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Given the Secretary of State's exchanges with the hon. Member for Luton, North, who is no longer in his place, it is a little odd, and inconsistent, that the Prime Minister's scheme is to be funded-so it is claimed-through general taxation. However, the Secretary of State said that it is not possible in such areas to consider general
taxation as an option for what has been proposed under the scope of the Green Paper. That inconsistency needs to be clarified and explained.
The Secretary of State seemed to take his cue from the Prime Minister's new-found spontaneity last week. The former announced out of the blue that, rather than dissolving the disability living allowance into local authority budgets, as the Green Paper had implied, he would keep the DLA. That was in spite of the statement made early last week in the other place by the Under-Secretary of State for Work and Pensions, the noble Lord McKenzie of Luton. He said that the Government were looking at "all disability benefits" for dissolution into the national care service.
Will the Secretary of State clarify whether the attendance allowance will stay or go? He did not do so when he was on his feet a few moments ago. This point is exercising many people in all parts of the country, and not just in England.
Angela Browning: Is my hon. Friend as concerned as I am about another benefit-in addition to the ones that he has mentioned-on which I have received requests from constituents: quite an old benefit called the severe disablement allowance, which is still recognised? It is usually a lifelong benefit for people with lifelong learning disabilities. Is that, too, on the table?
Mr. O'Brien: I am most grateful to my hon. Friend, because that could impact greatly on those in receipt of the benefit. We require clarity because we are dealing with people who have arranged their lives completely, having often struggled to have their needs recognised, and who now need to know that that level of support will not be removed. We need clarification, therefore, on the attendance allowance and certainly on the SDA.
If the Secretary of State has decided to axe those-he sought to suggest that there would be an underpinning guarantee, but again he did not specify how it would be put in place-what measure does he intend to take to protect the care of those most dependent on the allowance? His U-turn on the disability living allowance has come as a welcome relief-I do not deny it-to many with disabilities. It was much needed because there really was distress. It also came as a welcome relief to their carers and advocates. However, the Government continue to keep people over 65 in the dark about whether their DLA will be under threat and whether the attendance allowance remains under threat.
If the Secretary of State wishes to offer an explanation, I will be more than happy to take an intervention. Otherwise, it must be taken that there is no guarantee that the DLA will remain for those over 65. His decision to discard some of the benefits is bafflingly contradictory. He claims that he wants to give more responsibility to individuals through personal budgets, and yet he takes this responsibility away again by threatening to cut disability benefits. How can we move towards a more personalised care agenda if he is not prepared to trust individuals with benefits designed to offer more choice and control over the services that they receive? That is fundamental to how we need to move forward.
To be clear, I say officially, as it were, from this Dispatch Box that we have said that we will oppose any plan to cut and redistribute attendance allowance, because
in our view it is not the way forward. Unlike the Government, who are trying to create the impression of a national approach to social care, by nationalising it in effect, we believe that personalisation is the right path to take. Attendance allowance is one way for people to commission informal care services. If we were to back the Government's approach, more and more of those informal care arrangements would have to be made formal through local authorities. That would be costly and restrictive for those at the receiving end of care. Although we will continue to examine the evidence, a retreat back to the state as the sole provider might restrict the flow of funding into front-line care. In a society where individuals are often the experts in their own care needs, that would surely be a step backwards.
On top of those concerns about disability benefits, older people continue to worry about whether they will have to sell their homes to pay for their long-term care. That is a feature that Tony Blair himself mentioned in a promise in 1997-a promise that has not been delivered under this Government. Instead, the Green Paper revealed a loose preference for a partnership model for social care, whereby the state would pay for a set proportion of each individual's care fees. It is worth mentioning that the partnership model was discussed in detail in the 2006 review by Derek Wanless-a review that the Government refused to commission and which has been on the table for debate for more than three years. It is only now that the Government have chosen to explore its implications.
I have some concerns about the Government's proposals for a partnership model of care. First, the Green Paper states that
"everyone who qualified for care and support from the state would be entitled to have a set proportion-for example, a quarter or a third-of their basic care and support costs paid for by the state."
However, there is no guidance on how individuals qualify for that subsidy and no firm pledge to provide a specific proportion of funding. In their answer to our parliamentary questions on the issue, the Government could confirm only that there would be no new money involved and that
"Costs would be met from within the public spending envelope set for future spending reviews".-[ Official Report, 12 October 2009; Vol. 497, c. 758W.]
How can we trust the Government to deliver on reform when they leave the public playing guessing games about the funding of their proposals?
By the Government's own admission, older people want security, dignity and independence for as long as possible. Everyone wants to be able to plan and save for their own care needs, but at present the public stand no chance of being able to anticipate whether they will be able to afford the cost of care. The Government have let our elderly down through their lack of detail. The other serious question hanging over the Government's proposal is their failure to deal with the accommodation and food costs of long-term care. Those hidden costs often prove to be the most crippling for older people, as they move from their own homes to a residential setting.
Andy Burnham: The hon. Gentleman accuses us of a lack of detail, but let me put a direct question to him. Does he still stand by the £8,000 figure that he and his colleagues put forward on the eve of the Conservative party conference?
Mr. O'Brien: I am coming to that in detail. I am sure that the Secretary of State will be pleased to hear my clarification of an absolutely superb policy that is now being much welcomed by those who care to understand it, in contrast to the rather disappointing tribal political ping-pong with which he tried to de-dignify his speech earlier.
It is enough for older people to make the transition to long-term care without having to worry that their most basic needs, such as food and accommodation, may not be taken into account when they undergo a means test.
The Secretary of State has tempted me to move straight on to the next part of my speech. Whereas the Government's Green Paper offers no firm guarantee that every individual will be able to access care in old age, the Conservatives have already placed a large and, I would argue, innovative brick in the wall of social care reform. Our home protection scheme will enable older people to keep their homes and guarantee their care in older age. Our policy will deliver on the promise that Tony Blair made, but failed to keep, more than 11 years ago. We are looking to build on that policy by rigorously examining the options for domiciliary care, so that older people can preserve their independence for as long as possible.
Despite what the Secretary of State said, picking up on some of the rather less informed comment from when the scheme was put forward, let me make it clear that there will be no perverse incentive or adverse selection, because access to residential care via a local authority will be based on assessments of need alone. We will ensure that, as well as ensuring consistency, by putting in place proper national assessment criteria, so the point about perverse incentives is simply not valid.
Mr. David Anderson: Surely that is what happens now. People are assessed for need by the local authority, but when they need to go in to a care home they refuse to, because they do not want to. When the scheme is introduced, there will be an incentive for people to go in to care because they will keep their homes, so if they are assessed for need, they will go in.
Mr. O'Brien: The hon. Gentleman seems to misunderstand that we all agree across the House that, above all other things, older people want to maintain their independence, dignity and so forth as best they can. There are no people sitting out there thinking, "I must rush into a residential care home." It is only when the need requires it that it happens, although the local authority might have no incentive to meet that need because of capacity issues.
Andy Burnham: Will the hon. Gentleman give way?
Mr. O'Brien: I would like to move on. I think that I am about to answer the Secretary of State's question, which I can anticipate, because his questions have so far only been about somebody else's brief.
Andy Burnham: The hon. Gentleman just said that there was consensus that people want to keep their independence and stay in their own homes. My understanding is that his proposal would offer no additional help to people to do that, so how can he stand there and make that statement? The only support would go to people who moved into residential care.
Mr. O'Brien: I was right. The right hon. Gentleman is trying to read out the criticisms that those who are rather embarrassed that they have not been able to attack our proposal successfully are now trying to peddle. The truth is that I am about to come to that very point.
Let me just make sure that the home protection scheme is understood. The whole point is that it is part of the overall approach to care, which has to include domiciliary care, which is not addressed by the right hon. Gentleman's own proposals. The firm guarantee is that our home protection scheme would offer every person the chance to protect their assets and guarantee their care through the option of an one-off payment of around £8,000. All care fees would then be waived for life, should the individual ever need long-term residential care. Unlike the Government's partnership model, this single lump sum, paid for at the age of 65, would cover not only care but food and lodging.
The scheme would also be self-financing, an important factor to consider, given the public deficit. The Government might be refusing to be up front about the funding of their partnership model, but the Conservatives are giving careful thought to the ways in which we can both steward the public finances and deliver long-term care to those who need it. The Government's own insurance model would be priced at £20,000-an unrealistic saving goal for the individual-compared with our £8,000 option, which has been verified by a leading actuarial firm and welcomed by Aviva and the Association of British Insurers. If the Secretary of State wants to study the quotes from the ABI, which has looked at this proposal extensively, I would be more than happy to pass them over to him.
Mr. Burstow: I just want to make sure that I fully understand the proposal that the hon. Gentleman is setting out before the House today. Did he use the term "domiciliary care" in the context of the package that he is proposing? In other words, will domiciliary care be covered by the scheme? If not, how will it be covered? Do the Conservatives have a plan for that?
Mr. O'Brien: If the hon. Gentleman will be patient for a second, he will hear about that. This proposal does not cover domiciliary care. This is to address the Government's failure-
Mr. Burstow: Precisely: it does not cover domiciliary care.
Mr. O'Brien: It does not cover domiciliary care. It covers the Government's failure to honour the promise given by Tony Blair as part of his attempt to get elected in 1997. People are fearful about having to sell their homes when they have to go into residential care, and that is what we have at last addressed.
Let me get on to the other point, which is obviously important, and let me make sure that this is fully understood. The Government's partnership model would require every person who believed that they were in need of care to undergo a means test. Our approach is open to everyone, regardless of their financial circumstances. State-funded care would still be available to those on low incomes, but the majority of people who do not qualify for state-funded care would have the option of guaranteeing that their residential care needs would be
met at an affordable cost. At present, all the costs of elderly residential care must be met by the individual if they own just £23,000 or more in assets, including the value of their home. Our home protection scheme would enable everyone to access affordable care.
The affordability of our scheme is based on the principle of sharing the risks together. We want to encourage the public to begin to pool their risk of entering long-term care, so that the cost of care for those who need it is lowered. I note that the Secretary of State has now disappeared; he obviously does not like my answer. An analysis of data from the NHS Information Centre suggests that one in seven people will eventually enter long-term care. The Personal Social Services Research Unit has made a series of projections regarding the future cost of care from the current figure of £26,000. An analysis of these data, carried out in consultation with the King's Fund and with actuarial experts, has led us to the premium price of around £8,000.
It is highly unusual, wholly welcome and totally transparent for an Opposition party to lay out a proposal in such detail, and those who have scrutinised it have clearly been unable to pick holes in it. This demonstrates that we have imaginatively addressed a problem that the Government, led by a Prime Minister who never delivered on his 1997 promise, have signally failed to address. That failure has resulted in people with more than £23,000 of assets remaining fearful that they would have to sell everything in order to pay for the residential care that they need.
As has already been said in the debate, when it comes to care, we realise that we need to fight the cause before we reach the crisis. Prevention is always better than costly cure. The hon. Member for Sutton and Cheam (Mr. Burstow), who is just leaving the Chamber, raised the point, so he might have waited for the answer. Everything must be people-focused.
Sarah Teather: Will the hon. Gentleman give way?
Mr. O'Brien: I am answering the intervention by the hon. Lady's hon. Friend the Member for Sutton and Cheam, who has chosen to leave the Chamber at the very moment the answer is being given.
Public health has been neglected under this Government: budgets have been raided and specialist staff have been cut, so they cannot begin to talk of joined-up health and social care services until they view public health as a priority. Under a Conservative Government, a new priority will be given to public health reform. There will be a Secretary of State for public health, and local directors of public health with the power to allocate independent ring-fenced-I emphasise ring-fenced-budgets to make effective interventions across the health, local government and social housing sectors to promote independent living for elderly people.
While the Government want to standardise care through their national care service, we want to personalise it. We have our sights set on two areas of technology where local directors of public health will be able to use public health budgets to deliver support systems to enable people to live independently in their own homes and reduce the need for costly, complex interventions.
Telecare is the key to giving patients and families the peace of mind to maintain an independent lifestyle. It provides them with a technology-based system of local monitoring, which identifies risk and monitors need without the use of costly or intrusive observation. A telecare scheme in north-west Surrey showed that this sort of preventive technology could reduce the number of people entering residential care by 11 per cent. in a single year. In Scotland, a new programme provided to 7,900 older people last year achieved savings of £11 million and significant improvements in self-reported quality of life for both elderly people and carers. For too many elderly people in too many areas, these services are not on offer.
Sarah Teather: I am struck by the hon. Gentleman's comments and my reading of a section of the Green Paper reminds me of some important issues raised by a local Age Concern group in my constituency. It pointed out that prevention is not just about the practical issues, as it is often about emotional support. That is what allows people to live independently. Depression is often unreported in elderly people. Day care services, visiting services and listening ears, with people making face-to-face visits, are just as important as the really practical things.
Mr. O'Brien: I could not agree more with the hon. Lady. Any of us familiar with these issues in our own families are fully aware that the contact of counsellors or other people of good will-perhaps those with some professional abilities not just to be good listeners, but advisers who can hold people's hands through the labyrinthine process of accessing their necessary support and care needs-is just as vital for the mental and emotional stability of elderly people. I understand absolutely the views expressed by that local group and those requirements must be met as part of the domiciliary care package.
That is why, in addition to the telecare that I mentioned, we need to look at home adaptations, which allow people's living environments to be tailored to their care needs so that injuries are prevented and people can stay in their homes for longer. Around half of people over 80 have a fall at least once a year, many occurring in the home. Many of those falls are easily preventable with the right home adaptations in place.
The final important group to consider is carers. Despite the vital work they do in caring for relatives and friends, our carers have suffered from serious neglect. Last year, the Prime Minister himself pledged £150 million for the carers strategy, with £50 million to be disbursed this financial year, mainly to support respite care. Only two weeks ago, as the hon. Member for Sutton and Cheam mentioned, the Princess Royal Trust for Carers reported that up to £40 million of it has gone missing-soaked up in local primary care trust bureaucracy. The Secretary of State's answer is that we MPs should press our PCTs on that, as it is not for him to impose from the top. When central money is being used to spur action, it is vital to know where that money has gone and to have some means to account for it.
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