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I listened closely to my hon. Friend the Member for South Cambridgeshire-I was having a cheese sandwich at the time, but I like to follow these things from near or far-and what he actually said was that an insurance model might well incentivise insurance companies to enable people to stay in their homes. That is far from the parody that the Minister paints. The insurance model that the Government identified as a possibility in the Green Paper could well be constructed to incentivise insurance companies to bring about exactly
that outcome. I do not take such a limited view of the options the Government described in the Green Paper as the Minister has come to. He has done so rather hurriedly, given that it was published only recently.
It is clear that the No. 1 priority identified in the Green Paper is that we need more joined-up working. That has been touched on by contributors on both sides of the Chamber. The Green Paper states:
"We need services that will keep people independent and well for longer...through better joined-up working between health, housing and social care services and between social care and the disability benefits system."
As you know, Mr. Deputy Speaker, I have a long-standing interest in disability issues, and I wonder about the proposal that disability benefits should be redirected to local authorities to provide care. I wonder whether we are thus caught on the horns of a dilemma, on the one hand trying to provide more personalised care and on the other depersonalising the benefits system. Joined-up working necessitates proper discussion with local government and a proper assessment of how it will do the job that the Bill gives it.
"fully joined up between the NHS and the new National Care Service."
However, I have heard nothing this evening to reassure me about the information provided by the health service to care services, or about the role of third-party organisations such as Headway, which helps many brain-injured people and with which I have been involved for many years. It allows people with acquired brain injury, often suffering from serious disability, to stay in their own homes. They are frequently younger people, whom we should not exclude from our considerations tonight.
Mr. Hayes: I notice that the Minister freely acknowledges that. It is important that the views of organisations such as Headway be taken into account. Mechanisms must be put in place to ensure that the support given to people in Headway houses, which provide support for carers as well as the young people affected, is properly accounted for in the Bill. I hope the Minister will say something about that area of policy.
"people receive more appropriate care in the right setting, reducing costs, improving outcomes and ensuring that services work together to keep people healthy and active wherever possible."
I am not convinced that the Bill will ensure any of that. Its single substantial change will be made out of context and out of place and is born of short-term, limited and arguably political ambitions. As the King's Fund has warned, the Bill makes the Green Paper's proposals "incoherent". Age Concern and Help the Aged have spoken of the need for
"fundamental reform of the entire care system".
I and the Opposition Front Benchers anticipated the need for such a root-and-branch reform as a result of the Green Paper and the discussions it provoked. The Learning Disability Coalition has argued that the Bill contains "perverse incentives" that will prevent people from taking advantage of the most appropriate care.
Surely we need an holistic approach, as my hon. Friend the shadow Secretary of State said, with an emphasis on more preventive care to ensure that more people stay in their own homes. That means that we must be sceptical about any plans for cuts in disability living allowance and attendance allowance, or any redirection of allowances into the care system that takes place without proper discussion and consultation with representative organisations.
I invite the Minister to answer one or two further questions. Will he clarify the marriage between the care budget and the various allowances that will feed the process financially? Will he say something about the estimates he has made of the displacement effect on local government? Will he draw a clearer picture of the effect on wider services that my hon. Friend the Member for Beckenham mentioned? My hon. Friend the Member for Eddisbury, the shadow Minister, in summing up, will add to and amplify those questions, and he will of course have cleverer ones of his own, but speaking with an appropriate degree of humility on a subject of which my only knowledge is derived from representing the interests of my most vulnerable constituents, I ask the Minister, at least as a starting point, to deal with those fairly fundamental doubts.
"Home is where one starts from",
and as I have said, it is also where we frequently return for care and support. The objective of facilitating more personal care at home is one that will be widely shared across the House, but it requires far greater consideration, and more careful reflection and proper planning, than is suggested by the Bill. To work, the measure must work well, and to do that, it must be carefully conceived and properly considered. We owe those who will be most affected by the Bill nothing less than that.
Mr. Tobias Ellwood (Bournemouth, East) (Con): It is a pleasure to follow my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes), who not only entertained but educated us in relation to the Bill. He orated to us in a way that we are now accustomed to, and has an intellectual status that we esteem and aspire to.
It is noticeable that this has almost been a Tory debate in the last hour or so-in fact, I cannot see one Liberal Democrat Member, although a couple of Labour Members have wandered in and out. I am, I believe, the third consecutive Conservative speaker-
As a representative of Bournemouth in Dorset, the issue of looking after the elderly, who are some of the most vulnerable people in our population, is pertinent. However, as my hon. Friend the Member for South Holland and The Deepings pointed out, it is about not only the elderly, but younger people-it is about those who are not able to look after themselves. Society therefore requires some form of safety net and security
so that we can ensure that people have the type of care that we would all expect to receive in the same situation. At this point, I pay tribute to those who work in the care and support sector-not only the professionals, but the volunteers, including the many family members, who tirelessly devote many hours, days, weeks and years to looking after those who are close to them and important to them.
Winston Churchill talked about the importance of the safety net that society requires to capture those people who fall in their station in life, whether that is their own fault or otherwise. I should like to make a more modern analogy-the community that we are in is like those penguins found in Antarctica. When the sun is shining, we go about our business, enjoy ourselves and act as part of the community; but when times are tough and the storms come in, the penguins gather round in a tight-knit circle. In fact, they move around ever so slightly to keep those in the very centre warm and to ensure that those on the outside are exposed and vulnerable for only a very short period. That is exactly how society should work. When we require care, we are surrounded by the warmth of our community and its support, be that from the voluntary or private sectors or the state, to ensure that we can weather those difficult times. That is why one aspect of care is prevention-it is not always about what happens when care is required-but that is entirely absent from the Bill.
Like many right hon. and hon. Members, I have been exposed to the care and support requirements of our community through my work as a Member of Parliament. Clearly, the confusing system that we have does not make it easy for those requiring access to care to ensure that they have what they expect. That was highlighted when I visited Douglas House in Boscombe in Bournemouth, which serves 16 severely disabled adults. It is a fantastic unit, and I pay tribute to those who work there. They are dedicated to looking after those severely disabled adults.
Unfortunately, forgetting the idea of choice, the Government want to close the centre down and push its residents into the community. I have not got a problem per se with the concept of allowing those involved, including parents, to decide to move someone who requires care into the community. However, those 16 families very much want to keep that place open. I understand that moving those who are currently at Douglas House into the community would cost five times more per person. I do not understand, if we are pushing the idea of choice, why the Government are telling Bournemouth and Poole primary care trust that it cannot keep Douglas House open.
I plead with the Minister to consider this. We have handed in a petition of more than 10,000 names to No. 10, but we have hit a brick wall. I reiterate that this is the desire of parents with children in that facility. We are not listening to the requirements and needs of those people, and that will cost the taxpayer more.
We need to recognise the importance of upgrading our care offering, and I am saddened by the fact that so few hon. Members are in the Chamber to debate this important subject. Their absence may be linked to the size of the Bill, because there is not much in it to debate. Every single hon. Member who has spoken has added things that they would have liked to see in the Bill.
The Secretary of State began by saying that the Bill is a great stride forward in the move to reconcile the care package provided in the United Kingdom, but the two minuscule clauses are simply election posturing. As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has pointed out, we will have an opportunity in Committee and in the other place to make this Bill into something of which we can be a little more proud. As it stands, it does not reflect 10 years of hard work by any Government.
The development of care policy by the Labour Government has been a story of procrastination. Back in 1997, the royal commission on long-term care was set the task of looking at the system and recommending a series of changes. It was not until 2008 that we had a six-month engagement process. That was useful, but it was a long time after the initial commission made its recommendations. We then had the Green Paper, "Shaping the Future of Care Together", issued this year, with big statements about a National Care Service. It was a bold and radical proposal to shake up the care and support package available. Then we had the huge announcement by the Prime Minister at the Labour party conference of his intention to include a Bill in the Queen's Speech. In total, it has been a 13-year process, in which progress has been slow and which has not reflected the urgency that this subject requires.
Joan Ryan (Enfield, North) (Lab): The hon. Gentleman has referred to royal commissions and Green Papers. However, he has not mentioned the dramatic change in social care that has taken place on the ground, in the move towards personalised care and personal budgets. Perhaps he could say something about how that move is linked to the Bill.
Mr. Ellwood: I am not going to digress from my examination of the changes that should have taken place. We are here to debate the Second Reading of a Bill that is very small and does not do justice to the length of time that the Government have had to change the system, or to the sound work in the Green Paper. Many people who have done all that work and participated in consultations on the Green Paper will look at the Bill and ask, "Is that it?" They will be severely disappointed unless the Bill is radically changed in Committee or in the other place.
The exchange between my hon. Friend the Member for South Holland and The Deepings and the Minister was interesting. My hon. Friend was pondering which way to vote this evening. I hope that more of our hon. Friends will turn up to decide that, otherwise this will be a short debate. The question for the Minister is whether he would be willing and open enough to accept amendments tabled in Committee and in the other place to build on the opportunity provided by the Bill, separate to other initiatives on the ground. That, I think, is the test for the Minister himself. He is shying away from even looking at me now, so I suggest that the answer-
The Minister says that he is writing copious notes. Well, it would be nice to get an indication, either now or in the winding-up speech, of whether this
Government are open to amending the Bill to beef it up and make it something we can respect.
We are debating the Bill on Second Reading, which happens to fall three months before a general election. It looks like there has been a dash for policy and a rush to put a tick in a box, so I have to ask the Secretary of State, in his absence, whether he was constantly last in the queue when the Prime Minister was doling out time for Bills to be debated in Parliament. How many Parliaments have we had to go through before finally reaching the Second Reading of such a Bill? We now seem to have a concession: a small Bill squeezed in just before we go to the polls. That is a shameful exercise, I am afraid, considering the deterioration of the service, which has been remarked upon across the Chamber-the fall in the coverage of care and the rising costs of it over the past decade.
The timing of the Bill is certainly questionable. It is also questionable in relation to the Green Paper, because we are midway through a wider consultation on the aspects of social reform. My intervention-the first the Secretary of State took-was to ask why we are having this Bill now. He could not give me a clear answer; he could not acknowledge the fact that the Bill is part of an electoral cycle, rather than solid policy being put forward.
Also, we have to ask ourselves what is not in the Bill. It is thin on substance and there is little to disagree with, but there is little in the Bill in the first place. The costs of the Bill have not been outlined at all. Perhaps we will get more clarity in the winding-up speech. We have had the pre-Budget report, which included a black hole in the finances. We now have a Bill that includes a black hole in the finances. It is vague about how local authorities will foot the bill without having a knock-on impact on other services.
It is worth reminding ourselves what personal care means. It is personal hygiene, such as bathing, continence management and assistance with eating; personal assistance, such as dressing and so forth; and simple treatment. It does not include nursing, which is not seen as part of personal care. The Labour royal commission on long-term care, which reported in 1999, recommended that long-term care should be split into living costs, housing costs and personal care, and that personal care should be available after an assessment and paid out of general taxation. Most of the recommendations were accepted, but not that one concerning personal care. The reason cited was that there were not enough resources.
"The Government's view is that the Bill has little overall effect on public sector manpower and public expenditure"?
Yet here we are, talking about the resources that will be required to put through what at the moment is a flimsy, unfunded Bill. We know that the costs will be much greater than the Government are willing to admit.
I am grateful to my hon. Friend for that intervention. Perhaps it is timely that the Secretary of State has returned to the Chamber, because he might be
able to clarify the exact cost to the Exchequer of this Bill-not just the up-front costs, but, as my hon. Friend suggests, the funding requirement for the extra staff who will be required to implement what is proposed here. That is not clear at all.
The next big document that the Government produced-a number of years later, in July 2009-was the Green Paper entitled "Shaping the Future of Care Together". Having digested that document, I have to say that there are many interesting ideas in it. It puts together a wide array of issues, and a number of pieces of the jigsaw are there. However, the Government have chosen to take just one piece of that jigsaw and promote it today, completely missing the wider context of what else is happening in care.
That Green Paper, which I hope the Secretary of State might be willing to look back at, points out that the current system is based on legacy and calls for bold reform, such as that which created the NHS. By changing things in incremental steps and limiting the objectives, things will begin to overlap and we will end up with a confusing structure. Rather than heeding the advice of the Green Paper, we are ignoring it and just coming out with another little building block to add to the confusing layers that we already have.
The scale of the problem is evident. We are all living longer. It is estimated that, by 2026, 1.7 million adults will expect care in one form or another. One in two men will expect some form of care as they get older, and two in three women will have high care needs. The problem will not go away. The type of care available will also become more complex, as advances in science are made. People's expectations will increase, yet what we have today is confusion over funding. Wide variations of care are offered, with standards differing from council to council across the country. That is another example of the postcode lottery, but I do not see how the Bill will challenge that.
Money is not always appropriately spent. As I mentioned earlier, so much more effort could be invested in prevention, rather than in a cure. The current system is effectively a means-tested structure, so savings are used to pay for care. As has been reiterated time and again, we now see a requirement for people to sell their property in order to pay for the care that they will need. That is scandalous.
"a universal and sustainable system which empowers people to live their lives the way they want to",
providing access and support to people regardless of location; an easily understood system with agreed levels of assessments across the country, based on personal circumstances and recognising individuals' ability to pay, and all fully co-ordinated with the NHS and, of course, fair and affordable. That is a bold statement. That is radical. That is what we should be working towards in this Bill.
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