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Having said that, I understand the Government's position that people cannot receive money twice, so if they are having all their care needs met, they cannot also expect to have attendance allowance on top of it. What we could do, of course, is continue to give people attendance allowance, but top it up to the level needed to meet their care assessments. In that way, we could maintain attendance allowance and meet the full cost of people's personal care, which is the aim of the Bill.
Mrs. Lait: I just want to put to the hon. Gentleman the thought that the benefit of attendance allowance is that it can be spent on what would not necessarily be regarded as part of a care package, but would immeasurably contribute towards somebody's well-being. For instance, if a keen gardener became unable to continue gardening, they could pay for a gardener and enhance their own satisfaction at seeing the lawn cut, which might keep them psychologically on an even keel.
Dr. Ladyman: The hon. Lady is absolutely right. That is why I call attendance allowance the ultimate direct payment: it is cash to meet people's care needs however they want to meet them-and they could meet them through telecare; they could meet them through providing money for a carer; they could even use it to save up to provide respite care and pay it to a voluntary carer or a family member. As I say, it is theirs to do with as they like; for that reason, it is an incredibly powerful benefit.
I take slight issue with how the hon. Member for South Cambridgeshire put it. If the Government chose to pass the value of the attendance allowance to the local council to meet someone's care needs, other legislation that we have at the moment means that someone can simply ask their local council to have their care needs met by a direct payment, rather than with direct care. In other words, they would get the cash back by another means if they wanted to go through that route. My argument is: why go through that route? Why not just leave the attendance allowance in place, with all its benefits, and top it up to the level of free personal care? I hope that the Government will ultimately come to that conclusion.
In terms of how the money is to be provided to people to meet their care needs, I hope the norm will be that it should be provided in terms of a direct payment that they can spend how they want to meet their care needs the way that they want, which raises the question, of course, of how it will be assessed-whether it will be assessed by the normal processes councils go through at the moment when costing someone's care plan, or whether it will be some sort of flat-rate payment. Although a flat-rate payment might be simple, I would certainly not want to choose that particular route.
The Government could have met their objectives in several ways, I guess. They could have had a much more complex Bill, which would clearly not have been passed before the general election, so it would not have given people in the most urgent categories of need the care that they need in the time scale that we are talking about. They could have done it as they have done by essentially putting the onus on local authorities to decide the care package. There was a third choice, which I do not know whether the Minister considered. That was to alter the criteria for NHS continuing care-bringing those criteria down to include the category of people with the most serious needs, so that the funds would effectively have come through the national health service.
The Minister has chosen the route that he has chosen for good or ill, but I would like to suggest one way of achieving flexibility in the arrangements and perhaps even a better outcome for people. At the moment, local councils and local national health services can voluntarily choose to set up a care trust to manage the care of older people, in which case both parties put money together, which can be spent as the care trust decides. That gets over the problem that there are certain legal limitations on what the NHS can spend money on. Equally, there are certain legal limitations on what local councils can spend money on, but those limitations do not exist for a care trust. If everyone has put the money in together, it can be spent in the best way possible for the people concerned.
At the moment, that is a voluntary arrangement for older people; it is not a voluntary arrangement for children, as we have reached a position where we insist on children's trusts being created to manage the funds from all the various agencies on behalf of children. I have never quite understood why we have not gone the next step and insisted on the creation of care trusts throughout England, which would also help to leverage in some extra money, I suspect, from the national health service, as well as from local government. It would give us considerable benefits in implementing this type of care plan.
Christopher Fraser (South-West Norfolk) (Con): Does the hon. Gentleman accept that some councils would be better placed than others to find the money through their own provisions, so there is a possibility that these measures as presented by the Government could lead to a postcode lottery?
Dr. Ladyman: I certainly think that there is a risk. One of the risks could be reduced, depending on how the Government decide to distribute the money that is going to be made available. I think that it was the hon. Member for Beckenham (Mrs. Lait) who asked whether the money was going to be distributed through the normal local government formula or on the basis of need. If the Government were to choose the number of older people in a particular local authority area as a good proxy for the level of need in that area and distribute the money on that basis, I suspect that they might find that there were far fewer problems. That having been said, we all know that eligibility criteria are different in different local authority areas and charging regimes are different in different local authority areas.
The only local government funding that is not ring-fenced is funding for adult social services. That used to apply to all forms of social services funding, but the Children Act 2004 effectively took the children's money away and put it into a ring-fenced fund. A local authority can only make up its own mind how much of its money to spend when that money is for adult social care, which is why many authorities choose to spend it in different ways.
Let me give a particularly bad example. When my local authority, Kent county council, decided that it needed to find several hundred thousand pounds to fund its own propaganda television channel, it increased charges for older people's care. It can raid the fund and get away with it because it is a Conservative council, and because the fund is not ring-fenced. Perhaps we should consider reforming that arrangement as part of our overall reform of adult social care.
Having said all that, I should add that the Government have made it clear that the Bill represents only a first step towards the reform that we all seek-the first small part of the journey towards the creation of a National Care Service. Many questions remain to be answered, and we need to understand much more about the way in which the Bill will work once it has been implemented. However, to the extent that it delivers some urgent care for a desperately unhappy group of our constituents at this moment, and allows them to gain some relief while we deal with all these tortuous processes-
Mr. Ellwood: Will the hon. Gentleman give way?
Dr. Ladyman: I am about to end my speech, but I will give way briefly.
Mr. Ellwood: I am grateful to the hon. Gentleman for giving way just as he is beginning his final crescendo. He says that the Bill is a "first step", thus suggesting that there are other steps to follow. Given the approaching election, and given that the first step was, in fact, taken back in 1997, when does he expect the next step to be presented to the Chamber?
Dr. Ladyman: The hon. Gentleman is trying to trivialise a serious issue. He may wish to visit the House of Commons Library and conduct some research on the steps that the Government have already taken in reforming social care. In particular, I suggest that he read a seminal document on the subject: "Independence, Well-being and Choice", a Green Paper on the reform of adult social care. Modesty forbids me to tell the House which Minister was responsible for it, but it sets out exactly the action that we need to take in order to reform what the hon. Member for South Cambridgeshire identified as the key issue: the quality and level of provision of social care. How are we to make the whole process more affordable? It started with that Green Paper. The process that the Government have gone through, the consultation, the Green Paper and the "Big Care Debate", allow us to create a structure- [Interruption]-in which perhaps- [Interruption.]
Madam Deputy Speaker (Sylvia Heal): Order. The hon. Member for Bournemouth, East (Mr. Ellwood) must bear in mind the rules governing debate in the House.
Dr. Ladyman: That process allows us perhaps to create a framework within which we can proceed to at least a partial consensus. Whatever we decide to do will have to last through Government after Government. Even if we assume that at some time in the far distant future the Conservative party will win a general election, the consensus will have to survive.
The Government initiated that first stage. I expect further reform to be highlighted in the White Paper that I hope we will see in the new year. I want to see a Labour Government make reform of the funding of social care and implementation of the White Paper their highest priority immediately after we win the general election in the next few months.
6.54 pm
Norman Lamb (North Norfolk) (LD):
I am pleased to follow the hon. Member for South Thanet (Dr. Ladyman). What he said towards the end of his
speech was absolutely right: the reform has to last. What worries many of us, however, is that the Bill may not be moving us in the right direction.
The hon. Gentleman raised a number of legitimate and serious concerns about aspects of the Bill, and made a number of other good points. I agree with him about the value of care trusts and bringing together health and social care organisations. There have been some exciting developments, particularly in places such as Torbay where the integration of services appears to be improving as a result of the pooling of resources.
It is good that, at long last, we are discussing this most urgent of priorities. The Secretary of State made the fair point that much had happened over the past 12 or 13 years, and it is true that in some respects the position has improved. The right actions have been taken in respect of the personalisation agenda, for instance. Useful ideas have been developed through a partnership between central Government and local authorities.
Kelvin Hopkins: The hon. Gentleman has referred to significant developments over the past 12 or 13 years. Does he agree that the most significant of all was the report of the royal commission on long-term care, which has been universally ignored?
Norman Lamb: I was about to add that although some good things have happened, since the commission reported there has been inertia, and deterioration and decay of the system have affected many people. If we are honest, we will admit that we all know that many elderly people are not receiving sufficient care or-as the hon. Member for South Cambridgeshire (Mr. Lansley) pointed out-care of sufficient quality.
Over the past 12 or 13 years, we have seen an escalation in fees and charges and a tightening of the criteria. Far fewer people now access care from local authorities. All that is evidence of a deterioration of the system and a growing crisis for many vulnerable people. That is why our priority is to address the problem in a way that will last: to produce reform that is supported by a consensus, and is sustainable.
The reason why the Liberal Democrats have moved away from the position of the royal commission-we will be quite up-front about this-is connected with that question of sustainability, which was mentioned by the hon. Member for South Thanet. Given demographic change and the ageing population, the cost of genuinely free personal care for all would be enormous. We should also bear in mind the care needs of not just elderly people but younger adults. More people with substantial care needs are surviving, and the total cost of that is huge. Our conclusion is that there should be a partnership between state and individuals, rather than the state's bearing the whole burden.
Kelvin Hopkins: The members of the royal commission subsequently made estimates of cost which were, at the time, the equivalent of 1 per cent. above the standard rate now, and 1.5 per cent. above the standard rate by 2050. The cost may even be double that. I have asked many people whether they would prefer the fear of not being cared for in their old age or a significant increase in tax to ensure that everyone is cared for, which is the basis of the national health service.
Norman Lamb: I respect the hon. Gentleman's position. The increase would be significantly more than that at first. There is a perverse effect that one ought to consider. At a time when public finances are very tight-this is something that the Wanless commission specifically identified-a significant amount of public money is being given to some very wealthy people who could choose to fund at least part of their care themselves. I have severe doubts about whether we would be using public money to the best advantage by giving substantial sums to the very wealthy, which would be the effect of the policy that the hon. Gentleman advocates.
We will not divide the House on the Bill; we will support it at this stage to facilitate debate. We will vote with the Conservatives on the programme motion, because it is important that the Bill is fully debated and that there are no time constraints. I shall deal with the origins of the Bill first, and then its impact and where we go from here.
The Conservative spokesman, the hon. Member for South Cambridgeshire, made the point that the Bill came out of the blue in the Prime Minister's speech to the Labour party conference. It is stretching language to the extreme to describe it as a bridge to a comprehensive reform of the care system. If it genuinely were a bridge, the Green Paper, which took many months to produce, would have referred to a first bridge to a new system, yet it was entirely silent on this unexpected proposal. The Green Paper was long overdue, but it was deliberative and consultative-it went through the process of consulting all interested parties-and, ultimately, it was quite well received across the health spectrum, and particularly by groups representing those with greatest need. Then the Bill came completely out of the blue.
In politics, the most devastating criticism tends to come from people on one's own side, and that is especially so when they have expertise in the subject under discussion. That is true of the comments of Lord Warner and Lord Lipsey on this Bill. Lord Warner said of the proposals:
"There has been no proper impact assessment, and no data to show how this would work."
Lord Lipsey was, of course, a member of the royal commission to which the Secretary of State referred. He said:
"I think it is a bad policy but also a very bad way to do policy just to find a nice highlight for your Labour Party conference speech."
That is pretty devastating criticism. He also said that it was "a bit of gimmick", and that he hopes that the Prime Minister
"will reflect on whether this proposal is in the national interest or merely designed to achieve party political interests."
Dr. Ladyman: I cannot stop myself pointing out to the hon. Gentleman that Lord Lipsey was the member of the royal commission who wrote the dissenting report that the Government adopted, and that from the date it was produced until now the Liberal Democrats have been telling us that he did not know what he was talking about.
Norman Lamb:
Lord Lipsey is a Labour peer who was chosen to sit on that commission and who until now has taken a position that is entirely consistent with the Labour Government's. The Labour Government have now chosen to move away from his position.
[Interruption.] As my hon. Friend the Member for Leeds, North-West (Greg Mulholland) says, that makes this measure even more devastating.
Kelvin Hopkins: Was Lord Lipsey not put on that royal commission at a late stage by Downing street, in order to create a minority report and thereby to prevent the commission's findings from being unanimous, and that he is now worrying that the Government will backslide on his minority report?
Norman Lamb: I have no idea, but I would not be surprised, given the way this Government operate. One is left with the sense that this is an utterly cynical move by the Government.
Not only people such as Lord Warner and Lord Lipsey have criticised the Bill. Niall Dickson, the highly respected chief executive of the King's Fund, who is leaving that organisation after several years of service, has said that these latest proposals
"have been hastily put together and appear to cut across the options set out in the government's own Green Paper."
He did not see them as a bridge to the future, either, adding that:
"After all, the government has only just finished consulting us on the very different proposals set out in that document."
He went on to talk about the "danger of perverse incentives", which is another point that the hon. Member for South Thanet rightly raised.
Mr. Stephen O'Brien: Does the hon. Gentleman agree that the economic modelling that lay behind the Green Paper might not have been made available, in part because it had to be re-scrambled and meshed with the unbridgeable announcement made at the Labour party conference?
Norman Lamb: The hon. Gentleman makes a very good point, and I suspect that his assumption may well be correct. Ultimately, this is law-making of the worst possible kind; it is from the "back of the fag packet" school of legislating. It is all about electioneering, but it is not about serious reform, which is what we all ought to be engaged in.
Christopher Fraser: Does the hon. Gentleman agree that the delivery of these health care services in rural constituencies such as ours, where the dynamics are quite different from those of inner-city areas, has not been addressed at all in this Bill?
Norman Lamb: That has neither been addressed in the Bill, nor been addressed for a very long time. The costs of delivering care in rural areas are often much higher and, to mention just one difficulty, it is often very difficult to recruit care workers, so the hon. Gentleman makes an important point.
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