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4.18 pm

Angela Browning (Tiverton and Honiton) (Con): I intend to focus on people receiving care in the community rather than on the part of the Green Paper that deals
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with residential care, because, important though residential care is, it has already been mentioned a good deal. There are aspects of care in the community that give me cause for concern, and I hope that the Minister will cast some light on them when he responds.

Page 97 of the Green Paper refers to the cost of care for people who are disabled early in their lives. It states:

presumably, during the early part of their working lives-

That sounds very encouraging and reassuring, but the Green Paper seems to contain conflicting information about how people receiving certain benefits would be affected. The Minister dealt with the question of disability living allowance, and I am delighted about that, but we have not yet been told what will happen to DLA recipients aged over 65, or to the people with lifelong disabilities whom I mentioned in an intervention on my hon. Friend the Member for Eddisbury (Mr. O'Brien)-namely, those on severe disablement allowance. Since the paper was published, I, like many MPs, have received correspondence from constituents on all those benefits who have been extremely unsettled by their reading of the Green Paper as to how they as individuals might be affected.

The Green Paper mentions what will happen to people when their services are based on personal circumstances, but also states:

I can see a slight conflict there. On the one hand, they are being told that their money will be individualised and personalised; on the other, they are told that it

That brings me to the initial concern I felt on reading the paper, which is the focus on universal assessment for entitlement to universal entitlements. I would be grateful if the Minister could confirm that I am not misinterpreting the paper. Those people over 65 on attendance allowance think they will lose that benefit, which will go into a pool and the money will then be "used wisely" by a centralised state. The state will transfer the funding through local social services to avoid a problem the paper has not got to grips with: the system of assessment of need by social services. I would like to try to get to grips with it here.

We want to fulfil people's needs as individuals, whether they are the over-65s on attendance allowance, younger adults on disability living allowance, or-as mentioned earlier in the debate-those who have needs but at the moment do not quality for any recognised benefit at all. There are many of them. We all see from our casework young adults who fight to get DLA and quite clearly should get it, but somehow do not tick the right boxes.
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Among that group, I would particularly identify people with chronic and ongoing mental health conditions, people on the autistic spectrum and people who do not tick the right boxes at the moment.

Kelvin Hopkins: The hon. Lady talks about ticking boxes. I have had two cases recently in my surgery involving people who have been interviewed by a doctor on behalf of the Department of Work and Pensions and told that they are fit to work when they clearly are not. They have then looked at their form and found that the doctor has lied: the individual has said that they cannot do something and the doctor has put down that they can. Some of the medical practitioners are telling lies when filling in forms.

Angela Browning: I am grateful to the hon. Gentleman, as I was just coming to what is now regarded in this country as a universal assessment of the ability to work. Only this week I have had two cases that I am taking up and which I think are quite appalling. All of us in all parts of the House understand that there are a number of people on long-term sickness benefits who could be assisted to get back into work. In my constituency, a great many want that assistance and want to get back into paid employment, but we must understand that does not necessarily mean full-time work; it may also mean some progression into work that is suitable for them. It is not just about retraining but about a range of other things to enable the individual to take their place, either again or the first time, in the workplace.

Following on from the hon. Gentleman's comments, let me highlight what universal assessment means. There is a lady who has worked full time for many years who has had a mastectomy as a result of breast cancer. Her clinicians say she is not ready to go back to work full time. She has had extensive chemotherapy and radiotherapy. She was required to attend for an assessment, at which she was asked to raise her arms above her head; as she was able to do so, she was told, "Okay, you're ready for full-time work"-with no mention of her possibly being able to go back on a part-time basis. Anybody who knows how draining chemotherapy and radiotherapy are on the system will know this is not just about asking, "Can you raise your arms above your head and start work full time on Monday?" She wants to return to work, but this is about gradually reintroducing her into the workplace. Her clinicians have said she might be ready to go back part time, but that she needs to do this gradually because she naturally gets tired very quickly, but that possibility has been totally dismissed.

Another case I have dealt with is really quite tragic. A young girl in her 20s has had a tumour which has ravaged one side of her face, and she has had to have aggressive surgery to stop the spread of the tumour. She will need at least two or three more sessions of major surgery to help to rebuild her face, following the necessary removal of half of it in order to save her life. This young woman is single. She had her own home, which she lost as a result of being out of work while having this long-term surgery. Thankfully, she has now got a home of her own again. The comments made to her when turns up to these back-to-work interviews are outrageous. They are totally insensitive to a young woman who has gone through what I have described. The interviewers do not seem to take into account the emotional damage done to somebody in such circumstances.

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In assessing people's disability and how it impacts on their ability to manage their lives-perhaps with a little, or a lot of, support-we must look at the person as a whole. That is why individual plans and packages can triumph over the concept of the universal standard, where there is a tick box and someone's circumstances might not happen to lead to it being ticked or the person conducting the assessment not seeing the right category printed in terms. Further, I would not be happy for there just to be a list of conditions. As we all know, there are levels in respect of many medical conditions, and individuals can be affected very differently by them. For some, a condition can considerably hamper their ability to look after themselves, whereas others might be able to cope with a little help. This notion of universality therefore worries me enormously, because it means there will be winners and losers, and the losers will be those who are least able to make their case.

Greg Mulholland: I commend the hon. Lady for making her points so very powerfully. Does she agree that there is insufficient acknowledgement both of mental health conditions and the fluctuations of many conditions both physical and mental, and that they are simply not taken into account in current assessments?

Angela Browning: The hon. Gentleman is absolutely right. I am sure the House has become fed up with me going on about these two issues, and particularly mental health and the autistic spectrum. Such conditions do not fit neatly into any identified national criteria. They are very difficult to assess, and because people's conditions can fluctuate, on one day they might pass a test and some might think, "There isn't much wrong here," but they can deteriorate very rapidly, or circumstances can affect them and make them deteriorate very rapidly. I thus find the one-size-fits-all attitude to providing for the most vulnerable in society worrying, and I hope the Minister will reassure me on this. I know that he has a great deal of knowledge of these matters, and certainly of the autistic spectrum as he has taken the Autism Bill through the House with many of us who have an interest in the subject.

I want now to talk a little about those at the other end of the age spectrum: the elderly. I have mentioned my concern about their being denied disability living allowance, but there is another problem in respect of the elderly. I agree that old age is marvellous-I have been to two 100th birthday parties in my lifetime; this has been in the past few years because as a child one did not trot round going to 100th birthday parties-and the fact that people are living longer, which we can all observe, is to be celebrated. However, this is again about balance and a realisation of what comes with really old age.

Frailty, which might not necessarily involve a diagnosis of any particular condition or illness of which everyone is aware, has an impact on the individual. It affects their physical ability and their mental ability. Nobody ever really thinks they are going to get so old that they cannot do things for themselves, so there is a mental impact to consider.

Loneliness has been mentioned, and social isolation has a huge impact on older people. I represent a rural seat, where one sees a lot of this; some people still live in isolated conditions and do not have the usual arrangement whereby neighbours live right next door. In this universal
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system, how are these people who are as entitled-and we are talking about entitlement-to get the right help and support as those who live in the larger, urban conurbations, to be treated as individuals, and how are their needs to be met? When I read the document, I worry that they have not been thought of and that they will get left behind.

I serve on the Public Accounts Committee. The Minister will know that in recent years the National Audit Office has put before the PAC reports on very important subjects. We had an excellent report on dementia, another on stroke services and a more recent one on autism-another one, on rheumatoid arthritis, is coming up. Common themes run all the way through all those reports, but the one that perhaps emerges the strongest is the inability of Government Departments and local government departments to work together when they need to do so-for example, in health and social service. They work in silos.

We have heard a little this afternoon about the need for services to work together to provide a holistic approach for the individual, but I must tell the Minister that that will require more than everybody just standing up and saying, "We need to do this." If there is a need for any national structure, it is in this sphere. A national structure is not about saying, "Fred Bloggs in one part of the country will receive this." I would rather somebody more local to Fred Bloggs decided what he needed, based on how he presents at any given moment in time. If there is indeed a role for national structures, it is for the Government to examine carefully what needs to be done to ensure, from the top, that we have a system whereby Departments, including the Department for Work and Pensions, work together with social services, local Jobcentre Plus branches and the housing departments. All those public sector bodies that can deliver the solution to an individual's needs now require more than just having their heads knocked together. There needs to be an imperative from the top that makes all this happen.

I realise that it is difficult; we all understand about budgets. One of the weaknesses in any system aiming to resolve these problems is that if one puts a little bit of money into this year's budget to resolve a problem at the lower end, be it dementia, autism or something else, people feel that it should have been spent on the "higher" needs. Yet if it is not put into this year's budget, somewhere along the line, perhaps even a few years later, the problem will turn into a massive call on the public sector purse because it will have turned into a crisis.

Let us consider the economic point of view. All the reports that the PAC has seen relating to health have shown a very clear benefit to the public purse to be had from doing things the right way. I know it sounds hard when a politician talks just about the economics, because of course every one of those reports contains the human interest issue; each one deals with the impact on people's everyday lives. When the Minister winds up, will he give me reassurance and clarity on that point? I believe that the way forward, particularly with care in the community, is to have people's needs properly addressed.

I would not want to see the bar being raised yet again for the eligibility assessment, particularly when we talk about how this is to be financed. The bar could simply
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be raised, which would exclude more people at the bottom in order to provide for those at the top. It might sound a logical argument to provide for the most needy-of course it does, and that has to be done. However, it is quite interesting and surprising-this applies all around the country and not just in my part of Devon-to see how many social services departments settle out of court when, very occasionally, somebody challenges the statutory services through the courts or even starts the process of legal action, in order to obtain their legal rights. That tells us something. It tells us that the authorities know they are not fulfilling their role as they should, properly identifying needs and coming to an agreement to fund a package that will meet the needs of the individual.

Finally, I am a great fan of direct payments. I have some personal knowledge of them within my family, but the way the system has been introduced around the country beggars belief. In some areas, it has been done in the most simplistic way as far as the user of the service is concerned. I will name an authority that I think is an exemplar in this regard: the unitary authority in Bournemouth, which is not in my constituency but is an authority with which I am familiar. When it first set up direct payments, it made quite sure that when people employed someone, all the necessary paperwork and administration were in place and simple to follow. It has a helpline for the people who use the system and the forms are extremely simple and straightforward. The authority did a lot of research and did it before people started to use the system.

If such a thing can happen in one area of the country, why do authorities not share the information with each other? Instead, we have seen some authorities whip away the services from those who were receiving them directly from the local authority before they had decided how to get them on to a direct payment system. It totally backfired and caused the most terrible anxiety to people and their carers.

If we want to take a top-down approach, let us take exemplars of best practice and let the Government make it their business to ensure they are spread throughout the country so that people can see how to do it properly. Let us not have the Government or a national system telling individuals from the top down what is needed in their package or who is going to deliver it. We need that freedom so that people's packages can be tailored to their individual needs. Taking that away from them will be a retrograde step.

4.38 pm

Mr. David Anderson (Blaydon) (Lab): As Parliamentary Private Secretary to the Minister of State, Ministry of Defence, my hon. Friend the Member for Harlow (Bill Rammell), I have had quite a tough week. I have sat through Adjournment debates, statements, an Opposition day debate yesterday afternoon and a Westminster Hall debate. If I stand back from the issues being discussed, I can see that what was really important and what made it a huge experience for me was listening to people across all this House who had true, real-life experience of what we were talking about. They were people who had served in the forces. Today's Opposition Whip, the hon. Member for Ludlow (Mr. Dunne), spoke yesterday about his experience in the reserves-I believe in the naval reserve. Those people knew the real world that they had come from.

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I want to speak from my experience as someone who worked as a care worker; 20 years ago this month, I fell into care work by mistake. I had been made redundant as a coal miner, which I had been for 20 years, and I was looking for something to fill my time in the short break before I picked up something else. I went for a 13-week part-time contract at Newcastle city council as a care services driver and 16 years later I left to come and work in this place. But the importance of the story is not why I went there and stayed there. I was fortunate that I went to work in a place that was built by two visionaries: Jeremy Beecham, the leader of Newcastle city council; and a gentleman who is no longer with us, Brian Roycroft, who was the director of social services and, in fact, the leader of social services directors across the country. In the mid-80s, they purpose-built a building in Newcastle called the Minories project, which was constructed to deliver real care in the community. The place was expensive, but it was quality. It included sheltered housing, and the people who lived there had access, as and when they needed it, to staff who worked in another part of the building. It had a respite centre with 16 beds, which meant that over a 10-week period 160 people could stay, giving their families some relief while we looked after them and saw to their needs.

The building had a restaurant that was open to the public, and people over 65-years-old right across Newcastle could go there and meet their old friends. It was a real place that really worked. It had a day centre that was second to none, and we even had our own bus-a 1970s Mercedes bus, which I loved driving. If I live until I am 90, I shall never, ever forget the pleasure that I used to get from driving that bus and seeing a particular old lady called Florrie, who used to look out of the window, with the sunshine in her eyes. The only thing was that she could not see, because she was totally blind, but the look of pleasure on that lady's face will stay with me as long as I live. Memories like that represent the real experience of people who work in care.

I went from being a man working the coalface in March 1989 to being a man standing with a doctor in March 1990, helping to put a prolapsed womb back into a 91-year-old lady. It was totally different, but that is the real work that carers have to do, day-in, day-out, 365 days a year. I want to put on the record my appreciation of the work that they do, whether they are professional carers or carers who help their family or friends. The real joy of that job was the total appreciation that we got from people after doing something as simple as cutting up their food, fastening their laces or helping them go to the toilet-things that we all take for granted, but things that, sadly, they were no longer able to do. But we had to do that work, and it was a privilege to do it.

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