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I had a close look at the Green Paper. I see that everyone on the front page is smiling, and, rather alarmingly,
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so is the Prime Minister on page 2, but perhaps they are all smiling at the DLA announcements-so there we are.

About 115,000 people in Wales have a right to attendance allowance, 80,000 of them at the higher rate. They, including 2,370 in my own Caernarfon constituency, value it as a targeted and dependable source of help. Since its inception, it has provided a way of promoting and enabling autonomy, just as the mobility allowance provided a way of addressing the needs of disabled people living out in the community. That was also the principle behind the groundbreaking moves in the '70s and '80s, particularly in Wales, to shut large institutions under the "All Wales strategy for mental handicap", as it was called at the time-something I was intimately involved in as a young social worker.

Attendance allowance helps people to be independent. There nothing wrong with being dependent. There is nothing dishonourable about it. However, the direction of social policy over the past 30 years has been towards autonomy, choice and enhanced independence for those who, in darker decades, might never have seen the outside of an institution. I therefore consider the current move to be a step in the wrong direction.

Given that the provision of care in Scotland and Wales is the responsibility of the devolved Administrations, I hope that the Minister will explain what will happen in Scotland and Wales if attendance allowance is, as it were, taken in-house throughout the United Kingdom. Will the Scotland and Wales element be transferred to the Welsh Assembly and the Scottish Parliament as a block grant for them to administer? That would be something of a constitutional novelty. Will the Welsh Assembly, for example, be able to administer an attendance allowance for Wales on the basis of the old system, or will it just spend the money on health and social services in Wales in the normal manner?

Mr. Harper: Will the hon. Gentleman give way?

Hywel Williams: I will, although I am loth to do so given the pressure of time.

Mr. Harper: I am grateful to the hon. Gentleman. He has reminded us of a comment made by the right hon. Member for Croydon, North (Malcolm Wicks) about joined up-government, not just in Westminster but throughout the United Kingdom. It is essential for conversations between the Westminster Government and the devolved Governments to take place at an early stage.

Hywel Williams: That is a very good point. I would certainly like the Welsh Assembly Government to take more responsibility for attendance allowance, although, as I have said, that would be a constitutional novelty.

I think that we need some answers from the Government before we take this much further, because there is a real fear in Wales and Scotland that DLA and attendance allowance will disappear, and we are unclear about what will take their place.

5.31 pm

The Minister of State, Department of Health (Phil Hope): We have had an important-indeed, I would say crucial-debate on the Government's proposal to create a national care service for older and disabled people. Members have spoken with great passion and considerable
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knowledge. We have heard from former Ministers, and from Members with personal and constituency experiences. I shall take each of the contributions as a submission to the Green Paper consultation, which will boost the numbers.

In opening the debate, my right hon. Friend the Secretary of State spelled out the need for change. My right hon. Friend the Member for Croydon, North (Malcolm Wicks) and the hon. Member for Eddisbury (Mr. O'Brien) rehearsed some of the core arguments about the change in demography. For me, a key fact is that there will be 1.7 million more people needing care in the future. Is the current system of care provision able to cater for that? The Government's conclusion, and one of the drivers behind the decision to change the system into a national care service, is that it is not, and that we need to find ways of responding to that.

Another key issue is the anger that I have heard expressed up and down the country at the unfairness of the means test, which forces people to use their savings or sell their homes to pay for their own care. That was mentioned by my hon. Friend the Member for Blaydon (Mr. Anderson). People are also worried about the quality of care services. I think that every Member referred to that. People are worried not only about whether they will be cared for well, but about whether the standard of care will vary according to where they live. Many are worried about the postcode lottery. Adults with disabilities are particularly worried about a variation between care assessments in different parts of the country. They do not feel confident that their care needs would be met if they moved to another area.

In proposing a national care service, we have used the building blocks of much of the very good work that has already been done throughout the country over the last four or five years. I must directly contradict claims by some Members on both sides of the House that we did nothing during those years and then suddenly embarked on consultation about a Green Paper. I remind them that it was back in 2007 that we launched "Putting People First", which received huge support across the country. Local authorities, the health service, third sector organisations and the private sector signed up to the agenda for the transformation of care services. We set aside an additional £520 million for local authorities to personalise social care services in the way that every Member here wants. Most councils are now getting more than £1 million each to support the agenda during the period 2008-11. That is a major building block as we aspire to create a national care service.

Many Members mentioned carers and the importance of recognising their contribution in caring for a loved one. The carers strategy, published in 2008, is a 10-year programme to help to ensure that carers get increased care and control and can have a life outside of caring, which is what they aspire to and what we aspire to on their behalf. I understand the criticisms, repeated today, about the money being delivered by the primary care trusts that have received extra cash, for example for respite care. I will be meeting the Princess Royal Trust for Carers, with senior NHS officials, to discuss how we might take this forward.

I find it difficult to accept criticism from the Conservative party about that issue as it voted against the extra money going into the health service in the first place. It
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now criticises us for the fact that the health service may not be giving the money out as it would have hoped. I cannot accept that and I find its position to be a little hypocritical.

Others have mentioned the importance of services for people with disabilities. I want to remind the House that another key building block that we put in place to create a national care service was Valuing People Now, our three-year strategy to transform the lives of those with learning disabilities and improve the quality of and their access to local public services. I was disappointed when the hon. Member for Brent, East (Sarah Teather) criticised the Green Paper for not addressing the needs of adults with learning disabilities, as the whole of the Green Paper is about adults with disabilities, including learning disabilities. Many of the features of the service that they will receive are captured in the Green Paper. We also have a specific strategy to drive forward in particular services for adults with learning disabilities.

Many Members have mentioned dementia as being a key pressure at the moment and one that is likely to grow because of the demographic changes. My right hon. Friend the Member for Croydon, North made that point. We have our national dementia strategy, published in February. It talks about earlier diagnosis and earlier intervention, which is a key part of how we help people to live well with dementia as well as providing new services. I visited my right hon. Friend's constituency where there is a very good memory clinic-one of the forerunners of the national dementia strategy, it is a model of good practice that we would like to be replicated across the country.

Mental health has been mentioned. We have just completed our consultation on New Horizons, a major shared vision for mental health for the future, whose twin aims are to improve mental health services generally but also, specifically, to improve the mental well-being of the population as a whole.

We also have the national strategy on adults with autism. The hon. Member for Tiverton and Honiton (Angela Browning) was gracious in recognising the contribution of the Government in creating a statutory basis for that in a Bill that I think will receive Royal Assent in a few days. I am certain that it will. It is a landmark for the care and support of adults with autism.

We also have our Dignity in Care campaign. Not a single Member mentioned that, which is why I mention it now. It is another key building block in driving change forward from the bottom up. Ten thousand individuals have now identified themselves as dignity champions in residential care homes, domiciliary care, the NHS, local authorities, the third sector and private sector organisations. They are all committed to playing their part in taking forward what I regard as a social movement to put dignity at the heart of care.

More recently, we published the social care workforce strategy. My hon. Friend the Member for Crawley (Laura Moffatt) was a model for how we might undertake consultations in our constituencies with individuals and groups on such proposals. From today, I would encourage every MP to spend the next two weeks-we still have another fortnight before the closing date-talking to local carers organisations and user groups, as well as third sector and private sector care providers and local authorities. We must ensure that everybody is fully
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engaged in this debate. Members should be leaders and shapers of the debate in their constituencies, because it is very important. The Prime Minister recently announced that from October 2010 people with the greatest needs will be offered free personal care in their own homes, which is a major step forward in creating an integrated national care service for the future. We are working through the detailed modelling of how that will work, but it is of central importance and a building block towards achieving a national care service.

We must work through each and every one of these strategies and bring them together. Each of them is good in its own right but, because of the concerns that have been raised, we all know that in order to meet the needs of both carers and the users of care in our constituencies we have to reform and reshape the whole system, as well as put in place and improve the individual components. Many Members have highlighted the key features of the national care service, and I think the public should start to expect them as an entitlement. Those features include services that enable people to live longer in their own homes, and prevention-that has been a theme throughout the afternoon. This will give carers support, and also peace of mind that the person they are caring for-perhaps a family member-is being looked after, such as through telecare or telehealth. I disagree with the sweeping criticism made by the hon. Member for Sutton and Cheam (Mr. Burstow); I think telecare and telehealth have an important role to play in helping people, alongside other measures.

Mr. Burstow rose-

Phil Hope: I understand why the hon. Gentleman wants to intervene, but I am sure he will understand that I do not have much time. Let me just say that I do not think we should dismiss these measures too readily.

The idea of a national assessment of a person's care needs based on the aspirations they themselves have about their way of life and independence was raised. I want to reassure the hon. Member for Tiverton and Honiton that that is exactly what we want from a consistent and national system of care. It will of course be delivered locally, but to a pattern and a set approach that will allow people to have consistency of care in different parts of the country. It will not impose a system that negates individual needs and local distinctiveness; rather it will reinforce the needs of the individual and in a way that does not lead to different outcomes in different parts of the country. I hope that reassurance is sufficient.

The disability movement in this country has been championing real portability, and wants that to be the outcome of the care needs assessment. I am delighted that the national care service will be a major achievement for the disability movement in this country.

Mr. Harper: I agree about portability and the disability movement, but what is important to note is that this is not a national care service, but an England care service. We must not get more portability within England and then make the borders between Wales and Scotland real barriers to people who might want to move about our United Kingdom.

Phil Hope: I will make this point now, although I was going to come on to address the contribution of the hon. Member for Caernarfon (Hywel Williams) as well
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as that which of the hon. Member for Forest of Dean (Mr. Harper) made from the Back Benches-it is confusing that he is now sitting on the Front Bench. Officials met colleagues from the devolved Administrations and territorial offices to discuss the content of the Green Paper before publication in July this year. Officials have been in regular contact since then with all devolved Administrations. We have been holding various meetings since the publication, and a further series of meetings is planned to ensure a co-ordinated approach and to take into account the very real and understandable concerns Members have raised.

Members have asked about the extent to which social care and health care services can be joined up. My right hon. Friend the Member for Croydon, North made a particular point about that in relation to housing. This is not just warm words in a paper; it is practical action that we know can happen, whether through joint strategic needs assessments or joint commissioning processes. We also have some structural changes. There are eight care trusts, for example. Each of these models is being tried. Some are better than others. There is not a one-size-fits-all attitude. Indeed, we now have a range of integrated care pilots. I am unsure whether my right hon. Friend has come across them, but they were launched recently. The clue to what they are about is in the title; they offer integrated care. Issues being looked at in 16 localities include integrated care for people with dementia and the elderly, end-of-life care and care for people with long-term conditions, fluctuating conditions or mental health conditions. So we are taking practical steps to find out, through practice-through making it happen-how we can do this better.

Providing more information and advice is another key feature of the approach; it could be said to be an entitlement that people should expect from a national care service. People and their families should know what care, support and choices are available and how they can properly access them. We need to be able to reach out into the community to those who might not be accessing services under the current system.

Mr. Burstow: The Minister is discussing access to advice, but does he think that there also needs to be a similar entitlement to advocacy?

Phil Hope: Yes, this country has some excellent examples of support for advocacy, particularly among the user-led organisations; there are many varieties of this. We are funding the development of a range of user-led organisations up and down the country, and I have met such organisations. The one that I can remember most vividly is the Essex Coalition of Disabled People: not only are its people advocates, but they manage the direct payments system for many disabled people in Essex who use it-those disabled people find that things work very well. That coalition is run by disabled people for disabled people, and it provides a successful advocacy system too. Advocacy would need to be a part of any future national care service.

The idea of personalised care and support is crucial. The word "personalisation" runs through the whole of the Green Paper. It is about giving people choice over the care that they receive; giving people control over their care and when and how they receive it; and genuinely enabling people to live the independent lives that they
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want to lead. This personalisation should apply not only to care provided in people's own homes, but to residential care. The point has been made, not least by the hon. Member for Sutton and Cheam, that we need to ensure that in residential care settings people are given personalised care. I can remember visiting one residential care home where two residents in their 80s had got married. They were living ordinary lives and doing things that other people do, such as having relationships. That is the right way forward.

The key theme that every Member's contribution has touched on is fair funding. We know that all the options will have their advantages and disadvantages-in fact, we spell them out in the Green Paper to encourage the widest debate possible, as people understand how we could have funding that is sustainable for the longer term. A number of hon. Members, not all of whom are still in the Chamber, have reflected on the value of general taxation as a route for funding a national care service. May I emphasise that a lot of care is funded through general taxation right now? That is what is being delivered at the moment. We know that more resources are being put in from general taxation to fund the care system, of which the free personal care announced by the Prime Minister is the latest example.

I have a key question to ask hon. Members, including my hon. Friends the Members for Blaydon and for Luton, North (Kelvin Hopkins), who commented on this: given the demographic change that will take place-there are four people of working age to every pensioner now, but that will become two in the future-would it be fair between the generations to place all the burden of paying for older people's care on people of working age? The system would have to be not only fair between the generations-I have met many people who feel it would not be-but sustainable. Can it actually work in practice, or would the level of the tax burden on the working age population be so high as to be unacceptable?

Mr. David Anderson: The Minister has obviously made the assumption that the only way to pay for this is out of income tax. However, people carry on paying tax long after they have retired; everybody pays VAT every day of the week. I made the point in my contribution that one possible approach would be to have a 0.5 per cent. rise in VAT, which would put £2.5 billion directly into the care budget.

Phil Hope: All I can say to my hon. Friend is that we are listening hard to what everybody has to say about the way forward. I have tried to explain why the models that we have proposed are sustainable in the longer term-over decades of an ageing society-but we welcome any thoughts that people have and any contributions that they wish to make.

I wish to try to address some of the misconceptions that are inevitable when a debate of this kind is generated. First, I wish to say that this is a Green Paper for all adults; although the media may have portrayed it as a social care Green Paper that is just for older people, it is not-it is for adults with disabilities too. We are keen to ensure that we have a national care service that rightly provides the choice, control and independent lives that adults with disabilities rightly expect. I hope to hear more about that from their organisations in the future.

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