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The Green Paper makes little mention of carers' needs or the problems of the funding system, so it is time for a change of approach. In his very first statement of Conservative aims and values in a document called "Built to Last", my right hon. Friend the Member for
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Witney (Mr. Cameron), the Leader of the Opposition, committed to better rights to flexible working and respite care for carers. Again, it is a matter of giving people more independence and freedom over their use of social services so that we as a country and the Government in office provide public services that are responsive to people's needs and preferences rather than just a "system".

We know that local authority investment in home adaptation primarily benefits the NHS through reduced hospital admission costs and benefits individuals by providing security in the home. We know that NHS investment in telecare benefits local authorities by reducing their domiciliary care costs and enables individuals to have greater involvement in their care. We also want to know why these projects are not being more widely encouraged and promoted. The Commission for Social Care Inspection's final report found that innovative solutions such as joint council-NHS commissioning and the use of personal budgeting were still the

We will require PCTs to promote joint working with local authorities, which will mean budget-pooling and joint commissioning. When the prize is independence, security and dignity for our elderly population and peace of mind for relatives, the bureaucratic barriers that stand in the way must be removed. That would also help to deliver on the quality agenda mentioned by my hon. Friend the Member for Rugby and Kenilworth in an intervention.

These are the final questions that the Secretary of State must answer. What action will the Government take in response to the consultation that ends on 13 November? When will we see a decisive and realistic route forward? When will the White Paper be published, other than just before the next general election, which must take place by June next year? May we have a specific date? The Green Paper alludes to the creation of another quango, an independent organisation to advise the Government on the provision of care and support. How would that organisation be funded, and what exactly would its role be? When will the action plan to examine developments in the social care work force be published?

Above all-we have often said that this would be very welcome-when will the Government, rather than engaging in what is often rather disappointing ping-pong across the Dispatch Box and elsewhere, invite any Member of the Opposition to go into their office and talk to them, even if it has to be on private terms, as an earnest of the attempts that they say they are making to build a consensus? So far no such invitation has been offered, although we have made clear that we are open to discussion on what kind of consensus might be built. Given that that has worked to a degree in the pensions arena, there is no reason why it should not work in the social care arena, but it takes a willing Government to cease to be tribal and try to build a genuine consensus.

The question facing the public is a simple one. Can the Government be trusted to deliver social care reform that is so desperately needed? The answer is also simple. The Government's threatened actions will threaten the most vulnerable, whereas we will oppose any measures to cut attendance allowance. Their inaction on residential care will loosen the grip of every older person on his or her assets and home, which is a real fear for such people.
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Our home protection scheme and our plan for home adaptations will offer older people security and certainty in old age. The Government's uncosted proposals place an unprecedented burden on our public finances, whereas we will confront the issues of funding head on. They have chosen to prolong the status quo, whereas we will choose the necessary change.

I hope that the Government will realise that consensus would be better than this, but until they invite us in, we must continue to make our arguments and make them strongly.

3.2 pm

Malcolm Wicks (Croydon, North) (Lab): It is a pleasure to serve under your chairmanship, Madam Deputy Speaker, not least because of your long-standing experience, interest and indeed work in this area.

I want to present a brief analysis of why the issue that we are debating is so vital to us, and why it is so vital for us to crack it in an appropriate way, in the next Parliament at the latest. I also want to make some comments on the proposals in the Green Paper, which I hope Ministers will accept as constructive criticism.

The issue of what we now call social care-whether it involves younger people with disabilities of various kinds or suffering from mental ill health, including schizophrenia, or, as is more common, the care of frail elderly people-is one of those issues in politics which are a matter much more for people's agendas and family discussions than for what we often call the political class. It is far more important than Governments and Parliaments have given it credit for over the past 20 years. Within the extended families of which we are so well aware, there will be extensive discussions and great concern about, for instance, what will happen to a person with Down's syndrome when she is no longer a child but is becoming an adult. More typically, there may be concern about someone with dementia, perhaps Alzheimer's, when residential care looms. There may be serious problems involving mental ill health, often affecting remarkably young men, and I mentioned schizophrenia earlier. It is about time that Parliament and Government got a grip on the issue because people "out there" are concerned about it and are impatient for action. Within that, the financing of long-term care is most obviously the unfinished business of the post-war welfare state. We need to sort this out in the next Parliament.

Much has been said about the ageing of our population. Reflecting on this for the first time in a few years, given other interests that I have been pursuing, I think that there are three trends in terms of the ageing population, not just two. One is the ageing of the whole population. We can cite the ratios between those of working age and those who are retired and we have known about them for a long time. We have also known for a long time about the second phenomenon, namely the ageing of the elderly population. It is not so much an issue about those in their 60s or 70s; they may well be an issue for the pensions debate. But more people are living into their late 70s and 80s, which is why this is a crucial area for health and social care.

In 2008 almost 2.8 million were people aged 80 or over. By 2018, it will be 3.5 million. By 2033, according to Office for National Statistics estimates, it could be as many as 5.7 million people, which will be about 8 per cent. of the population.

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There is also a third trend that we should note: the ageing of the very elderly population. Far more people will now live into their 90s and far more will get the equivalent of the Queen's telegram-given the demography, it could be from the Queen herself-in 10 or 20 years' time. In 2008 there were 97,000 people aged over 95. By 2033-not so far away-there could be 464,000 people over the age of 95, representing about a fivefold increase during that relatively brief period.

We need to think carefully about the "so what?" question. What are the implications? I have always thought that we should not immediately get into a debate about frailty, health care and social care when we speak about demography. We should applaud the fact that we now live in a society in which people will have a decent lifespan. I remember my professor at the LSE, the great Richard Titmuss, writing an essay about why we thought of the "problem" of ageing. The problem, he thought, was when people died in infancy or before they could retire. There is an ageism in society that we need to confront and there is a paradox: as our population grows more elderly, ageism becomes more rife. We need to confront that ism.

However, we must acknowledge a grim reality- the correlation, although it is not an inevitable one, between disabilities and illnesses of different kinds and an ageing society. There are different indicators in terms of different conditions and different levels of mental and physical disability. Let me give one indicator in relation to dementia. Research from the Alzheimer's Society, of which I have the pleasure to be a vice-president, shows that there are 700,000 people with dementia in the UK today. Of those, 62 per cent. are thought to have Alzheimer's disease itself but, given the figures I have mentioned and the growing numbers of elderly people, the society estimates that by 2021 the total number with dementia in the UK could be 940,000, or almost 1 million people. The number could rise again to 1.7 million by 2051, and that is one of the reasons why we need to pursue the science and research on Alzheimer's: to see whether, with this illness, as with so many others, the scientific and medical communities can start to make an impact. However, that one indicator shows the seriousness of the issue we are talking about today.

The figures I have just cited mean that in all of our constituencies there will be many hundreds of our citizens with dementias of different kinds. The Alzheimer's Society estimate for my constituency is that some 900 people are suffering from dementia. For those who reach the age of 80 or over, there is a one in five risk of dementia. That illustrates the scale of the problem. That level of risk raises issues in respect of how we insure against this, and gets us into the debate about the financial options, which I will come on to shortly.

There are huge implications for all of us in the demography and the epidemiology of some of these issues. There are certainly huge implications for social policy and public spending. I doubt whether we can seek to constrain public spending in this area over the next five or 10 years; if we are to match the scale of the need, it obviously has to be increased. There are also huge implications for families and extended families, and particularly for those husbands and wives or partners,
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sons and daughters and all the rest of the family and friends and neighbours who become what we now refer to as the carers.

The Green Paper is an important document, and the fact that the Secretary of State is here sends a signal about the seriousness of the issue it addresses, because, regardless of what it says on the plaque in Whitehall, he is actually the head of a Department of health and social care. That is the reality. For too long, the care bit has been merely one division, although an important one, of a great Department. It is often the big health issues-sometimes crises-that take up all the attention. I am therefore pleased that the Secretary of State is giving so much attention to this other area. My comments are offered in the spirit of constructive criticism, and I am sure that he and his Ministers will take them in that way-although they have not heard them all yet.

The Green Paper makes some important comments on entitlement. It acknowledges a truth that is universally observed by us: there are great variations across the country, from local authority to local authority, in the provision of care. As it says, that is not good enough. We need to move towards a greater system of universal entitlement, so that if people move-as they often do when they are frail-they will not find in the new area a totally different system from the one they were used to. I say that because people do not like the idea of a postcode lottery. In some of our debates on these kinds of topics there is a fashion for localism. I am not against localism in terms of innovation, trying out different things and responding to particular local needs, but in this sphere we need to blend the concept of localism with that of national entitlement.

The Green Paper contains some interesting proposals on assessment. Page 10 states:

I welcome that, and I ask the Minister who will respond to the debate to say more about it. How broadly might that assessment range? When I was Minister with responsibility for pensions, based in the building in which the Minister lives and works-I suspect he lives there for a lot of the time, and he certainly works there-we were developing and rolling out the new Pension Service, including, importantly, the local pension service that performs so many domiciliary visits and assessments of not just the obvious things, such as pension credit issues, but energy efficiency programmes and so on. I do not want to push this too far because people need expertise to conduct assessments in the field of social care, but has the Minister been in talks with the Pension Service and the Minister with responsibility for pensions to see whether there could be a more joined-up approach to these assessments? One of the problems in this field is that once the welfare state is introduced into the life of someone with great frailty, there can simply be too many assessments, so could he say more about that?

Hywel Williams: The principle behind the assessments for attendance allowance and disability living allowance is self-assessment, in that the applicant fills in the form. Presumably, any new system would require the involvement of some professional help, so there might be a difference in principle in any new system.

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Malcolm Wicks: That is an interesting and difficult point. When people can simply provide information by themselves or with the help of a relative, through a computer, that is often convenient, but a fellow human being will often be needed to assess a situation properly. The Minister will doubtless be able to respond to that point when he addresses my related point.

My second point deals with effective care in the community-or home support. I shall discuss residential care in a moment. We all know-we have touched on this in the discussion about assessments-that we need to address issues associated with housing, which are so crucial in effective community care, with social service support, with health support and with other forms of support. As something of a student of these things, I noticed that the Green Paper says that we need more joined-up working. We all put our hands up to agree with that. It states:

It continues rather boldly by stating:

The following paragraph states:

I do not believe that it does, but will the Minister say more about that?

I suppose that I am trying to put the Minister on the spot, but I do so seriously. If I had had time, Madam Deputy Speaker-you will be aware of some of this documentation-I would have been able to find similar phrases in important state documents about health and social care going back at least 30 years. I would probably find such statements even in the White Paper on growing old produced by a previous Conservative Government. I know, as a student of this subject and from my ministerial experience, that it is one thing for the civil service to draft such fine prose and for Ministers to recite it-I have done that myself-but it is very difficult to make it happen in practice. This is the old story about the lever being pulled in Whitehall and sometimes our assuming that things are happening in the locality when that is not necessarily true.

There is now lots of super practice of joined-up work, particularly between the health and social services, on which to draw. However, I wish briefly to detail my experience as an Education Minister, when my Government introduced the Connexions service. I remember talking to my hon. Friend the Member for Corby (Phil Hope)-he is a Minister now, but he was a Back Bencher then-about that. I waxed lyrical about the importance of the Connexions service for young people and about how we were going to overcome barriers and join up agencies. Did that happen in the field? Sometimes it did, but often it did not. I challenge the Minister, in a friendly way, to prove to me that his fine prose is not just the usual fine prose and that the Department has serious ideas on how its approach will work in future.

Mr. Harper: I share the right hon. Gentleman's scepticism about how easy it is to join things up. I do not know how much thought he has given to this, but does he think that one way of doing that might be through the personalisation agenda? The Government are in favour
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of that and my hon. Friend the Member for Eddisbury (Mr. O'Brien) spoke about it forcefully. It is one option, whereby we would make more of the money from different funding sources-from different Departments-go into the hands of the individuals, and those individuals would then spend it. That might be the most successful way to join up effectively the services that they receive and the outcomes they obtain.

Malcolm Wicks: I agree with the hon. Gentleman that that is one way through this. We could use empowerment, by giving more of a say-more of the budget-to the individual herself or himself. Another way through would be to be more radical about trying to pool budgets across agencies. Some such pooling goes on in health and social care. I think that the Cabinet Secretary, Sir Gus O'Donnell, has recently spoken about that happening at a more macro-level, and it is an interesting idea. In other words, instead of public spending simply relating to the Whitehall furniture or the local furniture of Departments and so on, we say, "Here is a larger sum of money than we provide at the moment to crack this problem." We need to experiment with that in the future as we enter difficult times with public expenditure in a range of areas. I want the Minister to comment on this. The issue about joined-up working, which an earlier Labour Government called the joint approach to social policy-everyone has had a go at trying to make it work-is that achieving it is like finding the holy grail. It is very difficult but well worth the effort.

My third point is about carers. We have all acknowledged their importance. There are nearly 5 million to 6 million of them, some caring, I am almost tempted to say, too much. Some are caring almost around the clock-and some for more than 50 hours-until sometimes they drop because the fatigue and stress are too much. I want gently to say to the Ministers that I think the provisions in the Green Paper on the treatment of carers are a bit feeble. It looks to me a bit like they have been added on-when I was a civil servant in the Home Office many years ago, somebody referred to it as "joining up with a staple," although I think that there are now electronic ways of joining up a document. I was disappointed that carers were not more central to the analysis. I know that the Government have done a great deal on carers-more than any other Government-and that there has been a recent statement on the issue, but I would like to have seen the subject more central to the analysis, because the choices about how to provide care and the difficult decisions about residential care are ones that the carer and the wider family have to take as well as the cared-for person.

I am not sure whether the Green Paper mentioned carer's assessments at all-if it did, forgive me, but they certainly were not central to it. I speak with a vested interest as the promoter under a Conservative Government of a private Member's Bill that became the Carers (Recognition and Services) Act 1995-the first Act, with all-party support, to enable the carer to have her or his own needs assessed. That is important and we should have heard something about it in the Green Paper.

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