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"In England we have come to rely upon a comfortable time-lag of fifty years or a century intervening between the perception that something ought to be done and a serious attempt to do it."
Perhaps that is a little harsh, but we all remember Tony Blair's pledge at the 1997 Labour party conference that he would sort out social care, and yet now, nearing 13 years later, the Government are still dealing with only a relatively small part of the overall picture, of the demand that has been coming from all quarters for many years.
Broadly, we have had a good series of discussions this afternoon. Time constraints have, however, been placed on us by the Government's somewhat bizarre programming decisions. This is not a free-vote issue, and nor is it a matter of national security, so it is puzzling that we have been given only this brief opportunity of one day to cover all the remaining stages of the Bill on the Floor of the House, rather than having the fuller scrutiny it would have received with a longer Committee stage upstairs and potentially a full Report stage. Frankly, we have ended up little, if any, closer to the clarity we need on some issues, such as the true costs of this measure-not only the basis for many of the estimates, but the costs post-2012 and the potential costs if the estimates are wrong. We expressed sufficient doubts to raise some serious questions about that. The Government have given little hope to local council tax payers and service users, who are set to bear the brunt of any funding shortfall.
The potential legal loopholes in the Bill are very worrying for the added costs they would bring, such as in respect of care homes restructuring, residential care qualifying as "home", and, of course, the human rights implications of the measure, which we have rightly discussed at length. A number of questions remain about reablement: who will get it, whether it is carer-dependent, and whether the costings are accurate and who will pay if they are not. Most disturbingly, the Government have refused to budge on their position regarding people with palliative care needs, although the discussion we had on that gives us some grounds for optimism that the situation may improve.
The proportionality of this legislation remains in serious doubt. The benefit estimated-that word again-by the Government is only £190 million a year, less than a third of the cost. The measure impacts on only 279,000 people, of whom 166,000 already receive care for free. It makes a difference to only 110,635, fewer than 2.5 per cent. of what the Government have said are the 6 million people in England with care needs.
The Bill makes no attempt to allow the whole gamut of social care to be addressed in the future. The Government have our home protection scheme before them. They have made various criticisms, but none of them amounts to anything other than the usual political rhetoric. As we have made clear, that scheme only addresses residential care, but their policy addresses some very narrowly defined domiciliary care. One could seek to put those two together and build a more consensual approach to trying to plug all the gaps and address the whole waterfront, as it were, of social care. In that, one can see the prospect of an opportunity for an approach that is a little less adversarial than, sadly, we have experienced, particularly in terms of the last group of amendments, which was a shame.
The Government have done little to reassure us that they know the meaning of the word "free" in terms of public policy: "free" means that somebody else pays. In this instance, they are pledging to cut money. A number of budgets have been mentioned, and they have sought to give rebuttals. We will study very carefully the rebuttal put forward at the Dispatch Box on research budgets, such as those targeting diseases such as dementia and cancer. There has also been a pledge to cut some money from the NHS IT programme. As Ministers are aware, I have been ferreting around, using parliamentary questions to try to get some answers, but the Government have never come clean about what contractual break clauses there are in NHS IT, or in some other contracts to do with the supply of swine flue vaccine, which I know my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State, looks forward to receiving in terms.
It was important to make sure it is recognised that the Government have not pledged to support this policy with money from the centre, other than some proportion of it. They are also relying on the efficiency savings they simply announce can be made from local government-a full quarter of a billion pounds.
Of course, I wish that the Government had taken the opportunity to look beyond the narrow confines of this particularly electorally inspired Bill, whose provenance was the Prime Minister's comments at the time of his Labour party conference last September. With the money resolution being as tight as it is, there was not the opportunity for them to undertake full and proper consideration, not least of our home protection scheme. We would have enjoyed having the opportunity to debate and propose that. However, that is how it is, and we recognise that it will be difficult to persuade this Government to do what we hope they will do, which is to bring together a number of us to try to find some way to deliver on the very legacy that the Secretary of State claims he is trying to secure.
The Secretary of State says that he seeks some "unstoppable momentum for legislation" in this area. It is impossible to know now whether the Bill will complete all its stages, given that it must go through the upper House and that we have no idea when the general
election, which must come before June, will be called. Thus we cannot be sure whether this Bill is "unstoppable" or whether it represents "momentum"-we are not even sure that it will be legislation. What we do know is that establishing unstoppable momentum requires a degree of consensus. If the Government genuinely wish to take that approach, I would be more than happy to be asked to participate in such a discussion, as I dare say those from other Opposition parties would.
As the measure goes strongly against what the Government set out in their Green Paper, we have faced the difficulty of trying to understand how to place the Bill in the context of the wider reform that so many of us seek and know must be addressed-our political generation has no option but to do that. In our consideration of this Bill in the time available to us, we have faced particular difficulty in understanding the true evidence that lies behind it and the calculations of the costs. A lot of us, including many outside this place, have had desperate concerns about the thoroughness and robustness of the impact assessment, even when the Government have sought to reissue some of the numbers. None the less, we have tried to give the Bill reasonable scrutiny.
Interestingly, the Bill may face its biggest difficulty when it goes to another place. The Government may well have a tougher time of it there, where they have some noble "Friends"-I assume that that word still applies-in Lord Warner and Lord Lipsey who have certainly, in comments to date, been squaring up for something of a fight on this. Lord Lipsey has called the Bill a "gimmick" and said that it is
"bad policy but also a very bad way to do policy just to find a...highlight for your Labour Party conference speech."
Who knows, perhaps everything has changed in Lord Lipsey's mind after the apparently rousing call to arms by the "Mr. I'm a team player" Prime Minister at the parliamentary Labour party meeting last night-we will wait and see.
In advance of what might be considered in the other place, what matters is that we have done our very best to try to unearth what truly lies behind this Bill and how it will in fact be made to work, given that it is proclaimed to service the needs of some-only some, not all-of the most vulnerable in our country. I am grateful not only to you, Mr. Deputy Speaker, and to all those who have assisted us in going through the process of scrutinising this Bill, but particularly to my many Conservative colleagues who have taken the opportunity to contribute to this extremely well-informed and responsibly discussed debate on an important matter.
9.23 pm
Dr. Ladyman:
For a relatively small group of people across the country who are struggling at home with a high level of care need and who are worried about the cost of that and whether they can continue to live in their own home or will have to go into residential care, this Bill will transform their lives. We need to put things in context, as I have attempted to do all the way through these debates, by saying that that group is relatively small. That is why this Bill, despite being good and worthy of support, is only the next step in the reform of social care. It is not the first such step and it is important to emphasise that over the past 12 and a bit years many
advances have been made in the provision of social care. One that the Opposition continually fail to mention is the fact that if someone goes into care and does not want to sell the family home that they have lived in, local authorities now have the money to put a charge on that home to pay the social care debts after that person's death. The reason why so many people still sell their family home against their will is that Conservative councils and, I have to say, Liberal Democrat councils all around the country forget to tell people about that benefit that is now available.
That is not the only social care reform. Extensive efforts have been made to upgrade the status of the social care work force, to qualify them, to ensure that the regulation of social care is fit for purpose and to ensure that appropriate training is available to people who work in social care. Measures have been taken to improve the methods of discharging people from hospitals so that there is no longer bed blocking and to ensure that social care provision is available for people in the community when they need to be discharged from hospital. Reablement schemes are available around the country and improvements have been made to the provision of services and to the integration of services between the NHS and social care. Efforts are also being made to extend the availability of telecare and of extra care accommodation. I remain disappointed by some of the comments made by the Opposition about extra care. If, as they say, they are approaching this Bill in an open-minded spirit and if they want to approach me, I will happily take them to see some extra care accommodation and to see the benefits that such care can provide to people.
All the measures that have been put in place so far have been the first steps in improving social care provision in this country, but the Bill that we are discussing today is only the next step on that path. The biggest step of all remains in front of us: we need to fold all those measures together into the comprehensive social care package that we know we have to face up to. In my view, it will necessitate some form of co-payment and some method of bringing in extra resources from the population. I said on Second Reading that my preference would be a hypothecated inheritance tax, and I shall continue to reiterate that until somebody takes the idea seriously. Whether we use that solution or some other insurance-based solution, a solution will have to be found. We must find a solution to how we can get local councils to assess people's care to ensure that packages are portable and to agree on how they will be funded so that they are funded to the same level around the country. That will have major implications for localism and the role of local authorities in the future.
These are huge issues that will have to be addressed-and addressed they must be-but this Bill is nevertheless a valuable contribution to that process. It will radically transform the lives of that group of people with high levels of care needs who want to stay in their own homes. For that reason, this Bill is absolutely worthy of the House's support, but only with the caveat that we should all commit ourselves to taking the next step as soon as possible.
9.28 pm
Norman Lamb:
It is a pleasure to follow the hon. Member for South Thanet (Dr. Ladyman). I absolutely agree with his last point: we must all commit ourselves
to finding a sustainable, long-term solution that meets the needs of all those with care needs and not just the small group whom this Bill addresses.
Let me start by making it clear that there are two other points on which we all agree. I am sure that we all agree on the absolute importance of the idea that any reform should facilitate people's remaining in their own homes for as long as they can. For the group of people who will benefit from the Bill, that will clearly be the case. We must ensure that that principle is at the heart of the final reform that we achieve.
The second absolutely important principle, which this Bill addresses, is the value of reablement. The Bill recognises that at present we do not do reablement well enough. There are patches of good practice around the country where authorities have been able to demonstrate the enormous potential savings and, more importantly, the dramatic improvement in people's lives of committing properly to reablement. However, in too many parts of the country reablement is not provided well enough. At its best, the Bill provides an incentive to the system to ensure that reablement takes place. That is a good thing.
Following the debates today and on Second Reading we still have three core concerns, the first of which is affordability and sustainability, particularly given the trend towards an ageing population. We used to be attacked by the Government for our previous commitment to free personal care. Two years ago, we removed that commitment. I took a paper through our party conference, because I reached the conclusion that one could not, in reality, argue the case for free personal care given the demographic changes that we are witnessing. The Green Paper recognises that point, but the Bill shifts in that direction. That causes me real concern, because the cost of the duty to provide free care to the relevant group of people will keep rising.
The Government have set a cap on the amount that they will contribute, so the other potentially pernicious impact is that if the rest of the funding has to come from local authorities as the numbers continue to increase, something else will have to give. My fear is that, owing to this duty, other vulnerable people who benefit from care from local authorities on a discretionary basis will end up losing their care, or part of it. If the demand is higher than the impact assessment has concluded, the impact will again be on local authorities here and now, and the potential consequences could be very damaging.
Our second core concern is that the proposal is a partial solution. I think that everyone recognises that. The Government's case is that it is a bridge to reform, but as long as it remains the only reform to have happened, and until we have more comprehensive reform, it will have perverse consequences. As the right hon. Member for Charnwood (Mr. Dorrell) has made very clear, it will provide an incentive for local authorities to push people into care homes. That is not a good thing, because it will change behaviour and will benefit one group of people but not another. Another perverse incentive was mentioned on Second Reading by the hon. Member for South Thanet-it will provide a disincentive to people who are considering insuring to protect themselves in old age.
Another danger, or consequence, of the fact that the proposal is a partial solution is the inherent unfairness in the Bill. Why should we choose to support and provide free care to one group of people-those with
critical need who are cared for at home-but not another group who, through no fault of their own, end up having to have their critical needs met in care homes because they simply cannot be cared for at home? That is perverse. Why should one group benefit and not another? The Government have provided no answer to that.
Our third core concern is whether what is proposed would be the most effective use of public funds. The Green Paper strongly makes the case that in any reform we have a duty to ensure that we use public funds to the best possible effect to achieve the best outcome for all those who have care needs, but the Bill does not do that. The impact assessment confirms specifically that the group of elderly people who would benefit most from the proposal would be the wealthiest.
The Secretary of State for Health (Andy Burnham) indicated dissent.
Norman Lamb: The Secretary of State shakes his head, but the impact assessment makes that clear. At paragraph 5.21, it states:
"The recipients of free personal care are believed to fall into the bottom, 2nd and 3rd quintiles because even the wealthiest older people (who represent the main beneficiary group) are in the middle of the income distribution of society at large."
In other words, the wealthiest elderly people are not the wealthiest people in society, but they are the main beneficiaries of the Bill. I find it bizarre that a Labour Government should choose to use available public funds to benefit most the wealthiest older people, given that there are many others with acute care needs. The conclusion must be that that is not the best use of available public funds.
I am also concerned that the Bill has been oversold by the Government. The Minister again quoted a figure of 400,000 for the total number of people to benefit from free care, and that of course includes those who would benefit from reablement. However, when one looks at the number of new recipients of free care at home, the real figure is 110,000. The Government do not use that figure at all in their pronouncements.
The Government say that the Bill protects the care of those currently receiving free care, but it is hard to envisage circumstances in which those in critical need who are benefiting from care on a means-tested basis would lose that care. Therefore, it is somewhat disingenuous to argue that there is some great benefit for that group. The new recipients of free care will total just 110,000. As the hon. Member for South Thanet made clear, that is a relatively small group, compared with the total number of people with care needs who will have to be supported in any final reform of the system.
Finally, I find that it strains the use of language to describe this Bill as a bridge to reform. As a sceptic, the hon. Member for South Thanet made the best possible case for supporting the Bill but, whatever happens to it, we must all be committed to a more fundamental reform of the system. I think that we are all agreed on that.
I want to repeat the case that I made on Second Reading. In this pre-election period, there is a real and overwhelming need for all parties to put aside their differences and to join in a process charged specifically
with building and achieving consensus on this matter. I know that that would be supported massively by those groups outside Parliament who represent people with real care needs. Such a consensus would have the benefit of facilitating reform in the next Parliament, and it would also put pressure on whoever wins the next election to ensure that reform takes place.
The hon. Member for South Thanet is absolutely right to say that the urgency of completing the reform process is overwhelming. We must not allow this Bill to delay that.
9.38 pm
Mr. Tom Clarke: I think that I have listened to every speech and contribution made today, and I have found them extremely stimulating. Far from objecting to the Committee stage being taken on the Floor of this House, I take the view that we ought to do this much more often. I do not think that it takes away from the scrutiny performed in Committee upstairs, but I believe that people might get involved in what we do here to a greater extent if we had more of the transparency to which this Bill has been subjected today.
I welcome the Bill, and I also welcome the contributions made by the Minister of State, my hon. Friend the Member for Corby (Phil Hope). A few harsh things have been said about him, but I have many relatives in the steel industry down in his area and they will be supporting him. They do not say that he does not distinguish his post, because he so clearly does. I am sure that they are proud to have him as their Member of Parliament.
Briefly, I should like to thank the House for the involvement of people with learning disabilities. For all those who will benefit because they need personal care at home, the Bill is progressive, meaningful and welcome.
Although we heard threats about what might happen in another place, I hope that people such as Lord Morris and Lord Ashley and many others there will recognise the progressive nature of the Bill and will see that the Government and many organisations have welcomed the provisions. I believe that they will welcome the fact that at this stage in our Parliament we have given such prominence to something so profoundly important. I hope that that will be a beacon and a signal of the relevance that we give these matters in the next Parliament, when I expect to be speaking from the same spot.
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