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"adamant that no one is getting their mitts on vital extra-cost benefits".
It makes the point that such benefits are designed to help to meet the extra costs of being disabled and needing such care, and that people would lose choice, control and independence if they were removed.
Leonard Cheshire Disability also opposes any moves to take the DLA care component and attendance allowance into broader social care funding. The National Autistic Society is very concerned about the proposals, as is Age Concern. So a broad spread of organisations that work in the field are very concerned.
"The AA/DLA recipient...decides what to spend the money on...the core principle behind Individual Budgets, whereas transferring AA/DLA to social care...would involve extending bureaucratic control over people's lives, undermining the new philosophy of individualisation and choice."
That is exactly the point that I made earlier. The Government need to think again about this change. The Secretary of State has gone some way by ruling out changing DLA for those under 65, but that still leaves more than 1 million over 65 and a significant number on attendance allowance with concerns that have not been allayed.
"Social security is a reserved matter in Great Britain and a single body of legislation applies across England, Wales and Scotland. Any move to change the benefits rules in England alone would...be a significant departure".
That is of especial interest and concern to me, because I represent a constituency that borders Wales. For example, we no longer have a national health service across the UK: we have four different health services with different policies and different ways of dealing with challenges. A national care service would really be an England care service, which would deliver care in England, not across the UK. For people who live towards the southern end of my constituency, in Sedbury or Beachley for example, the nearest town is Chepstow, which is in Wales, and I would not want them to face artificial restrictions on the best option for them because that would involve
crossing a border within the UK. Equally, somebody living in Wales with a service to be delivered in England would be restricted. That would be a retrograde step and not one that we should support.
The Minister knows that I am concerned about that matter, because I asked him a question at Health questions a couple of weeks ago. New information has come into my hands since then. I drew his attention to the fact that there had been a Green or White Paper-I forget which-on this in May 2008 that had talked about the impact on the devolved parts of the United Kingdom and the necessity to talk to the Scottish Government and the Welsh Assembly Government. He kind of indicated that that might have happened. I asked him about it, and I think that he said that those discussions were taking place.
I received a briefing for this debate from the Scottish Association for Mental Health. According to that association, the Scottish Government reported as late as 16 September this year that they had not been consulted about the effect of the policy change on people in Scotland. A paper was produced touching on the impact on the devolved parts of the United Kingdom in May 2008 and the Green Paper before us was published in July this year. Things have been left remarkably late, therefore, given that the Government are talking about publishing a White Paper in the next few months yet discussions with devolved Governments had not taken place as of 16 September.
It would be helpful if the Minister could indicate whether those discussions are now under way-whether at official or ministerial level-or, if they are not, when they will start. If they are under way, will he indicate where they have got to? We must ensure that we do not make changes to the UK-wide benefits system that will affect different parts of the United Kingdom without having had those conversations. That might leave people in the lurch, as my hon. Friend the Member for Tiverton and Honiton suggested has happened in other local authority areas.
There are real concerns about the impact on benefits which affect, as I said, on average 4,000 people in every constituency in the United Kingdom. That will concentrate the minds of hon. Members on both sides of the House as we approach the general election. There are also other issues that have not really come up about the impact on the devolved parts of the United Kingdom. I know that the Minister will be short on time, but if he can at least touch on those points, I would be most grateful.
Mr. Paul Burstow (Sutton and Cheam) (LD):
I am delighted that we are having this important debate. The Secretary of State was right when he identified that the matter before us will pose an important challenge in the next Parliament for whoever find themselves in Government. The question is whether we can build a consensus this side of the general election. Although this debate has many threads that could be pulled together to create a consensus, the environment in which we are having the debate-with a general election not far off-probably makes it impossible this side of the general election to reach that final consensus. Whoever is in government after the election, however, will need to drive quickly and forcefully to deliver a consensus,
because if we do not have it, we will be talking about this matter again and again in a decade, but still have made no further progress.
In an intervention on the Secretary of State, I referred to the consultation process. My local authority-the London borough of Sutton-has participated in that and organised two events with carers groups, carers themselves, people in receipt of care and various providers. It came up with five key findings in a 16-page report that will be winging its way to the Department. I picked up a draft this morning. The findings were that people
"preferred local to national (local flexibility with national assessment and minimum standards)...wanted a simple, transparent system that ends the 'post-code' lottery...preferred comprehensive over partnership and insurance (there was a distrust in insurance)...were interested in discussing taxation as an option"
"wanted more information on the subject generally".
The last point is particularly germane to our debate. There is a huge level of ignorance about social care until people enter the system or encounter it vicariously through a relative's experience. Until that happens, most people do not know what the system is about. I would therefore greatly support anything that can be done to raise awareness or ensure that social care is a central issue at the next general election.
The hon. Member for Blaydon (Mr. Anderson) talked about the rationing of care, in effect, through the use of eligibility criteria. Although there have been welcome changes in that respect over the past 10 years, I am also proud that my local authority, the London borough of Sutton, which has been under Lib-Dem control for the past 23 years, has managed to sustain its eligibility criteria in the "moderate" band. That ought not to go unmentioned, as only a handful of London boroughs still do that.
Quality of care has been referred to in this debate in a number of ways. I want to pick up on two or three points that illustrate why we need to strive to do more to address concerns about quality. In their briefings for this debate, both the Parkinson's Disease Society and the Alzheimer's Society reported concerns about the quality of care and, in particular, the lack of social activities in residential care. People are left to receive care passively and, although routine tasks are performed, they do not receive the emotional support and engagement that comes through social activity. There is also a crying need for more training, particularly on dementia.
One subject that is a particular concern for me, and which I also think is a marker of quality of care, is the inappropriate-and I would go so far as to say abusive-use of antipsychotic drugs in residential settings. Not only do they bring people's lives to an end prematurely, but in some cases they kill people. The evidence has mounted over the years. I hope that Professor Sube Banerjee's report, which I am told is to be published next month, will not just be published, but generate genuine action from the Government.
There has also been a lot of talk about home care, which is undoubtedly an important component of what we want to see happen. However, home care can become as isolating and institutionalising as residential care if it is not well delivered. There are plenty of documented cases and audit reports demonstrating that. Again, training is an essential part of that, particularly in
manual handling. We need to avoid having a revolving door of poorly paid and poorly trained staff or a succession of ever-changing faces coming in and providing brief care interventions. We also need to avoid having to chase people to get them there in the first place.
Reference has been made to telecare. I have seen it being developed and delivered in many parts of the country. It undoubtedly has a contribution to make, but it cannot be a substitute for emotional support or that human touch and kindness. If telecare is a substitute for those things, what has it become? It has become little more than the electronic tagging of the elderly.
The central debate is about funding and how we pay for care. When we address the care of the elderly part of our population, we must keep in mind dementia and the fact that two thirds of those in care homes suffer from it. The bills that they face are huge. Some would describe them as a tax on dementia-indeed, the Alzheimer's Society labels them as such. We therefore need to design a system in which the risk is fairly shared across society, find ways of removing barriers to accessing to capital-the figure of £1 trillion for the assets that the over-65s owned before the recession is not to be ignored in this debate-and ensure that people can access financial services in contributing to the costs of their care.
However, the silence in the Green Paper on the means test thresholds and the overall funding levels makes the whole thing ring rather hollow. Without those, it is hard to judge what the intention or purpose behind the design of the system will be. One way in which the Government clearly hope to try to redirect resources is through the change to attendance allowance and disability living allowance. Although I welcome what has been said about disability living allowance in respect of the under-65s, there are still question marks over the rest.
Let us be clear: DLA and attendance allowance are the perfect direct payments, because they maximise individuals' personal choice and control over how they use the resources that they receive. They are based on need and are not means-tested. We need to understand the consequences of folding them up into social care budgets. One of the consequences, as we have just heard, is the possibility of breaking the link to the carer's benefits and possibly making it harder for that benefit to be paid at all. I therefore hope that we do not go down that path.
My hon. Friend the Member for Leeds, North-West (Greg Mulholland) mentioned the personal expenses allowance. In the past, there was a promise of a consultation on that, and the Green Paper would have been an ideal opportunity at least to ask whether the allowance was fit for purpose and sufficient. Anyone who goes into residential care and is funded by the state will find that the state takes most of their money away from them. They are handed back only £21.15 a week to meet all their personal costs. Frankly, that is not enough to give anyone a reasonable quality of life, to give them the right to buy a present for their grandson, to have a decent haircut, or whatever else they might need. The Joseph Rowntree Foundation suggests that at least £40 is necessary to give any justice to those people in residential care.
The national care service seems to be the centrepiece of the Green Paper, but what is it really going to be? Will it be a virtual organisation, or will it become a real
one? It is not entirely clear what is intended. If it is about providing a national framework of eligibility, that is welcome. If it is about greater clarity and the portability of care packages, that is welcome, too. It is important to recognise, however, that concerns have been expressed about how national eligibility criteria will be made to stick around the country. Those concerns emerged from the consultations in Sutton. How can we create assessment tools that will guarantee consistency of approach? We have seen, as the continuing care framework was rolled out across the country, that there are clearly inconsistencies between one part of the country and another.
The right hon. Member for Croydon, North (Malcolm Wicks) talked about joined-up assessments, and he was absolutely right. That leads me to ask another question of the Minister: whatever happened to the single assessment process? It was trumpeted in 2002, when the national service framework for older people was launched. It was going to provide the way of ensuring that people were not put through endless, untimely assessment processes; only one process would be needed. That did not happen. Surely that process needs to be revisited if we are to have an assessment tool that really delivers.
I have said already that I welcome the portability of care packages, which is mentioned in the Green Paper. I also welcome the recognition of the value of advice and information for all, and of how empowering that can be for individuals. There is, however, a question mark over whether there is enough recognition of the differing capacities of individuals and families to navigate their way through the system. That does not seem to have been reflected in any discussion about advocacy or about how we tailor support for families so that the system really delivers for everyone.
I speak to constituents who have experienced direct payments, and the hon. Member for Tiverton and Honiton (Angela Browning) demonstrated graphically how we can learn from experience around the country in that regard. People have been turned into book-keepers and diary-keepers; they have effectively become the brokers of the system when they really wanted to be a carer. In some ways, direct payment takes that away from them and gives them something else which they have not signed up for. We need clarity about advocacy.
It is also important to make it clear, when designing a new system fit for the 21st century, that human rights are a strong and resilient thread running through all of it. In a rights-based, entitlements-based system, the individual can ultimately force the joining up of services-through the courts if necessary-and ensure that they are wrapped around to fit them, rather than the other way round.
I welcome what the Secretary of State said earlier about the need to root out ageism by 2012. That is long overdue, but very welcome. We should not have arbitrary age bars or differential charges for services. How can the charges for someone in a young adult care facility be massively higher than those for someone in a residential care home for the elderly? What is it that those elderly people are not entitled to that results in their care costs being so much lower than those for younger people?
That brings me to carers, to whom I referred in an intervention. Carers should be part of the Green Paper and should be enshrined in the principles of the national care service. Just last week, I attended the annual review
of the Sutton carers centre, which covers 19,000 carers in the London borough of Sutton. I heard some very inspirational presentations given by local carers there-and by Jill Pay, who I understand is on the Standing Commission on Carers. These are ordinary people doing exceptional things, and we all know that their own health and well-being often suffer as a result of taking on caring responsibilities. Reference has been made to the £53.10 carer's benefit. What we need is a timetable that delivers a significant enhancement to that benefit, well before the 2018 target set in the Government's carers strategy.
We also need transparency and accountability regarding the £150 million that the Secretary of State has put into caring services through the NHS. When I raised the matter in a debate in June, the Minister told me that I should go and ask my primary care trust. I did just that. Three months and endless e-mails later, I received a letter yesterday. Let me read what it said at the end:
"NHS Sutton and Merton was expecting these resources to be allocated specifically, and not as part of general growth allocations. However, it only became clear in April 2009 that the funds were actually included in general growth which the PCT had already committed some 4 months earlier in the Strategic Plan."
The money is not going where it was intended, irrespective of whether or not the Minister tells us it is. I hope that he will say more in his summing-up speech about how we will be able to track this in the future. I am not talking about ring-fencing; the Minister should not go down that path. I am not in interested in that; I am interested in local accountability for how the money is spent. At the moment, on the basis of the behaviour of my PCT and many others, that is not demonstrable.
To conclude, I hope that the Green Paper will not only provide better care and support, but be a driver for law reform. We need a comprehensive new social care Act that brings together all the carers legislation passed piecemeal over the last decade. It should update the legislation, remove the last vestiges of the Poor Law that are still part of our system and deliver the safeguarding, security and decency of care that all our citizens deserve. With that, I look forward to seeing the White Paper, but rather than delivering anything, it might be a first shot in the general election. After that election, whoever sits on the Treasury Bench will have to build a real consensus, which is what all our constituents want.
Hywel Williams (Caernarfon) (PC): I will endeavour to be fairly brief. The Green Paper is concerned with care in England. My hon. Friend the Member for Glasgow, East (John Mason) speaks for Scotland, and I speak for Plaid Cymru and Wales. In the past, I have resisted intervening in debates on care in England, despite the strong temptation.
Our main concern-and that of constituents in Wales and Scotland-is the particular worry about attendance allowance and disability living allowance. There has been some confusion over the last few months, some of which was cleared by the announcement on DLA for the under-65s. That still leaves the concern I expressed earlier about over-65s, particularly those in Wales and Scotland, given the devolved nature of care, social care and health services.
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