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There are already insufficient occupational therapists. Anyone who needs, or knows someone who needs, an occupational therapist knows how long people have to wait for one. Anyone who needs physiotherapy knows how long it takes to get a physiotherapy appointment unless they have an immediate medical requirement. We can forget about psychologists, given how long it takes to see one, particularly following the introduction of talking therapies. It will take years to get hold of the professional skills that will be required to deliver the rehabilitation services that we would all like, because we
have to recruit professionals from schools, get them through their training and then through what are, in effect, apprenticeships. It is almost an unfair promise to say that comprehensive services will be delivered to elderly people who are in great need, because we will not be able to get those services to such people as they need them.
Dr. Ladyman: I am enjoying the hon. Lady's contribution, and I agree that there is a serious issue with providing those different professionals, but does she agree that we will have to go through that process anyway, irrespective of what reforms we agree in relation to the model for funding social care? We will have to make those changes anyway, so those points are irrelevant to the Bill.
Mrs. Lait: I wish that they were irrelevant. The purpose of the Bill, if I have read the Government right, is to be able to say during the election campaign, "We will deliver to you, from October 2010, these sophisticated services," but those sophisticated services will not exist in the volume that will be required. That is the unfairness implicit in that promise.
Bed blocking will still be an issue, and the hon. Gentleman has taken me around in a circle back to where I needed to be. Many years ago, we spent endless hours in the Chamber talking about bed blocking. We were talking about it then because assessment processes were not in place. They are now better, and although I would not say that bed blocking is gone, we are not talking about it to the same extent. Also, we now realise that once an elderly person, or someone who is not very mobile, has been in a bed for 48 hours, they will need intensive rehabilitation to get them back into their home. Some of those services are available and are better than they were, but provision certainly is not as comprehensive as the Bill promises. It has, however, shown the need for expansion in the availability of those skills, and we have not addressed that problem.
Dr. Ladyman: The Bill amends the very Act that sorted out bed blocking. It takes the Community Care (Delayed Discharges etc.) Act 2003 and simply says that we are going to make services do what the Act requires of them for longer than the current six weeks. I agree that the situation is not what the hon. Lady wants it to be and that we need those extra professionals, but the key thing that the Bill does is to say to people who are currently funding their own services that we will fund such services for them in future. It will take a long time to deal with her logistical concerns, but they are not relevant to the Bill.
Mrs. Lait: I congratulate the hon. Gentleman on getting in a mention of the 2003 Act, which he took through Parliament, and I congratulate him on the Act. Let us not get into a long debate about how bed blocking was cured. The point remains that the Bill explicitly promises that from October 2010-only 10 months from now-people's rehabilitation care will be provided for an indeterminate length of time, and the relevant services to do that do not exist. That is the unfairness of the Bill.
Mr. Stephen O'Brien:
My hon. Friend makes her points extremely powerfully. It seems to me that she is worried about promises being made on this vital service,
on which so many people depend, not least given the experience in Scotland, where the capacity to deliver against a promise simply was not available. Therefore, the promise could only be broken because there was not the capacity in the first place. Is that the case?
Mrs. Lait: My hon. Friend is absolutely right. My mother benefited from that system when it first came in. Sadly, just after she died, the budgets had to be cut back. I have seen that situation on a practical level. We face a general election in six months, and this is yet another Bill that should be called a "shore up the Labour party vote" Bill. That is what is so distressing about this short Bill.
I want to hop briefly on to another of my current hobby horses-the programme motion, which I am glad we are voting against tonight. Yet again, we have a demonstration of how the Government have inadvertently ceded to the House of Lords legislative control over the Queen's Speech. It is no longer this Chamber that makes final decisions on legislation, but the House of Lords. I do not find that acceptable. I was not elected to this place to give my job to the House of Lords and I very much hope that in a few months' time when my Government come in they will reverse the process of ceding control to the House of Lords.
Mr. Robert Syms (Poole) (Con): We all know why the current Government, and indeed former Governments, have not moved rapidly on personal care-it is horrendously expensive. If we look for a moment at the economic situation, we see that the country is accumulating a large debt. If we look at the pension situation, we see that people are living longer than ever and if we look at the care situation, we see that because people are living longer and are frail, there is potentially a large bill for the Government, local authorities and individuals.
There is no easy answer. Earlier in the debate, one or two Members suggested that we should just lump the costs on to taxation and that might do the job, but of course the British tax system tends to hit people at a lower and poorer level than is sensible. All the surveys on poverty show that young families with children fall into the bottom poverty quartiles-at least for a period, when one parent cannot work.
It would have been far better had the Green Paper in July been allowed to take its course and if we had accepted representations from a range of people and taken a decision about where we wanted to go in the future. The Government could have introduced a degree of certainty in the debate, so that both the private and voluntary sector and local authorities could plan and work to it. If we want any kind of insurance scheme to be a success, we have to be sure that the boundaries are clearly drawn-what the state will do and what individuals are expected to do.
I have the privilege of representing a constituency that is probably in the top 35 in terms of older electors. It is not unusual for an elderly couple to come to see me at my surgery about their parents who are even frailer. The problem is that the system relies greatly on carers, some of whom are very elderly and unable to lift their loved ones or look after them. It is a good thing that families care for the elderly, and it needs to be encouraged.
One of the things we need to look at as a state is whether if we gave individuals personal budgets, they could use that money to pay their relatives to look after them. From my understanding of the situation in Holland and one or two other states, I think that would be a good thing.
Because of the sudden rush of blood to the Government's head, we have a partial change that will have perverse incentives on the rest of the system. We have not managed to ascertain tonight quite what the demand will be-until the service is implemented we shall not know-and as my hon. Friend the Member for Beckenham (Mrs. Lait) said, we do not know whether there will be full back-up. A big problem in Poole is that if somebody wants to stay in their own home, they need adaptions, which sometimes need planning permission, but the budget seems to be limited so it takes some while to get the adaptions that people need. That is one of the factors that will cause a problem.
I am a little concerned about the funding, which seems to be calculated on the back of an envelope. In all my time in both local and national Government, there has been something called the magic pot, which is usually somebody else's efficiency savings projected over a period of years. If somebody else works a bit more efficiently, we can fund a particular service in the full knowledge that if local government cannot provide it efficiently, it will have to put up council tax.
I spent longer in local government than I have as a Member of Parliament, and in my humble opinion local authorities are, on the whole, quite efficient at delivering services. They are certainly better at controlling money. They are better at dealing with a limited amount and getting what the Government want from it. It may not be everything the Government want, but local authorities manage to deliver an awful lot.
I am not sure that the measure is being properly funded. The council element is questionable, as are one or two other elements, so the problem is that we shall come back to the pinch point of eligibility. At the end of the day, if councils do not have enough money, they will use eligibility criteria that fit the funds they have. Local authorities have been capped and are expected to make savings. On top of that they are now expected to deliver a major reform, which will require a great deal of investment-for example, in physiotherapists and adaptions to homes. It will also require funding, and ultimately if the funding is not there, the legislation cannot be carried out.
Another perverse incentive is that, to some extent, the measure would discriminate against people going into care homes, which may be the best thing for some people to do. Families may try to keep someone in their own home when it is inappropriate because they do not want to burn up the value of the house by moving that person into a care home.
We need to think carefully about the measure. I am glad that my hon. Friends have said that they intend, if given sufficient time, to scrutinise the Bill fully to ensure that we have answers to some of the major questions that have been raised.
The hon. Member for North Norfolk (Norman Lamb) made a very good point; there is a lot to be said for all-party consensus. Whatever is agreed needs to be agreed for between five and 20 years. We do not need
somebody coming in with their new version and reinventing the wheel. We need long-term arrangements, so it is a pity that the Government rushed off in their own direction and did not listen to the opinions of the consultees, who initially thought they were genuinely being asked and were a little upset that the Government had already made up their mind-certainly on one aspect.
My hon. Friend the Member for Beckenham made an important point about the distribution of the money on the basis of grant. Many of us have a heavy weighting of elderly, but also low grant levels, which will create a difficulty in delivering services. If the money is distributed on the basis of an older population, it would be welcome but there will clearly be losers, who might have an opinion. There are some very wealthy areas of Poole, but although many of my constituents have an asset in the form of a home that is worth a lot, their income is low-not least because people's pension arrangements have not been quite what they expected, for various reasons.
Keeping people in their own home if they have no income or savings will be at a high cost, even if we can find enough people to run around and look after them. At present, many members of the Polish community do a great job looking after the elderly in most of the care homes in my constituency, but there will be a real problem finding people with adequate training to provide those services. In the past, as we all know, because of staff turnover and the terms and conditions both for those who work in care homes and for those who deliver care to individuals in their own home, the commitment to training has not been all it should be. If we are serious about providing a care package for people who remain in their own home, we have to increase the pay, rewards and training for those who look after the elderly, so that they receive the best care and so that caring is seen as a proper career and people do not go into it because they cannot do, or are not skilled enough to do, anything else.
The Bill is interesting and I am glad that my hon. Friends will scrutinise it fully. We have a major problem, however. This is yet another initiative that, however worthy, needs to be funded against the background of a country that is spending rather too much. Unless we get a grip on that, there will be problems in the long term not only for our fellow citizens but for the children and grandchildren of some of the people we have been talking about in the debate.
Mr. John Hayes (South Holland and The Deepings) (Con): If the Bill were an emergency measure-an emergency response to a problem-it would have happened sooner. After all, the circumstances with which it deals are well established and well known. If, on the other hand, it was not an emergency measure, it should have been part of a bigger Bill, a greater plan, as was envisaged in what the Government said earlier this year, as highlighted by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) from the Front Bench and by others.
So one is left in a quandary about what the Bill is for. There are those in the Chamber who would take a cynical view. I alluded earlier to that view, my hon.
Friend was kind enough to say, with irony. Some would say that it was purely a political calculation, but I like to think better of the Government than that. I cannot believe that Government Members would behave in such a low and dishonourable way. It would be certainly hard to imagine them doing so.
I want to spend some time considering the Bill on its merits, however slim they might be. My hon. Friend identified two prevailing themes that should have underpinned the legislation. He spoke of quality. If we were to break that down further in respect of care, we would talk about where care was provided, by whom, at what point and in what form. One might have hoped for a little more clarity about any or all of those aspects of care in the opening speech from the Secretary of State, but it was short on such details, as is the very small Bill itself. We are not left in any greater certainty about what is to be provided, where, when or to whom; or at least not exactly to whom, for although the explanatory notes make an estimate of the number of people affected, as my hon. Friend highlighted, this calculation is imperfect.
From even a preliminary glance at the Bill, it seems to me that it is likely to have two profound effects. One is a displacement effect on what is already being done, and the second is a catalyst effect on what might happen. Let us deal with them in turn. The displacement effect could have severe repercussions, certainly for local authorities, which are to provide much of the service on an unfunded basis. From where will they draw the money and what other services will suffer as a result of this displacement?
Mr. Hayes: It is difficult for me to comprehend that anyone would want to read a newspaper during this immensely penetrating and exciting oration, but self-delusion is a feature of politics, I suppose.
The displacement effect of the Bill is likely to be serious. The House deserves a better explanation of what the Government have modelled in those terms. We heard earlier, rather alarmingly, that the consultation on the proposed legislation has been, at best, slight. None the less, it is inconceivable that the Department will not have modelled some of the effects on local authorities. I hope that when the Minister sums up, we hear more about that modelling.
There is a displacement effect in other respects. Other services that are provided to people in order to deliver the quality of care to which my hon. Friend referred may be at risk, as my hon. Friend the Member for Beckenham (Mrs. Lait) highlighted.
Equally limited is the estimate of the catalyst effect of the Bill. When I come to the main part of my speech, I shall speak about the home and care in considerably more detail, but in these preliminary remarks, I urge the Government to provide, perhaps in the summing up, greater clarity about what the catalyst effect might be.
It is surely inconceivable that people will not reorder their affairs to take advantage of the extra care. That is not in any sense a criticism. I guess it is what many of us might do in similar circumstances, but again, there is a
singular absence of information about that-no obvious estimate, no modelling available to the House. I entirely endorse the sentiment expressed from those on the Opposition Front Bench that these matters need to be explored in considerable detail in Committee, which is why the programme motion is disappointing, to say the least.
The only modelling that we have is in the explanatory notes, but the calculations there-the estimates of the number of people in the main beneficiary groups and the table that forms part of that-seem to be imperfect. My hon. Friend the Member for South Cambridgeshire mentioned the mathematical imperfections. Given the displacement that I described and the incentive effect that I mentioned, perhaps the table ought to be recalculated. I hope that a pledge might come from Ministers to examine those matters more closely in the light of the contributions of various hon. Members on both sides of the House.
Mr. Newmark: When I asked the Minister about the cost of individuals giving up their time-constituents in Braintree often tell me about the time that they give-the figure was some £80 billion. That represents what all our constituents collectively do by way of giving to family members and close friends. However, there is a sense of social contract and obligation that the Government should have in respect of our constituents who put in time-that is, non-financial benefits and non-financial support. Has my hon. Friend thought through these issues and the shortcomings of the Bill with respect to the non-financial support that the Government should give to our constituents?
Mr. Hayes: Indeed. That very good point was made not only by my hon. Friend, but also by the hon. Member for South Thanet (Dr. Ladyman), who speaks with some authority on these matters. The hon. Gentleman asked the Secretary of State about the relationship with carers and the effect of the Bill on carers. In doing so, he was echoing the sentiments so strongly expressed when the Bill that the present Bill amends was introduced in the House back in 2002.
The then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), made it clear that the purpose of that legislation was to marry care with health and to take into account all the elements that constitute quality care-not merely the information provided by health authorities to those responsible for care, but some calculation of the various individuals and agencies that collectively comprise quality care. I shall have more to say about the 2003 Act, which has been mentioned several times in the debate, and about how the Bill marries with that precedent.
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