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When can we expect councils, as part of their planning duties, to design their town centres around what I like to call "liveability" for older people, and
design older-people-friendly town centres, so that older people have an incentive to move from remote accommodation into their own accommodation but in the town centre, where it is far easier to provide them with the care services that they want?
Richard Younger-Ross: Will the former Minister answer the question about how we deal with rural areas where people want to live in their community? He seems to suggest that such people should move to the towns.
Dr. Ladyman: I am absolutely not suggesting that, but many people live in suburbs and around towns and are happy to be urban dwellers. Some people may be happy to move from rural to urban communities, and if they want to do so that is fine, but we can still organise services differently around rural communities to minimise cost. Telecare is one option. Where are our proposals to ensure that every older person is entitled to a package of telecare? If one lives in a remote rural cottage, one could make feasible the provision of care in one's home environment through telecare. Perhaps that should be the universal option that we put forward.
I mentioned earlier direct payments, of which I am a great fan. The right hon. Member for Charnwood rightly mentioned that the Conservatives introduced them, but they made it only optional for councils to offer them; we made it compulsory for councils to do so, and compulsory for councils to give such payments to individuals who requested them. We should continue to do that, but the ultimate direct payment is attendance allowance: it is not means-tested; it is a universal benefit with a national eligibility criteria. It is the ultimate direct payment; it is simply not called a direct payment at the moment.
One worrying proposal in the Government's Green Paper is the option that we take the money from attendance allowance and put it into a pot to pay for the social care service. If we are serious about direct payments, all we will do if we adopt that proposal is take attendance allowance off people with our left hand and, calling it something else, give it back to them with our right hand,. It would be far better just to call it attendance allowance, leave it as it is and recognise that it is in place to pay for that first element of somebody's care.
Finally, the Supporting People budget needs to be brought into the debate, too. The way in which we provide help through that budget is another element of the package which we have not addressed. I commend to Members the debate that my hon. Friend the Minister wants, and I commend the Government's amendment.
Mr. Geoffrey Cox (Torridge and West Devon) (Con):
I shall try to confine my remarks, to make them relatively short and, in the spirit of my right hon.
Friend the Member for Charnwood (Mr. Dorrell), to avoid the partisan rhetoric in which it is too tempting to engage on the eve of a by-election. I was, if I may say so, struck by the sincerity and dignity with which the hon. Member for Colne Valley (Kali Mountford) addressed the House, and if I were tempted to engage in the debate in a partisan spirit, her presence here, listening to me, would shame me into not doing so.
This is a profoundly serious debate. As somebody with a 97-year-old grandmother, who lives near me, whom I am responsible for, who is in residential care, who has gone through the often bruising experience of losing a great many assets and who is now, I am afraid, afflicted by dementia, I must say that the problem is all too present and real to my family and to me. This debate is therefore not one in which I can engage with any light or bantering tone. Plainly, the situation that afflicts my grandmother as she descends into dementia afflicts tens of thousands of people throughout the country, and they look to this House not for party point-scoring, although hon. Members in all parts of the House have engaged in such activity in good humour today, but for solutions.
I have been struck by something in this debate: we seem to have made a breakthrough. In recent years, it has been particularly depressing to note that there has been an element of deception in how we have approached the foundation of public policy on this issue. Indeed, the more I have come to play a part in the system under which we now operate-on behalf of constituents and personally-the more apparent it has become that the system has become cruelly deceptive of those who operate in it. For example, carers are said to be entitled to an assessment and a carer's package. How often do we Members experience that as a reality as we carry out our constituency functions? In the rural part of the south-west that I have the honour to represent, it is more of a declaration than a reality.
In Devon, part of which I represent, it is not true to say that when a person has exhausted their assets they can choose a home or remain in the home in which they have been resident. If the county council will not pay the fee associated with such homes, more and more families end up digging into their own pockets to top up the amounts that the county council will pay. Alternatively, a benevolent fund or charity-whomever one can find-becomes involved.
The alternative with which the resident is presented is that of moving from a home in which he or she has become happy, or at least contented and used to. That is cruel. Having paid all they can and descended beneath the relevant threshold of assets, the resident comes to the system. In many parts of the country-particularly in Devon, which has the sixth worst social care grant in the country-they find that the reality is not what they were led to expect, which was that the state would provide for them in their straitened circumstances.
Far too many in residential care are affected by serious conditions such as dementia; the hon. Member for Colne Valley spoke a little about that, but did not go into detail. My grandmother is in a home, clearly suffering from moderate, and increasingly severe, dementia. That is not, we are told, a matter for the health service and it is extremely difficult for her to access the mental health services that might assist her. I
suspect that thousands of elderly people in residential care are affected by dementia. I fear that the curious assessment system that decides who falls under the health category and who falls under the social care category is also, to a large extent, a deception. The system is variously interpreted in different parts of the country and one senses that the lower the Government social care grant for a local authority, the more people who should be paid for from the health budget are in the homes of that authority.
I make criticisms of that, but I understand its springs and origins; it comes down to a shortage of money. I said that we had made a breakthrough in this debate and the run-up to it: it is that I have yet to detect anybody who seriously contests the notion that all parties must make a frank and candid admission to the country. It is that we cannot conceivably fund these measures through taxation, and if both sides of the House start from that point, we will at least have the beginning of a consensus-the start of a foundation on which we can build a policy.
I have yet to detect that; indeed, the Liberal Democrats went to the country at the last general election with a policy based on precisely that position. That reminds me of Harold Macmillan-I am going to indulge in a little badinage, but I hope it is good-humoured-saying that the Liberals are full of original and practical ideas, but the problem is that the original ones are not practical and the practical ones are not original. One has to say that the policy with which the Liberal Democrats went to the country three or four years ago was not practical. I am delighted to hear that they are no longer wedded to it, given that even their own party members considered it to be based on a deception.
We cannot go on suggesting to the people of this country that we can sustain elderly and social care on the basis of taxation. I agree with my right hon. Friend the Member for Charnwood that there must be a balance. I am going to risk provoking the concern of my Front-Bench colleagues by saying that we need to use public funds more effectively. I say to the Minister that I am not speaking for my party, so let him not make too much of this. I participated in a Select Committee that looked into fuel poverty and asked, "Are we making enough of the public funds?" and "Are we directing them and making them more effective?" That Labour-dominated Committee decided in its report, which I commend to the Minister, that we were not making effective use of the public means at our disposal. In my judgment, winter fuel payments should not be paid to those on higher-rate tax bands. It makes no sense to do that, and we could save about £250 million by not doing so-a small amount, but it would be a start. We are not making effective use of the many different allowances that are-I fully accept this-designed and targeted to relieve the poverty of the aged, including fuel poverty. On top of that, we should, as my right hon. Friend the Member for Charnwood suggested, adopt an insurance system over and above a particular threshold.
If the insurance had to be paid while one was working, which seemed to be the suggestion of the right hon. Member for Charnwood (Mr. Dorrell),
and if it were made compulsory, how would it differ from national insurance, which is effectively just another tax?
Mr. Cox: Plainly, the detail needs to be examined. I can think of solutions through the insurance system that would not necessarily mean that the money was lost if one did not subsequently have to call on the insurance fund, and other techniques could be used. The danger is that there would be no incentive to engage in it. However, it would be retrograde and unfortunate simply to have a tax on those who were elderly or a tax on their estates; we must look for alternatives to that.
The silver lining that I perceive in this debate, starting from a position of far less expertise than those who have participated in examining the problem in government, is that we have all been able candidly to accept-nobody has sought to argue otherwise-that we will need a system that is based at least partly on the private financing of those affected. If we can build on that as a starting point for this policy, we then have a responsibility to develop it. Twelve years ago, the former Prime Minister came into government promising that he would solve this problem. It is a bit late for the Labour Government to produce a policy now, but I am glad that they have, because at least we can all begin to talk about this in an adult and sensible way and to say to the public that it can no longer be done on the basis of public means and direct taxation.
Dr. Richard Taylor (Wyre Forest) (Ind): At the beginning of the debate, I was quite depressed by the partisan nature of the contributions, so I am delighted to speak towards the end and follow three or four excellent contributions that show the willingness of Members on both sides of the House to take this matter seriously. I welcome the debate as an attempt to look at the problems of long-term care realistically, sensibly and openly, and, I hope, to achieve consensus.
I absolutely agree that the proposals have been rather slow in coming. I have spent quite a bit of time looking back at the Select Committee on Health's report on continuing care, published in April 2005. I had to examine the membership of the Committee to ensure that the Secretary of State himself was not a member at that time, because, as far as I can see, most of the recommendations in that report are covered in the Government's proposals and the Green Paper.
"Inconsistency of criteria between PCTs/SHAs"-
"leading to inequity.
Gap between eligibility criteria on paper and application and interpretation in practice.
Inconsistent approaches to assessment and a lack of fit with the Single Assessment Process.
Inaccessible or incomprehensible criteria (both for professionals and patients).
Concerns over exclusion of many chronic needs (especially dementia) because of focus on physical care",
"Confusion over relationship between high band RNCC-
"and fully funded continuing care."
"We therefore recommend that the Government's review of continuing care funding arrangements take the form of a full, formal public consultation, in line with Cabinet Office recommendations."
"what is health and what is social care",
"We strongly recommend that the Government remove once and for all the wholly artificial distinction between a universal and free health care service operating alongside a means-tested and charged for system of social care."
"If by recommending that the Government remove the distinction between health and social care, the Committee is really recommending the removal of means testing for care services, then this would have significant cost implications."
The cost implications that we identified then were a mere £1.5 billion, estimated to rise to more than £3 billion by 2020, not taking into account the costs of looking after patients, such as food and residence costs. The figure of £20 billion is possibly more nearly correct, and that is obviously quite unaffordable from taxation. There appears to be a general consensus about that.
The Government are to be congratulated on the fact that at a time of recession, they have introduced a Green Paper inviting consultation on how we can find the money. I cannot help hoping that that spills over into the national health service as a whole, because we have to ration money for the NHS as well.
Mr. Graham Stuart: I welcome the hon. Gentleman's desire not to be partisan in spirit. I put it to him that one reason for some of the venom on the Conservative Benches is that this important debate has been launched nine months before an election, when it will be impossible to get consensus. Even if it were possible, it would not be possible to get legislation arising from it. The frustration is about the Government's failure in previous years to bring the consultation forward, although it is welcome whenever it comes.
"a single, universal set of national eligibility criteria for continuing care to end the inequities and inconsistencies that have developed as a result of the current system."
The situation was ridiculous. There were two separate systems for assessing eligibility for fully funded NHS care and for assessing the need for the registered nursing
care contribution. I hope that the Green Paper will address all those matters and, most importantly, genuinely tackle the problem of resources.
With your indulgence, Mr. Deputy Speaker, at the last moment, I will consider a rather different aspect of care of the elderly, which is incredibly important. The reason for allowing myself perhaps to digress is that the motion uses the words, "encourage respect" and
"promote security and dignity in old age",
What do independent elderly people living alone need, as well as peace of mind about long-term care? They need the security of knowing how to access appropriate acute care and that they will be cared for expertly and appropriately in the right setting. One of the disadvantages of the rapid changeover of Ministers in the Department of Health is that, just when one has got a particular Minister to recognise something important, he moves on. I am referring to the right hon. Member for Exeter (Mr. Bradshaw), with whom I have had more than one debate about access to emergency care. That is particularly important for the elderly.
I want to put it on the record, so that current Ministers do not forget, that they are working towards a single, three-digit telephone number, which will allow the elderly to know that they do not have to traipse round the minor injuries unit or an accident and emergency department or to look for out-of-hours care. They can ring the number, which will point them to the correct pathway. That is the first thing that I do not want to be forgotten.
The second thing is also crucial for elderly people. Let us imagine an elderly person found unconscious in the street and taken to an A and E department. The first thing casualty officers do is measure blood sugar because, time and again, that puts matters straight. They whop in the sugar and, if it does not work, they take further tests and discover that the person has terribly low blood pressure and terribly low sodium. That raises all sorts of possibilities. If that patient were accompanied by an electronic summary care record, the doctors would be told the reason for the particular problems immediately. The electronic summary care record is crucial to quality of care for the elderly, and I cannot understand why it has been so delayed when we have an absolute model for it in Canada, where there is, on a single computer screen under eight headings, all that an emergency doctor needs to know. I hope that Health Ministers will recognise the importance of that.
I hope that, in the excitement of publishing the elderly care Green Paper, those other matters will be remembered and that everybody will engage, especially, as the right hon. Member for Charnwood has said, in working out how we can find the resources.
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