access the advice and information that they need. Again, I am happy to share the Minister’s view on the importance of having access to good information and advice.
Low earners often have limited savings and their primary source of wealth is, as it happens, their homes. The Resolution Foundation’s report says that 72 per cent. of low earners have levels of wealth that can exclude them from free care and argues that reform of the long-term care system is more important even than improving hospitals. That is the call for action coming from so many of the people who find that long-term care is their primary need.
I share the Minister’s view, as I am sure hon. Members in all parts of the House do, that finding adequate resources to meet all those demands is a major challenge, given all the other challenges that we face. That is why it is important to get the Minister to urge all his colleagues and the processes within Government to come up with the final reviews, so that the final recommendations can be made and decisions taken. The principal frustration, at least on the Conservative Benches, is that we have been subjected to such a series of reviews that people do not have that base of information that is so important in coming to the conclusions required.
Mr. Burstow: In his opening remarks, the hon. Gentleman was critical of the Government for publishing a consultation document that was long on analysis but short on prescription. Surely the way for him to start goading the Government into developing their policies is for the Conservative party to set out what it would do, but that is signally not what we have heard so far. Will he tell us what the Conservative party thinks about such issues?
Mr. O'Brien: All in good time—and that is not just a light aside, but a serious point. When a Government are in office, they have a responsibility to produce the data that we have called for, upon which everyone can then make an informed judgment and formulate policy. [ Interruption. ] The Minister may say from a sedentary position that Wanless has done that, but the Government have said that they did not use the Wanless report as the base upon which they made recommendations. Indeed, the Minister’s predecessor said that there needs to be a zero-based review, but that has not come forward. That is why we are all so mindful of the fact that the Government have not yet produced the base upon which policy is to be articulated.
The issues are wider than just care. Work force issues come high up the agenda in any reform of the sector. In 2007, Dame Denise Platt reported on the status of social care, with recommendations on supporting the work force with the establishment of a skills academy, a research centre, which I assume is what the Government launched last week, a journal and social care awards. I should be grateful if the Minister could update the House in his winding-up speech on those recommendations that he did not touch on earlier.
There are other issues, too. On Monday, The Times reported that criminal records checks for thousands of migrant staff are not being done. According to The Times, an estimated 240,000 foreign-born individuals were employed in the care-related sector in 2006, and they are vital to that sector, as the Minister said. The concern is not only that such individuals are going unchecked. Care providers are also concerned that they have paid £36 a time for checks that are not properly undertaken. Can the Minister tell us whether the providers are told when a proper check has not been carried and, if not, can the provider get its money back?
The issue is one of some interest. I understand from representations that I have received that the amounts of money are significant, which is causing care home owners and others to become anxious about a process in which they are obliged to engage. If the Minister cannot answer my questions immediately, I would be grateful if he agreed to write to me and anybody else who is interested.
This is a crucial debate for the House, and if it will speed up the Government’s production of their review—I know that I speak for millions of people in this country in saying this—we would love that to happen. We would give a resounding cheer if it did. However, we are trapped in a consultation process, or even paralysis, when what is really needed is hard data collection, costed options and a grown-up discussion that can lead to a consensus policy approach based on the Government’s proposals and recommendations.
I pay tribute to the many third-party organisations that are campaigning on this issue, and I urge them to continue to hold the Government’s feet to the fire. I urge the Minister to put the vast resources of his Department, and the army of civil servants at his disposal, into collecting the necessary data and to bring those data, along with some serious measures, to the Floor of the House so that we can reach consensus on what is best for the most vulnerable people in our society. As Gordon Lishman of Age Concern said:
“What we need is not just a discussion but a timetable for action. These problems have been with us since Labour came to power”.
The Crewe and Nantwich by-election might have been, as the Minister has suggested, the beginning of the end for Labour. The Prime Minister and the party he represents might, as the Minister has indicated, be out of touch, but there is certainly a call to action on this issue. It is up to the Government to answer that call with more than just words; they need to translate them into deeds.
3.36 pm
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