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Listening to the remarks by the hon. Member for Eddisbury (Mr. O’Brien), I thought that they were a model of the speech that someone should make if they
were keen to be spotted through Google. All the key words were trotted out, such as Alzheimer’s Society and Age Concern—it was a list of the key words that people interested in the issue would punch into a search engine, but anyone who found the hon. Gentleman’s speech in that way and started to read it would find that it had nothing at its heart. It had no substance: we heard nothing but analysis, with no prescription or any attempt to suggest that the Conservatives had any policy, other than during an exchange with the hon. Member for Kingswood about the Conservatives’ 2005 policy.
That 2005 policy is, we understand, the party’s current position on the funding of long-term care. It is described as a “limited liability model”. Well, it is certainly limited, in a range of ways. Most importantly, it is deceitful in saying that the state will step in to meet the care costs of an individual in long-term care only after three years. That is deceitful to the public because the average life expectancy of someone in care—these figures are quite dated—is little more than 18 months. For most people, therefore, the liability is limited absolutely and they would never become eligible for state support under the system proposed by the Conservative party at the last general election. The reality is that, in the past few years, because of tightening of eligibility criteria, life expectancy in care homes has become even shorter.
We also heard the curious argument that the Conservative party is in some way frozen, unable to develop a policy, because the Government have not yet published all the data. The hon. Member for Eddisbury gave us data by the bucket load, yet the Conservative party still cannot articulate a policy of its own. I hope that the timetable that the hon. Gentleman urged on the Government will soon be published by the Conservative party, too. The people of this country need to know what the Conservative party, as well as my party and the Labour party, has to say on these issues.
I want to move on and say something about my party’s position.
Linda Gilroy: Before the hon. Gentleman moves on to the subject of his party’s position, did he notice, as I did, that the hon. Member for Eddisbury spoke with some pride about a Conservative council that gave free care to the over-80s? Does his analysis of that coincide with mine, which is that in those places—I would call them the leafy suburbs, although the Isle of Wight, which he was talking about, hardly fits that description—where people are better off, they tend to live longer? That means that the better-off are favoured compared with those who struggle throughout their lives to live, to eat and to have good health.
Mr. Burstow: Those issues are inherent in the system. There is that difficulty. The hon. Lady has made her point very clearly and it is now on the record.
When I approached my preparation for this debate, I was overwhelmed by an incredible sense of déjà vu. More than a decade has passed since Labour came to power, promising to tackle the long-term care issues that were facing this country. Secretaries of State and Ministers have come and gone, and so have consultation papers, Green Papers and reviews—even Prime Ministers have come and gone. Yet one constant
remains: social care in this country is still a poor relation of health policy and of almost any other aspect of public policy. It is undervalued and underfunded, and there is much within it that is unfinished business.
Why do I say that? One has only to look at the record. For example, in March 1999, as the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Frank Dobson), concluded his statement on the royal commission on long-term care—I am sure that some hon. Members will remember that august group and the publication that it produced, which is still gathering dust in many parts of this House—he said:
“I hope that the royal commission’s report and the debate that it will stimulate will help us to find a way of ensuring that people have access to high-quality long-term care that is fair to both individuals and the taxpayer. I hope that it will be founded on a consensus that will stand the test of time: a dependable contract across the generations. That is of great importance because, second only to good health, elderly people seek financial certainty and security, and that is what the Government are determined to deliver.”—[ Official Report, 1 March 1999; Vol. 326, c. 743.]
Some determination—10 years have passed, but those words could have been almost exactly replicated by the Minister today. Indeed, in some ways, they were.
I do not deny that it is good to have consultation and dialogue and to build consensus, but the Government embarked on the process in 1999, and 10 years on we are still waiting for the action that will begin to transform the system. Ten years on, the system for funding long-term care is as confusing, unjust and unfair as it ever was. Instead of acting, the Government have been content to defend and tinker with the status quo, introducing piecemeal changes of the sort that have been set out by the Minister in his speech today, but failing to tackle the fundamental unfairness in the system.
In those 10 years, the health service ombudsman found that the NHS and the Department of Health had allowed thousands of elderly people to be ripped off, paying for care that should have been fully funded by the NHS. Just this week, a constituent of mine wrote to me to tell me of the long-running battle to recover the costs of their mother’s care, which, as is now accepted, should have been funded by the national health service. She has just received a cheque for £91,000 as a consequence. The sums that have been repaid to people as a consequence of what is, frankly, the mis-selling of care by the Government and the NHS run into hundreds of millions of pounds. Yet, thanks to the conspiracy of silence between the NHS and far too many social services departments around the country, people have been means-tested, which happened to my constituent’s father, who was forced to sell his home to pay for long-term care.
Even now, the lottery of access to care continues. Huge disparities remain between the numbers of people primary care trusts say will qualify for NHS continuing care funding. Of course, the new framework is welcome, but it does not yet appear to be getting the traction necessary to effect the sort of change that the rhetoric suggests is being demanded. For example, figures from Age Concern just last year show that, in Gloucestershire, funding for continuing care covered just six out of every 50,000 head of population, compared with Coventry, where 88 out of every 50,000
people got access to NHS continuing care. Any plan for the future of care and support must deal with the funding question.
A new financial settlement for social care must strike a better balance between the funding of health and social care by local and central Government and individuals and families, as well as the mixing in of private and voluntary sector contributions. The royal commission on long-term care offered a way forward to deliver such a rebalancing of the system, but the then Chancellor of the Exchequer set his face against the commission’s central proposals. Indeed, by the appointment of those who served on the commission, he sowed the very seeds of its own failure and destruction.
I regret the fact that the then Chancellor chose to set his face against the commission. I believe that good policy demands that we look at the evidence and that we learn from experience. That is why the Liberal Democrats championed the case for implementing the commission’s central proposal. In government, that is exactly what we did in Scotland, and we saw the idea made reality. Perhaps it is not a perfect reality, but we still believe to this day that we should see that as a cause of pride, because it made a difference in Scotland and because those who independently assessed the scheme acknowledge that it made the system somewhat fairer, although perhaps not fairer overall.
Mr. Burstow: I will take the hon. Gentleman’s intervention, as we sparred on a number of occasions on these subjects when he was a Minister.
Dr. Ladyman: The independent assessment that said that that policy was a good idea was carried out by the man who came up with the idea in the first place.
Mr. Burstow: I am referring to the assessment done by the Joseph Rowntree Foundation a couple of years ago, which was separate from Lord Sutherland, who, quite rightly, has also done such an assessment, in which he was prepared to acknowledge both the warts and the good points. The Joseph Rowntree Foundation acknowledged in its assessment that the system had been fairer than the one that still operates in England.
Kelvin Hopkins: I have been agreeing with the hon. Gentleman, and I strongly support the royal commission’s conclusions on paying for care. Since then, however, the Liberal Democrats have backed off and joined the Tories and the Government on these matters. Is he not speaking against his own party?
Mr. Burstow: Not at all; I am taking some interventions that have stopped me getting to the point of my comments. At the top of this part of my remarks, I simply said that no good policy and no one involved in policy making can ignore evidence and experience. Although there are good aspects to the delivery of free personal care in Scotland, some aspects of it are not working. Some perverse incentives have been built into the system. We accept that they mean that we must change our policy, and we are doing so.
Let me set out what we think needs to happen. Even if we are changing our policy, we are the only ones who
still have a policy and are prepared to articulate one. No policy has been articulated by the Conservatives, and we have not yet had one from the Government. As the hon. Member for South Thanet (Dr. Ladyman) rightly suggested in his intervention, Lord Sutherland said that the system in Scotland had problems, but he also acknowledged that it is working well in many ways. In recognition of those difficulties, we have changed our policy.
In striking a fair balance of funding, it is essential that absolutely everyone is clear about who pays for what. Lack of transparency is the fatal flaw in the current system that must be addressed. We believe that when framing new policy, any Government must clearly mark out what funds come from the state through the taxpayer, and what comes from the individual. The foundation of any new system must be the principle of universality, to ensure that every person has access to a guaranteed minimum standard of care.
Liberal Democrats believe that the work that Derek Wanless did for the King’s Fund offers a practical way forward: that work suggested a personal care grant based on need, not ability to pay, for those who require personal care. Under our proposals, that payment will be set at two thirds of the cost of all the care that a person needs, guaranteeing a minimum standard of care. On top of that, every pound that an individual spends to make up the other third should be matched pound for pound by the taxpayer. That would create the climate necessary to incentivise and reward saving and ensure that there is the necessary means to fund fully a care system. Those who are on low incomes should be entitled to support for their care costs through the benefits system.
Putting that new settlement in place will not be without a cost. The point made in interventions in this debate is absolutely true: we cannot get something for nothing when it comes to trying to drive up standards and deliver better quality care.
Mr. Burstow: I shall just develop my point a little bit, if the hon. Gentleman does not mind. Based on the modelling that has been done for the London School of Economics by Julien Forder, who was involved in the Wanless work, it is estimated that the cost to the taxpayer of our proposal for paying two thirds of the cost of care and matching additional individual contributions pound for pound would be £2.1 billion. That cost, and how we pay for it, will be set out in detail in the costings documents that we always publish as part of our manifesto, which are always appraised independently, found to add up and found to be effective in demonstrating how measures are delivered.
Paul Holmes (Chesterfield) (LD): Unlike the Conservatives.
Mr. Burstow: Unlike the Conservatives.
Mr. Burstow: I am spoiled for choice. I will give way to the Minister.
Mr. Ivan Lewis: I respect the hon. Gentleman’s contribution to our debates, but from an economic literacy point of view, how on earth can one come up with a policy without identifying how it will be paid for? He has just conceded that his party has not yet done that, but says it will find a way of doing so at some point. He has identified the policy and how much it will cost, but he has completely failed to identify how it will be paid for. How much extra tax would the average taxpayer have to pay if the policy were delivered?
Mr. Burstow: I will not take any lectures from Treasury Front Benchers, given the debacle of the doubling of the 10p tax rate and the fact that extra money was borrowed to get us out of that policy. The Government’s record on fiscal responsibility went out of the window then. We have said that we will identify specific savings, which will be earmarked to pay for our policies, and we are doing so. We have already set out some, and we will set out more. We will deprioritise some issues in order to prioritise care of the elderly. Surely that is what any sensible Government do when allocating resources.
Dr. Ladyman: Will the hon. Gentleman give way?
Mr. Burstow: No, I would like to make progress. I will take another intervention in a minute, if the hon. Gentleman will bide his time. I am sure that we will still be somewhere near the subject when he gets his chance to intervene. It is not just our belief but that of many independent experts that that £2.1 billion extra a year is the minimum necessary to provide the care guarantee that every elderly person in the country needs. Such an approach has been welcomed by a wide range of organisations. I will not make a “Google point” by listing them. Let us be clear: there is no cost-free solution, as much as the Government might want us to wriggle on that hook, and might want to try to embarrass my party and me because we have outlined how much extra we think needs to be spent. The current system is unfair and not fit for purpose, and additional investment is essential to allow the system to move on to what we need for the future.
Dr. Ladyman: Will the hon. Gentleman give way?
Mr. Burstow: I will; the hon. Gentleman is persistent.
Dr. Ladyman: I am grateful to the hon. Gentleman. He described his policy as a two-thirds-for-free package, followed by a pound-for-pound match by the taxpayer. According to my simple arithmetic, the Liberal Democrats have moved away from free personal care to five-sixths free personal care. In other words, the only extra money that the individual will provide is one sixth of the total cost of personal care. Given the demographic changes that we foresee in the next 20 years, that is not a £2 billion cost but a cost of something like £10 billion. Where will he get that sort of money from?
Mr. Burstow:
The hon. Gentleman will recall from his detailed study of the royal commission’s report when it considered projections that it concluded, first, that we should not allow ourselves to be driven to
distraction by the myth that a demographic time bomb is about to explode and make it impossible to provide dignity in old age; and secondly, that in terms of the share of GDP that will be necessary over the next 20 to 30 years, the increase will be less than 1.1 per cent of GDP to realise the free personal care proposals.
In his report, Derek Wanless set out the implications for GDP. By 2050, the cost reaches about 2.6 per cent. of GDP, compared with its present level. As a price that society should be prepared to pay, a slightly increased share of GDP for dignity in old age is a price that I am prepared to go to the electorate and argue for. I am disappointed that the hon. Gentleman is not. There is no cost-free option.
Derek Wanless published a report for the Government which advocated increased investment in health care. It was a seminal moment after the 2001 general election, which gave the Government the case that they needed—the Chancellor’s case—for a significant boost in spending in the national health service. We strongly supported that and voted for the extra resources to be made available. That report contains the seeds of a further concern of mine.
In his report on health spending, Derek Wanless rightly made a link between health and social care spending. He rightly identified that social care spending had lagged behind health spending. Over the past decade, NHS spending has increased by 70 per cent., whereas social care funding has risen by 14 per cent., yet in so many ways they are two halves of the same system: underfund one, and we undermine the other.
The Wanless report recommended a review of social care funding. The then Chancellor said no to such a review. Is that still the present Prime Minister’s view? Is he willing to commit to the investment in social care necessary to deliver a sustained and better future for social care? That is the question that the Government so far have not answered, yet they expect us in opposition to do so. We have been clearer about our position and how much it will cost than the Government have been prepared to be so far.
All the indicators point to a system that is under huge pressure. Care is being rationed ever more tightly. The Commission for Social Care Inspection, in its report “The state of social care in England”, paints a depressing picture of the system’s difficulties. The number of older people receiving services has fallen year on year, while the number of people with unmet needs has risen. More than 120,000 fewer people are receiving home care than when the Government came to power. The commission found that more than 250,000 people are receiving no support at all from local authorities, charities or commercial care providers for the daily tasks with which they need help, and almost 500,000 are receiving less help than they need to maintain a decent standard of well-being.
That adds up to over 700,000 older people in England who are not getting the care package that they need. At the same time, there has been a 25 per cent. fall in the number of people having their care costs met by local authorities in the past 10 years, as a direct result of ever tighter eligibility criteria. The Leonard Cheshire report “Your Money or Your Life” has been mentioned. It paints a disturbing picture and presents ample statistics. I do not want to cite them, but I shall
give two quotes from the report about the impact of ever tighter eligibility criteria on real people’s lives.
“He tried to commit suicide by drowning himself—he has fallen and banged his head”.
The other quote is as follows:
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