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29 Oct 2009 : Column 513

The Green Paper and the Prime Minister's speech are regrettable announcements. Of course it is important to deal with those who have the most critical needs, as the Prime Minister said in his speech, but the Government must also acknowledge that people with lesser needs all too often miss out because of the pressure on local councils, which have to change their eligibility criteria.

I welcome the fact that the first substantive Government policy announcement on the issue since the Green Paper commits new money. It is not a huge amount, but it is reasonably substantial. If we are to have a consensus, for which the Secretary of State stressed the need, it must start with one very simple premise: there must be more Government investment and money. We can discuss how much that should be and of course, in the recession, we should talk about how much the Government can afford-to echo the comments of the hon. Member for Luton, North (Kelvin Hopkins), we should talk about priorities and overall Government spending commitments-but any serious policy to deal with this important area of care must commit new money. I welcome the fact that the Government have at least done that, but I wonder whether that will be all that is included in the Labour party manifesto at the next election.

The Liberal Democrats acknowledge that there is a need for more investment. Any policy that does not deal with that is simply not credible. I look forward to seeing whether the Conservatives acknowledge that too, because all the experts and reports, including Government reports, and all organisations involved, stress that there must be more investment. Any party that does not do that-Help the Aged and Age Concern have said this explicitly-is not a party to which older people should turn.

Other hon. Members have mentioned the important subject of carers. I cannot put it better than the right hon. Member for Croydon, North (Malcolm Wicks) when he said that the mention of carers in the Green Paper is a little feeble, and that carers are not at the core of its approach. I accept that it is a cross-departmental issue in the sense that theoretically carers and their benefits come under the remit of the Department for Work and Pensions, and that this is a health debate, but we need more joined-up thinking to recognise the extraordinary contribution that Britain's carers make. It is too awful to contemplate what would happen to many of those in need of social care without the contribution of those millions of people, many of them elderly themselves. It has been estimated that the annual contribution to society by carers is worth more than £87 billion-more than the entire NHS budget-but carer's allowance is still at a level that does nothing to recognise that contribution or the loss of income that carers often face because they take on those responsibilities.

While there have been some important local initiatives-I have had the pleasure of visiting many of them-not enough support, advice and respite is offered to many carers. I reiterate the point made by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) about the real concern that the £150 million earmarked for carers is not getting through. I ask the Minister to look at that and provide reassurance that the money is getting to the people whom it is designed to help.

I also wish to raise the issue of personal expense allowance. The Conservatives have talked about this issue, and it is important, because we do not want
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people to have to sell their homes and we must do all that we can to support people to live in their own homes. However, we must also ensure that people in residential care have a standard of living that allows them to live out their later years in dignity, as we would want our own relatives to be able to do. The expense allowance is not currently set at a level to allow that, and that needs to be looked at.

As a member of the all-party parliamentary group on dementia-the chair of the group, the hon. Member for Rugby and Kenilworth (Jeremy Wright), is no longer in his place-I could not end my comments without raising that issue. There is a real crisis, given the number of people who suffer, and will suffer, from the set of awful conditions that come under the dementia umbrella; it is forecast to rise to more than 1 million by 2025, which is not very far away. It is frustrating that the Green Paper is not clear about how much the focus will be on dealing with the particular and additional care needs of those who suffer from forms of dementia and their families, many of whom are carers themselves.

Over the last year or so, I have been pleased to work with the Alzheimer's Research Trust and the author Terry Pratchett to call for more research into dementia. I appreciate that that comes under a different Department. There are real possibilities if we invest significant money in preventing some of those conditions, especially if more people can be enabled to carry on living independent lives. I ask for more joined-up thinking on the approach to dementia, so that more research is at the heart of the overall process, as well as a focus on the care needs of people with dementia.

I, and my colleagues on the Liberal Democrat Benches, fully accept that we need to work together. I made my criticisms of the Government at the beginning of my speech; but now it is important to move forward. Whoever the Government after the next election-be it a Liberal Democrat one, a minority Labour one or possibly even the Conservatives in coalition with the nationalists, to which I think the right hon. Member for Croydon, North alluded-from next summer they will have to make this an absolutely top priority as part of their programme for the next Parliament. We do not want to go into the election after next with people saying, "Yes we will do wonderful things in the future." We have had that for the past 12 and a half years.

We need a consensus and to start by agreeing that any reform, however funded, must involve increased Government investment. We need a fairer and clearer system that is easier for people to access and understand. We need a complete overhaul of the care system in this country. We need a system that will ensure support for those who currently are not getting it even though they need help-unfortunately, many are in that situation. We need a system that does not punish people for saving and being thrifty throughout their lives. We need a system that means that people are not forced to sell their homes in the way that too many are still forced. We need a system that is focused a little more on preventive services.

Mr. David Anderson: The hon. Gentleman has laid out a plan with which I fully concur. Will he give me an idea of his party's position on how much such a system will cost the public purse?

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Greg Mulholland: As the hon. Gentleman knows, we have committed to a form of the Wanless partnership model, and we are very clear that we believe that that is the right approach for moving forward to a system in which everyone receives an entitlement that they can know and understand. The hon. Member for Luton, North will not agree, but my party believes that both the state and individuals have to contribute. The question for the debate and consultation is by how much. That does not rule out considering increasing taxation; I echo comments that people taking part in the consultation should be allowed to consider that.

We believe that we need a system that supports carers better and better represents their enormous contribution to society. We also believe that we need a system that finally starts to break down the social care and health divide, to which hon. Members have alluded. That is unfinished business in the NHS and the system as a whole, and it needs to be addressed. The Liberal Democrats are committed to a consensus, which is why we did not launch any partial policies at our party conference. We need to have comprehensive solutions that will deal with the system. It will not be easy. We should have been having this discussion two, five or 10 years ago, but we are having it now.

Whoever are in government after the next the election, the Liberal Democrats will play their part in moving forwards to a social care system that, finally, is fit for the end of the 20th century-never mind the one that we really need, which is for the 21st century. In that society, older people will finally be able to live out the remainder of their lives, knowing what their entitlements are, what they can and should receive and where to go for support, and knowing that, whether they are in residential care or their own homes, they will be supported and appreciated by successive Governments in this country.

3.59 pm

Laura Moffatt (Crawley) (Lab): I have had an interest in this subject for many years, particularly as an acute nurse who cared for people who then became well, or as well as they could, and had to return home, but who then often found that the services that they received were not of a standard that did justice to a fantastic NHS.I am delighted that we now have the opportunity to consult with our constituents on how best to move forward on shaping the future of social care.

I decided to trust my constituents. I said, "Why don't we have a conference to bring together carers"-that fantastic band of people who care for others-"and those for whom they care?", because they are an important element of this debate. "Why don't we bring them together with those who are in charge of adult services, those who look after people from organisations such as Mind and Age Concern, and social care workers, who do an amazing job, day to day, keeping people in their own homes? Let's gather together 50 people who genuinely have an interest in the debate." I do not care how this debate today came about or why we have decided to have it; I am just very glad that we are having it and that we can raise such matters on the Floor of the House, because I want to ensure that the views of my constituents get through.

I thank my hon. Friend the Minister, who has responsibility for social care services, for the time that he took to greet my constituents and for the care and
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the honesty with which he engaged with them to make them feel that they were part of the consultation, for we are talking about a Green Paper. That is the important thing that we need to understand, and there are options that need to be discussed. That is why I said that it was important that I trusted my constituents to look at the Green Paper in that light and to consider the options; and, as good people will, they came up with even more thing for Ministers to consider. I would like to put those forward.

I will not reiterate why we are having this debate. We know that the demographics of this country are changing. However, I agree with my right hon. Friend the Member for Croydon, North (Malcolm Wicks) that knowing that most people will live into their retirement is a good problem to have and one that we should celebrate. We need to ensure that that retirement is happy and dignified. That is why I believe that many of the proposals in the Green Paper will secure the future for people.

I thought carefully about how we should try to pull all those thoughts together, because it is difficult when there are 50 lively people in a room who just want to get their views across. We therefore decided to put the questions that were posed in the Green Paper to them, to try to give some structure and a sense of purpose to the meeting. However, there were undoubtedly further issues to be raised. The first question raised in the Green Paper is how we build a national care service. My constituents felt very much that it was important to have a national standard that we can use as a benchmark for how local authorities roll out care in a way that is suited to people. Personalised care is incredibly important to people, but understanding that there is a quality standard in place was crucial to our debate. Indeed, I was so pleased that everyone who spoke knew that we needed to concentrate on the quality of the service.

When I received the Unison briefing on the proposals in the Green Paper, it was interesting to see how much my constituents and carers echoed its views on ensuring that people are properly trained, so that, in whatever service they are in and however it looks, they have the necessary employment laws to back them up and that they receive the education and training that they need. However, that cannot be done on the cheap.

Mr. David Anderson: May I suggest to my hon. Friend that one of the dangers of the personalisation of social care is that people will choose to employ those who have not been properly trained and do not have the experience or knowledge to look after people properly?

Laura Moffatt: I thank my hon. Friend for his intervention. There was indeed a sense of concern about that. Although people were keen to have their own care sorted and to feel that they were in the driving seat, there was also a great sense that we need the Government and the NHS to be involved to ensure standards and quality. In that respect, I utterly agree with my hon. Friend.

When everyone came together at that conference, it was interesting to see a care worker sitting opposite the adult care services manager and alongside a carer as they tried to thrash out how we should create a national care service. It was stunning to see how much agreement there was among those people on how we should move forward. There was a tremendous sense of the future as
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they considered the document. One question that was asked was, "What will happen if we are not able to achieve this in this Parliament? Would the system be dismantled in the future? Can we afford to have a sense of hope for a decent social care network and a strategy for the future, or might the system be dismantled?" There is a great sense of insecurity about these things being promised and it being impossible to deliver them, and we need to be able to offer people a sense of security about the future.

Mr. Harper: I think I know what the hon. Lady is alluding to, and I am sure that the Minister will say more about personalisation later. We have certainly always made it clear that we are very committed to ensuring that individuals have control over their services, so her constituents need have no worries. Whoever forms the next Government, personalisation will be very much on the cards and will continue to be part of the forward strategy.

Laura Moffatt: I am grateful to the hon. Gentleman for his intervention. I suspect, however, that my constituents were also worried that they might be saddled with a scheme that would cover them only if they went into a nursing home if they had paid a contribution of £8,000, rather than a system that would cover all people, whatever their needs. I suspect that they will have real concerns about that. I hear what the hon. Gentleman is saying about personalised care, and that is something that the Government support, with all the provisos on quality, education and employment standards set out by my right hon. Friend the Member for Croydon, North. We must ensure that this is done properly; it cannot be done on the cheap. That is why Labour Members are having a proper debate about this. We must ensure that people understand that this cannot be done without a contribution, perhaps through taxation.

In those discussions in my constituency, it was interesting that people really tried to understand the situation. I sincerely hope that we go for a comprehensive system, as that is what my constituents want. They said unanimously that the comprehensive system was the way forward. If they were to choose a method that involved a one-off payment, that would be their choice. They also asked what was going happen about setting up the system now, and whether they could plan for the future. There was a degree of ambiguity involved. Should this be a system in which they could make their contribution by paying a capped social insurance premium over a period of time, or could that be achieved by a one-off payment? I was really impressed by the way in which they held those discussions.

Kelvin Hopkins: I admire my hon. Friend for the consultation process that she has held. If I were to put my view to her constituents-or perhaps to my own-that the best system would be a professional public service, with fully trained public servants employed on an accountable basis, available to everyone, would they not have preferred that?

Laura Moffatt: I thank my hon. Friend for that contribution. I suspect that if that question were put directly to my constituents, they would say yes. They were very pleased about the statement from my right hon. Friend the Secretary of State for Health about the NHS being the preferred provider, in whatever sphere. I
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suspect that that is true. There will be no elimination of the private sector in health. As the preferred provider, however, there is no doubt that the NHS offers security in the future. There is nothing better than knowing that the system is fully funded. That is why we are having a bit of a strange debate here, as it is all about genuinely looking at what will never be a cheap option, but one that should be fair, equitable and allow everyone access to care without having to sell their home. Even in the short time available during that morning conference, my constituents were beginning to understand how to implement and pay for such a service. That showed me that they believed that the proposed strategy was the right way forward.

I am deeply grateful that one problem has been eliminated from our considerations. I would not have liked standing up to express my concern about the loss of disability living allowance for people up to the age of 65; I am delighted that I do not have to do that now. As we know, there is still a debate about the payment of attendance allowance to the over-65s, but, none the less, we need to continue to consider such important matters.

One great shortcoming that people identified was the lack of information about available services; people felt that such communication should be very much a part of a national care service. Part of the difficulty they identified is that those most empowered with the ability to find out what is available always seem to get it. The service must offer proper outreach; it must be able to contact people and to offer the care. We are asking a lot of this service, to say the least, but I do not believe that we need to be mealy-mouthed about it. This is our opportunity to be bold about social care. If we are going to ask people to make a contribution, the service must, frankly, be beyond anything we have ever known in the sphere of social care.

I pay tribute to those working in social care, because I know that they are doing their very best on constrained budgets. We have already talked about demographics and the fact that people are living longer, which means that more and more care must be provided. None the less, if we give people the tools to do the job they wish to do in the way they wish to do it and in a professional manner, I certainly believe that the service they provide will be incredibly special.

Interestingly, people attending the conference also had a sense that we had a personal responsibility for our own health in older age. They were very keen that social care offered the means to overcome health inequality by ensuring that pensioners had access to health checks and took responsibility for their own health through exercise. I think that that is an incredible change. Very often in the past, I think, the NHS was viewed simply as a giver of care, but that sentiment has changed absolutely, particularly in Crawley where we have the "Wellbeing" programme. That programme offers people the opportunity to exercise, to assess their diet and to enjoy different activities in order to allow them to take responsibility for their own health. We know how much that can prevent ill health later on in life.

The conference was very clear in what it wanted to put to the Minister. He spent a long time with us, but even more points were raised after he left. I could not stop people talking, as there were other things that they wanted to say. They were particularly pleased their points appeared to be taken seriously by the Minister.
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They are also pleased to know that I have had this further opportunity to press their points to the Minister today.

We are looking at a system that could be fair and it could certainly be the best in the world if we managed to set up a national care service that prolonged people's active lives. That is what the service is in the business of doing-making sure that people keep well and are able to remain in their own homes. There is little point in offering a strategy that helps those who are going into nursing homes when it is undoubtedly the case that the overwhelming majority need to remain in their own homes. That is an absolute given. We must ensure that people can receive the care, help and love that they need in order to remain at home.

We shall have to tackle all those matters without imposing undue stress and strain during what will undoubtedly be difficult years while we put the public finances back in order. Anyone who does not accept that is living in cloud cuckoo land. We cannot offer the world without requiring any contribution from those who would benefit from the service that we are providing, either through taxation or through a system of giving. Either way, we shall have to pay.

When we discussed the issue at the conference, I was a bit cheeky and asked people to say whether or not they were taxpayers. There was an absolute divide between taxpayers and non-taxpayers over who should contribute. I believe that we should consider a taxation system, but that we should also consider how we can help others to make a contribution to ease the burden. It need not be an either/or system.

Kelvin Hopkins: The problem with the taxation system is that it is regressive. If it were made much more progressive, the sort of taxpayers at the conference would not suffer. In fact, they would be better off.

Laura Moffatt: I thank my hon. Friend-I think-for his intervention. I hear what he says.

Without question, my constituents chose the comprehensive system as being the fairest and most equitable. Crucially, they also felt that it was the most sustainable. We know exactly where a system allowing people to opt in or out would lead us. People who wanted to keep their homes would choose to make a contribution of, say, £20,000 in order to do so, leaving everyone else behind. I firmly reject that system, and I am glad to say that my constituents do as well.

We are being presented with an exciting opportunity. I sincerely hope what has been said today and by our constituents will be taken seriously. Today there has been a real sense that we have been given a chance to get the system right. The issue has never been tackled as well as it is tackled in the Green Paper. We have an opportunity to move forward, and to ensure that our constituents, and we ourselves-for I think that, as we grow older, we should declare an interest-enjoy security in old age, along with the care and dignity that older people so richly deserve.

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