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Mr. Paul Burstow (Sutton and Cheam) (LD):
I want to contribute briefly to the debate in two particulars. Many useful contributions have been made about the proposals for paying for long-term care, and there is a genuine sense of déjà vu about them. Not least, yesterday's statement contained echoes of the statement made by a former Secretary of State in May 1996. I want to use the
debate to ask the Minister two questions, which need to be asked with only three sitting days left before we break for the summer recess.
The first relates to a commitment that was made last June by the Minister's predecessor immediately to produce a paper on prescribing anti-psychotic medication to people who suffer from dementia. That scandalous practice affects more than 100,000 people a year in care homes, and it probably accounts for the premature deaths of around 23,000 elderly people up and down the country. It is clear from the evidence that has been compiled over many years that such drugs cut lives short, that they result in strokes and that they cause many of the symptoms that are then used to justify yet more prescribing. Government action on this issue is long overdue, so will the Minister tell us when the now overdue report on prescribing will be published and the necessary action that will be taken?
My second point is about the Government's commitment to do something about elder abuse more generally and put in place new measures to tackle that scandal. Some 342,000 people a year are the victims of elder abuse in this country. That is a scandalous tally, and it does not even include those in care homes or those with dementia. I would therefore like the Minister to tell us when he expects the "No Secrets" review to release a publication. The codes of practice for consultation-codes to which the Government say they adhere-suggest that a publication should have come out in April. However, we have seen no analysis of the responses to the consultation, nor have we seen any indication of the Government's proposals.
I have heard that the intention is to smuggle out an analysis in electronic form-a rather flawed and partial analysis-of the consultation on "No Secrets" on the Department of Health's website tomorrow and that that will be done with no fanfare, no scrutiny and no indication of what actions will flow from it. It would therefore be useful if the Minister were to confirm today that it is not the Government's intention to do that, that there will be full accountability to this House and that there will be a genuine effort to keep minds open to the case that has been made by the police, the Commission for Social Care Inspection and almost every statutory body that responded to the Government's consultation. Legislation should be introduced to put the protection of vulnerable adults on a similar footing to the protection of children. Surely that should happen, because it is long overdue.
In particular, I want to refer to something that the hon. Member for South Thanet (Dr. Ladyman), a former Minister, said about the Opposition motion. The issue has been on the Opposition agenda for some time. From where I am standing, I assure him that it is not in our motion, because of the Green Paper that was published yesterday. Partisan comments have passed
across the Chamber, but I am a Norfolk MP and make no bones about it. The issues that affect people in Norwich equally affect people in my constituency, so I make no apology for bringing up that matter.
The fact is that elderly people feel vulnerable, but at the same time people in Norfolk are proud people: they want dignity and respect in retirement; and they want the state there as a hand-up, not as a handout. The fact is-this comes up on the doorsteps-that there is much social and economic deprivation across the county of Norfolk. I have spoken to people in Norwich and in my own constituency, which is highly rural-Norfolk is a disparate county that covers eight constituencies of various sizes-and they are concerned that what is being proposed today is too little, too late.
Tony Blair talked about the issue 12 years ago. I have a quote here from a constituent who came to see me at my surgery: "It's 12 years of hardship and misery-not just for me, but for my family and all those people whom I am now reliant on to give me the support I cannot get from the state." That is the fact of the matter, and that is what we face every day. I encourage hon. Members to listen more to constituents who say such things. That is not partisan; it is our job as Members of Parliament to stand up in this House and represent those points of view, however people may see it from the Government Benches. I am doing this, because it is right for the people of my constituency and the people of Norwich.
At the end of the day, we have a growing elderly population, who realise that their pensions will not cover the cost of care that they have to provide. They feel penalised as they go about their daily lives. They have made a contribution to the community and to society, and they have paid their taxes, yet in their hour of need, they often feel that the rug has been pulled from beneath them.
The families of many elderly people have moved away, because they can no longer afford to live next door, so they can no longer invite their grandmothers, grandfathers, uncles or aunts to live with them. Families have had to move because of work. My constituency covers 1,200 sq miles, and people can live very far away from each other while remaining in the same constituency. Villages and rural areas often do not have a proper infrastructure or a proper transport system. It is all very well to say that elderly people can get help from their families, but that is just not practical and it does not work.
Mr. Graham Stuart: Does my hon. Friend agree that the black hole in finances and resources is such that the honest message must inevitably go out from this place that families need to do more to support their loved ones in their old age? There is unlikely to be a solution that will provide the security that older people need without greater personal commitment from families.
I agree 100 per cent. with my hon. Friend. There is no doubt that families try. No matter what their political persuasion or where they live, they try to help each other as best they can. At the end of the day, however, selling one's own home to pay for care is not the solution. Over the past 12 years, many people
waiting for help from the Government have done their best to sort, but selling one's home in an economically and financially difficulty environment is not the easiest option.
Some of the proposals in the Green Paper will not suit people, because they will not be around to see the benefit of them. There is no mention of people who are coming to the end of their lives having struggled to manage. What are they to do? What is the Government's commitment to them? The Green Paper talks about the next generation, but we are talking about the here and now. The Green Paper goes some way towards dealing with the problems, but it is too little, too late.
Norfolk is a good example of a local county council in a diverse county doing its best. It serves local farming communities, rural villages, larger towns and, of course, the city of Norwich. Long distances mean that costs go up. People in my constituency, and in Norwich, will need to decide in a couple of months' time whether they can afford to fuel their homes or put food on the table. That is as bare as it gets, and it is a very difficult thing to decide.
People feel very isolated, and they do not have to live in a rural community to do so. People who live in terraced houses in streets with 150 other residents can feel just as isolated if their neighbours have no respect for them and do not feel the need to knock on their front door, and if local services do not have enough money to offer services such as meals on wheels. Other charitably based organisations sometimes cannot offer services to the community. People are making great sacrifices in difficult times, and the Government must address that problem. The people of Norfolk and the rest of the county-and, of course, the people of Norwich-deserve better.
Mr. Stephen O'Brien (Eddisbury) (Con): We have had a wide-ranging debate that has been characterised by thorough and thoughtful contributions from both sides of the House. In addition to all our constituents, many of us have parents, grandparents, other relations and friends for whom these subjects are a genuine reality. In that spirit, I pay particular tribute to the measured, moving and brave speech by the hon. Member for Colne Valley (Kali Mountford). It was one of her understandably rare speeches in the House, and we all listened to it with great care.
The debate has also been characterised to some degree by disappointment in the Government. That disappointment coalesces around the question: who has been in Government for the past 12 years? We must also ask who promised, 12 years ago, to deal with the very issues before us today. My hon. Friend the Member for Eastbourne (Mr. Waterson) opened the debate with an excellent speech that covered the economic issues affecting pensioners and addressed the aspects of the motion that cover care of the elderly in the round. He pointed out that the present Prime Minister promised to end the means test for elderly people, but had not done so. The Labour party promised in its 1997 manifesto that
"all pensioners should share fairly in the increasing prosperity of the nation",
"brought up in a country where the only way pensioners can get long-term care is by selling their home".
On that latter point of care, it is not as if the Government have not had chances to deliver. On the subject of caring for the elderly-the title of this debate-the Government set up a royal commission on long-term care as far back as 1999. In 2006 the King's Fund published the Wanless report, which set out the models and problems faced much more thoroughly than the Government's Green Paper published yesterday did. In response to the Wanless review, the then Health Minister, the right hon. Member for Birmingham, Hodge Hill (Mr. Byrne), who is now Chief Secretary to the Treasury, announced a zero-based review. There is no evidence of any serious work being undertaken as a result of that; it seems that it amounted to little more than kicking the problem into the long grass.
Expectation then coalesced around the comprehensive spending review in 2008- fuelled by comments by the then Minister, the hon. Member for Bury, South (Mr. Lewis), who is now a Foreign Office Minister. He said that the Department would
"secure a fair and reasonable settlement as part of the comprehensive spending review"-[ Official Report, 21 February 2007; Vol. 457, c. 98WH.]
"the government is publishing a consultation document setting out the challenges we face and why we must now look again at the options for reforming our current system of care and support."
"What is now needed is a major debate about the challenge we face and the options for addressing it. This Green Paper sets out those options and the principles which we must now consider. This is the start of a process of discussion rather than the end".
It is thus a fair question to ask just how many starts the Government need. We rightly ask that question, as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) comprehensively did in his response to yesterday's statement.
Let me touch briefly on the question of consensus. Throughout this debate Ministers, including the Prime Minister, have deployed the word "consensus". The Prime Minister ended his King's Fund speech by saying:
"I look forward to building a consensus in this country about the best way ahead."
But the Government's record suggests that their understanding of the concept of consensus is to use it as a cloak when they are in trouble. At no point have they approached vast numbers of people in the third sector, let alone the official Opposition, to discuss the ways forward. As far as I know, they have not talked formally even to the Liberal Democrats or others. One would have thought that that was hardly a way to build a consensus. More importantly, the Government have consistently withheld the work they have commissioned and paid for with taxpayers' money, using it for political leaks rather than for informing public debate.
If this talk of consensus is to be more than warm words, the Government need to start building one, as urged by the hon. Member for Wyre Forest (Dr. Taylor) and by my hon. and learned Friend the Member for Torridge and West Devon (Mr. Cox), who spoke powerfully,
informed by his experience of caring for his grandmother. They need to build consensus around agreement that social care in all its ramifications cannot be fully met from taxation alone.
I turn to the so-called models or options set out in yesterday's Green Paper. On the first, which the Government call the partnership option, the House must be careful about the choice of words. Derek Wanless described a partnership model, but for him, the Government would pay a first section of the costs and would match-fund the next section-an element that has slipped away in the Green Paper. The insurance option is actually a partnership plus, with insurance coming in to fill the gap. This was favoured by my right hon. Friend the Member for Charnwood (Mr. Dorrell), who spoke authoritatively and reminded us that it has been 12 long years since a proposal was first promised by the Government.
From the Government's presentation, it did not look as though traditional insurance solutions would work, so considerably more examination was needed. Inexplicably, however, the state-backed version of the insurance model has not been modelled. Indeed, an impact assessment, signed by the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope), who is about to reply to the debate, said that all the benefits had been properly assessed for impact. When we get to the comprehensive model, however, it is equally problematic, and the impact assessment admits that this model has not been specifically modelled.
According to the impact assessments, it looks as though all the Government's preferred solutions and schemes assume that money is to be taken from abolishing the attendance allowance. The Green Paper is blind on this issue, so will the Minister explain what assumptions the models make about the disability living allowance?
"Disabled and older people were hoping for leadership from the government in care reform."
It is clear that there are few ringing endorsements for the Government from the care sector. Indeed, it has been pointed out that reform was urgent for 12 years and remains so today, and that those under 65 with lifetime care needs have been completely overlooked.
We need to ask the Government a question that they have sought to skate over, not least yesterday. They call this a national care service. The national health service was extended throughout the United Kingdom from the outset. Can the Minister explain what the Government's plans are as regards cross-border portability in social care in a national care service, when it is impossible for Members, or indeed Government policy, to impose what the Government claim will be part of a national service on three parts of the United Kingdom? That question has yet to be answered.
I hope that the Minister will also be able to tell us what provision the Green Paper makes for meeting the costs of accommodation and food-the so-called hotel costs. It is interesting that, having said that he would set out his own party's policy, the hon. Member for Leeds, North-West (Greg Mulholland) failed to do so, because-not least at the last general election-the Liberal Democrats said that they would meet care costs, including "hotel
costs", because that had worked in Scotland. It did not work in Scotland. Indeed, in answer to a question from me in Westminster Hall, the hon. Member for Romsey (Sandra Gidley) put it on record-it is in the Official Report-that the Liberal Democrats' policy had been dishonest, and that the writers of her party manifesto had used that approach.
Lest anyone become carried away with the word "consensus", let me say that politics is about choices. Let me take this opportunity to explode the myth that Labour has been peddling about Conservative policies, not least in Norwich, which I have visited twice. How many times has the Minister been there? Labour is saying that we would cut pension credit, but that claim is dishonest. We have never said that we would cut pensions or pension credit. Labour is saying that we would scrap free television licences, but that claim too is dishonest. We have no plans to scrap free television licences. Labour is claiming that we would scrap free bus passes for the elderly, but we have no such plans, and it is dishonest to claim otherwise.
Let us rise above Labour's mischief, however. The debate has given us all a chance to rededicate ourselves to delivering, above all, independence, dignity, security and good-quality care to our elderly population. We must all work towards that, and nothing less. It is the job of our political generation to find the way forward, and we shall.
The Minister of State, Department of Health (Phil Hope): We have had a vigorous debate. Some of it has been driven by political motivations-we know where they are coming from-but some has been driven by the experiences of constituents and by Members' personal experiences. I welcomed the contribution of my hon. Friend the Member for Colne Valley (Kali Mountford)-who spoke from huge experience-and that of the hon. and learned Member for Torridge and West Devon (Mr. Cox). Both expressed sincere concern, analysing their experiences and seeking solutions for the future.
Care for older people is an issue that arouses strong feelings, and rightly so. Given that a country is measured, ultimately, by how well it looks after its elderly, it is right for this question to be at the heart of our political discourse, whether here in Westminster, in Norwich or in any other part of the country.
I recently met an elderly couple in Croydon who were receiving excellent care through a unique partnership between the national health service, the local authority and a voluntary organisation, which were working together to give them high-quality support. They made it clear to me that they wanted us in Parliament, and in Government, to ensure that they would be looked after financially, and wanted to be reassured that their health and social care needs would be met so that they could play an active part in their community. They wanted it to be recognised that although they were elderly and frail they still had something to offer society, and they wanted the opportunity to prove it. It is up to us to rise above the party political division that will inevitably accompany debates of this kind, and try to reach a consensus on a better future for older people.
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