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29 Oct 2009 : Column 482

Andy Burnham: The crucial issue is whether my hon. Friend has spoken to all people across all ages and whether he has spoken to a representative sample of the whole population. The idea might be more appealing to older people, who might find it an attractive option, but less appealing to people in their 20s and 30s who are struggling to get on to the property ladder. We have to take a view across the entire population and to consider what will be fair to all generations and sustainable in the long term. That is the consensus that we are struggling to find. If my hon. Friends want to make strong representations to me about reconsidering this matter, we will listen. However, I think the King's Fund was right to say that the best chance of finding consensus rests in the notion of partnership between the state and the individual.

The "Big Care Debate", which began a national conversation about social care, ends on 13 November and I urge Members on both sides of the House to make one last push in their constituencies to encourage people to contribute and send in their views.

Only a few days ago, we were reminded why this debate is so important. The recent population projections from the Office for National Statistics tell the story of how quickly Britain is ageing. By 2033, the ONS suggests that the number of people aged 85 will rise from 1.3 million to 3.3 million, while the ratio of working age adults to pensioners-the so-called dependency ratio-will drop below three. Parallel to that, improvements in medical treatment are extending the lives of those with disabilities or long-term conditions. That all points to the exchanges that we were just having about the affordability of any system in the long term and, in particular, the ratio of working age people to those in retirement.

Angela Browning (Tiverton and Honiton) (Con): In the context of the figures that the Secretary of State has just announced, when he considers the results of the consultation will he pay particular attention to the fact that as the population gets older, and given that older people have a higher level of dependency, so, within families, do their carers? Increasingly, pensioners are looking after even older pensioners who are their dependants. He cannot ignore that, because the strain on older people in a caring role is very great.

Andy Burnham: The hon. Lady makes an intelligent and important point. That is the nature of how the world is changing. People in their 60s and 70s have caring responsibilities, which place considerable stress and strain on them. My parents' generation is perhaps the first generation to have seen that and to have had caring responsibilities for children, grandchildren and, at the same time, parents. That places very considerable pressure on some people. As I was saying to the hon. Member for Rugby and Kenilworth (Jeremy Wright) a moment ago, any system needs to rethink how we provide care and support so that it helps people to cope with that pressure by providing support when they need it, when it is most valuable to them, and so that it makes the life of being a carer more tolerable than it is today. This does not mean replacing or sidelining the role of carers; the only way that the system we are talking about would work would be if we did a better job of helping people cope than we are doing today. That would be crucial in helping us to face the demographic challenges of the future.


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Mr. Burstow: Earlier this year, the Government announced a very welcome injection of £150 million for carers over two years. In a debate that we had earlier this year about carers, I asked the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope), how we could track that money. He quite rightly urged me to go back to my constituency and ask those questions. I did and I finally received a letter yesterday-three months later-to tell me how the money was being allocated. I was told that because the money was being allocated through general growth, specific plans had not been drawn up to spend it on caring activities. My concern is that the £100 million that comes next year will go the same way-it will just be rolled into general spending and will not particularly benefit carers. What can be done to ensure that it gets to carers?

Andy Burnham: We are issuing guidance on how to commission appropriate services for carers, but I recognise the issue that the hon. Gentleman is raising. The Princess Royal Trust has done some good work on that issue. There is a balance to be struck. The hon. Gentleman and his colleagues on the Liberal Democrat Benches have sat there and lectured us many times about being too top-down, on ring-fencing too much and on target-setting too much. They say we are taking away local discretion and how disgraceful that is, but then the hon. Gentleman says that if we allow too much local discretion, local bodies do not do what we want. There is a balance to be struck. The Government allocated this money because of the importance of the issue, but I stress to the hon. Gentleman that although I and the Minister responsible for care services, the Minister of State, my hon. Friend the Member for Corby (Phil Hope), have a responsibility to ensure that our objectives are met, it is the responsibility of Members of Parliament to challenge primary care trusts if they are not commissioning services in the expected way.

I was speaking a moment ago about people living longer, particularly those with disabilities and long-term conditions. The life expectancy of people with Down's syndrome is just one illustration of that. Just after the war, a child with Down's rarely survived into adulthood. Today, it is possible for them to live well into their 60s and, with the right support, to enjoy a full and rewarding life. What a wonderful sign of health and human progress that is, yet the sense of a world transformed brings into sharp focus the challenge ahead for social care.

It has been remarked, quite fairly, that if William Beveridge had sat down today to develop the welfare state he would have put social care at the centre rather than the periphery of his plans. More than 60 years after the birth of the NHS, it is worth reflecting that the same unfairness that originally drove Nye Bevan still exists in social care today, and it is this: people with the greatest needs are paying the most; the services that a person receives vary markedly according to geography; and what an individual spends on their care is only loosely linked to their ability to pay for that care.

Hon. Members will appreciate that the spectrum of care costs is extremely wide. About one fifth of people can expect to need care costing less than £1,000; for another fifth, the cost will be in excess of £50,000; and, for a smaller but growing proportion with very high needs, particularly those who develop dementia, the
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cost can run into hundreds of thousands of pounds. That is a cruel lottery, and the fact that people born after the war, the first real property-owning generation, will soon enter the care system only intensifies the need for change. We could see unfairness played out on a far greater scale over the next 20 or 30 years if we do not make changes to the care system today.

It is therefore no exaggeration to say that the Government's Green Paper "Shaping the Future of Care Together" is a Beveridge moment for social care. It is a chance to rebuild the social care system from first principles and to raise our ambitions for care and support in the future. One of the main messages that I should like to communicate today is this: in the time that this Parliament has left, one collective responsibility is to build an unstoppable momentum for legislation on social care in the next Parliament.

Kelvin Hopkins: Does my right hon. Friend agree that at the heart of the Beveridge plan was the principle of universality? It was also at the heart of national health service planning. However, what my right hon. Friend talks about is not universal.

Andy Burnham: My hon. Friend should study the Green Paper, which talks about the creation of a national care service that will include universal entitlements to assessment, reablement and other services. People will be entitled to have some of their care needs met.

Social care was outside that original consensus, and for that reason has always been a partnership involving the individual, the family, the community and the state-all of them playing a role in the provision of support. Care has always been provided on that basis, but the purpose of this exercise is to ask, "Can we find a fairer way that spreads the costs and the risks across us all and is a collective system that provides more peace of mind for us all?"

Jeremy Wright: The right hon. Gentleman mentioned that the issue will effectively be a problem for the next Parliament. Regrettably, it has come before this Parliament at its end rather than its beginning, but we are where we are. He mentioned dementia, and he knows that that is growing as fast as, if not faster than, the other problems that he has described. He knows, too, that people with dementia are among those who are particularly affected by the mismatch between the quality of the services they receive and the amount of money they pay to receive them. One reason is the lack of training for those who provide dementia care. May I commend to him the report of the all-party dementia group, which I know his colleague, the Minister of State, the hon. Member for Corby (Phil Hope), has seen? I hope that the right hon. Gentleman will include it in the Government's thinking on the improvement of social care more generally.

Andy Burnham: I know that the hon. Gentleman chairs the all-party dementia group, and my hon. Friend the care services Minister has just informed me of the valuable work that it does. I must correct what the hon. Gentleman said at the start of his intervention, however. It is not as though we have done nothing, to be fair. The Department of Health has produced a dementia strategy, which has been widely welcomed. Indeed, its preparation drew on a range of voices and outside organisations, and it is an important piece of work. There has been all the work with individual budgets, too.


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However, I have said in many speeches-I am owning up here-that politicians have for too long flinched from the debate, because it raises difficult and awkward questions about funding. I am signalling very clearly that that cannot continue, and we have to make care an issue on which the parties lay out their different options. It should feature prominently at the next election, and the expectation should be that if we can agree on one thing it should be this-that we create an unstoppable momentum for legislation in the next Parliament.

On the history of the issue, I note that the royal commission, which the Government set up in 1998, could not find a consensus, but I am clear that we cannot proceed with reforms unless we find a broad consensus across the country. Such is their reach and their importance to us all that we could not implement them with 51 per cent. support for one option and 49 per cent. against, based on the options that my hon. Friend the Member for Luton, North (Kelvin Hopkins) has pushed towards me. Whatever the option, we would have to implement it with a broader sense of fairness and consensus. That is what we are trying to find, but the hon. Member for Rugby and Kenilworth makes a very valuable point, and we take such issues very seriously.

We have to seize the moment; otherwise we face a bleak future in which inadequate budgets are stretched ever more thinly around an ageing population, providing in the process less and less dignity and a worse quality of life in retirement. It is not a very encouraging prospect; in fact, it is very depressing, and that is why we need to act.

The Government's proposal for a new national care service to sit alongside the national health service is the right and radical answer to the mounting unfairness. Under the national care service, people would have the reassurance of a universal system, the security to plan for the future and the knowledge that they would not need to sell their home if they required high levels of care.

There would be a new standardised assessment to end postcode lotteries in the current system, and free information and advice would be available to all, helping people to navigate the system when they are most in need of a helping hand. The national care service would be anchored in prevention and early intervention, with care services working far more closely with the NHS to ensure that people received the integrated support they needed. In particular, reablement-intensive support, helping people to recover after illness or bereavement-would be at the heart of all options.

Mr. Burstow: Will the Secretary of State address an omission from the Green Paper? It is very important that he does so if we are to understand the direction of travel. The omission is means tests on, and thresholds for, the assets that a person would be able to hold before they accessed state support. The Green Paper is silent on that and on whether the Government think that additional new resources would be needed to achieve an improvement in care quality. Will the Government spell out those points in their White Paper?

Andy Burnham: They would obviously have to be spelt out. The Green Paper's approach was to consult on principles, providing not all the details of how we would construct the options, but the principles that fit most closely with the consensus in the country. Under
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each option, we could apply a more progressive approach, whereby those with more would pay more, or a flat fee and universal approach, whereby everybody paid the same. The Green Paper touches on those questions, and in the consultation we want to draw them out. We have an open mind on those questions.

The current threshold of about £23,000 is a crude cut-off point, and we can do better to give people more peace of mind in retirement. That is what we are working towards, but the question about the extent to which any new system should involve means-testing is difficult. It is not a popular subject among older people, and we need to test people's sense of fairness on building a system with either means-testing or a more universal approach at its heart. We are open-minded on that question, as we are on all questions in the Green Paper.

However, one area in which we have indicated that we will go further is the provision of free personal care for those with the greatest needs. The long-term aim of a 21st century care system should be more people living full and independent lives in their own homes for as long as possible. In that respect, the Prime Minister's landmark announcement of free personal care for those with the highest needs is an important staging post for the type of care service that we want to build. It is an opportunity to start to address the unfairness in the system here and now, and to do so in a way that listens to people's fundamental desire to remain independent and in control of their lives for as long as possible. For me, that does not mean creating new incentives to put people into residential care. In my view, it is no solution to say to people that the only way to protect their home is to go into a home.

I am disappointed that the shadow Secretary of State for Health is not here today, either because he felt it was not important enough or could not find the time. Had he been here, I would have wanted to question him closely on how promoting a scheme that provides help only if individuals go into residential care can possibly hold an answer to the future care needs of this country. Surely the future is about helping people to stay in their own homes for as long as possible and giving them access to the support that makes that possible, not having a system that creates an incentive to put people into residential care. That is a depressing view of the future and an inadequate and flawed response to the challenges that the country faces. Though I welcome the Conservatives' engagement in the debate, at long last, I am disappointed that the shadow Secretary of State is not here to speak up and begin to try to explain how the plans that he has put forward could possibly answer the country's needs.

Kelvin Hopkins: At this moment, people feel pressurised into keeping their relatives at home because they fear losing what may be a relatively small amount of equity to some people, but is a lot to them-and the only equity in the family-if they lose granny's house having been forced to use it to pay for granny's care. That is what is happening. I have come across cases in my constituency of people who are deliberately keeping at home unwell relatives who would be better off in residential care.

Andy Burnham: I certainly recognise the problem that my hon. Friend describes. That is why reform of the system is growing ever more urgent. There has been a
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fundamental shift. My parents' generation are the first major property-owning generation. In the past, people in my constituency, a former mining area, did not own their properties, but today they do. People in their 60s and 70s have bought their homes and now have an asset that they own. They may not have a lot in savings or other assets, but they do own a home. It is important that we create options for the future that are not just about residential care. This is about how to help people, and the people who care for them, by enabling them to enjoy and stay in their own home, and if necessary to pass that home on to the next generation. That is at the heart of the entire Green Paper, which is about doing it better than we are doing it today.

Mr. David Anderson: I share my right hon. Friend's unhappiness that the shadow Secretary of State is not here. Does my right hon. Friend have any idea how much of the £8,000 that was proposed to be put forward as a donation by anyone going into residential care would be kept by the private insurance company?

Andy Burnham: That is why it is disappointing that the shadow Secretary of State is not here. We cannot see how a system that requires an £8,000 contribution to care can possibly be workable, on any basis. Indeed, on the eve of the Conservative party conference the Daily Mail had a front-page headline saying "£8,000 to save your home". Two days later, a spokesman for the shadow Health Secretary was saying that "top-ups might be required". The £8,000 figure lasted all of two or three days, yet during the big care debates people have been using it as though it would be the extent of the contribution that would have to be made. We cannot conduct the debate in those terms. People have to be open and honest about the scale of the costs, not put out misleading figures for political purposes that then fall to bits in their hands, and think that they are adding to the debate.

Mr. Nigel Dodds (Belfast, North) (DUP): This issue clearly affects all parts of the United Kingdom and serious issues arise in relation to older folk: we have heard about them being kept in their own homes by their family and I have experience of that happening in my constituency. Many families talk about this problem and want to know when it is likely to be resolved. Can the Secretary of State tell us when there is likely to be an indication of the way forward? In other words, how long are we going to have to wait, because these are pressing and urgent matters?

Andy Burnham: That is why I have put them at the very top of my list of priorities. There is nothing more important than building, first, momentum, and then consensus around reform of the system. I agree that people need to see how this will play out. I have said-I cannot say more than this-that we will have a White Paper before this Parliament is dissolved, and we will then take a proposal to the country on reform of the system. I want to create an unstoppable momentum whereby there will be legislation in the next Parliament. Obviously, I cannot promise that, as it depends on many different things. However, we should, collectively, make it our mission to ensure that the next Parliament
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legislates on social care. [ Interruption. ] In answer to the hon. Member for Reading, East (Mr. Wilson), we are coming forward with a clear vision of the future-ideas to put on the table. The Labour party created the national health service, and now it has a very clear idea about the social care system. I think that people will look to us for ideas because of our history and what we have done in providing better support for people. The hon. Gentleman is chucking jibes over here, but where are his proposals on how he will make life fairer for older people in this country? Where is his shadow Secretary of State, for that matter?

Our vision for the future is about bringing more support into people's homes-not putting people into homes, but giving them more support, using new technology to the full. The answers are out there already. Many Members will be able to call to mind examples from their own constituencies involving telecare and other technologies, helping people stay in their homes for longer, and personal budgets opening doors and extending choice for individuals and their family. A progressive system of care and support should open up options for people, not close them, and that means embracing new ways of thinking about care.

We must also create a system that empowers and enables carers to cope. The biggest challenge to carers is not the inflexibility of employers but the inflexibility of services. Their contribution must remain the bedrock of any future system of care and support. We must continue the journey started by the carers strategy to ensure the provision of care services is shaped around their lives rather than the other way round, in the same way that child care and early-years support was built to help people to balance family commitments with work commitments. In other words, just as Sure Start supports the child while helping parents to return to work, the national care service can achieve the same end by helping and empowering the individual and the family receiving support.

Let me move on to funding. The Green Paper sets out three clear options and gives the indicative cost that an individual would pay to fund the care service. In addition, we are exploring a number of options to pay for the portion of basic care costs that the state would pay for as part of our proposals. Let me reiterate that we have ruled out any suggestion that disability living allowance for under-65s will be brought into the national care service. There may be a case for bringing together elements of some disability benefits, such as attendance allowance, with social care funding. However, that will be done in a way that guarantees that people receiving these benefits at the time of reform would continue to receive an equivalent level of support and protection under the new care service scheme.

John Mason (Glasgow, East) (SNP): May I ask the Secretary of State what that equivalent level of support will be? Will people get care instead of money? If so, does that not go against what is happening in the Welfare Reform Bill, in which we are trying to give people more money so that they can spend it on the care that they want?


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