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“He had 77 hours of care a week and it’s been halved—he can’t be on his own—he now shuffles around on his knees. He needs constant care.”
Care is now routinely restricted and rationed in this country to those with substantial or critical need. I had to look up the definitions to be clear what that meant—just how critical one had to be, how substantial the need had to be.
The rhetoric is all about independence—a vision we can all share and embrace. The hon. Member for Kingswood rightly talked about the need for far greater emphasis on independent living in what the Government do. But to qualify on the basis of critical or substantial need, one has to have been the victim of abuse, to be the potential future victim of abuse or at death’s door. Those are key criteria used to sift out those who are entitled to the largesse of the state and its support and those who are turned away.
The future of care support has to be a lot more ambitious. We must connect the lofty goal of independence to the reality of people’s experience of the system on the ground. That is why the review of eligibility criteria is important, but it should not just ensure a level playing field. The level is so low at the moment that we have to do more to be ambitious to get the quality of life that we want people to enjoy.
It is not just who pays for care and the level that the taxpayer contributes to that care that have to be addressed. There is also a need to overhaul the legislation governing adult social care. Today, there are more than 40 Acts of Parliament governing the organisation and delivery of social care in this country. The legislation has all the hallmarks of its piecemeal evolution, with differing philosophies of care, reflecting the era in which the legislation was drafted. The National Assistance Act 1948 is a good example: crafted for a rather different view of the world in terms of how politics and public services would be delivered.
Private Members’ Bills have attempted to crowbar important reforms into statute, the carers legislation being an obvious example. That is a good example of individual private Members leading the policy agenda in the House through legislation, but surely the Government need to take stock of the carers legislation. There are also considerable gaps, overlaps and contradictions between different existing pieces of legislation.
How is any practitioner, or anyone who wants to access the system, supposed to keep abreast of all the primary legislation, let alone the regulations and guidance? It is a mystery to me how we expect that someone we wish to take control of their budgets and personal lives will be able to do just that. The Minister was right when he talked about unintended consequences of the community care legislation, which to an extent left self-funders out of the system of being given support and helped to navigate through the system. That is why we need a new comprehensive adult social care Bill, which would consolidate and reform the way social care is organised and delivered, setting out in law the key
principles that underpin the system. In many ways, this would address how we deliver that notion of independence.
The only way we can deliver a notion of independence is by empowering individuals to have the rights, even through the courts, to demand what they are entitled to. If it is down to care plans, guidance, Ministers making promises at Dispatch Boxes or local executive members of councils promising things, none of those is ultimately as tangible as the ability to take them to court and hold them to account. We need to look at how we ensure that the system is reformed in that way. At its heart is the idea of empowering users of services and carers to get what they need. In this way, the essential needs of carers can be met too.
No matter how good or gold-plated the social care system becomes, there is no substitute for the huge contribution of family carers. I have no doubt that the new national carers strategy, which is to be published next week, will contain much that will be welcomed on both sides of the House. Many will have contributed to the consultation, but unless carers have a legal right to services, too many will continue to shoulder a burden of care, paying the price with their own health and well-being as a result.
The Minister knows that I have raised concerns over the years about the scandal of elder abuse in this country. Elder abuse is a serious matter and the Government are to be applauded for funding a study that found that 342,000 people over the age of 66 are the victims of one form or another of abuse: fraud, theft, psychological or emotional abuse, assault, restraint and various other things. The study set some pretty high hurdles before someone could be counted in it as a victim of abuse. It excluded those in care homes, who are now to be included in their own new study, and anyone with dementia. The study’s figures must be a conservative estimate of the problem.
To be honest, I would rather we went beyond just catching and punishing abusers. That is important, and the Government have introduced measures that might help us to do that, but we need a system that prevents abuse in the first place. A new adult care reform Bill could place the user and carer clearly at the heart of the system so that they can determine the service provision that they need. Getting the service right will reduce the risk of abuse happening in the first place. In that context, I hope that the Government will give local authorities and the courts the powers necessary to protect vulnerable adults from abuse.
There have been proposals; they have been around for more than a decade. In 1995, the Law Commission said that it had no confidence in the adult protection procedures that existed at that time. However, not a lot has changed since then. The Law Commission proposed that to protect vulnerable adults, social services departments be given powers similar to those to protect children: a duty to investigate; powers for magistrates to issue entry warrants; temporary protection and removal orders; and an offence of obstructing officers acting on behalf of the courts. However, all that was put to one side, and we had the guidance issued in the form of “No Secrets”—worthy words that have not changed hearts and minds or secured the change necessary on the ground.
In 2006, Action on Elder Abuse completed its own study on behalf of the Department, and it found that “No Secrets” was not being taken up consistently across the country. It recommended that in respect of protection, vulnerable adults be placed on a statutory footing equivalent to that for child protection and domestic violence. That was in March 2006. Two years later, in March 2008, there was a welcome, perhaps overdue, Department of Health announcement—of yet another review. It was a review of “No Secrets” and one that may consider legislation.
When Victoria Climbié tragically lost her life because of neglect, abuse and failure in the system, it convulsed the child protection system and galvanised the Government into doing something. It cannot be right that we should have to wait for a similar shock to the adult protection system to achieve long-term, long-overdue reform and action.
In conclusion, the case for a new deal for social care is overwhelming and there are two essential elements for delivering that transformation. The first is dealing with the unfinished business of who pays for care. That must be settled. A partnership model that shares the burden clearly and fairly between the state and the individual is now the best way forward and the only way to secure a lasting consensus. Secondly, the transformation of the system that hon. Members want can come only by giving the users and carers power to drive change themselves. I am thinking not only of policy change but of statute. That means clear legal rights to services through a reform of adult social care law. Those most vulnerable and in need in our society deserve no less; I hope that in their remaining time, the Government do something about those two key challenges.
Mr. Deputy Speaker (Sir Michael Lord): Order. Before I call the next hon. Member, I should say that the speeches so far have been extremely lengthy, perhaps for good reason. However, the whole House can see how many people are seeking to contribute. If hon. Members make shorter contributions, we can try to get everybody in.
4.33 pm
Dr. Stephen Ladyman (South Thanet) (Lab): I pay tribute to my hon. Friend the Minister for his leadership on this subject. It takes only a short review of his curriculum vitae to see that he has the portfolio towards which his entire career had pointed him. That experience is being put to good use, as he shows real leadership on this subject. I congratulate him on that and on his opening speech.
As far as the opening speech made by the hon. Member for Eddisbury (Mr. O'Brien) is concerned, the least said the better. However, I should like to offer one particular criticism. Like many Conservative speeches, it fell into the trap of using a stereotype of what care is all about. I well remember that when I had the ministerial portfolio on these matters I was constantly having debates with the Conservatives about care homes. They were convinced that we had to take immediate action to keep care homes open around the country even though people did not want to go into
them. There were shades of that view in the hon. Gentleman’s speech, indicating that they still have not heard that we want to create a new vision for social care.
As for the speech of the hon. Member for Sutton and Cheam (Mr. Burstow), he is right that we had many enjoyable jousts when I was in that job. However, I must take him to task over the arithmetic that underpins the Liberal Democrats’ policy. We clearly heard him say that their new policy is to invite the public to pay one sixth of the cost of personal care with the state picking up five sixths of the cost, instead of the entire cost, which was their previous policy. Let us examine that. There are 1.2 million people working in social care at the moment. The wages for 1.2 million people, even if they are on the national minimum wage, must be about £25 billion or £26 billion a year. The state puts £14 billion into the cost of social care, so the private sector, at the most conservative estimate, must be providing £12 billion. The hon. Gentleman’s policy is to raise £2 billion from some undisclosed place and invite the public to kick in £2 billion of their own money, after which the missing £10 billion will be magically found from somewhere else. If he had said, “The Liberal Democrats’ policy is that we need to kick an extra £10 billion a year into social care”, I would have replied, “Well, all right, that is in the right sort of ballpark. With an extra 4p or 5p on income tax, you go away and take that to the public and see how you get on at the next general election.” However, they are not going to take that policy to the public, because they know that the sums that they have come up with are profoundly dishonest.
Kelvin Hopkins: My hon. Friend is trying to frighten us with big numbers, as so often in the past. The royal commission suggested that the figures would be far less, even over the next 50 years. Does he accept that such sums are scare figures and in reality are much smaller, and that even if they were at that level, the majority of the population would probably agree to pay for them out of taxation, provided that it was fair?
Dr. Ladyman: First, I would say that the royal commission is entirely wrong. Secondly, the figures that I quoted are today’s figures, not tomorrow’s figures or made-up figures. There are 1.2 million people working in social care. Their wages, paid for by the public sector and privately, must be in the region of £25 billion. The public sector only kicks in £14 billion. The difference is the cost of personal care made up for by people’s personal contributions. If the Liberal Democrats are saying that they are going to pay for that, they must promise to pay for all of it, not some mythical small amount.
My hon. Friend the Member for Luton, North (Kelvin Hopkins) mentioned the royal commission and its idea that social care can somehow carry on over the next 50 years as it is and that we should not let the potential demographic time bomb deflect us. Let us look at those figures. We know for a fact that the number of older people has quadrupled in the past 100 years and doubled in the past 75 years. We know that the number of people over 65—currently 9.3 million—will increase to at least 17 million by the middle of this century. We know that the number of people over 85 will at least quadruple by that time. We know that the number of people with learning disabilities—about 800,000—will increase to 900,000 by 2020—
Mr. Burstow: I am sorry to interrupt the hon. Gentleman as he trots out those important demographic statistics, but may I ask him about his attack on the position of the Liberal Democrats? Our policy is founded in the research and modelling done by the London School of Economics for and on behalf of Derek Wanless in respect of his work for the King’s Fund. Is the hon. Gentleman saying that that was complete rubbish and therefore should not be the basis for any policy making?
Dr. Ladyman: The Chancellor has already indicated that he will not use that work as the basis for policy making, and one reason why may be that he shares my concern about the number of people for whom we will have to provide care in the future. In a moment, I shall come to my vision of how we should resolve these issues. I have some proposals to put to the Government, and I do not know whether they will be taken up.
We have to start planning for a transition from where we are today, spending about £10 billion from the public purse on older people’s care and another £4 billion on the care of people with disabilities, to the position in 2050. We should be planning not on spending twice as much at that point, but on spending three or four times as much to provide the same level of care as we do today. I agree with my hon. Friend the Member for Luton, North, who I see is shifting in his seat waiting to intervene, that that is not enough. We are not spending enough today, and we have to plan on spending three times more just to stay still, if we are to carry on doing the same thing.
Einstein used to say that madness is continuing to do the same thing and expecting a different result. My argument is that we have to start repositioning social care. We have to think again about what social care will look like in the future, because we cannot plan on the basis of its looking as it does today. Not only do we need a completely different vision of social care and the way in which it will work, we need a completely different vision of how we will pay for it. When the hon. Member for Sutton and Cheam and my hon. Friend the Member for Luton, North, whom I shall give way to in a moment, talk about social care funding, it is clear to me that they are talking about where the money goes to, but in my view they are failing to think about where it comes from. I shall give way to my hon. Friend; I am sure that he will tell me that he would be perfectly prepared to put up income tax to pay for such care. I suspect that our voters would not be.
Kelvin Hopkins: I have asked many of our voters about this issue, and they say that they would be happy for income tax to be raised to pay for care so that they would get it. Why do we not look at the models of Scandinavia, Germany and France? Even today, France and Germany spend 2 per cent. more of GDP on health than we do—£30 billion more on health in British terms. We are miles behind the levels of spending in Germany, France and Scandinavia, and we should be spending at those levels.
Dr. Ladyman:
I agree with my hon. Friend that we need to spend more on social care. We are not putting as much into it as we ought to be. All I am saying is that even if we put that right today, and carry on providing social care for the next 50 years in the way in
which we do now, we will not be able to afford it in 50 years’ time. We have to start investing in different ways of providing support for people that will reduce the cost of social care.
My hon. Friend the Member for Kingswood (Roger Berry) touched on some of those ways. Adaptations and telecare have a huge potential to lower the cost of social care by allowing people to be provided with care and support remotely. We should be making significant up-front investment in helping people to implement telecare. We need to be thinking of providing tax breaks to those who are prepared to put such adaptations into their homes, if they want to be self-supporting and they do not already have them.
I have argued passionately for some years that we need a huge expansion of extra-care accommodation; I know that the Department is keen on such accommodation. We need to get that message across to the Department for Communities and Local Government as well. Extra-care accommodation is where people live in their own flat or bungalow in a community in which flexible care packages are available. People go into those communities when they are relatively fit, hale and hearty, and if they have the flu for a couple of weeks in the winter and need a bit of care, a flexible care package is available. If their condition deteriorates as time goes on and they need more care, they can build up their care package. As they are living in a community where many people have different needs, care can be provided in a very cost-effective way. Most of all, it maintains people’s independence. When one asks people what two things they want out of the social care system, my constituents reply, “We want to maintain our independence and stay in our own home. We don’t want to go into a care home. We understand that some people may have to go into care homes and nursing homes, but we don’t want to be those people.” The extra-care model provides that independence. People have their own front door and the ability to stay behind it if they wish. In addition, private home owners can lock away some equity in the cost of the home. People want to continue to have some equity and pass it on.
I shall cut my comments short because so many colleagues want to speak, but I encourage my hon. Friend the Under-Secretary to examine some research by the International Longevity Centre. I provide some advice to the UK branch, and a researcher called James Lloyd recently produced some excellent research, which considers inheritance packages in this country. It shows that there is huge expectation among people of a significant inheritance. Approximately 2 per cent. of people a year get a significant inheritance, but many people expect to get an inheritance of tens of thousands of pounds at some time. That does not apply to everybody, but it suggests that more than enough wealth is locked away in personal property for many people to provide for their social care and a comfortable standard of living in their old age, if they can find ways to free up equity that do not put their entire equity at risk but allow them to manage their affairs appropriately. Buying extra-care accommodation is one method of achieving that.
Another method of unlocking some of the equity and putting it into social care that the International
Longevity Centre recommends is a social insurance model. That encourages those who can do so to make a lump sum payment into a social insurance model at the age of 65. The money will provide the billions needed to provide free social care to all those who contribute to the model for the rest of their lives. It would provide the sums of money that the hon. Member for Sutton and Cheam needs to seek and the free personal care that people need. It would share the burden between everybody who reached that age. Existing state funds could then be used for those who do not have the equity or the means to contribute to the social insurance fund. Those are not the only ideas that we should consider, but I believe that they should be given some thought in the consultation on which we are about to embark.
Kelvin Hopkins: I have asked many people whether they would prefer to put at risk their small amount of equity in granny’s family home or pay slightly higher taxes. Without exception, everyone said that they would much prefer paying a slightly higher rate of tax to putting the small amount of equity at risk.
Dr. Ladyman: I take my hon. Friend’s comments at face value—I am sure that his constituents say that. However, my constituents do not say it to me; perhaps we have very different constituents. I also stress to him that I have not proposed models that put equity at risk. In both models—extra-care, whereby people buy into care communities, perhaps with some sort of tax incentive from the Government, and social insurance, whereby people use some of their equity at the age of 65—the remaining equity would be protected. Their inheritance to their kids would be protected if that is what they want. The rest of us would not be faced with a demographic time bomb and potentially huge increases in income tax to pay for such care. Perhaps my hon. Friend would like to propose his idea of paying for all that through extra income tax. I am perfectly happy for that to be on the table, but we should consider the full cost, not the Liberal Democrats’ mythical £2 billion. We should consider the full £10 billion or £15 billion and then see whether people are prepared to pay the hike in income tax that would be needed to cover it.
Paul Holmes: If the hon. Gentleman’s constituents are not willing, as other people are, including in my constituency, to pay the extra income tax needed to provide coverage across the board for everybody, can he clarify why they would be willing to put their equity into a care community or social insurance, knowing that everybody who was not doing so would be paid for by the taxpayer? Why are people not willing to pay through taxation, but happy to use the system that the hon. Gentleman describes?
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