| Previous Section | Index | Home Page |
Jeremy Wright (Rugby and Kenilworth) (Con):
It is a pleasure to follow my hon. Friend the Member for Norwich, North (Chloe Smith), because I agreed with a great deal of what she said. May I apologise to you,
Mr. Deputy Speaker, and to the House for missing part of this evening's debate? I was chairing a meeting of the all-party group on dementia. As the Secretary of State said, many people with dementia will be directly affected by what the Government propose.
I wish to start my contribution, as many have done, by applauding the Government's intention-it is right that we should do so. There are few more important issues than social care and it is right to make a start on this, but we cannot accuse the Government, over most of their term of office, of legislating with breakneck speed on it. The Wanless report, which asked a number of important questions about social care, was followed a considerable number of years later by a Green Paper that asked all those questions again, and now we have before us a Bill that proposes to answer part of one of them.
If the Bill is even to do that, it needs to deliver on its promises, and that is where I am in entire agreement with my hon. Friend the Member for Norwich, North and with others who have made this point. If the Bill is incapable of meeting the expectations that it has raised, not least by its title, it will be a cruel deception for those who are most reliant on social care and who will hope for most as a result of what the Government are proposing to do. That is why the uncertainty over the potential demand for free social care-the Government have not set out the terms of that in the Bill, but I hope that they will do so in the regulations that will follow it-is so important. This is about the unknown impacts on those currently funding social care themselves who may subsequently approach the state for free social care, of those who will not subsequently choose residential care as otherwise they might have done, and perhaps even of those in residential care who may choose to leave that care and return home to be cared for there-as we know, many prefer such an option.
As my hon. Friend said, if we do not know what the demand will be, we do not know what the cost will be. We have heard that the estimate of the cost for the first year is £670 million, £250 million of which is expected to come from local government efficiency savings-one can only imagine the joy with which that news was greeted in town halls up and down the land. The remaining £420 million is expected to come from the Department of Health's research and development, marketing and consultancy budgets. I refuse to believe that the Government spend anything like £420 million on the Department of Health's marketing and consultancy budgets, so a substantial amount of the sum must be expected to come from the research and development budget. I hope that the Minister will be able to reassure me, and the House, that that will not affect the crucial work that goes on, not least in the field of dementia, where we already spend too little on research. If we do not spend a great deal more, it is very unlikely that we will find the cure that we hope for or, failing that, effective treatments, which will reduce the demand on our social care system in the first place.
If there is a gap in funding-it is at the very least foreseeable that there might be, given the uncertainty, as we have heard, about the figures-who will pay for that gap? Will it be local or national Government? I rather agree with my hon. Friends who suspect that the answer is likely to be local government, once again. We must be sure, if that is the case, that it will be given adequate support to enable it to carry that burden.
Let me say a word or two about the detail of the Bill. I agree with many who have spoken that reablement-although I am with my hon. Friend the Member for Beckenham (Mrs. Lait) on the elegance, or lack thereof, of that term-is a crucial point. It is vital that we get people back into being able to deal with their own daily lifestyle needs to the extent that we can and to the extent that they can. However, I am concerned about the practical implication of that. It seems to me to be inconceivable that in order to move to a process of helping someone with reablement, there should not first be some form of assessment to ensure that they will benefit from the process. That means that there will be one assessment to ensure that somebody is suitable for reablement, a process of reablement and then another assessment, assuming that that is appropriate, to decide whether they are entitled to free social care under the criteria.
We all know that assessment takes a long time-we all deal with constituency cases weekly that involve long-running processes of assessment, assuming that there are enough people to carry out the assessments in the first place, as my hon. Friend said. We also have to assume that we are capable of withstanding the extra pressure on the system that will inevitably be caused by the extra demand for the extra social care provision. That will include many people who have substantial care needs, but not quite the critical care needs required for the free social care, who will ask and expect to be given a reassessment. A great deal more assessment will suddenly need to be done, and if that assessment and extra demand on the assessment system are going to cause further delay, that is a concern. There will be a big step between those who are assessed as having substantial care needs and those assessed as having critical care needs, in much the same way as we experience with NHS continuing health care.
Let us be charitable, however, and assume that we can establish whom we will be paying under this scheme and how we will pay for it. We still have to answer the question of what we will be paying for. I do not want to revisit the debate that we had last week on attendance allowance and disability living allowance, but the freedom to spend the money that one receives in the way that one chooses was crucial to that debate and, I suggest, it is important in this one, too. The Minister will have seen, as I am sure many other hon. Members have, that Carers UK, in its response to the Bill, which I accept broadly welcomed it, also expressed concern about the situation of those families where family members are prepared to offer care in the home but would value assistance with other things such as gardening, shopping, transport and so on. We have to ask whether the provisions will enable such families sufficient flexibility to have what they need rather than what the Government wish to give them. We come back to the question of how committed the Government are to their personalisation agenda, to which I fully subscribe.
There are broader issues, too, about what we pay for. The Minister has heard me talk before about what is commissioned. That point applies to residential care but, in this context, it applies particularly to domiciliary care. We must consider not only how we pay for this, but, alongside that, what we are paying for. We must ask ourselves whether commissioners are commissioning the right things and whether they should, as they do all too often now, be commissioning for blocks of time-such
as commissioning 15 minutes for a particular task-or whether there is a better way of commissioning good quality care. We have to ask whether it is acceptable for a different agency care worker to arrive on someone's doorstep every day of the week, when the advantages of having someone they know and trust and for whom they can leave the door open while they take the dog for a walk are considerable.
Those are substantial issues that are as fundamental as the question of who pays for the care that is delivered. That is why it is regrettable that we are dealing with these issues piecemeal and we do not have the opportunity to consider what is being provided on domiciliary care, as well as who should pay for it. This issue is, as others have said, too important to deal with in a piecemeal fashion. We should not have had to wait for 12 years, from when one Labour Prime Minister said in a conference speech that it was very important to deal with social care and that it would be a disgrace if we did not. Now, suddenly, because another Labour Prime Minister wanted an eye-catching initiative to fill a passage in a speech, we have to legislate in haste to make things happen.
A potential problem with the Bill is the fact that it has a big title but not much content beneath it. Aside from raising hopes unduly, it would be tragic if we were to miss the opportunity to discuss more substantially, even at the end of this Parliament, the big issues surrounding social care. Another problem with the Bill is the fact that it does not answer with authority questions about whom exactly it would help, how it would help them and how much it would cost to do so. It does not even try to answer the bigger questions that are thrown up by the social care debate for us all to address. That is a shame, and we could and should do better.
9.20 pm
Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): May I begin by apologising to you, Mr. Deputy Speaker, and to right hon. and hon. colleagues, for arriving so late for this important debate? I was in Blackpool with the Secretary of State for Transport, who was making a very important announcement in the town. [ Interruption. ] I could digress into the electrification of the Blackpool to Preston line, but I shall not. That is a debate for another occasion, especially as I have so little time.
It is interesting to follow so many Opposition Members, and I am heartened that there seems to be unanimity. I hope that that has been displayed in the essential focus on what the Government are attempting to do, which is to provide care at home, free of charge, to the people who are deemed to be in the most critical need and at most risk. I am surely not the only Member of Parliament who finds, when they speak to adults with disabilities and to elderly people who are in need of social care, that those people much prefer to be cared for in their homes. The more domiciliary care that we can offer to such people, therefore, the better. Lest anyone should misunderstand me, let me explain that I visit a lot of residential care and nursing homes, many of which are of a high quality. Representing a seaside town, as I do, I know that many people retire to the seaside and that some prefer to go into residential care when they are very elderly. The majority of those whom I meet, however, would much rather be supported in their own homes. That is why the Bill is so important. I have not met one such person who has disputed what we are trying to do.
Everybody that I have mentioned the Bill to fully welcomes it, so let us start from that premise and move on to the questions that we need to ask so that we can get things right. The hon. Member for Norwich, North (Chloe Smith) made that point. We need to get the issue right, and to do so we need clarity about the sorts of people to whom we are providing a service, how that service will be assessed and whether there is sufficient funding to pay for a quality service. I know that my hon. Friend the Minister cares passionately about social care, and he will also want to get things right and to ensure that those issues are addressed and explored in more detail as the Bill goes through the House.
I, too, want to place the Bill in the context of the Green Paper-an exciting document that cannot be seen in isolation. I disagree with Opposition Members on this point. It is a mistake to look at what has happened in social care simply through White Papers, Green Papers and royal commissions, because an awful lot has been happening on the ground. There has been a transformation in the delivery of social care with the whole personalisation agenda, direct payments and individual budgets. Also, the way in which professional social workers assess the needs of their client groups has changed dramatically. I want to ask the Minister how all those positive moves in the personalisation agenda can be carried forward in the Bill.
We need to look at the assessment and eligibility criteria. My hon. Friend the Minister is working closely with professional social workers and is doing all he can to raise their status. They need to know how they are to assess need under the Bill. Age Concern has produced a long list of questions, which I am sure he has seen, and he will know the sort of issues that are being raised.
If a person previously received a personal budget, what would happen to that budget? How will the personalisation agenda affect them? Will they still have a say about the intensive care they are receiving that will no longer be charged? If they are in that critical category, will their informal carers-family members-be able to have a say? The role of informal carers is important and their voice must be heard, but separately from the individual who is being cared for. That individual must have an assessment of their needs and the informal carer too should have an assessment of their needs. To pick up on the point made by the hon. Member for Rugby and Kenilworth (Jeremy Wright), we can do both: we can have an intensive package of domiciliary care for the individual who needs it, while also looking at the needs of the carer. I know of excellent befriending schemes, such as care and repair schemes that offer the gardening help he talked about, or that allow respite care for informal carers.
The Bill should not be considered in isolation, but as part of the package that is offered.
Jeremy Wright: I accept that we can do both, but there needs to be sufficient flexibility in the system to allow people to have what they want rather than simply to be given what they are expected to take. That is the concern.
Mrs. Humble:
But that is the whole point of the personalisation agenda, and why I very much welcome it. The hon. Gentleman and the hon. Member for
Norwich, North gave instances of poor service. We have all heard of individuals raised from their beds by people coming in at 6 o'clock in the morning-or at 10 o'clock in the morning or even 12 noon. People should get up when they want to and that is where the personalisation agenda came in. Individuals could choose their carer and tell them, "Right, I've got my personal budget and I am paying you to come in. This is when I want to get up. This is when I want to go to bed, and this is what I want to do in between." I hope the personalisation agenda will be a key process in the implementation of the legislation.
Appropriate links with the health service will also be a key element. I recently visited the Bispham nurse-led rehabilitation unit in my constituency where I saw excellent rehabilitation reablement work. My hon. Friend the Minister needs to look at linking the rehabilitation reablement work done in the health service with that done in social care. People with the intense needs covered by the Bill will be receiving support from both health and social care. The two organisations have to work together, not just on delivering integrated packages of care but also in the reablement process.
My final point is about funding. As somebody who spent 12 years in local government, seven of them as chair of Lancashire social services, I am well aware of the pressures on social services budgets. My hon. Friend needs to look carefully at ensuring that there is sufficient money in the system to deliver the quality services that he and I want. With that, I warmly welcome the Bill and I look forward to hearing my hon. Friend's comments.
9.29 pm
Mr. Stephen O'Brien (Eddisbury) (Con): It is interesting to follow the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), who is from Conservative-controlled Lancashire.
As the former Prime Minister, John Major, might have said, this is not an insignificant day. It was another former Prime Minister, Tony Blair, who promised at the 1997 Labour party conference that no one should have to sell their home to fund their long-term care. Twelve years on we are debating the first bit of relevant legislation. There were three Labour Back-Bench speeches, none from the Liberal Democrats, and no fewer than six from Conservative Back Benchers. If ever there was a true benchmark of care, that is it.
One question that Ministers must ponder is how they could do more through the Bill. Which? called it "a missed opportunity". The House will recall that the policy behind the Bill was announced by the Prime Minister in his speech to his so-called comrades at the Labour party conference. Cleared just 20 minutes before the Prime Minister's announcement, there was no hint of the policy in any of the preceding debate. It undermines the Green Paper process, and the speed of its gestation puts the policy on infirm evidential ground. Let us take, for example, the use of a blog as an authoritative source in paragraph 5.27 of the regulatory impact assessment:
"see http://healthcare-legislation.blogspot.com/2009/11/does-acturarial-value-trump-medical-loss.html".
Lord Lipsey, who sits on the Labour Benches in the other place, branded the Bill a "gimmick" and said that
"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."
If Ministers can churn out that policy in a couple of days and try to rush it through Parliament with only a single day in Committee of the whole House-patently a ruse to bypass questioning and to bang it through for, as some say, electoral purposes; surely not-and if they can expedite the Bill, could they not also, given that the Green Paper consultation has concluded, support legislation to address some or all of the other parts of the social care waterfront? As my hon. Friend the Member for Bournemouth, East (Mr. Ellwood) asked in a trenchant speech, "Is that it?"
One way that the Government could show their earnest in their call for a consensus is by agreeing to amend the Bill to bring into effect our home protection scheme, a policy that deals with another part of the social care agenda, for which the costs can be much more catastrophic to individuals than even those for the critical level of domiciliary care. We never claimed that our scheme would solve all the issues, but it is an essential part of such a solution.
The House must remember that the Bill deals only with those with critical needs. Those whose needs are substantial, moderate or low are ignored. It addresses only those who stay at home. Those who opt for, or have to go into, residential care are left out. In the Green Paper, the Government said that in 2012 there would be 6 million people with care needs. The policy that we are debating claims to help just 270,000, and even that figure has been called into question. It represents less than 5 per cent. of the total. The point was highlighted against his own Government by the hon. Member for South Thanet (Dr. Ladyman), who said that the Bill covered only a small part of care need, not the total architecture. It is our hope that the Government will expand the Bill's horizon and ambition.
The Government must do more to assure us that the Bill will not fall foul of the Human Rights Act. It has one of the longest depositions to the human rights committee that I have ever seen. The Government must work hard to suggest that it is not unfair to give people a differing amount of state support, depending on where they live. Many organisations, such as the Learning Disability Coalition, have expressed concern at the perverse incentive that the Bill could provide for people, who would be better in residential care, to stay in domiciliary care against all personalisation principles-the very issue about which the hon. Member for Blackpool, North and Fleetwood expressed concern.
According to the impact assessment, the purpose of the Bill is
"Funding care to those in need at the time of their need"-
close to what the Prime Minister said at his conference, and uniquely for a policy of this Government, seeking to provide peace of mind to everybody. However, the Government changed the purpose for the European convention on human rights sign-off to
"enabling, supporting and encouraging more people to avoid or delay entering residential accommodation".
The former and, some might say, real purpose of the Bill might well fall foul of the courts, so we need to ensure that the Bill does not proceed through the House on a flawed basis. That is just one more reason for more time in Committee than the proposed day on the Floor of the House.
| Next Section | Index | Home Page |