| Previous Section | Index | Home Page |
Mr. Lansley:
My hon. Friend will have noted, as I did when he was quoting the Green Paper, that it included remarks about recognising people's ability to pay. The
proposal in the legislation before us is that people with higher care needs should be given free personal care regardless of their ability to pay. The principles for the National Care Service that the Government set out in the Green Paper are therefore not the principles on which they propose to legislate.
Mr. Ellwood: I am grateful to my hon. Friend for that clarification on one of the many issues that will undoubtedly be scrutinised further in this Second Reading debate, as we highlight the Bill's shortfalls.
On cost, the funding proposals are completely vague. This has been stated already, but the care requirements or needs of the average 65-year-old will probably be around £30,000 over their lifetime. In reality, that amount could be only £1,000, but in other cases, extra care-more detailed and more complex care-is required, the cost of which can reach £50,000.
The Bill has two simple clauses. The first concerns the removal of the six-week limit on the provision of care offered for free, while the second is almost just a tidying-up exercise, linking Wales with England. It really is a pathetic Bill, considering where we are in the whole process of designing a new care system, costing around £670 million, as my hon. Friend the Member for South Cambridgeshire said. The Secretary of State's claim is that the Bill is the first step towards a National Care Service. What a shame that we do not have the other steps, and that we are only now debating the initial stage, when we could have done so much in the past 10 years.
The Bill guarantees free personal care for about 280,000 people, although that figure requires clarification. I do not think that anyone in the Chamber will disagree with the proposals, but, time and again, hon. Members have pointed to what is missing, and to what a missed opportunity this is. Attached to the Bill is, of course, another consultation, on proposals for regulations and guidance. All this is coming out in the lead-up to the general election that is just around the corner.
It is interesting to read the research paper on the Bill produced by the House of Commons Library, which is a neutral body. On page 10, it provides comments from other organisations and agencies. Andrew Harrop, the head of policy for Age Concern, stressed:
"It will be essential that councils are properly funded to provide this care so that there is not an incentive for them to push older people into care homes or claim that their needs are not critical enough to warrant free care at home."
Jane Ashcroft, chairman of the English Community Care Association,
"queried why the Government had not introduced the policy at the same time as the green paper on social care."
Consumer watchdog Which? viewed the Bill as "a missed opportunity". Lord Lipsey, a former member of the royal commission on long-term care, is quoted as saying:
"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."
Those are voices that we should respect. They are critical of the Bill, saying that we should think again on these issues.
I think that we all agree that an advanced, civilised society needs a fair, accessible and compassionate care and support system that allows people to live their lives
to the full and meets the needs of people as they grow older in an affordable way. The Government have proved that there is some vision, as was highlighted in the Green Paper, but the Bill is far from having any vision at all. The Government have woken up to the urgency of the need for reform very late in the day, despite gaining a head start more than a decade ago when they were prompted by the commission to go in this direction.
This is a timid Bill, and it falls short of many people's aspirations, including many in the industry. In the introduction to the Green Paper, "Shaping the Future of Care Together", the Prime Minister says:
"What is now needed is a major debate about the challenge we face and the options for addressing it."
I would hardly call what we have had today a major debate. We have been denied that, because nothing major has been put in front of us. The Bill is not properly financed. It comes without a proper impact assessment. It gives little clarity on how the provisions will dovetail with the NHS, and provides no indication of how many extra staff will be needed. It is a pathetic piece of the bigger jigsaw set out in the Green Paper.
On top of all this, we have a programme motion-which we have yet to talk about-that will limit the amount of time for debating the Bill. Proper debate might just add to the Bill, either in Committee or in the House of Lords. This is a rushed Bill, and it represents a missed opportunity. It has very little chance of getting on to the statute book. It has just one aim, and that is not to help the vulnerable people across Britain but to help a vulnerable individual in No. 10. If this is the best that Labour can muster after a decade to help those in need of care in Britain, it is proof-if any more were needed-that Labour has run out of ideas and that it is time for a general election.
8.53 pm
Chloe Smith (Norwich, North) (Con): It is a pleasure to follow the powerful contribution of my hon. Friend the Member for Bournemouth, East (Mr. Ellwood). I will also begin by describing the confusion surrounding the Bill. As many Members have said, the Bill is part of a much bigger picture. I hope that the House will forgive me if I lighten the tone by sharing a feature of the Smith family's multi-generational Christmases, following the evocation of Dickens in the speech made by my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes). The Bill is a bit like one of those mystery jigsaws. We start with a bit of sky and a bit of grass, but we have to fill in the rest as best we can because there is no picture to guide us-
Mr. Ellwood: They have lost the lid.
I follow on from the Lord Lipsey quotation already given:
"What has gone wrong is that in the middle of the consultation... the prime minister has declared that it is government policy for people with severe care needs in their own home to be paid in full".
I will come on to what we all think about that principle, but to try another analogy and to bring back the idea of homes, this is like trying in a consensual way to build a community of homes that will withstand the future,
only to find that on one plot in the street there is a jerry-built shed which might well shelter some in a storm but which has not been made with the care and forethought that the whole project requires.
Considering that we are looking for a White Paper in 2010 to follow the Green Paper that came this year, it is not enough simply to say that we need something rather than nothing-that something will do in the place of everything. We cannot hide the haste of a piece of legislation that, as ably noted earlier, has only two clauses and yet has been 12 years in the making. That is not the way I or many people outside this place would expect to go about such weighty matters as personal care at home-raising false expectations on the back of something that might turn out to be very poor quality. I shall return to that.
Of course I join colleagues in welcoming the concept of personal care at home and, for many people, the concept of personal care at an affordable or zero price for those who need it. Nobody wants to be pushed out of their home; nobody wants to face high costs at particularly hard times and in emergency circumstances; nobody wants to be dependent on others or, indeed, on impersonal caring environments; nobody wants to lose any dignity; and nobody wants to be uncertain or to be the victim of a postcode lottery. However, we must be cautious in what we do from that position.
I said in last week's debate, tangentially on the Green Paper but specifically on the continuation of the attendance allowance and the disability living allowance, that we must proceed with clarity on those issues, because we are dealing with a section of society that is often very vulnerable, but for the same reason we must go with caution. We rather randomly concluded in last week's debate that we should not approach the topic with heightened political emotions, but it is equally important to get it right. It is important not to get it wrong for the same reason as given last week-the size of the question ahead of us. There is still a demographic bomb ahead of us, so the scale of getting this wrong is important. As many Members have pointed out, the scale of the task is, frankly, unknown, but the scale of getting it wrong looms ever larger as an exponential problem ahead of us. I am afraid that putting one small piece of the jigsaw in place is simply not enough in this case because of that characteristic.
Christopher Fraser: I entirely agree with my hon. Friend. Does she agree with me that in large counties such as Norfolk-a great county that both she and I represent-with disparate communities in both rural and urban areas, a one-size-fits-all solution will not work, because some councils will be able to afford the provision and others will not?
Chloe Smith: I thank my hon. Friend for his contribution. I will come to what our local authority has had to say on this matter, as I have had conversations about it. He is right that the aspiration to end the postcode lottery may well be laudable, but the practicalities of getting it right are far harder.
I will now deal briefly with costs and how the proposal might work, on the basis of the bare detail that we have been given so far. I cannot resist noting a comment made from the Government Front Bench earlier that the proposal will be subject to the "normal spending
review process". It is a shame that the Secretary of State has disappeared again, as I wanted to put it to him that it is a shame that we have had no comprehensive spending review to help us determine how it fits into the bigger picture, in terms not only of the health budget but of where our country is going.
The Secretary of State has told us that the Bill will require a contribution of £420 million from his coffers and a further £250 million from those of local authorities. As has been suggested by my hon. Friend the Member for South-West Norfolk (Christopher Fraser), and also by my hon. Friend the Member for Beckenham (Mrs. Lait), the co-ordination that the policy demands from local authorities is one of the main problems that we face. Informal discussions in which I have engaged with Norfolk county council, the local authority that I share with my hon. Friend the Member for South-West Norfolk, suggest that the council could incur a cost of £5 million. Perhaps the Minister will confirm that that could add up to £250 million if spread over an appropriate number of authorities on an annual basis. It should be borne in mind that Norfolk has already had to squeeze £15 million of efficiency savings out of next year's budget.
Mr. Timpson: Does my hon. Friend agree that whenever the Government present a new policy or a new Bill to the House, the cost of implementing that new policy or Bill seems to fall on local authorities, which are having to make saving after saving? Is she still unaware, as I am, of the total efficiency savings that the Government are asking authorities to make over the next year and beyond?
Chloe Smith: I share my hon. Friend's perplexity. I know that my local authority will struggle to find more money in addition to the efficiency savings that, because it is a scrupulous and forward-thinking authority, it has already had to identify. Moreover, much of the work that that forward-thinking authority has tried to do will be imperilled, including some of its work on prevention in this very policy area.
My hon. Friend the Member for South-West Norfolk will know that, thanks to the Government, Norfolk is currently subject to local government reorganisation, which means that a particular burden falls on our local authorities and also those in Suffolk and Devon. That involves a cost for which central Government refuse to foot the bill. Having said that we must take this action, they then say, "We will not give you any money for it and, what is more, you had better not raise council tax to finance it." That is an enigma wrapped in a puzzle wrapped in any other Churchillian quote that Members may choose to employ-
Mr. Stephen O'Brien: Wrapped in a jigsaw.
Chloe Smith: Indeed-and still with no picture on the lid.
I want to make one more point about costs before I deal with other aspects of the Bill. According to answers given to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the Government's contribution is not connected with whatever action they want to take in relation to attendance allowance and disability living allowance. I am almost tempted to ask, "If that is the case, why?" Either the Bill is connected
with the Green Paper and therefore connected with those benefits, or it is not. That is another question that the Minister must answer.
Let me now raise the issue of fairness. I believe that the worst risk posed by the Bill is that it endangers real reform. It pays for what is, on the overall scale of things, almost a minor reform, and it potentially helps people who are not the poorest in society. As my hon. Friend the Member for South Cambridgeshire pointed out, that principle is not in the Green Paper. The Government seem to be operating on the basis of two entirely different principles, at a time of soaring national debt. It is not as if there are spare pounds floating around that can be thrown any which way.
Nowadays we must be particularly careful to scrutinise any item of public spending, and Members are wary of poor quality. Many of us welcome the idea of free personal care at home, which is a wonderful principle, but the poor quality that we risk with legislation such as this may be the enemy of the people whom the Government-and we-are so keen to help. Other Members have already spoken about the aspect of quality that I wish to dwell upon: the staffing implications of these measures. My hon. Friend the Member for Beckenham made the point very strongly. In an intervention on her, the hon. Member for South Thanet (Dr. Ladyman) said that we must find staff to make this change happen anyway, but that will not necessarily be the case. It is much easier to find staff to operate a well planned, well oiled and well funded system than it is to find adequately trained staff to operate a system such as that planned for October of next year, which, frankly, looks like a black hole at present. The Royal College of Nursing says:
"It is essential that those with the highest needs receive the highest quality of personal care. With only 10 months until these measures come into force the RCN is concerned that there may not be sufficient numbers of properly trained social care staff and community nurses to meet the undoubted increased demand for care, which will follow from the introduction of these measures."
I fully agree. There is a real risk that a hasty introduction of these measures will lead to a gap in the provision of properly trained and funded staff, which will imperil some of our society's most vulnerable people, whom all Members wish to help.
Time and again, MPs hear horror stories on this topic from their constituents. I suspect that I have heard fewer than many other Members, but the message comes across loud and clear none the less. There are stories about carers who leave the elderly person in their care alone for most of the day, and turn up when they think that it is time for breakfast, which might be noon or 7 pm-or whatever time chosen by the carers who have been found to fill those personal care gaps. That is not a vision of personalised care; rather, it is a nightmare for many of our constituents. We risk that becoming a reality by introducing these measures with such haste.
In this debate, all Members should be focusing on the value of good care staff. I am not sure that such a hasty introduction of these measures will allow us to fit that into the system, however. Proper planning for the requisite training takes years, but this Government have done the following things to hinder that. They have let the Learning and Skills Council go bust. They have also let my local further education college become stranded with insufficient classrooms because of a capital funding crisis-I am
sure many other Members' FE colleges are in the same situation. This Government have let higher education students-some of whom may be involved in providing more specialist needs-suffer with no funding until Christmas.
Also, the apprenticeship system has been asphyxiated, and a huge variation in training has developed-in the experiences that people are able to access, in whether red tape holds them back and prevents them from training properly, and in what places can be promised to younger people seeking training or to older people seeking to do their best for society. That is our current training picture, and we must ask ourselves how it will affect the system that the Minister is looking to have in place in 10 months' time.
I am tempted to conclude by asking the Minister whether he agrees with me that the following very simple precautions would assist the Bill in its passage. It should be part of a larger reform. It should also help, rather than hinder, local authorities. It should give the Minister the opportunity to ask his colleagues to provide clarity and consistency in other sectors around this one, such as further education. The Minister might also consider instituting a licence to practise, or any other measures that could improve the safeguards in this area for vulnerable people, whom we all care about.
The sad truth is, however, that the Minister cannot agree to those simple precautions, because, as Members have already picked up, he does not know the numbers. None of us knows how many people will be involved in this system. We can estimate the number of people who pay for their own care at present, but we cannot estimate how many more will come forward when such an incentive is offered. We cannot therefore estimate the full costs of this policy, or the number of trained staff that will be required to fulfil it and make the dream that we all wish for, of proper social care and personal care in the home, become a reality.
There is a final thing that, through this Bill, the Minister is not allowing local authorities such as Norfolk county council to do. I am pleased to see the hon. Member for North Norfolk (Norman Lamb) back in his place; he is the third Norfolk Member in the Chamber, so we are doing well. The legislation does not allow local authorities to deal with the demographics of the future. An enormous squeeze is coming down the line, not only in public spending-we all are, or should be, painfully aware of that-but in the number of people who will require such care in the future, whatever the incentives to provide it or to pay for it. The numbers are the key, but this Bill contains almost none. It certainly does not contain the numbers to allow us to scrutinise it properly. As the Bill is not connected to the bigger picture, it does not allow us to look ahead to the challenges coming down the track. I can but look forward to the day when the Minister looks up and gives us that bigger picture.
9.10 pm
| Next Section | Index | Home Page |