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5.32 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am sure the House is grateful to the Secretary of State for taking so many interventions with a view to our understanding not only the purpose of the Bill, but how it is intended to work. Although it is a short Bill, considerable complications arise from it.
The debate on the principles of the Bill takes place in the context of the Government's Green Paper and the reform of social care and support. There are two topics that hon. Members across the House would not want to leave out of account in considering how we should reform care and support for the future. First, we must continuously look beyond organisation and funding issues to understand the quality of the service being provided to people at home or in residential care homes. The Care Quality Commission report a fortnight ago on social care made it clear that a considerable proportion-about one in four-of care providers are not yet meeting the good or excellent standards that we would expect for ourselves or our relatives.
The Minister of State, Department of Health (Phil Hope): Four hundred were poor.
Mr. Lansley: But many were only adequate, as the Minister with responsibility for care services knows very well. That is not a party political point. We need to ensure that quality is as good as any of us would expect for ourselves or our relatives.
The second thing that we need to do is well understood but not always achieved: we must be sure that we have the social care work force available to make that happen. That is affected by the esteem in which social workers are held, and by factors in the social care sector. It is not a well-paid sector, and it is rarely at the forefront of the public's mind when it comes to understanding what provides value in the community. However, it does provide important services on which we depend greatly. The presence of that work force is important, and it is important that we support it. I say that because in these debates we tend to focus on funding and organisation, but we must always look beyond that.
The Secretary of State, in his introduction to the Bill, said something that I echo: for 12 and a half years, which just happens to be the length of time that the Labour Government have been in office, the Government have failed to bring to care, support and long-term care funding the long-term structural reform that they repeatedly promised. It was in 1997 that, for example, Mr. Tony Blair said that he did not want to live in a country where older people had to sell their homes to pay for care. Some 13 years later, that is still precisely the situation.
Just after the 1997 general election, the Labour Government established the royal commission on long-term care, which reported in 1999. The Secretary of State said that this Bill was the direct response to that, but
perhaps I have missed something, because my recollection was that a Labour Government had rejected the central recommendations of that royal commission.
Mr. Lansley: I shall certainly give way to the hon. Gentleman. I do not recall him, when he was the Minister with responsibility for these matters, approving of what the royal commission said, but perhaps he will tell us otherwise.
Dr. Ladyman: I shall deal with that point if I manage to catch Mr. Deputy Speaker's eye later. First, I want to deal with the issue, constantly replayed by the Conservative party, that people have to sell their homes when they receive care. They have to do so because Conservative councils consistently fail to tell people that the money was given to those authorities to put a charge on people's properties so that they could be sold, if necessary, after their death. If Conservative councils actually told them about that, many more people would keep their homes.
Mr. Lansley: The hon. Gentleman seems to be squirming because of the simple fact that Labour made a promise almost 13 years ago which has not been kept, and 45,000 people a year end up selling their homes to pay for their care. Many of them are already in long-term residential care. The issue is not whether their property is sold at the time that they enter care, while they are in care or, even, after they have died; for them, the issue is that they wanted everything that they had worked for, saved for and accumulated in assets throughout their whole lifetime not only to provide them with financial security, but to be a heritable asset for their families, and that simply has not happened.
Dr. Ladyman: Will the hon. Gentleman give way?
Mr. Lansley: I have not really begun yet, but I shall of course give way in a minute.
I find the situation very strange, because over the past decade Scotland has increasingly demonstrated that a policy of free personal care is unaffordable. Indeed, colleagues from other countries in the United Kingdom are present, and owing to the circumstances in which the policy was applied in Scotland, it has cost a great deal more than the authorities intended and they have had to cash-limit it, introducing therefore just the kind of unfairness in terms of access against which the Secretary of State now rails. Furthermore, the policy does not meet the accommodation costs of those in long-term residential care, so those costs have also escalated. The policy has not made people feel the intended sense of financial security.
Those are all the reasons why a Labour Government said for many years that free personal care, as Scotland has offered it, is simply unaffordable in England and cannot be supported. I do not dispute that we supported that conclusion, because I made the same point myself. Indeed, a Government Green Paper published as recently as July said that to pay for the costs of care out of general taxation would impose an unreasonable burden on those of working age; that it would have a major, further distributional impact between generations and
on those who continue to work; and that the Government therefore ruled it out. In July, as far as we were concerned, the Labour party was continuing to rule out free personal care, but in September the Prime Minister got up at the Labour party conference and said that he wanted to offer free personal care paid for out of general taxation.
There is no sense in which the Bill constitutes a bridge between the current position and the options in the Green Paper with which the Government are proceeding. They are talking about three options: the partnership model with universal care and a third of it paid for up front, a comprehensive insurance model, or an involuntary insurance model. Under none of the three models in the Green Paper would those with substantial or critical care needs have all their needs met out of general taxation.
Andy Burnham: The hon. Gentleman is not making a fair point. In any scenario under the reform options in the Green Paper, people with the greatest needs would receive more help than they receive today. I am not saying at this Dispatch Box that this Bill is the perfect reform, but I am saying that it will get more help now to the people who would be most helped under any more fundamental reform of the system. The point that he is missing is that those people have already had to dip into their own pockets to a significant degree to fund the costs of the care they are receiving. Our argument is that we should make it fairer for them now.
As regards Scotland, this is not the same proposal-it is about targeting help on people with the most critical needs, not paying for free personal care across the board, as is made available in Scotland.
Mr. Lansley: This is interesting. I understand the Secretary of State's point, but this is not an interim proposal towards long-term reform. It is perfectly okay for the Government to say, "This is something that we would like to do on its own terms. We think it is justified." I will go on to examine whether it is the appropriate priority for the resources to be used within the care and support context. However, it clearly cannot be construed as a bridge to any of the other proposals. Otherwise, the structure of support that would be offered would be intended not to provide free personal care but to provide for people with substantial or critical care needs some of their care for some period of time-or a proportion of it, such as a third or a quarter-free, universal and up front. That would be the logical corollary of the options set out in the Green Paper.
The proposal does not seem to bear any examination as a substantial measure of long-term reform. It prompts a question that the Secretary of State and I argued about last week. Surely it would be better for the Government to be clear about what they think the structure of long-term reform of care should look like, and for us to do the same, before the point at which this House is asked to spend a considerable sum of money, and to put in place legislation in a very particular form, without our having even seen what the Government's longer-term legislative intentions are and our having had the chance to set ours out in the same way.
Andy Burnham:
Is the shadow Health Secretary comfortable with the fact that for people with the most critical care needs, their care is a lottery, with some
receiving all their care paid for, and some part funded? Is he saying that it is not worth making this change so that at least the most vulnerable people get care according to their needs, not their postcode?
Mr. Lansley: The Secretary of State is asking me to anticipate the rest of my argument. We have made it clear that we see a case for enabling people to have greater certainty. That is why at our party conference my colleagues and I proposed- [ Interruption. ] Every time we ask the Secretary of State to answer a question yes or no, he always gives us a long answer, which is never yes or no. I do not see why I should be any different.
We want to give people the opportunity to create greater certainty and to meet their costs. The question is what is the best way of doing it. In their Green Paper, the Government put forward options that include using disability benefits, forcing people to take insurance, or giving people the opportunity to take out insurance. We, for our part, made it clear at our party conference that we wanted to develop the opportunity for people to take out insurance but did not think it right to do that for every care need.
As I have said before, there is a good argument for offering people the opportunity to take out what we regard as affordable insurance not only for long-term residential care costs that place their home at risk, but for critical care needs, because the costs of care for those who are means-tested tend to accumulate and can deprive them of their assets. The Secretary of State must know that those are people who have significant cash assets and whose home is not at risk at the point in question. There may be a realistic and affordable opportunity to allow them, too, to offset their risks through insurance and have the certainty for which they are looking.
Dr. Ladyman: Will the hon. Gentleman concede that given that the average cost of care home fees is about £26,000 a year and that most people who go into care homes spend a little over two years there, his proposals for insuring against care home fees would effectively mean that for every one person who benefited, at least another seven would have invested in an insurance policy and got no benefit? The policy will require him to set the cost of care homes, set the quality and standards of them even more rigorously, and set eligibility criteria for those who go into care homes.
Mr. Lansley:
As the hon. Gentleman has asked me that, I shall turn to something that I was going to say later. I agree with his last point: of course the policy will require there to be an objective assessment of need to enter long-term residential care, otherwise insurance providers would run the risk of people choosing to go into residential care when they did not require it. However, I do not agree with his interpretation of the numbers. I have set out clearly that we are operating on the basis of people paying about £8,000 at age 65. There is then a considerable period before the average point at which people enter care, which will allow that fund to accumulate. As he says, about £25,000 or £26,000 is the current figure per year, for just over two years on average, which means that there will be a cost of about £50,000 a person for the one in five who enter long-term care-£10,000 per person insured-to be funded by the approximately
£8,000 that they originally paid in, which will have accumulated more over a period of time. I am grateful to the hon. Gentleman for allowing me to make it clear that the numbers are straightforward.
Norman Lamb: Will the hon. Gentleman give way?
Mr. Lansley: I will, and then I had better get on with the Bill itself.
Norman Lamb: Will the hon. Gentleman concede that, just as the criticism of the Bill is that it is a partial solution with the potential for perverse effects, exactly the same criticism can be applied to his proposal? It could end up affecting behaviour and pushing people in a direction that might not be the most rational for them as individuals.
Mr. Lansley: I understand that it is important for us not to have a perverse incentive that means that people who should be in long-term residential care are not, and that they are instead being looked after at home in ways that are not necessarily in their best interests. There are clearly worries about that. Many families and individuals make the decision for their older relative, partner or spouse to be in long-term residential care most reluctantly and when it is in their best interests to be there. We should not create an ideological fixation on people not being in long-term residential care. We should operate on the basis of what is in the best interests of older people themselves.
Equally, I agree with the hon. Gentleman that we should not seek to create a perverse incentive for people to be in long-term residential care because there is not adequate support in the domiciliary context. That is why, as I have just said, we should consider the opportunity of extending the voluntary insurance concept to critical care needs in domiciliary care. In the circumstances that we have described, with an affordable insurance market to meet the costs of long-term residential care, insurance providers will have an incentive to help people stay at home rather than go into long-term residential care, so we can begin to create the broader insurance system that I understood underlay one of the Government's options in the Green Paper. To that extent, although we clearly have problems with the Government's Green Paper, we have not said that we are not prepared to use it as a basis on which we can develop our own proposals. We have already done so, and we helpfully added to the proposals at our party conference, as I described.
The Bill is very short. It contains only one substantive clause, containing a number of amendments of previous community care legislation. As I shall explain, I fear that it has significant flaws and that there are significant unanswered questions. Of course, it is undercosted and as yet unfunded. Essentially, the local government component is simply to say to local authorities, "Here is this additional statutory obligation. By the way, you'll find the money for it won't you?" Local government has been through such a process many times before. The Government seem to be engaging in double counting. On Wednesday of last week, they were telling local authorities to achieve those efficiency savings and scoring them as part of the reduction of the deficit; this week they are presenting legislation that scores the same efficiency savings but then tells local authorities they have to spend them. They cannot have both.
We need clarity on the future of social care. The Secretary of State keeps asking whether our intention is to reform social care after the election, but why is he so fussed about that if he is confident of being in office then? He clearly is not. There is something deeply ironic in saying, after 13 years of a Labour Government who have not achieved the reform of social care, "It's about time a Conservative Government who are committed to the reform of social care came in."
We have had 13 years in which hundreds of thousands of older people have had to sell their homes to pay for care, contrary to Labour's promises; 13 years of rising costs and, as the Office for National Statistics has demonstrated, falling productivity in social care; and 13 years of decreasing council-arranged care, when the proportion of people with moderate and lower care needs has been falling. Now, months before a general election, having said for 13 years that providing people with free personal care was unaffordable and unattainable, the Labour Government say it is their priority; and now, lo and behold, they suddenly say that they can find the money, starting in October 2010. It all fits into the same pattern that we heard so much of from the Chancellor in his pre-Budget report-make the Government virtuous, oh Lord, but not yet.
Mr. Hayes: My hon. Friend, with typical, measured and moderate understatement-the sort of understatement that he personifies-is making the charge against the Government that the Bill is political. I would go further, and I hope he might join me: is this not about vulnerable people staying in their home, but about one vulnerable person staying in his home-namely, the Prime Minister in Downing street?
Mr. Lansley: My hon. Friend makes a very good point. At the time of the Queen's Speech, the Prime Minister described the Bill as one of his flagship pieces of legislation; in truth, it is more like a life raft or an attempt to keep the Labour Government afloat.
Greg Mulholland (Leeds, North-West) (LD): Does the shadow Secretary of State agree that if there is a March election, as is rumoured, the Bill will hardly be on the statute books, never mind implemented? What is the point of talking about this Bill now, when as he knows, we need a real reform?
Mr. Lansley: It is not for me to speculate on election timings.
Mr. Lansley: The Minister tempts me, but I will not do so. The hon. Member for Leeds, North-West (Greg Mulholland) asks about a March election. For that to happen, it must be called at the end of February, but the consultation on the regulations on this legislation will conclude only on about 23 February. Clearly, the Bill is more about propaganda for a general election than the delivery of social care reform after it.
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