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Roger Berry (Kingswood) (Lab):
I very much welcome this debate. I do not feel completely paralysed about talking about policy while waiting for someone else to produce some data. I genuinely hope that the national debate, and the response to the consultation document, will produce a consensus that will take us forward. I genuinely agree with the hon. Member for Eddisbury (Mr. O'Brien) that it is important for these matters to move quickly. Like him, I note that the Green Paper is planned for next year, and I urge my
hon. Friend the Minister to ensure that it is produced early next year, if possible, and that decisions are made soon thereafter.
My hon. Friend the Minister is doing an outstanding job [ Interruption. ] I have just agreed with the hon. Member for Eddisbury, yet he is churlish enough to speak from a sedentary position. I will continue, however. The Minister is doing an excellent job of developing this agenda, and I very much welcome the actions that the Government have taken thus far. Inevitably, however, there are certain things that we can urge them to do better and more quickly. Again, I agree with the hon. Member for Eddisbury
I agree with the hon. Gentleman that urgent action on some issues is necessary. The needs of many disabled people, older people and carers are not being met. The system is bureaucratic, wasteful and inefficient
There is little doubt that we have unmet need and inefficienciesmultiple assessments are an exampleand my hon. Friend the Minister has acknowledged that there are inconsistencies in local authority provision. Those factors, together with the fact that care packages are not portable between local authorities, mean that many disabled people, older people and their carers do not have the freedom of choice that they have every right to expect. I want briefly to discuss those issues.
It has been well documented that more than 70 per cent. of English local authorities restrict access to support to those who meet the highest eligibility criteria. There is an issue about access and about charges. Yesterday evening, I hosted a meeting on behalf of the National Centre for Independent Living to draw peoples attention to a report that the centre has published on charging for care. It was a pleasure to be at that meeting with the hon. Member for Eddisbury. I will not repeat the conclusions that he brought to our attention, and I am grateful to him for doing so, but it is a factalbeit, in this study, based on a small samplethat people are being discouraged from securing the care and support they need because of charging. They are afraid of increases in charging in the future. That is notwithstanding the fact that the Government have put far more funding into social care than the previous Government. It is a fact that funding for local authorities more generally has been significantly higher than under the previous Government. However, we all know that demands are increasing for demographic and other reasons, and that aspirations are, understandably, increasing.
The Coalition on Charging is right to say that we need an urgent review of charging policy in the context of the debate about care and support. It represents 18 well-known organisations, including Age Concern, Radar, the National Centre for Independent Living,
Disability Alliance, Carers UK, the Alzheimers Society, Mind and Mencap. Those very well-known, competent, professional and knowledgeable organisations are all urging us to tackle charging.
Jeremy Wright: Does the hon. Gentleman agree that one of the difficulties with charging is defining what is a social care need and what is a health care need? The Minister described a number of times the Berlin wall between health and social care. Is not the problem that sometimes some of the issues are being smuggled in or over the Berlin wall between those two, so that what is really a health care need, which should be funded entirely by the state, is called a social care need, and the person receiving the care has to make a contribution?
Roger Berry: The division between so-called health care and so-called social care has been a problem since 1948. Indeed, it was a problem before then; it was just that in 1948 our predecessors set up a national health service and did not attach a similar importance to setting up a social care system. I should declare an interest, although no longer financial, because both my parents are in the advanced stage of dementia. I therefore have direct experience of the problem, as well as the experience that we all have from our constituents. I have never understood why dementia, as a medical condition, means that the NHS can abandon its responsibilities and hand people over to the social care system, whereas for those with cancer, which is also a medical condition, it does something different. The logic is clear: if people have needs as a result of their condition, we should have a uniform policy.
In terms of funding, as a society the taxpayer needs to make a significant contribution. As my hon. Friend the Minister said, it is right that individuals and their families inevitably will make a contribution. That is the nature of the debate. However, I do not find it useful, and never have found it useful, to distinguish between health care and social care in the sense of trying to find one set of principles for access or funding that can be applied to health care, and then making a great leap and saying, But by the way, there should be a completely different set of principles that apply to funding and access in terms of social care.
We are, as a society, trying to make progressthere is much closer working, for example, between the health services and social services in my area than there was 10, 15, 20 years ago. There is joint commissioning and joint budgets. For reasons that I do not need to repeat, I share the hon. Gentlemans concern that often we apply different principles in different circumstances without being able to justify them intellectually or in any other way.
On charging, my understandingI hope I have got this wrongis that the review of charging announced in the independent living strategy, to be led by the Office for Disability Issues, is set for 2009-11. I hope the Minister will tell me that I have misunderstood, and that it will be brought forward to become part of the welcome overall review of care and support.
Let me make a point that arises from the report published yesterday by the Coalition on Charging. As I have said, many organisations have expressed concern
about this issue: organisations representing 10 million disabled people, 6 million carers, and who knows how many millions of older people, depending on the definition. Of course there is some double-counting and, indeed, some treble-counting, but the community of interest in care and support represents a very large proportion of all our constituents.
Disability organisations, older peoples organisations and carers have united on this issue, as they have on the related issue of independent living. We would be well advised to recognise that, according to a major body of public opinion, it is time we did more to ensure that disabled people, older people and carers have the same rights, choices and freedoms as everyone else, along with access to good-quality care and support. Whether we agree with those organisations or not, as elected representatives we must recognise that they speak for a fundamental and significant group of our constituents, who will rightly demand action from us. A coalition of interests is emerging that I did not observe three or four years ago, and it is clear from the Governments response to the concerns expressed in the consultation document that they recognise that as well.
The report by the Coalition on Charging refers to the additional costs incurred by disabled people for such necessities as heating, equipment and accessible transport. Disability-related expenditures are important to the determination of charging policy, but it is often said that many of them are not taken into account for that purpose. We need to address charging policy extremely seriously.
Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): I am very interested in the meeting that was held yesterday. I am not sure whether Leonard Cheshire Disability is a member of the coalition, and I do not know whether my hon. Friend has read its report Your Money or Your Life. According to that report, when social care support is cut, family members are much more likely to leave their jobs to become full-time carers, and families then slide into debt, poor health and endless worry. Is that covered in the coalitions comprehensive report, and does my hon. Friend agree that the Government should take it into account?
Roger Berry: Leonard Cheshire Disabilityanother admirable organisation, for whose work I have great respecthas raised such issues on a number of occasions, and they are very pertinent. Earlier this year, it examined the implications of disability-related expenditures for the extent of poverty among disabled people. It is relevant to the debate, for obvious reasons, that according to official statistics three in 10 disabled people3 million out of 10 millionlive in poverty. If necessary expenditure on extra heating, adaptations, equipment, accessible transport and personal assistance are taken into account, according to the most conservative estimate a disabled persons cost of living is 25 per cent. higher than that of a non-disabled person. Leonard Cheshire Disability deserves credit for coming up with what must be the most conservative estimate, but if it is true, that means that not three in 10 but six in 10 disabled people live in poverty.
The additional dimension that I therefore want to introduce into the debate on the future of care and support is thatdespite the Governments achievements
in reducing poverty very significantly, including for disabled people, the extra money going in and all the other policieswe must recognise that as of today, there is a real challenge here, because many disabled people are living in poverty. When we talk about charging policies for care and support, we must not forget that fact.
Nor must we forget the obvious, which is that means-testing does provide disincentives for people to save. GoshI am agreeing with the hon. Member for Eddisbury again, but I am sure that we all know that. This is an important issue, particularly for those living on very low incomes. Indeed, if the Government are to meet their poverty targets, which I believe they will, they will have to address disability poverty, because we will not meet our child poverty reduction targets without reducing disability poverty. So this is an enormous agenda, and it is all related to the future of care and support.
My hon. Friend the Member for Luton, North (Kelvin Hopkins) raised the question of funding, and the truth is that we get the social services and social care that we as a society are prepared to pay for. I have always accepted the viewindeed, a sane person could not do otherwisethat taxation is the price we pay for a decent, civilised society, so it is self-evident that anyone who wishes to spend more money in a particular way has to be prepared to vote for it and to indicate where that money comes from. That is as true now as in any other circumstances.
I would add, however, that there are significant savings to be made in the social care system. There are ways in whichI am sure that the Government are looking at this; the organisations certainly arethe system could be made less bureaucratic, wasteful and inefficient. First, there are multiple assessments for benefits. I am often driven to tears, as we all must be, when a constituent tells me how many forms they have had to fill in to access benefits. Then, there is social care, housing, accessible transport, adaptations and so onthe list goes on and on. I met a constituent the other day who had assessments going into double figures. This is a complex issue and it is not easy to solve, but we can do better than that.
Mr. Kevan Jones: On adaptations, does my hon. Friend agree with me that it is not just a question of the bureaucratic cost involved, but the delay? For example, in County Durham the assessment is done by the county council and the adaptation by the district council, and the delay involved is sometimes not weeks but months. Throughout that time, the person who needs the adaptation is clearly suffering and having a very poor quality of life.
It must be said that sometimes, it takes a long time for the assessment to take place, and then it might be out of date, so another assessment has to be made. Alternatively, the assessment is made when one is absolutely convinced that the relevant local authority has no intention of sanctioning the expenditure. Resources are spent assessing peoples needs when there is grave doubt, to put it mildly, whether the resources are there to meet those needs. That is not a very efficient way of using money.
Also, reducing delays in meeting peoples needs can be not only the right thing for the individual but incredibly efficient in using public resources. The Office for Disability Issues has examined a range of initiatives on independent living and has pointed out, for example, that investing in housing adaptations and improvements can result in long-term savings. If we invest in the adaptations necessary today, we are less likely to have to spend on social care or residential care further down the line. On occasion, I am not sure whether we have a system at all. We have a jigsaw puzzle; we have a mixture of initiatives, some coming from one area, some from another. The collective effect of our complicated system is that if decisions were made quickly, they would often result in overall efficiency in the system. Some up-front funding in a range of areas, including housing adaptations and support, could lead to the efficient use of resources in the future. We must recognise that we get the care and support system for which this country, as a society, is prepared to pay.
Dr. Ladyman: Does my hon. Friend agree that another problem is that the one significant area of a councils budget that is not ring-fenced is the adult social care budget? That means that it is in the councils interest to raise charges, to extend eligibility criteria and to exclude people from care, because it can then use the money somewhere else, if it wants to do so.
Roger Berry: My hon. Friend, who has great expertise in this area, is absolutely right; the point has been well made, and I hope that he will get the opportunity, in a moment, to make it at greater length, because it is significant.
I have been talking about the fact that investing more in improving the care and support system can, in many respects, be good finance, because money is saved further down the line. We should not forget the obvious: that investing in enabling people to live better quality lives not only gives them their rights, but it enables them to contribute to society. The Minister made the point that we are talking about individuals who not only have rights, but who, if they are enabled by having the same freedom, choice and opportunity as everybody else, can make enormous contributions to our society. We should get away from any notion of a burden.
I wish to give others time to contribute to the debate, so I come to my final point, which relates to the inconsistencies in local authority provision and the fact that care and support packages are not portable from one local authority to another. I was first made aware of that major problem more than 10 years ago, when there was a lobby in support of disability rights in Westminster Hallthat has since been repeated. I met someone from Lambeth who told me that he wanted to move to SouthwarkI cannot remember whether he wanted to move in order to work or to live in Southwark, or to do both.
This individual wanted to move from one London borough to the borough next door. When I did thatI used to live in Lambeth and I now live in SouthwarkI encountered no problem; I just moved. He faced the serious problemit was not the trivial problem of just finding and sorting out somewhere else to liveof not being able to take his care and support package to the
next-door borough. He was terrified of the prospect that if he moved from one borough to another, he would lose his entitlements and, moreover, that it might take ageshis perception is more important than the reality, but we know that these things take timeperhaps a year or so, for his care and support package to be sorted out by the next-door borough. He told me, I am a prisoner in Lambeth. I dont have the freedom that you have. It took me ages to sort out a decent care and support package. I am happy with it, because it is a good package, but I want to live somewhere else. We are not talking about another country, because he was moving next door, to another London borough, yet his package is not portable.
For many years I was a local councillor and I believe that localism has many merits, but it also has many disadvantages. The hon. Member for Eddisbury and I were at a meeting last night and the one occasion on which I got a round of applauseperhaps the rest of my speech was not very goodwas when I said, This is localism gone mad. The disabled people, older people and carers present knew what I was talking about. Baroness Jane Campbell and many others have made the point that the lack of portable care and support packages denies disabled people freedom and choice. It is not good enough that each individual local authority should have its own packages.
My personal view is that disabled people and others want a fair and universal system for care and support packages. I am not saying that local authorities should not be the very important agents that implement the packages or arguing that we should reduce their important role in this matter. However, it imprisons disabled people if they cannot move their care and support packages.
Care and support is a vast and challenging area, and I commend the Government on the progress that they are making. It is part of the commitment to make progress on independent living. However, we still have a long way to go before everyone can exercise the freedom, choice and rights that independent living means. It should be a priority for policy developers and for resources, because millions of our constituents deserve nothing less.
Mr. Paul Burstow (Sutton and Cheam) (LD): I welcome this debate on the Floor of the House on a key aspect of public policy that all too often does not get the attention that it deserves. It is especially good to follow the hon. Member for Kingswood (Roger Berry), who rightly drew the Houses attention to the coalescing of coalitions around the need for a much more rights-based approach to the delivery of care as a key part of making progress on this agenda. I hope that at the end of the debate the Minister will respond to the hon. Gentlemans remarks about portability, because it is nearly impossible for people with a care package to move from one locality to another with confidence that it will continue in place.
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