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Andy Burnham:
The hon. Gentleman makes an important point. We want to place at the heart of the system the control and empowerment that comes from the personal
budgets scheme, in many ways replicating the power and control that comes from direct benefits. People will want to look at the details and decide whether that desire has been translated into any new system, and the test of whatever comes out of the Green Paper will be whether it replicates that direct individual empowerment.
Mr. Mark Harper (Forest of Dean) (Con): The Secretary of State rules out touching the disability living allowance of those under 65 and that is welcome, but he will know that nearly 1 million people over 65 get DLA. His announcement at the conference last week will not have put their minds at rest. Will he say more about whether DLA for those over 65 is covered in the Green Paper proposals?
Andy Burnham: It is important to make the point that the Green Paper is not about taking away from people. The whole proposal is to do things better for such people. The fact that they are receiving that benefit means that they need significant support, and the whole thrust of what we are trying to do is improving the support that we can offer.
We have to live in the real world, and in the current financial climate, we cannot talk about creating a new system of care and support simply by saying that everything should come through taxation. That would not be a sustainable position for the public finances. Equally, it is not sustainable to say that if we are to build a fairer and higher-quality system of care and support, we should not consider the support that we already provide, such as the attendance allowance. The House has flinched from this debate for too long because it raises difficult questions, but if we do that again, we will let down disabled and older people.
Hywel Williams: The hon. Member for Forest of Dean (Mr. Harper) made a significant point about DLA for over-65s, which is paid specifically for mobility needs. Some of those people have capital commitments with regard to those needs, for instance to Motability, which cause them many problems. I appreciate that this is a Green Paper, but we need to make the Secretary of State aware of the complexities that might arise.
Andy Burnham: I take the hon. Gentleman's point, and he will have to test what comes after the Green Paper for such people, whose needs are considerable and who deserve the best support that the state can provide. I am talking about enhancing how we look after those people and doing more for them than we currently can. It is understandable that talk of change is unsettling for people, but I hope that he will help us relay to them the message that underpins everything we are trying to do, which is that this is about significantly improving how we provide care and support, not about cutting things, taking them away or leaving people without the support that they need.
Kelvin Hopkins: What is affordable and what is not affordable is a political choice. I have spoken to many people and explained that improvements might cost, say, 1p on the standard rate of income tax. Everybody has said, "Hooray, we would certainly pay that." People want them to be paid for out of taxation, but my right hon. Friend has made the political choice that they will not be.
Andy Burnham: My hon. Friend must think about not just the here and now but what the country will look like in 2050. The modellers and forecasters predict that by then, there will be two working-age people for every retired person. Today, that ratio is roughly 4:1. Is he certain that payment through taxation is sustainable and fair in the long term? The question of fairness needs to be tested over the long term, and I do not believe it is fair always to go to the working-age population. People expect to pay something towards their care costs, but it is not fair for them to have to pay out catastrophic levels of cost simply because they are struck down by a cruel condition such as Alzheimer's. We are seeking to end that unfairness, but any system has to be realistic and credible if it is to make progress.
I mentioned attendance allowance and the importance of people receiving an equivalent level of support. We must recognise that by strengthening the care service that we provide, we will not only save lives but save money and strengthen communities. Early Department of Health research indicates that a council can save £1 million a year through investment in reablement, about the same from telecare and more by developing alternatives to residential care.
It is apparent that if we can nip problems in the bud-for instance, by giving an older person the support necessary to stop repeat hospital admissions-we can also save money for the NHS. If we reflect on the fact that falls cost the NHS £1.8 billion, there is a significant "invest to gain" argument for better care and support.
That leads me to another important point. Today's debate must go beyond the architecture of local care services or the funding proposals that underpin them. Fundamentally, the challenge that we are discussing today is part of a wider shift-a drive to build a society for all ages, creating an environment and a culture that supports and empowers older and disabled people in all aspects of their lives, at whatever stage.
In social care, a lot of work is under way to break down assumptions that people of a certain age need a certain kind of support. The "Putting People First" agenda- and with it the £500 million investment that has gone into personalisation-is helping move councils away from the "slippers and sympathy" default position towards a system that treats people as individuals and works with them to find the right answer to their care needs. The growth in personal budgets is extremely significant in that regard, and something that I want at the heart of the national care service.
Despite that progress, however, there is still an undercurrent of ageism across public services-a continued tendency to read the age rather than see the person. That must change as this country's demographics change. That is why we have pledged to eradicate ageism in the years ahead, and why I think that it is important that the ban on age discrimination in the Equality Bill will apply to health and social care at the same time as to other sectors-in 2012.
The door is still open for discussion about the finer detail of the national care service, and that goes for my hon. Friend the Member for Luton, North, too. Those listening to the debate will have heard his strength of feeling about the matter. The Green Paper consultation will continue until next month, and the Government are still listening to people's feedback and ideas before developing a White Paper next year.
The Minister of State has done a superb job in speaking up for social care and carers and in taking the debate forward. He deserves great credit for his work. He and I want to use today's debate to draw out further thoughts from Members of all parties to contribute to the building debate about the future of social care.
I therefore return to the point with which I started. We need to find a clear consensus in the House and a commitment to bold and radical action. If we cannot, we face the depressing prospect of not being able to fulfil the standards to which we aspire for our parents and for ourselves in our later years. We must find a better and fairer way of spreading the risk and funding care in future. I believe that a national care service, built on the principles of fairness and universality, will best serve our ageing society for the future. I hope that we can have a good discussion today on that proposal so that we lay the ground for legislation in the next Parliament.
2.27 pm
Mr. Stephen O'Brien (Eddisbury) (Con): First, may I give a couple of apologies as a courtesy to the House? The shadow Secretary of State is obviously sorry that he is unable to be here to reply to the debate. It has been well known for at least several days that he is in Washington on a visit to fulfil a long-standing commitment to talk to various parties and interests in the United States about health care reform, at their invitation. It is interesting that we were notified formally of the Secretary of State's presence in the debate only yesterday. When I wrote my letter to the Speaker's Office last week, it was to be the Minister with responsibility for care services and I who would debate the matter. The Secretary of State's cheap shot therefore ill befits his office. After the debate, I hope that he will question his private office to find out why he was not informed about the courtesy that was shown last week. It is sad that he raised the matter on the Floor of the House.
Secondly, I am sadly unable to stay for the whole debate. Again, as I wrote to Mr. Speaker last week, I have to be in Stoke-on-Trent by 7 pm for a commitment that has long been in the diary and for which many people have sacrificed their time. I wish to do my best not to let them down. Mr. Speaker kindly agreed that that was wholly appropriate. Most important, and demonstrating our joined-up approach, my hon. Friend the shadow Minister for disabled people will take my place on the Front Bench for the conclusion of the debate.
Before we delve into the detail of the Green Paper, I shall remind the House of the debate's context. We are faced with the challenge of an ageing population, whose needs will stretch our social care services to the limit if they remain unreformed. In the next 20 years, the number of over-65s will nearly double, and the number aged over 100 will quadruple. The rise of dementia-the issue was raised by my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), who is chairman of the all-party dementia group-will be especially apparent in the older population.
Help the Aged and Age Concern estimate that 2.4 million older people in England have care needs, and 45,000 older people are forced to sell their homes each year
because of the rising cost of care fees. Indeed, the hon. Member for Luton, North (Kelvin Hopkins) made that point.
However, not only the elderly depend on social services. Those with learning disabilities such as autism, the blind or partially sighted, and the physically disabled members of our society all have needs that are met through social care. Those who care for the disabled and the elderly also derive a great deal of support from the social services. Carers UK estimates that there are 4.3 million carers in the UK, with one in five carers having to give up work to care. It was disappointing that the Green Paper somewhat pushed those groups into the background of social care reform.
Sarah Teather (Brent, East) (LD): The hon. Gentleman is making a point that I wanted to make, and the same point has been made by my local Mencap organisation. The Green Paper does not acknowledge that as well as the likely increase in the number of elderly people, the numbers of the people with learning disabilities is likely to increase because of increased survival rates. The Green Paper does not recognise that or have any answers on funding.
Mr. O'Brien: I am grateful to the hon. Lady for raising that point, because it was a disappointment that that broad area was not covered in the Green Paper. The Secretary of State referred to the Down's syndrome example, so to some degree he covered it in his remarks, but the hon. Lady is right to highlight that absence from the Green Paper, which was the point that I was making. Mencap and many others have been anxious about whether that is a signal of an absence of commitment in the area, given that most people are focusing on the elderly- [ Interruption. ] From a sedentary position, the Minister responsible for care services, the hon. Member for Corby (Phil Hope), is trying to suggest that that is nonsense, but he may have overlooked the fact that I was replying to an intervention from a Liberal Democrat and that I had not actually accused the Government of anything. He should be a little less touchy and a bit less sensitive about his personal reputation, when what we need is some kind of solution for what is a very pressing problem for many people, across all age ranges in society.
It is clear that a growing number of people in our population interact with the social services in some way, shape or form. I hope that the Secretary of State agrees that our thinking on the issue must be underpinned by the acknowledgment that social care has the power either to make or to break the lives of the most vulnerable in our society.
The Secretary of State asserts, a little presumptuously, in the introduction to the Green Paper that
"this is the beginning of a Big Care Debate".
The Prime Minister calls for a "major debate" in his foreword, despite having issued a similar call a year and a half ago in his speech to the King's Fund, when he said that
"we must now look again at the options for reforming our current system of care and support."
It is therefore perhaps important to remind the Government that the debate has in fact been going on for more than a decade. Tony Blair made-as it turned out-the empty promise to reform the social care system as far back as 1997, when he pledged that older people would not have
to sell their homes to pay for their care. I am sure that that is written in stone in the Department of Health and the Secretary of State's office.
Mr. David Anderson: Does the hon. Gentleman accept that the debate has been going on for much more than a decade? For the two decades before this party came into power, his party dismantled social care, promoted private care and cut billions of pounds from the care budget.
Mr. O'Brien: Rather than getting into a ding-dong dispute about that, I shall just say that I do not accept the hon. Gentleman's underlying point that there were cuts to the budget. However, I accept that there was a shift in approach. Many people were moved out of institutionalised care, particularly elderly people. Often, inappropriate presumptions about mental health problems were made and mental health problems were not properly diagnosed, and there was a move towards care in the community.
There are many arguments on that and it is fair to say, in the light of experience, that to some degree the pendulum went too far, and we are now trying to find a new balance. There is a difference between wanting to preserve people's independence and dignity and their ability to remain in their own homes with a certain quality of life, and wanting to preserve and maintain the dignity and appropriate care of those who on proper criteria need long-term residential care, particularly as they move towards the end of their lives.
Bob Spink (Castle Point) (Ind): Does the hon. Gentleman agree that the assessment of continuing care needs funding is a real problem for people who leave hospital and go into residential care, for instance following a stroke? The Government really need to put out stronger advice and guidance for health authorities to ensure that people's health needs are funded.
Mr. O'Brien: The hon. Gentleman makes a point about health needs, and some 30,000 people are under NHS continuing care, which is of course provided. The difficulty is the assessment criteria and the absence, at the moment, of a sufficient number of intermediate and rehabilitation places, which are especially useful for those who need continuing care, whether in the national health system or as they move across into the social services care system, which is of course differently funded and has different consequences. Above all, if we had sufficient places, it would help to remove to some degree the crisis and emergency aspect that characterises so much of the problem as people try to find an available bed rather than a place in a care home-if appropriate under proper assessment criteria-that is suitable to the person's needs.
The elderly, and all those in need of care, are unlikely to be fooled by any Government who claim that they are setting the agenda on this issue. Indeed, the hon. Member for Blaydon (Mr. Anderson) made the point that this is an issue that has been under discussion for decades. Promising a "big care debate" may sound good, but what people are really looking for is decisive action. As I will outline, my party has made some important decisions, and I hope that it will be recognised that it is the Government-who have issued a Green Paper-who need to be pressed to make decisions,
rather than having yet another consultation on a consultation. However, I do not deny that a consultation is indeed taking place.
As for the proposal for a national care service, the Government appear to have plucked the term out of thin air to give the appearance of weight to the Green Paper which might otherwise be absent, because it is so void of practical detail. It is clear that by creating the illusion of a national care service, the Secretary of State-as one might expect-wants to have his cake and eat it. The Government talk of a national care service, but they want personal budgets for individuals and funding autonomy for local authorities, as the Secretary of State confirmed a moment ago. The Government talk of service, but fail to specify exactly what kind of service the public will get for the uncosted £3.5 billion a year commitment. Most worryingly, the Government talk of care, but threaten to cut attendance allowance and DLA for the over-65s, which would deliver a stinging blow to the most vulnerable in our society.
The Green Paper proposals would be more believable if they were locally costed and specific. Instead, the Green Paper waxes lyrical about options for reform without giving the country the road map it so desperately needs. Given that the need for joined-up care services was drummed home no fewer than 40 times in the Green Paper, it is extraordinary that the Government have not felt the need to demonstrate a joined-up approach in their own proposals. Instead, what we have witnessed over the past two months is a quick succession of U-turns and botched announcements.
First, we had the surprise pledge from the Prime Minister himself in his conference speech about the provision of free personal care for those with the highest needs living at home. It is as yet unclear how that proposal relates to the Green Paper or where the money to provide that care will come from. The Prime Minister has specified a sizeable commitment of £670 million a year to provide 350,000 people with the highest needs with free home care, and the Secretary of State described that a few moments ago as a "staging post". But his Ministers were unable to answer our inquiry about which budgets that money would be taken from and how the figure of 350,000 individuals had been reached, as recorded in Hansard at column 809W on 13 October 2009.
Can the Secretary of State clarify the connection between the announcement by the Prime Minister and the Green Paper, and can he offer any further insight into the funding of the Prime Minister's pledge? There are still no details of the Prime Minister's policy on the Department's website. That, in itself, is of some interest, because any of us who take an interest in such care issues will have been struck by the Secretary of State's effusive response to the Green Paper, compared with the somewhat taciturn reaction to the Prime Minister's home care scheme. No one, however, has been remotely forthcoming about the numbers behind the scheme, leaving everybody questioning where the money will come from.
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