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"The social care system is broken and . . . millions of older people are failed each year."
Four years ago we made it clear that there needs to be a partnership approach. We made it clear that we need a system whereby people can be sure that their care needs are supported, a system that raises the quality of care provided in people's homes as well as in residential and nursing care, reverses the decline in productivity in the social care sector, and ends the scandal of people being forced to sell their home or lose their lifetime savings simply because they are unfortunate enough to need long-term care. We will build a system that guarantees our older citizens the care and dignity they deserve.
Andy Burnham: I cannot be alone in finding the tone in which the hon. Gentleman introduced his comments disappointing. Older people watching the debate today will want not the usual slanging match, but a better and more serious debate about the serious proposals that we have put forward. They will also think that the Green Paper we issued today and the options in it deserve a hearing.
The hon. Gentleman says that that is not good enough, and suggests that nothing has happened. The Government have increased funding for social care by 40 per cent. It is fair to ask whether that would have happened if the Opposition had been in government. We have not been doing nothing. We have been investing in social care, and it is this Government who have put forward proposals to give people more control over that budget, giving them direct payments so that they can build and buy the kind of services that they want to live their life. That came from the Government, so it is not true that nothing has been happening.
The hon. Gentleman mentioned the royal commission. [Interruption.] He will recall that the royal commission failed to find a consensus about the way forward, contrary to what he said. The royal commission came up with a majority and a minority report. That, in itself, identifies how hard it is to take these issues forward. [Interruption.] There are no easy answers, and the subject should not be the stuff of straightforward tit-for-tat slanging matches in the House. We deserve a better debate about social care.
The hon. Gentleman asked me about additional costs- [Interruption.]
Mr. Speaker: Order. There is far too much chuntering from a sedentary position from those on the Opposition Front Bench. The hon. Member for Eddisbury (Mr. O'Brien) will have ample opportunity over a period to express his views from the Front Bench at the Dispatch Box, but he should not do it by sedentary chuntering.
Andy Burnham:
The hon. Member for South Cambridgeshire (Mr. Lansley) asked me about additional cost to the taxpayer. The foundation of our proposals is
the idea that our existing investment to help people to deal with the costs of care can be better spent by combining investment in social care with disability benefits, particularly attendance allowance. That is at the heart of our proposals today.
The hon. Gentleman also asked about the estimated take-up of the voluntary option, and there is a figure, albeit only indicative, of about 20 per cent. The trade-off with a voluntary option is that because fewer people may enter the scheme, the cost would be higher; on the other hand, under any comprehensive or compulsory option, people would not have the choice but the cost might well be lower. He asked whether I favour a comprehensive or compulsory option, and I believe that the option deserves a fair hearing. However, this is a Green Paper; we are putting forward three broad options for the country to debate, and it would be wrong to force the pace of that debate. I said very clearly at the end of my statement, if he was listening, that a broad consensus would need to develop in the country around one of those options before any one of them could be taken forward.
I was disappointed to hear the hon. Gentleman rule out, so early in this debate, the notion of a national care service, or of moving towards more national standards and entitlements in care. If he reads the Green Paper, he will see that we do not propose to remove the role of local government; we say that it would continue to have a crucial role to play in delivering such national entitlement to people in all parts of the country. However, he has leapt up with knee-jerk responses to the Green Paper. He has not come to the House with a considered response to the serious issues that it raises. It is the product of three years' work among a number of Departments, and it deserves a better hearing than the one that he has given it this afternoon.
Norman Lamb (North Norfolk) (LD): I thank the Secretary of State for early sight of the statement and the Green Paper. The truth is, however, that it comes 12 years too late. It is this Government's shameful legacy that they will leave office having failed to reform a system that the Secretary of State himself has described as a cruel lottery. The former Prime Minister said that he did not want
"a country where the only way pensioners can get long term care is by selling their home".
Yet 12 years on, nothing has changed; in fact, it has got much worse. Many elderly people have been left with inadequate care as criteria for care have been tightened and charges increased. Now we have a set of ideas that cannot be implemented this side of a general election, and the real risk is that the issue will disappear again into the long grass.
There are principles in this Green Paper which we welcome. The Liberal Democrats have called for a universal entitlement, a focus on prevention and the availability of advice and support. We support the idea of an entitlement to six weeks of reablement following discharge from hospital, and we absolutely support the importance of giving carers and care workers much more respect and the dignity that they deserve. We pay tribute to their work in very difficult circumstances.
On the voluntary option, will the Secretary of State publish the assumptions about take-up to which he referred? Does he accept that with both the voluntary
insurance model and the comprehensive model, there is bound to be a short-term funding shortfall? Will he rule out any increase in national insurance or council tax to pay for it? Will he publish all the costing documents? If we are to build a consensus, that is surely necessary. What happens to the current generation of retired people-those who are well over retirement age? Will they be able to make a payment into a voluntary scheme? And what about people with existing care needs? What about their circumstances?
Given the risk that the issue could be pushed into the long grass, and given that no one will have any confidence in a Conservative Government facing up to these real challenges, will the Secretary of State establish without delay a cross-party commission, in the style of Lord Turner's pension commission, to achieve consensus and, crucially, to commit any incoming Government to urgent reform? Surely we owe it to those with care needs to stop the talking and act now.
Andy Burnham: In response to the hon. Gentleman's final point, we are publishing these proposals today because we do not want this debate to go into the long grass.
Picking up on the welcome spirit of some of the hon. Gentleman's remarks, I take it that he may be interested in working with us on some of these options to see whether we can build a consensus around them. I welcome his support for some of the principles and specifics, such as reablement care and the importance of the social care workforce. We do not spend enough time in this House talking about the importance of the social care workforce and how we can invest in their professional development and recognise the huge contribution that they make. They do some of the least glamorous work in our society, and yet all our families depend on them, including mine over many years. They provide services that are crucial to our families, and we thank them for it.
I reject the hon. Gentleman's main allegation-if I may put it that way-that this is all 12 years too late. This Government have been investing in improving social care over the past decade; it is not true that we just sat back and have done nothing. We have put some £520 million into Putting People First, the scheme to give more personal control over social care funding. We were the first Government to bring in a national carers strategy, which had a whole range of measures to help carers, recognising the invaluable work that they do for the country. More recently, we published a dementia strategy, with £150 million attached to its introduction. All that is underpinned by a 44 per cent. increase in social care funding from this Labour Government. I do not think people would believe that a Conservative Government would have put anything like that level of funding into social care.
The hon. Gentleman said that I acknowledged that the current system was not good enough. I say that absolutely explicitly. I do not believe that we are doing as well as we might by older people, and I was hoping that collectively we may work to develop a consensus on proposals to do better. Conservative Front Benchers have already ruled that out, but I hope that at least we and the hon. Member for North Norfolk (Norman Lamb) can work together to address it.
On some of the specifics that the hon. Gentleman raised, the estimated take-up of voluntary options will be in the impact assessment published alongside the Green Paper. Obviously, the figures that we gave are broad, but they give an indication based on international experience.
We have ruled out increasing national insurance contributions because we felt that it would not be fair to the working-age population of today to put all the costs of care on to them. We think that a fairer approach is the partnership that underpins all three options that we have put forward.
The hon. Gentleman asked whether we would continue to deal with the existing care needs of people already in retirement. I can assure him that if we were to bring forward a White Paper with more detailed proposals, it would reflect the fact that some people would already be past the age of 65; that would have to be borne in mind.
Ms Patricia Hewitt (Leicester, West) (Lab): I warmly welcome the substance of my right hon. Friend's statement and the spirit in which he made it. As the Government take forward the debate on the three funding options that they have put forward, can he assure me that they will also continue to build on the excellent work that has been done with personal budgets and direct payments so that people receiving help with their care needs will continue to get as much choice and control as possible over the way those services are given to them?
Andy Burnham: I thank my right hon. Friend for her comments. I pay tribute to her for the work that she did when I served as her deputy in the Department of Health to introduce direct payments, which were controversial at the time but are now widely regarded as the right way to give people control and choice over the care services that they receive. I want to give her the clear assurance that any development of a national care service will take as its foundation that vision of social care, where the individual is empowered and able to bring in services to support them in living independently and having the best quality of life that they possibly can in retirement.
Mr. Speaker: Order. A further 24 Members are seeking to catch my eye. As ever, I would like to accommodate as many as I can, but I am looking to each hon. or right hon. Member to ask one brief supplementary question, and of course to the Secretary of State to provide us with a pithy reply.
Mr. Stephen Dorrell (Charnwood) (Con): May I invite the Secretary of State to respond to his own challenge to rise above the party political ding-dong and recognise that if we are going to address this issue seriously, we first have to ask whether any additional Government funding is available for any of the solutions that are canvassed at the end of the Green Paper? It is the absence of additional Government funding that has prevented the emergence of consensus at earlier stages. Did he say-I think I heard him say this to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley)-that no additional funding would be available from any source for any of the funding options?
Andy Burnham: I can explain to the right hon. Gentleman that I said clearly in answer to his colleague that we would better spend the existing resources that we put into supporting people with care needs. There is no commitment to additional funding, but what we are saying is that the additional funding could be brought into the system through the range of proposals that we have put forward. The right hon. Gentleman is somebody for whom I have great respect in this area, and is a predecessor of mine in this job, so I hope that he will give the proposals that we have put forward today a hearing. I believe that they deserve a fair hearing, and as I have said, we would do a great service by older people if we could reach consensus throughout the House.
Mr. David Blunkett (Sheffield, Brightside) (Lab): Does my right hon. Friend agree that the army of family and informal voluntary carers to whom he paid tribute at the beginning of his statement require not only support but an enhancement of the number of people encouraged to give time, energy and commitment, including in retirement, to keeping glued civil society together? Will he therefore consider issuing at the point of retirement a pack containing details of how those going into retirement and remaining healthy can get in touch with voluntary and statutory organisations that could help them to use their time and talent to the betterment of others?
Andy Burnham: I certainly recognise from my own family experience, as I am sure other hon. Members do from theirs, the intolerable pressures that carers and families face at times in trying to meet the care needs of loved ones and relatives. I say again that we are all indebted to the efforts of carers up and down the country, and that any visions for the reform of care and support must be based on the idea that families and communities continue to look after one another. A basic concept of neighbourliness and obligation to one another is the bedrock on which any system must be based.
My right hon. Friend's suggestion is good, but we will also need to draw on the support of the voluntary and charitable bodies in the sector that provide wonderful support to older people. I will explore the proposals that he has made with that in mind.
Jeremy Wright (Rugby and Kenilworth) (Con): The Secretary of State referred to the wish to see a system that "ends the cruel lottery of older people facing financial hardship" because they happen to get dementia rather than cancer, for example. I applaud that sentiment, but he must know that one of the main reasons for that distinction is that those who have dementia are considered to have social care needs, not health care needs. In all the possible options that he has set out, extra finance will be required from a person who needs dementia care. Will he look again at that distinction?
Andy Burnham:
First, I pay tribute to the hon. Gentleman, who I know takes great interest in the matter and has done very good work. I recognise the basic problem that he identifies, which is that some people with dementia get some help with the costs of their health care needs but not those of their social care needs. That is essentially the point that we are addressing in the Green Paper. We want to integrate services around
those individuals and, as I have said, make health and social care more equal partners in providing support for an individual. None of us can really feel comfortable with the notion that those who develop the very highest care needs through dementia or Alzheimer's continue to pay £200,000 or more to meet their care needs in later life.
Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): I very much welcome the clarity and certainty that the Secretary of State today offers care services users. Will he ensure that the debate on the options for payment also covers the sorts of services that should be available as part of the universal option so that individuals know who is paying for their care and what it entails? Above all, they should be in control of their care and managing their own budgets.
Andy Burnham: My hon. Friend makes an important point. I pay tribute to her as chair of the all-party group on social care and for her work on the subject down the years. She congratulates us on the clarity of the options. It would have been easier to pick up on some of the points that Opposition Members made and produce a timid and bland Green Paper, which was high on analysis and short on concrete options. With the Minister of State for Care Services, we have decided not to do that, but to put some serious options on the table, with all the risk that that entails. Very serious proposals for reform are not without risk, but if politicians are not prepared to take it, we will continue the drift and the delay, and we will not address the issues in the long term. If we are to build consensus for one of those options, there needs to be clarity about what people get for what they put in. My hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble) will see that the Green Paper spells out a clear vision for prevention, reablement and giving people the maximum ability to lead a full and independent life for as longas possible.
Sir George Young (North-West Hampshire) (Con): Much in the Secretary of State's statement can be welcomed, particularly the sentence, "It is time to make health and social care more equal partners." Does the right hon. Gentleman accept that, in the past 12 years, the national health service has had a much more generous deal than social care and that, in many parts of the country, social care services departments are under real pressure? Does he also accept that, whatever the option chosen, we need a step change in support for social care simply to meet the needs of demography?
Andy Burnham: I thank the right hon. Gentleman for his comments, but that is the logic of our proposals. However, unlike the national health service, the basis for funding social care will have to come not from taxation but from a partnership between the state and the individual, and the new resources will come from one of the three options that are proposed. I am grateful that he picked up on the sentence that he cited-I carefully inserted the notion of health and social care as more equal partners. It is not possible to say that they are equal partners today. Alongside the debate, we need to focus seriously on improving quality, and the calling of social care as a profession. I very much hope that someone with the right hon. Gentleman's authority will add to that debate.
Mrs. Ann Cryer (Keighley) (Lab): I wonder whether my right hon. Friend feels that the options that he has given this afternoon, which I appreciate, will help some of my constituents in care homes, who are being cared for by people with little knowledge of how to care for elderly people? Many of those carers have no or very little English, possibly because they are paid the basic minimum wage and because some-only some-care home owners are interested only in profit making rather than caring.
Andy Burnham: My hon. Friend makes a powerful point. It is important to send out a message from today's statement that we want a debate about social care and its status, and to take it more seriously. We could do that if we could bring in more resources for providing services for older and disabled people. My hon. Friend makes an important point. I said in my statement, and I repeat, that carers do some of the most important work, on which we all depend, yet the message that they get from society in terms of what they are paid may not always reflect that.
Mr. Paul Burstow (Sutton and Cheam) (LD): Many people outside the House who have followed for many years the issue of how we pay for long-term care will experience a terrible sense of déjà vu about the statement. Will the Secretary of State please "not flinch", as he said himself, and set out the timetable that he intends to follow for making decisions about the public expenditure implications of the proposals and, more important, for introducing his plans at the Dispatch Box?
Andy Burnham: If the hon. Gentleman will forgive me, I do not think that he can claim déjà vu because we have not previously had a Green Paper that puts serious Government proposals for care on the table. We had a royal commission, but as I said to the shadow Health Secretary, it did not identify consensus on a way forward. What I have announced today is new territory. We want a serious debate, and the hon. Member for Sutton and Cheam (Mr. Burstow) can help us build consensus. It is right that, if we can reach consensus about the debate, the subject should become a serious issue of consideration at the next general election so that the public can choose the party that has the best solution to the serious and long-term challenges.
Mr. Parmjit Dhanda (Gloucester) (Lab): May I associate myself with the remarks of my right hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) about family members? Taking that on board, will my right hon. Friend the Secretary of State consider a fourth option for family members, by using either tax relief or grants to support the building of granny annexes, in order to allow family members to keep the capital gain, to save the Government money and to create a far more caring culture in our country?
Andy Burnham: That is a very good point, but it is already the case that people can use personal budgets to help to offset the costs of family members as my hon. Friend describes. However, I encourage him to work up his ideas. Given that we have tabled three serious options, I am not ruling out others. As I said to my right hon. Friend, it is very important that we recognise, encourage and incentivise the role of the family community in this debate.
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