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This whole process raises some serious questions about who is ultimately responsible for the proposal. Given that there was nothing about it in the Green Paper, did it emanate from the Department of Health or from No. 10 Downing street? How long had the team at the Department of Health been working on the proposal prior to that conference speech? Does the Minister wish to intervene, because I would be very
interested to learn when that information was made known to the team working on the Green Paper? When were they informed?
I turn to the impact of the proposal. I completely support the Bill's measures on reablement. It makes absolute sense for much more to be done to prevent ill health in the first place, and to ensure that resources are put into maintaining people better in their own homes, but are the measures consistent with the Green Paper objectives? The Green Paper stresses the need to make the
"best use of public money to provide a joined-up, consistent and fair care and support system".
I strongly endorse that objective. It goes on to say:
"We can use the taxpayers' money that is already in the system to provide everyone"-
"with some care. We believe that that should be the starting point".
That is interesting, because that appears to be a very different starting point as a bridge to a reformed system. The Green Paper goes on to say that
"any system must be a partnership between the state and individuals".
The Green Paper also rules out funding the new system from taxation as too heavy a burden on people of working age. I appreciate that the intention is not to provide care for all, but for the Bill to go in that direction appears to be completely contrary to the intentions of the Green Paper. Therefore, the Bill fails on all these tests: it is not joined up; it is not consistent with the Green Paper; it helps one group, but not all; it is not a partnership approach; and it is funded by general taxation, contrary to the intentions of the Green Paper.
Greg Mulholland: The hon. Member for South Thanet described the people who would be helped as a very small subsection of the population. That is a useful phrase, as it is not consistent with how the Bill is being presented.
Norman Lamb: The hon. Member for South Thanet hit the nail on the head, because the number of people who will benefit is much lower than the headline number of 400,000 of which the Government have sought to convince the public.
I want to deal with the potential perverse effects of the Bill. It is a partial solution, and the risk of implementing a partial solution was highlighted by Niall Dickson. Andrew Harrop of Age Concern and Help the Aged also specifically highlighted the risk that the Bill will push councils into getting people into care homes, thereby avoiding the cost of caring for people at home. According to Andrew Harrop, there is the alternative risk that councils will argue that someone's need is not critical-that as a way of avoiding responsibility they will find that people fall below the level.
There is also a risk that the Bill will take money away from some vulnerable groups in order to give it to a particular group of vulnerable people and that we will end up with a costly and demeaning process of disputes about whether someone's care needs are "critical". We are likely to see a bureaucratic and time-consuming process of social workers carrying out assessments to determine whether someone's needs are "substantial" or "critical".
Kelvin Hopkins: Could all this not be overcome by providing long-term care, either at home or in care homes, free of charge-just like the national health service? All the cost and the problem would thus disappear. We are talking about money and not about care at the moment.
Norman Lamb: The hon. Gentleman is right in one sense, because he is advocating a comprehensive system that applies to everybody; when we start applying a process to one group of people, we create perverse effects and bureaucracy in determining whether somebody falls into or outside a category. He rightly identifies the need for a comprehensive solution.
The hon. Member for South Thanet also accurately identified the risk of a disincentive for people to take out insurance. It is almost inevitable that insurance will be part of the overall solution that we seek to achieve-if we can build a consensus. The Bill inevitably amounts to a disincentive for people to take out insurance to protect against potential need. Who benefits from the measure? Remarkably, paragraph 5.21 of the impact assessment identifies the group that will benefit most as the "wealthiest older people". It is bizarre in the extreme and it is extraordinary that the Government have chosen a partial solution-rather than a comprehensive one-that, according to their own impact assessment, benefits most the wealthiest older people.
There is also uncertainty about the cost and the number of people who will benefit. The impact assessment is riddled with uncertainty about the cost, and the Local Government Association has highlighted the point. First, the impact of take-up by people who are funding their own care is unknown; we do not know how many of the people who are currently funding their own care would come into the system. All we have is an estimate-that is all it can be. The Government say that they are confident that the figures are accurate, but they have no basis for that confidence. The impact of behaviour change with regard to residential care is unknown. The Conservative spokesman highlighted that the figures in the impact assessment are inconsistent with each other on that point. We do not know how many people will move from residential care to being cared for at home to take advantage of the offer of free care.
The data on the number of those who are classified as "critical" and the relative distribution of their needs and disabilities are not collected centrally, so again we have no idea how many people we are talking about. We also do not know how many people are already receiving reablement. We do not know the proportion of those who after receiving reablement would not require care. Thus, the central assumption on cost and numbers in the impact assessment is uncertain. If the Government are wrong in their assessment of the total cost, what would be the consequences? We know from the consultation paper on the regulations that there is a fixed total sum available, so who would lose out if the figures were wrong? Will the criteria be tightened even more-beyond the calculation of "critical" need? Something has to give and the Government have not said what that would be.
The LGA also raises serious concern about the potential for local government to fund its £250 million a year contribution. It is already making substantial efficiency savings, regardless of the £250 million that would be
required. We know that over the past decade social care has been the poor relation of the health service in funding increases. At each spending round the health service receives a substantially greater real-terms increase than social care, and now the Government expect social care to come up with £250 million of efficiency savings to contribute to the cost of this measure. We have no way of knowing whether the system is capable of delivering that sort of sum. There is a real risk that it will amount to robbing Peter to pay Paul, taking care away from one vulnerable person to provide it to another whose financial resources may mean that they are actually better able to pay. The Secretary of State has today conceded that the total number of people who will benefit is 110,000-not the 400,000 that has been talked about. As the hon. Member for South Thanet said, the Bill benefits a very small subset of people.
On specific issues relating to the Bill, I would be grateful if in winding up the Minister would deal with concerns that some groups have about the meaning of "critical". Will meeting just one of the critical areas, as defined, be enough to allow someone to qualify? What is the meaning of the "significant help" needed for the four daily activities? There is surely a need for greater clarity on that. Sense, the organisation representing deafblind people, refers to the fact that personal care, as defined in the Bill,
"excludes the type of communicator guide support which is so vital to deafblind people."
That group is one of the most at risk of having to go into residential care, but it is excluded from help-surely that cannot be justified.
Where do we go from here? There are serious concerns about the perverse impact that this unsatisfactory measure could have. The most pressing priority is to put in place a comprehensive, sustainable system-one that will last, as has been said-that will guarantee care for those who need it most, funded in a way that is fair and recognising the reality of the public finances. There is an urgent need to build consensus. Any Government coming to power next year, of whichever party or parties, have a massive challenge ahead of them in resolving this issue-such a resolution is overdue. Given the state of public finances, there is a real risk that this issue will be pushed, yet again, into the long grass. Surely we should all commit now to a process to secure a consensus. It is in the interests of any incoming Government that a process is already in place to achieve that. We should establish now-we should not wait until the next Parliament-a cross-party commission with a defined remit of achieving consensus in a tight time scale. Let us just imagine how the public would react if they saw the three main parties agreeing to come together to recognise that this challenge must be faced and must be met without further delay. That is necessary and it is of acute importance, so I urge all sides to agree to a process that secures that consensus on a sustainable system that will last into the future.
7.19 pm
Laura Moffatt (Crawley) (Lab):
It is a pleasure to follow the hon. Member for North Norfolk (Norman Lamb), who spoke of things being kicked into the long grass-I suspect that a fair bit of that is occurring on the Opposition Benches to say the least. It is disingenuous for the Opposition to say that they do not intend to vote
against the Bill in principle and then to go about trying to take it apart piece by piece and rubbishing it before it can get a head start.
I thoroughly support the Bill. Of course there are difficulties and issues to clear up, but at the heart of it we need to remember that it is desperately wanted and desperately needed by many people who live in fear of their future. This House has a responsibility to respond to those concerns, and not only to consider the measures carefully, but to ensure that they are put in place.
I firmly believe that the Bill is an excellent stepping stone to the much greater piece of work that is going on. Frankly, I would have gone straight for the National Care Service and forgotten about the consultation. It feels like motherhood and apple pie to me-like the early days of the NHS-to go ahead and set something up in that spirit. We should be considering social care in the same terms as the NHS. Of course, many people in the Chamber have had the opportunity to spend a lot of time examining the Bill in detail-including how we came to the position that we are now in-but I firmly believe that we need to get back to the principle of worrying about those who, without question, will benefit from it.
With those people in mind, I want to give a few reasons why we need to buckle down and get the Bill into place. It is not only desirable, but much needed. I was a member of the nursing profession for many years before I was elected to the House of Commons and was deeply aware of those people who, without support and help at home, found themselves in hospital or in social care. There is nothing worse for an acute nurse to know than that somebody for whom they are caring could, with proper support, have been kept at home and had the comfort of knowing that they would be looked after in their own home. For the people for whom this Bill will be most helpful-those with the dementia range of conditions-entering hospital for rehabilitative care is often incredibly damaging. It is confusing and upsetting, families become upset and it is often obvious at that point that it could have been avoided. For that reason alone, and for the many patients whose cases I have in my head who could have avoided admission, I support the Bill.
I was very interested to hear the Opposition suggest that carers would step away from helping their relatives if such a Bill were passed. Frankly, I found that insulting to carers. Anybody who undertakes that work knows very well that they want to work in partnership with the care services. They want to have time to be on their own and to be able to share their experiences with friends and families, without the constant burden of caring for their loved one. This Bill will help many hundreds of people to live their lives as carers in much more certainty.
Kelvin Hopkins: I think my hon. Friend has answered my point, in a sense, but does she not agree that hundreds of thousands of carers have enormous pressures on them because of elderly relatives who need much more care than they can possibly give and that giving more assistance to them is precisely what we should be doing?
Laura Moffatt: Indeed. I thoroughly concur with those views. That would improve the quality of life not only of the person in receipt of care but of the carers.
Many authorities are beginning this work already and that is why I do not have the depressed view that we cannot tackle the problem at this point. A year ago, the previous Secretary of State, my right hon. Friend the Member for Kingston upon Hull, West and Hessle (Alan Johnson), came to launch our well-being programme in Crawley. The local authority has come together with NHS West Sussex to provide excellent care at home-not only education on eating and smoking, but a full service that includes advice on preventing trips at home. I can imagine how much better it will be when we have a more comprehensive home care service for those people.
This Bill is utterly doable. It is disingenuous to say, "We thoroughly agree with it, but we will now produce 101 reasons why we do not believe that we can move forward." Those who will benefit from the Bill will listen carefully to those words-I shall ensure that they hear them. I hope that with due consideration of the Bill, in a reasonable and timely way, which of course we can achieve with one clause, we will move forward and get it in place. We can then move on to a National Care Service, which will be welcomed wholeheartedly in this country.
7.25 pm
Mrs. Jacqui Lait (Beckenham) (Con): I am delighted to follow the hon. Member for Crawley (Laura Moffatt). I think that the point she was making-I hope that I am correct-was that more people need access to top-quality services to ensure that they stay in their own homes for as long as possible. I do not think that there is any argument in the Chamber about that statement. The question is how we can best get there.
I am very conscious of the question of whether the Bill is needed at all, given that the best evidence that the Secretary of State could give us concerned the work that is being done on the Isle of Wight. The hon. Lady mentioned what is happening in Crawley, and I am sure that we can all cite cases from our social services departments in which, over the years, they have become more involved in intensive rehabilitation. That shows that these services are already emerging. I often wonder why we need to pass legislation so that people can continue to provide best practice. If it is best practice, and if it is saving local authorities substantial sums of money, it is in their best interests to do it. They do not need the legislative burden that is being imposed.
Although we agree that there should be better services for personal care delivery, the Bill is next to redundant. We should be moving much more towards deciding-as my hon. Friend the shadow Secretary of State for Health pointed out and as the hon. Member for South Thanet (Dr. Ladyman) implied, too-that there are a range of different ways in which to finance the achievement of better personal care. We would be better off, frankly, doing it comprehensively rather than piecemeal. The Bill has been referred to as a bridge and as a stepping stone, but I suspect that, in the long run, it will go on the statute book and will be ignored, not implemented or will have to be comprehensively reworked, should another care Bill be proposed.
In one sense, I welcome the debate that we are having on such a short Bill-it is, fundamentally, one clause long. Most of the Opposition's contributions have certainly questioned how effective it will be. I represent a constituency
in the London borough of Bromley, which is one of the wealthiest boroughs in London. It has, without doubt, the highest proportion of retired people of all the London boroughs. The hon. Member for North Norfolk (Norman Lamb) said that the Bill will mainly benefit wealthy people, and that is highly likely to happen in my borough. Apart from three main areas where we have genuine deprivation, the rest of the borough is relatively wealthy. People in the borough will have been meeting their needs using their own resources. The flaw of the Bill is, as he pointed out, that people who have been doing that, who might be in great need-I am not saying that they are not, and I sympathise entirely with their need to get proper care-have not been cared for in the public sector, and that the costs of care will therefore run completely out of control.
I am also concerned that East Sussex-here I declare an interest, because my husband is the leader of East Sussex county council-has a high proportion of retired people. Those people are not, by any means, the wealthy retired. If whatever money that is forthcoming from the Government-from saving on ad campaigns and research money-is distributed according to the local government formula, that will penalise people in counties such as East Sussex that are already suffering because of the perverse nature of the formula. I suspect that the hon. Member for South Thanet could say the same about his part of Thanet, although it is in a very wealthy county. If the money is to be distributed on the basis of the needs of the population, I foresee some squawks from the friends in the north, because it is much more likely that money will go to areas in the south with high numbers of retired people, which are not necessarily Labour controlled-not that much of local government is these days. We foresee perversity emerging in a variety of ways in relation to this one-clause Bill.
I have been advised by a member of the Association of Directors of Adult Social Services, who is such a director, that the costings have not been shared with the social services department or with a wider audience and that the estimates of need have not been shared. Estimates are therefore a wild approximation of what the demand, and hence the cost, will be. The Government could find themselves in a position that they do not want to be in of being unable to fund the programme that they have put in place.
Another area that the Government probably have not worked through properly-my hon. Friend picked up on this point-is the sheer scale of need in relation to the professionals required to deliver the rehabilitation services that everyone is talking about. I use the word "rehabilitation" quite deliberately, as I think that "reablement" is another ghastly politically correct word and that we would be better off using a familiar one.
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