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"The equipment...people are using is...the best that they've ever had".
This is a significant moment for the House, as it means that the long overdue reform of the funding of personal and social care in England is at last under way. Before we go any further, it is important to focus our minds on the people whom the Bill is intended to help. It will provide support to more than 400,000 of the most vulnerable people in our constituencies, including people with advanced conditions such as Parkinson's, dementia, Alzheimer's and motor neurone disease. They are people with the greatest needs, who require intimate personal care in all aspects of their daily lives. In many cases, they will already have paid significant sums out of their own pocket towards the costs of their care as their condition has deteriorated. Their families and carers will have faced considerable pressure in recent times as they have battled to get the help that they need, or sought to balance the demands of their own lives with looking after a loved one. Therefore, today, we are rightly focusing on those with the greatest needs, and on making their lives and the lives of their families and carers a bit easier.
Mr. Tobias Ellwood (Bournemouth, East) (Con): I am grateful to the Secretary of State for giving way so early in his speech, but I must ask him why we are debating this Bill now, when we are in the middle of a consultation and waiting for clarification on what is going to happen with the National Care Service in England. Are we not jumping the gun a little by introducing just one part of a much grander scheme, which would be better debated as a whole?
Andy Burnham: The Green Paper has kicked off a long overdue debate about the funding of social care in England, but it is our judgment that we do not need to wait for the conclusions of the review before making the system fairer-
Bob Spink (Castle Point) (Ind): To make this excellent Bill work better, we need to ensure that we can fund adaptations to homes-such as adapting baths to showers and installing stair lifts-quickly. Will the Secretary of State meet me and representatives of the Royal British Legion and the Soldiers, Sailors, Airmen and Families Association to discuss the problems involved in getting this through, to ensure that the people who need those adaptations do not have to wait months and years for them, and that there is no discrimination between privately owned and publicly owned housing?
I am grateful for the hon. Gentleman's kind words about the Bill. The Minister of State, Department of Health, my hon. Friend the Member for
Corby (Phil Hope), would certainly be happy to have the meeting that he has requested. In a moment, I will talk specifically about help in the home and about spending on the adaptations and technology that might help people to live at home. Too often, there has been a divide over spending health resources in that way, and the Bill seeks to change that. I appreciate what the hon. Gentleman has said.
In addition to helping those who need care at home, the Bill will help those who are at a low point in their lives and at risk of needing long-term care-for example, people who have recently had a fall, an accident, a serious operation or a bereavement.
Norman Lamb (North Norfolk) (LD): The Secretary of State mentioned that the provisions would benefit 400,000 people. The risk assessment that comes with the Bill makes it clear, however, that if we take those already getting reablement provision out of the equation, only 100,000 extra people will benefit from free personal care through the Bill. Does he agree that that is the correct figure, rather than 400,000, because the vast majority are already receiving help through the means-tested system?
Andy Burnham: In a moment, I will break down the precise figures on those who will benefit from the Bill. On reablement, it is important to say that these provisions will fund an expansion of reablement services, and we estimate that an extra 130,000 people will be helped through the use of a more preventive approach to social care, and a more intensive period of support when they are at a low point in their lives. I will come to the figures that the hon. Gentleman has raised in a moment, and show him that the 400,000 figure is a real one.
The Bill will provide powers for people to receive intensive support to prevent them from developing more serious needs. It will help them to remain healthy and independent in their own homes, and to extend their quality years of life. In helping these two distinct groups, the Bill therefore has two clear purposes. The first is to end the lottery in home care for the most vulnerable people in our communities. Today, help for people at home with the highest needs varies according to their postcode. The second is to make the existing system fairer now and pave the way for a bigger reform of social care in the next Parliament. Focusing on reablement and building a stronger preventive element into the system will provide a bridge to the forward-looking National Care Service that we seek to create.
Dr. Stephen Ladyman (South Thanet) (Lab): The hon. Member for Bournemouth, East (Mr. Ellwood) was right to say that the Bill needs to fit into the grander plan, when it is eventually published. Is he not missing the point, however, that there are people struggling now, and that they cannot wait for the White Paper or for the Bill that will follow in the next stage after the general election? We have to do something to help those people now, and that is what the Bill is about.
My hon. Friend makes a very important point, and I pay tribute to him as a former care services Minister for the work he did to take forward social care, particularly the improvements we have seen in the personalisation of care services in recent years. He is
absolutely right that the story of social care reform is that this House has flinched or backed away when it has all got too difficult and has found a reason to put off the reform of the system. That is why today is so significant-we are at last facing up to the unfairnesses that exist today and we are focusing clearly on the people with the greatest needs, who in my view deserve a better deal than the one they currently receive.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I wonder whether the Secretary of State could explain to the House how he sees the Bill forming a bridge to a longer-term reform in the terms in which the options were presented in the Green Paper. The underlying proposition of the Bill is that free personal care should be provided to people at home. The Green Paper had an option of taxpayer-funded free personal care within it and the Government expressly ruled it out as being unfair in placing too great a burden on people of working age.
Andy Burnham: I repeat what I said a moment ago. The measure paves the way for a major reform of the system in two ways. First, it is fairer in terms of funding. The people we are talking about will in the vast majority of cases already have paid significant sums out of their own pockets as their condition has deteriorated. Any reform we are talking about in social care is about spreading that burden of the costs of care more fairly and not letting those who are dealt the hardest hand of cards in life and who face the greatest needs bear all the costs on their own. That was the principle that underpinned the creation of the national health service and we believe that the same principle should be valid here.
The second point I would draw the hon. Gentleman's attention to is the focus on reablement and prevention. It is very important that we find a better way of investing in people's good health-investing the resources we have on the health service side and in terms of council funding-to create a more forward-looking preventive system that is geared around promoting people's independence and good health and supporting them to stay at home. For those two clear reasons, I say to him that the Bill is a bridge towards the National Care Service that we wish to see.
Sixty-three years ago, this House voted to create the NHS to end the unfairness whereby people with the greatest needs faced the highest costs and the people who had the least were in danger of going without their needs being met at all. Today, the same unfairness exists in social care. If someone happens to develop dementia in old age, rather than cancer or heart disease, they are yet to find the "freedom from fear" that was the promise of the NHS. That was an enduring unfairness, which until now this House has failed to address. It becomes more and more evident as people live longer and we can no longer afford to ignore it.
Mr. Andrew Pelling (Croydon, Central) (Ind): In being able to cross that bridge, there is obviously always the tricky issue of financing. There is some disquiet in local government that it is local councils that will have to find the bulk of this funding. In my own local authority in Croydon, 5 per cent. efficiency savings were secured-even better than the Government's target for it-so how can we cross the bridge with respect to that particular financial issue?
Andy Burnham: The hon. Gentleman is right to mention funding because it raises real challenges both at the national level and for local authorities, but he is not right to say that councils will be asked to find the majority of the funding. I have re-prioritised my budgets within the Department of Health to find the majority of the funding necessary. We are clear, however, that efficiencies and the potential for efficiencies have been identified within social care in local government that will enable local authorities to make a contribution to the costs of this care. There is already evidence from around the country that a stronger focus on prevention and reablement can help to save local authority resources in the long term.
As I said, the first aim of the Bill is immediate action for 280,000 people with the highest care needs, including those with advanced dementia, Parkinson's and other conditions. It does that by lifting the restriction in the Community Care (Delayed Discharges etc.) Act 2003 on the period of time for which councils can be required to provide free personal care for people living at home.
We know that many people want to remain in their own homes if possible. A 2004 survey found that most people expressed a preference for staying in their own homes, 62 per cent. with care and support from family and friends and 56 per cent. with care and support from trained care workers. Only last month, in its "Findings" series, the Joseph Rowntree Foundation concluded:
"Older people most often move to a care home as a result of crisis, with no preparation and little or no planning. Most do not choose to be there."
Currently an estimated 80,000 older people in greatest need receive free personal care, but 40,000 pay part of their own costs and 50,000 pay all their costs. An estimated 90,000 younger adults receive free care, while 20,000 pay all or part of their own costs. The Bill will end that lottery, and remove the enormous and unfair financial burden on such people and their families.
Those figures answer the question asked by the hon. Member for North Norfolk (Norman Lamb) a moment ago. The Bill will provide free care for some people who are currently paying all or part of their costs, and it guarantees that all members of that category will receive it in the future. As the hon. Gentleman knows, under the current system a local authority could change the eligibility criteria and, at any point, bring some of the people who currently receive free care into the ambit of charges.
Norman Lamb: It is probably unlikely that a local authority would change the criteria to remove free care from those in the most critical need-given that we are discussing that category. Will the Secretary of State confirm that approximately 110,000 additional people, on top of those who currently receive free care-both younger and older adults-would benefit from the Bill, and that the 400,000 figure is not an accurate reflection of the number who would benefit?
Let me break down the figure for the hon. Gentleman. Currently, 170,000 people receive free care. It is important that he acknowledge that the Bill will safeguard their position in relation to charging in the future. A further 110,000 people are funding either all or part of their own care; the Bill will exempt them
from charges. A further 130,000 people will benefit from the extra investment in reablement. That will be a recurring benefit, depending on who needs reablement in any given year. The Bill represents a significant step forward for all members of that category.
Let me give the hon. Gentleman a real example: that of an 89-year-old woman from Lowton, in my constituency. She lives alone in a one-bedroom flat. She is no longer independently mobile, is unable to prepare meals or manage her own personal care, and has impaired hearing in both ears. Relatives want her to be supported at home for as long as possible. They say that she would be devastated if she had to go into a care home. She has four visits during the day and one later in the evening, with two staff attending all visits to ensure safe moving and handling. The cost of the care package is approximately £500 per week, or £26,000 per year. As a result of the Bill, her care will be free.
Mr. Lansley: I am still confused about what the Secretary of State considers to be the purpose of the Bill. He seemed to argue at the outset that it was to give free personal care to those in greatest need, but he must surely know that many of those in greatest need have made substantial financial contributions and then go into long-term residential care. He appears to be offering nothing to them. In what way are they any different from those who receive care at home?
Andy Burnham: Let me repeat that the Bill has two purposes: to make the existing system fairer now, in the recognition that we cannot solve all the problems in advance of a major reform, and to prepare the ground for a more fundamental reform of social care in England which would encompass everyone, in all care settings. As I said a moment ago, it is important to create a system that helps people to live independently. In our view, that is the right way to create and reconfigure the system. I am surprised that the shadow Health Secretary is seeking to pick holes by asking, "Why aren't you doing everything now?" Surely it is right to do something now to help people in the greatest need, whose families are facing the greatest pressure as they seek to attend to their care needs, rather than to nit-pick by saying, "If it isn't a complete reform, it's not worth having." Our argument is that it is worth having, but we are also committed to reforming social care in the next Parliament, and I wonder whether the Conservative party is prepared to make a similar commitment.
Mrs. Jacqui Lait (Beckenham) (Con): May we briefly pursue the costs issue? As I understand it, the Secretary of State is expecting local government to find £250 million a year from savings. What discussions has he had with other Departments that are also asking local government to make savings, and what will be the cumulative effect of his demand for £250 million along with those other Departments' demands? Also, how do they expect local government to find that money-or is that why a 4 per cent. increase in council tax is one of the measures in the pre-Budget report?
The hon. Lady raises a fair point. She rightly asks where the efficiencies will come from. My hon. Friend the Minister responsible for care services has been working with colleagues in local government on a use-of-resources guide, which clearly demonstrates
how further savings can be found within social care, particularly by funding prevention services and helping people stay independently in their home. I will come on to an example from the Isle of Wight, where a Conservative-controlled authority has successfully invested in prevention and reablement, and thereby saved considerable sums of money. I shall not do so now, but I could cite examples of Conservative authorities that are doing the opposite-they are cutting social care. The hon. Lady asks me to update the House on where the savings can come from, which is a fair question, but we have identified that.
Mr. Brooks Newmark (Braintree) (Con): I believe that when the right hon. Gentleman was a Health Minister he made the point that the vast number of people in all our constituencies who work very hard on a voluntary basis to support families and friends save the state enormous amounts of money, and I wonder whether his analysis puts a value on that. More importantly, what support is he proposing to give to these individuals who are spending enormous amounts of their time to help relatives?
Andy Burnham: I agree with the hon. Gentleman's point: informal carers save billions of pounds that otherwise would have to be met by state-provided support. The actual figure has been costed by Carers UK and others, and it is huge. [Interruption.] My hon. Friend the Minister says that the sum is £80 billion. Carers do not see their care in monetary terms, however; they would always look after their loved ones.
Let me explain to the hon. Gentleman what is squarely my intention in respect of carers in reforming the system and bringing forward the National Care Service. We will always have to depend on their love and support for their families, but we can do better in making their life more tolerable, such as by letting them call down the support when they need it, rather than when the system says that they should get it. It is a fundamental part of any reform of social care that we provide to the many informal carers in this country the kind of back-up and support that makes being a carer tolerable and that allows them to balance that with all the other demands on their life. For me, that is a crucial aspect of creating a higher quality care system.
Mr. Newmark: The Secretary of State's comments will be extremely helpful to my constituents in Braintree. Each and every week I meet one or two people who give a lot of their time, and who ask me, "Can the state do more to help me, not on a financial basis, but on an enabling basis?" If the Secretary of State could give me one or two examples of how his Government will do that, that would be helpful.
Andy Burnham: I can give a very specific example. The hon. Gentleman may know that last year we asked primary care trusts to fund respite care for carers and for breaks, and I believe it was the first year that that requirement was included in the operating framework. Some analysis has been done, not least by the Princess Royal Trust for Carers, on whether that has been fully implemented around the country. I have been considering whether we can strengthen the language relating to that commitment as part of this year's operating framework.
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