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On carers, may I also pick up another important issue that is mentioned? Perhaps increasingly-and certainly numerically-lots of carers are workers and employees. We have heard how they might also be parents or
grandparents. That all adds to the busyness of the life of the British carer. The Government have done a lot in terms of what some people might call the work-life balance-or the employment-care balance-and I urge the Department of Health to push at that door. There will always be at least one other Department, which I know quite well, that will resist that, urged on by certain business interests, but we need to recognise that a modern economy and a modern society have to allow for the fact that people have a dual role as workers or parents of young children while also caring for elderly parents. Some 3 million people combine work and care and I am advised by the statisticians that that is some 12 per cent. of our work force. It is no mean issue.
Finally, I want to talk about the most difficult issue, which is the financing of long-term care. I have referred to it, not terribly originally-others have called it this-as the obvious unfinished business of the modern welfare state. We had a royal commission some 10 years ago, and a minority report was produced. It was an interesting document, but, to be blunt, the Government then parked it in the "too difficult" box. I am pleased that these Ministers are returning to it-[Hon. Members: "Or going."] I see that the Secretary of State is leaving-it is not that difficult an issue. However, I know that Secretaries of State have many things in their crowded diaries. Government and Parliament may have found the issue too difficult, but avoiding it actually left the people needing care and the carers themselves facing difficulties. Some of that care is difficult, and some of the issues that those people face are difficult, but unlike Parliaments and Governments, they have not been able to avoid them for 10 years.
On the Green Paper's analysis of financing long-term care, my assessment is, two cheers for the Green Paper. It advances the debate, and one option could see us through into the future. However, I must echo what one or two colleagues from all parts of the House have said. As a Daily Mail columnist might ask, "Why, oh why have you rejected what you call the taxation option?" I simply do not understand. Although I would not advocate a taxation option, I would look seriously at the pros and, no doubt, cons of a social insurance option-or what we now call a national insurance option.
To dangle that option before the public, while talking about its advantages and how many people rather like it, but then to reject it, was, to be honest, slightly strange. On page 116, however, the Green Paper states:
"During the engagement process, many people told us that they thought an NHS-style system, where the full costs of care and support were met through taxation...would be the fairest option."
"This would require a significant increase in the tax... For this reason we have ruled out this option."
Then, unless I have misunderstood the sequence of the Green Paper, it states:
"The advantage of this system is that it would be universal, and would probably be the simplest and most easily understandable way of funding care and support."
It is almost as if two hands wrote that section of the Green Paper, and I am bound to say that I see the cold, grey hand of the Treasury all over it. That option should not necessarily be the way ahead, but it requires serious study.
The Secretary of State talked about Beveridge, but I thought that, for my colleagues who are students of Beveridge, he was getting into trouble. After all, when Beveridge studied the risks and needs facing society then, and the likely risks and needs in the future, he thought that they were essentially insurable. One had a real risk-if I can use the world "risk"-of becoming old, so one needed a retirement pension. There was always the risk of unemployment, sickness and death, so a social insurance system was the fairest way ahead.
I look at those on the Liberal Benches and wonder, "May I refer to Beveridge as the last great Liberal?" [ Interruption. ] I am glad that they are still awake. He was certainly a great Liberal, and my guess is that, if back then the demography was going to mean that huge numbers of people faced frailty, he would have wrapped up care in his social insurance system. I do not really understand Ministers' argument that to do so now would be a burden on employees. Yes, it would, and I understand the immediate argument that many constituents feel they pay too much tax, and that there are burdens. We would therefore have to be careful, but, before we say that employees should not have to carry that burden, we should note that they do so with pensions. Otherwise, the argument would amount to an attack on our pension arrangements. I suppose that national insurance is really how we pay for our national health service, too.
I therefore urge the Government to reopen that idea, as an option, because it is a serious one. After all, the Secretary of State talked about the current economic difficulties, but we are presumably trying to fashion a system that is fit for purpose for 30, 40 or 50 years. Beveridge, in 1942, and those who became the Labour Government in 1945 had the vision and the courage to go for a, no doubt, expensive welfare state based around social insurance-and that was in 1942, when we had some economic difficulties and, if I remember my history, some difficulties with our European partners at that time. So are we really saying that, at the beginning of the 21st century, that idea is too difficult even to consider as a proper option?
Kelvin Hopkins: I very much agree with what my right hon. Friend is saying. I think that Beveridge, or the National Insurance Act 1948, set capital limits on ownership. However, the amount of capital that someone had to have was, in today's terms, absolutely enormous, so it covered only a tiny fraction of the richest parts of the population. If that were applied today, everyone would accept it; the problem is that the capital limits are far too low and affect millions of ordinary people.
Malcolm Wicks: Yes, that is helpful. Going for a social insurance option would not necessarily guarantee universal free care-a proportion could still be affected under the kind of arrangement that my hon. Friend has advocated. If we are consulting and thinking this through for a White Paper, that option should be there on the table.
Malcolm Wicks: I am happy to give way, but I must conclude soon to let others speak.
Hywel Williams:
I am grateful to the right hon. Gentleman. He referred to taxation paying for pensions. This is not just a matter of practicality-there is something
more fundamental to do with that terrible phrase, "cross-generational solidarity." That point is in danger of being lost, I think.
Malcolm Wicks: Of course. Unlike the era of Beveridge and another great Liberal-I am being polite today- [ Interruption. ] I am referring to Lloyd George; this is, after all, the centenary of his introducing the old age pension, is it not? [ Interruption. ] Perhaps we could have a Lib-Lab pact-you never know.
Mr. Stephen O'Brien: The hon. Gentleman is not a Liberal.
Malcolm Wicks: Well, he is a liberal with a small "l".
Unlike that era, we are now, demographically, in a situation where people might not only be retired for 30 or so years of their lives but, because of developments in higher and further education, be in education for 20 or 25 years. The issue that we are confronting is how to afford all the things we want in our social policies-both when people are young and when they are old-given that their working life will probably be only half their lifespan. Therefore, the idea that one way or another we should set aside more money during our working lives, whether through social insurance, private insurance or whatever, to pay for frailty, is not such an extraordinary one.
I want to comment briefly on the two options in the Green Paper. First is the insurance option whereby, if I have understood the proposal, someone would be entitled to a share of costs in return for a one-off payment of perhaps £20,000 to £25,000. I put it to the Minister-it is recognised in the Green Paper-that surely one of the great problems with that is that large numbers of people would opt out. I am not saying that they should opt out, but faced with a situation where they are thinking that it is a lottery with a one in five chance that it might be needed, surely many would do so. The amount of the population insured would then become rather problematic.
The Government's second option is the comprehensive option, of which I am much more in favour. It gets over the problem of people opting out because it is compulsory-let us use the C-word, although some would call it the nanny state. However, if we are serious about an insurance model, we need to ensure that everyone who could afford to pay would do so. Of course some people-ultimately the lucky ones, really-would get nothing out of it because they would not have any debilitating conditions and might die suddenly in their 80s. However, that is a bit like the national insurance system, and I do not feel that I have been tricked because I have not received unemployment benefit. I am rather pleased that I have not, and I look to the good people of Croydon, North to ensure that that continues, at least into the foreseeable future.
I end with three questions for the Minister about the comprehensive option. First, how do we cover younger disabled people, given that this is very much a case of something being triggered at age 65? Secondly, how would it work with different cohorts? I can see that someone reaching the age of 65 might pay a certain sum of money, one way or another, but what about the current 80-year-old-how would it affect her? Would there be some sort of phasing in?
Finally, following the Prime Minister's statement at the Labour party conference, which I welcomed, about free home care for those in the most critical need-I think that was the phrase-can the Minister say more about that? How does it relate to residential care? If somebody was getting free home care during their final months at home, and then the time came when they needed to go into residential care, perhaps for only a few months before coming back home or perhaps for ever, would that free care go with them? If not, would not a new unfairness be created there?
I am grateful to the House for its patience.
3.35 pm
Greg Mulholland (Leeds, North-West) (LD): I am pleased to take part in the debate, and after the rather bad-tempered exchange at the Dispatch Box, I shall make it clear that I was asked speak on behalf of my party today and am very happy to do so. I am not apologising for anybody, and I will be here for the beginning, middle and end of the debate, although I might pop out for a cup of tea a little later if permitted.
Here we are once again talking about the hugely important national issue of social care-talking again, rather than discussing concrete policies. Therein lies the frustration with how it has been handled over the past four years and indeed over the past few Parliaments. I will say one thing for the Government, which is that the Green Paper process and the current consultation process are entirely the right way to deal with this complex issue. The problem is that now is entirely the wrong time to put that process in place.
Much is made of the well known conference speech by Tony Blair in 1997, but even more significantly, on 4 December that year the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Frank Dobson), in announcing the royal commission on long-term care, said:
"The present situation cannot go on much longer. People are entitled to security and dignity in their old age, so we must find a way in which to fund long-term care which is fair and affordable both for the individual and for the taxpayer."-[ Official Report, 4 December 1997; Vol. 302, c. 490.]
Here we are 12 years on, and the rhetoric from the Government is absolutely identical.
Like many people, I like the style and the refreshing openness of the new Secretary of State, but he and the other Ministers have to take it on the chin that this has been a spectacular area of failure throughout the course of this Government's time in power. [Interruption.] If the Minister of State, the hon. Member for Corby (Phil Hope), wishes to intervene he is welcome to do so, but it is extraordinary that he can sit there and chunter when the Secretary of State himself has acknowledged today that the system is unfair, unclear and ineffective. I would not like to defend this Government's record on care, and I look forward to hearing him do so later.
The Secretary of State is right that the way to deal with this issue is through consensus, working through the complexities and building a coalition across the political divide and with the many organisations that do wonderful work for older people, those with certain conditions and others. It is right to bring them together in a consultation about what should happen. However, the Government are now simply saying that that is a
matter for the next Government, and that the current process is about obliging the next Government to act. That is disappointing and unacceptable.
We have to accept where we are and the fact that there has to be a move towards a form of consensus, because this is such a difficult issue. I regret the announcements by both the other parties of their partial policies that do nothing to take us forward to that consensus. Let us consider the problems-again, the Secretary of State gave an honest description of the failings of the current system and the reasons for change. The system is clearly underfunded, patently unfair and so unclear that, in many cases, people are not sure to what they are entitled or how to claim support and care.
The quality of care in the current system is variable and, in some cases, unacceptably low. Too many older people who could remain in the community cost-effectively are admitted to residential care against their wishes. There is concern about the unfairness of a system in which eligibility rules for free NHS continuing care are not applied consistently even throughout England, never mind Wales and Scotland, leading to a postcode lottery-I do not like the term-for those with intensive needs.
John Mason: Is the hon. Gentleman suggesting that we should have a uniform system across the UK, under which everybody gets exactly the same and there is no local decision making?
Greg Mulholland: Absolutely not. I was saying that there is not even consistently adequate care. I think that we all agree that we must reach a stage whereby all those who need care receive an adequate minimum level of care and know what the state will and will not provide and what they have to provide for themselves.
Kelvin Hopkins: Is the hon. Gentleman saying that there should not be a postcode lottery, but a standard that we should all expect, wherever we are?
Greg Mulholland: As the hon. Gentleman probably knows, our policy is to move towards a system-originally derived from Wanless and central to one of the options in the Green Paper-of minimum entitlement, on which people can rely. Beyond that, it is for local councils to retain the power to deliver services, hopefully in a much more joined-up way with local health boards, which will be elected under a Liberal Democrat Government. Moving towards a system of universal basic support, whatever that may be, is central to the Green Paper. The debate and the consultation are about that.
Mr. Harper: Will the hon. Gentleman say a little about his party's view of the personalisation agenda? His comments about entitlement refer to available resources, but the shape of services locally will depend to some extent on individuals' decisions about how to spend their budgets.
Greg Mulholland: We entirely support the personalisation agenda-we have made that clear all along. Services are best when they are suited to individual needs.
I want to mention briefly the important issue that many groups have raised: the potential changes to benefit. I welcome the fact that the Secretary of State has clarified the position on DLA for under-65s, but I echo
the worry that that has caused even more concern among older people and older people's groups about the future of the benefit on which they rely. As soon as people hit that arbitrary 65, they are no longer regarded as a carer or eligible for specific benefits-they have to rely on the state pension. The sooner we can get clarity from the Government about that and, indeed, about attendance allowance, the better.
Let me deal with the two policy announcements that were made suddenly during the party conference season. How far from the idea of consultation and consensus could that possibly be? I am afraid that the two policies seemed more like the first pages of election manifestos than a serious attempt by the Government to work within their Green Paper framework. There is nothing seriously wrong with some of the ideas proposed by the Government and the Opposition, but they must admit that the policies announced by both are partial, would help only a small number of the people who are affected in the wide and complex sphere of social care-
Mr. Stephen O'Brien: I never claimed that they did anything else.
Greg Mulholland: Indeed. It is welcome that at least we now have something from the Conservatives, having had radio silence from them for many years, apart from barbed comments across the Dispatch Box. At least they now have a policy to discuss, even if it is criticised.
It is a little rich for the hon. Member for Eddisbury (Mr. O'Brien) to sit there chuntering when all the Conservatives have is a partial policy that would help a very small number of well-off people. Let us be clear about that. The only people who will be helped by that rather odd contribution from the Conservatives are those who can afford to pay a lump sum of £8,000 at that stage. That may help a few of the people who the Conservatives think are more likely to vote for them at the next election, but if they seriously think that that is any kind of contribution to this important debate, it probably would have been better for them to have carried on saying absolutely nothing at all.
Mr. David Anderson: Does the hon. Gentleman agree that the very fact that the Conservatives call their scheme a "home protection scheme" shows where their minds are? Their policy is about protecting the home, not about delivering quality care for the elderly people of this country. [Interruption.]
Madam Deputy Speaker (Sylvia Heal): Order. If the hon. Member for Eddisbury (Mr. O'Brien) wishes to make a comment, he knows the way to do so.
Greg Mulholland: The hon. Member for Blaydon (Mr. Anderson) is right. I have heard a lot from the hon. Member for Eddisbury in debates in this House and outside, and it is extraordinary for him seriously to suggest that his policy will do anything on the wider, important issue of keeping people in their homes. I found it extraordinary that when he was challenged on the Conservative policy for the millions of people who need but are currently not getting care, he wandered off and started talking about public health. I do not imagine that I was the only one in the House who was a little confused by that. The Conservatives might think that announcing that they will have a Minister for public health is exciting, but it has no relevance to today's debate.
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