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There is so much more that I wanted to say, but there is not time to do so. I want to point out, as many people have done, the importance in any future care system of quality, the dignity of the individuals being cared for, and their protection from abuse. My last point takes the Minister on to a slightly different agenda. In the Queen’s Speech in the autumn, there will probably be a Bill on equality. One of the burning
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issues is whether there will be a full-blown outlawing of age discrimination in the Bill. Given all that we have heard in today’s debate, I urge the Minister to do his very best to make sure that the Bill outlaws age discrimination.

5.35 pm

Paul Holmes (Chesterfield) (LD): Like the previous speaker, I will cut short some of my comments, because we want to make sure that everybody can contribute before the end of the debate.

I will be fairly brief on the funding issue, which has had quite a good airing. We have already established that provision of care in all areas is underfunded, and the situation will get a lot worse. We have an ageing population demographic, people are living longer as a result of more prosperity and better health services, and not only are more disabled people being born, but they are living quite long and fruitful lives when they would not have done so 30 or 40 years ago, due to the sort of policies and medical capabilities that there were in those days.

Somewhere, someone will have to pay for the care that is needed. That can be done through general taxation, which is mutual insurance paid for according to ability, hopefully, although the Government’s tax policies penalise the poor more than the wealthy. The other way is to follow the extreme USA example, in which the emphasis is on the individual being responsible. If the individual has not earned or saved very much, for whatever reason, that is tough. About five years ago, I was in Lincoln, Nebraska. Those of us visiting met a voluntary group that gave us a fantastic explanation of how it helped elderly people to access support, care and so on when they needed it. There came a point when we suddenly realised that all that it did was advise elderly people on how to spend whatever money, personal insurance or benefits they had got for themselves. There was no state aid, effectively. I hope that we do not move towards that extreme in the coming years.

The Conservative and Labour Back-Bench spokesmen, but not my party’s spokesman, have today suggested that we cannot possibly consider taxation. They say, “We will not put forward any suggestions involving that side of things, because that would cost money and upset voters.” One way or another, we have to pay if we are to provide the decent society that various Members have talked about this afternoon. The money has to come from somewhere. It can come from a mix of taxation and payments; otherwise, there are the extremes: it could all come from taxation, or we could take the USA approach, which leaves one in five Americans with no medical cover at all. When they reach old age or have a disability, it is even worse.

We need to bite the bullet and be honest, especially given that we have only just reached the average level of western European taxation. We are not a highly taxed nation, contrary to what everybody on the street will tell you, if you ask them. I even read one analysis this morning suggesting that tax levels are lower than when the Conservative Government left office. I have checked the figures, so I know that we have just reached average levels of western European taxation. On health and education, which have had money poured into
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them, the average western European levels of investment has just been reached. We should not sell the pass completely and just say, “We are an incredibly highly taxed nation; we cannot afford to provide decent pensions, care, support and so on.” However, I shall not go into huge detail on that point.

Every MP has many examples brought to them by constituents. We have heard some today that illustrate the need for more and better targeted care services and care funding. One MP pointed out that he has two parents who are suffering from dementia. Many of us will have that experience in our families. Ten years ago, my father died with Alzheimer’s. Last summer, my mother-in-law died with aggressive dementia as a result of multi-infarct. A few weeks ago, my mother died with Alzheimer’s at 82. As so many others in the Chamber have done or will do, I have gone through all those problems that constituents bring us about ageing parents who physically need more help at home, and then start to lose their mental faculties. They may consider doing what we did: we moved my mother-in-law into our dining room and made it into a bedsit, and tried to cope in that way. As the dementia got worse, it became impossible. She needed 24-hour care. When one looks for care homes, all the issues of selling property, funding and payment arise. One way or another we will all go through that with members of our family, or ourselves, with our children going through it for us. The problem is widespread and we all have those experiences.

There are further examples that constituents have brought to me. One of them is early onset Alzheimer’s. Terry Pratchett, who was recently diagnosed with early onset Alzheimer’s, is a famous example. One constituent came to me five years ago and the problem has still not been solved. Her husband in his early 40s was diagnosed with early onset Alzheimer’s, which is quite rare at that age. As a result, no care home within decent travel distance was suitable. Although at 40 or 42 he had Alzheimer’s, he knew when he looked around the care home full of old-age pensioners that there was something wrong—that was not his generation of people.

My constituent’s husband ended up in a care home some miles up the motorway, up past Rotherham, with his wife trying to travel back and forth every day to visit him. We had round table meetings with all the medical professionals and social services. We all agreed that it was an immense problem, and five years later we have still not solved it. That will become more common as we get better at diagnosing conditions such as early onset Alzheimer’s.

Respite care has been mentioned, so I will not go into detail about it. We can all think of constituents with autistic children. We have had examples of elderly people looking after elderly parents, where both sets are old-age pensioners. I can think of at least three sets of constituents where the old-age pensioner has been looking after a disabled child who is now an adult—pensioners who need care and respite themselves, but who have 30 or 40-year-old adult children living with them. One, for example, was born with mental disability and was blind, and is still living with his elderly pensioner
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mother. She is approaching 80 and he is 30 or 40-odd. Such cases are becoming more common and need support and funding.

The entire year’s budget for Derbyshire for disability adaptations to housing could be spent in the first three months of each financial year clearing the previous year’s backlog. That would leave not a penny for anybody who applied for a disability adaptation to a house in the current year. That is an ongoing problem and I am sure it is not specific to Derbyshire. Other Members must have come across it as well.

Some hon. Members have mentioned direct payments, usually with great enthusiasm. We all welcome direct payments. They are excellent in intent and in effect for the vast majority of people who access them. Some people want them to be spread into some areas of NHS funding and support, for example, but how good is the guidance and support given to people who access direct spending?

What happens for people who access direct payment and become a small employer for the first time in their life, perhaps when they are a vulnerable adult? What will happen, for example, to a 73-year-old man who becomes blind virtually overnight, and at the age of 74 takes on direct payment and becomes a direct employer? First, he has carers through care agencies, but as one hon. Member commented, people do not like that. They have lots of different care workers coming in and they are never sure who is coming each day. In the example to which I refer, the man became a direct employer of one care worker, which worked well for a while.

What happens if the person falls foul of employment law and ends up facing thousands of pounds of legal fees and compensation—about £20,000 in all, for a 79-year-old constituent who is blind? How do we avoid that happening? How widespread is that? I hope the Minister may be able to comment or write to me. I shall send him details of the constituent in question.

Derbyshire country council might give me a substantive reply on the matter fairly soon. I wrote a month ago and asked some specific questions. I asked the council to provide me with hard copies of the documentation on being an employer that it provided to clients like my constituent five years ago, clearly indicating where it emphasised the legal obligations that direct payment would entail, and the guidance and training that it gave on the requirements of employment law. I understand that the situation was pretty chaotic five years ago and that Derbyshire county council undertook a massive rewrite of the procedures for that reason.

In the council’s latest newsletter to clients using direct payments, which came out only a few weeks ago, on 24 April, it said that it had a three-year-old manual that was prehistoric and needed rewriting because it was so out of date, and advised clients to take out employer and public liability insurance. Did it do that five years ago, four years ago or three years ago? How widespread is the problem? The Minister may know about that from cases that have reached his desk. I have asked colleagues, some of whom say that they have come across the problem. I will write to him with full details.

Now that I have raised the issue in the House of Commons in a fairly gentle way, Derbyshire county
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council will give me a full, detailed and substantive response. If not, I shall seek an Adjournment debate to deal with the matter in rather more detail.

5.45 pm

Mr. Kevan Jones (North Durham) (Lab): The debate today has been very good, and the thrust of the consultation document was to try to ensure that we not only support people in their own homes for longer, but make sure that their quality of life in old age is rewarding and comfortable.

There are cases, however, where it comes to the point at which people cannot be kept in their own homes. We need the fallback, especially in rural counties such as County Durham, of locally provided, resourced and staffed units to look after some of the more challenging and difficult cases with which relatives cannot cope at home.

The right hon. Member for North-West Hampshire (Sir George Young) mentioned the movement to community-based support for mental health services and said that the Treasury saw it as a way of saving money. My problem with the present policy is that lessons that should have been learned in the past are not being learned. My experience of working with local Alzheimer’s charities is that they give people with severe dementia or Alzheimer’s a tremendous amount of support. A lot of relatives want to look after those people at home for as long as possible, but we all know—reference was made to this earlier—that behaviour can become challenging and it can be difficult for elderly carers to look after those people.

In Durham, we have the Earls House site, run by the terribly named Tees, Esk and Wear Valleys NHS Trust. The trust covers County Durham and some of us pointed out that it might have been a good idea to put County Durham in the title when it was formed, but we were ignored. The unit on the Earls House site, which covers the north of the county, provides accommodation for dementia and Alzheimer’s patients with challenging behaviour. The trust is just about to announce the unit’s closure. I take issue with the idea that we can have a consultation document where the preferred option by the trust is already there. As the right hon. Member for North-West Hampshire said, the budget is driving this matter rather than the provision for elderly people in the north of the county.

The only provision for these patients will be 40 to 50 miles to the south of the county. We are hearing the right noises about supporting the community, but the beds are needed to support elderly people with difficult situations. For example, a Mrs Swann came to see me last week. She has a 77-year-old husband who has severe Alzheimer’s and has been in one of the two wards at Earls House, Appletree and Inglewood. She goes three times a week to visit her husband, who is grateful for the support he gets in that facility. She will now have to travel about 40 miles if the two wards close. Let us not make the mistakes that were made in the past, to which the right hon. Member for North-West Hampshire referred. We will need provision in local areas, and the idea that everything can be closed and pushed into the community is not the answer.


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My other concern was raised in a good speech by the hon. Member for Rugby and Kenilworth (Jeremy Wright). It is how we give carers and relatives a voice. Frankly, I opposed the setting up of the NHS Appointments Commission—the independent arm’s length commission making appointments to various health trusts, because I am a bit old-fashioned. I believe that politicians should take responsibility for decisions.

Local accountability is not there in respect of the weirdly named Tees, Esk and Wear Valleys NHS Trust. How will Mrs. Swann and other relatives have a say in what happens about the two wards earmarked for closure? The consultation is out, and my hon. Friend the Member for City of Durham (Dr. Blackman-Woods) and I are objecting to the closures. Will those people be able to have an impact and change the situation? I doubt it.

We need to ensure that we give a voice not only to carers, but to relatives. As we know, the individuals in these cases are often unable to articulate the views that are needed. We should have the debate by all means, but let us be careful not to get into a situation in which facilities are closed and we more or less say that somehow people will cope at home. They will not.

I also want to mention something raised by the right hon. Member for North-West Hampshire: the relationship between social services, acute trusts, local NHS trusts and primary care trusts. How do those interact? How do people work their way through that network? We need to consider that carefully. If we are to keep people in their homes for longer, we cannot have the silly situation mentioned earlier, in which, for example, the county council does the assessment for adaptations, the district council direct labour organisation does the work when it finally gets around to it and the poor client is unable to hurry up the case or, in many cases, to get an answer about some of the assessments. I hope that the abolition of the single-tier local authority in County Durham will help. However, if we are to have these joined-up care packages, I am concerned about how people will have that seamless service, whether they are in hospital, local authority care or, like Mr. Swann, in a hospital ward run by the acute trust.

This has been a good debate and the document is the right way to start the consultation. However, at the end of the day, what we are discussing will not be a cheap option for care. If all parties enter the process with that starting point and realisation, we may be able to get a system that is better not only for recipients of care, but for their carers and loved ones, who are also important and want their elderly relatives to be treated with pride and dignity.

5.53 pm

Mr. Ivan Lewis: With the leave of the House, Mr. Deputy Speaker, I should say that, on the whole, this has been an excellent, high-quality debate. However, I have to turn to the contribution from the hon. Member for Eddisbury (Mr. O'Brien), which demonstrated that Conservative Front Benchers have no policies, no vision and no substance when it comes to these and many other issues. I asked the hon. Gentleman how often the group set up by the Leader of the Opposition to consider
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social carers had met, and his answer was, “Many numerous times.” Will the hon. Gentleman write and tell me how often it has met?

Will the hon. Gentleman also speak to Sir Simon Milton about Putting People First, probably the most radical transformation of social care for a generation? It is happening in every local authority area. The hon. Gentleman described it as “a bundle of papers”. I should tell him that there was never any commitment to a Green Paper specifically on individual budgets; later this year, we will publish the results of the evaluation into the individual budget pilots in the 13 local authority areas. The rest of the hon. Gentleman’s contributions were very constructive.

I can assure my hon. Friend the Member for Kingswood (Roger Berry) that there is a commitment to issue a Green Paper early next year. There is no doubt that as we consider fundamental reform of the system, we must take seriously the question of differential approaches to charging and, specifically, the portability of care packages. I pay tribute to his long-standing contribution to championing the rights of disabled people.

On behalf of the Liberal Democrats, the hon. Member for Sutton and Cheam (Mr. Burstow) must answer the question about where the money for their policy would come from. Would it, as he hinted, come from cuts to spending elsewhere, such as in the NHS? Would there be a tax rise to fund it? He must also say whether their policy is genuinely sustainable in the long term or simply intended to get them through the next general election. I greatly respect the work that he has done on elder abuse and on dignity for older people, and I hope that he will think that the review of the No Secrets guidance comes up with an appropriate system for adult protection that reflects some of the tensions and challenges that have been evident in the debate.

Everybody I have spoken to regards my hon. Friend the Member for South Thanet (Dr. Ladyman) as having been an excellent Minister for social care. He put in place the foundations that led to many of the reforms that have taken place in recent times. He is right that it would be wrong to talk about the future funding of social care being based on the existing system and model. The challenge is whether we can have a vision for the future that reflects people’s changing aspirations, the opportunities presented by technology and extra-care housing, and people’s behaviour in terms of financial incentives. This is not simply about tinkering with the existing social care system.

I pay tribute to the contribution by the right hon. Member for North-West Hampshire (Sir George Young). He clearly “gets it” in terms of self-directed support. It is one of the most radical reforms of public services—a redistribution of power between the state and the citizen the like of which has not been seen previously in public services. It is important that the policy is explained to people and that they are enthused by it, because it is an incredible example of social
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justice and equality of opportunity in action. He is right to point to the obstacles and barriers and to the lessons that we need to learn in putting into practice this entirely new approach to vulnerable people’s rights to exercise self-determination and maximum control over their own lives.

I pay tribute to my hon. Friend the Member for Worsley (Barbara Keeley), who has championed the cause of carers for many years since she entered this House. I hope that she will not be disappointed when she sees the new carers strategy on the role of GPs as regards identifying and acting specifically on the needs of carers. She is right to refer to the appropriate balance between universal entitlement and local discretion, which has come up time and again in the course of the debate.

I pay tribute to the hon. Member for Rugby and Kenilworth (Jeremy Wright) for the work that he has done in the House on raising the profile of dementia. We have to bring dementia out of the shadows—that is one of our great challenges. He is right to prioritise the need for carers to have access to appropriate respite and to note that professionals sometimes do not treat carers with the respect that they deserve.

I pay tribute to my hon. Friend the Member for Stafford (Mr. Kidney), who is right to say that many of these issues are at the frontier of the new welfare state—they are the new challenges to which any responsible Government, and indeed Opposition, should face up. He rightly identified five themes from the work that he has done with Staffordshire university.

We did not speak enough about the work force. If we are to make a reality of this new agenda, it is essential to get the quality of the work force right. With a low-skilled, low-paid work force, we have a lot of work to do in thinking through the implications of the new system in terms of the people who will be required.

The hon. Member for Chesterfield (Paul Holmes) said that Labour has poured loads of money into health and education. We do not often see that acknowledgement in “Focus” leaflets. He advocated significant tax hikes, although I am not sure that he will do so in his own constituency. However, he is right about guidance on issues such as direct payment.

My hon. Friend the Member for North Durham (Mr. Jones) rightly talked about the nonsensicality of proposing the reorganisation and reconfiguration of services without being clear about the alternative provision that will be in place and the fact that that needs as far as possible to be available locally. There will always be a need for residential and nursing care, and sometimes acute hospital beds, for people with dementia. Decisions need to be made not just about the here and now, but with regard to planning for the long term needs of his constituents. I agree with him that there should be a genuine consultation but it must be about future provision and demand for people with dementia. It is important that the voice of relatives is heard in that debate.

It being Six o’clock, the motion lapsed without Question put.


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