Examination of Witnesses (Question Numbers
874-879)
RT HON
ANDY BURNHAM
MP, MR DAVID
BEHAN AND
MS HAZEL
HOBBS
7 JANUARY 2010
Q874 Chairman: Secretary of State, welcome
back to the Health Committee. Perhaps I may ask you and your colleagues
formally to introduce yourselves.
Andy Burnham: Thank
you very much. I am Andy Burnham, Secretary of State for Health.
Mr Behan: I am David Behan, Director
General for Social Care in the Department of Health.
Ms Hobbs: I am Hazel Hobbs, senior
civil servant dealing with disability and carers' benefits in
the Department for Work and Pensions.
Q875 Chairman: This is the seventh
and last evidence session of the Committee's inquiry into social
care. Secretary of State, it has been argued that the current
limitations of social care services place an unfair burden on
many informal carers. What should be the balance between care
provided by the state and that provided by family, friends and
neighbours?
Andy Burnham: That is a massive
question. Perhaps I may begin with an acknowledgement that I do
not believe the Green Paper talked enough about carers and how
this reform might benefit them and remove the burden from them.
The experience today of carers up and down the country is that
there is good support out there, albeit variable, but often they
face a real battle to get that help particularly when they look
after those with severe needs. Life is a battle. Looking back,
we were probably very good on the technical nature of the arguments
for reform but we need to explain better as we move towards the
White Paper how this reform will benefit carers by providing more
control, the ability to call down services when they are needed
and the ability to invest in a better trained and more motivated
workforce. I believe that all of those are really important issues
that need to be elevated in our consideration as we move towards
the White Paper. As to the balance, we must acknowledge that whatever
we do in any reform of social care in this country must be based
on the bedrock of family, friends, communities and neighbours.
I do not think that as a society we can function without that
bedrock of informal love, care and support that helps people through
the later stages of their lives or adults with disabilities in
the earlier part of their lives. What is the right balance? That
is really what we are trying to discover in our consideration
of all the options. We issued the carers' strategy two years ago.
The balance and fairness as it affects carers must be an important
part of our consideration as we get to the final analysis. There
must be a contribution by the individual giving time and energy
to support loved ones. We know that is what they want to do, but
the state needs to do more to make life tolerable for them so
they can care and raise their own children or go to work and I
believe that today we are not doing enough in that regard.
Q876 Chairman: Some commentators
have said that the more care the state provides the less incentive
there is for family and friends to care. What is your view? You
are telling us this morning that where there is a greater role
for individuals because of the severity of the needs under those
circumstances the state needs to care more, but does it disincentivise
families from helping?
Andy Burnham: I do not see it
that way. We have to make life tolerable for them; we have to
give those carers a certain quality of life through this reform.
This is not about replacement and if one looks at the demographics
and the public finances in the long term it just cannot be. It
would be wrong from a policy as well as a moral point of view
to suggest that the country cannot make that vast contribution
through informal care and support. Why should the state move into
that territory? That is the proper preserve of families, relatives,
communities and neighbours. But one must make it tolerable for
those who want to provide that informal support to do it and give
them support when they need it so they can have lives themselves.
In particular I am very struck by some of the stories I hear about
young carers and the life chances they lose through the support
they give. What more can we do to let carers do what they want
to do as loving family members but at the same time not stifle
their own opportunities in life? When the White Paper emerges
it needs to be more expansive on this point.
Q877 Chairman: Referring to the Green
Paper, our evidence shows great variability in the level of social
care support between different areas. Sometimes in neighbouring
local authorities there is a great difference. Are you not bound
to choose the option in the Green Paper of a fully national system
on the basis it is the only way to address that?
Andy Burnham: Not necessarily
because all of the options we have put forward are consistent
with a national care service. Obviously, the political judgment
is about how big one builds that national care service. Under
the partnership, the insurance and comprehensive option, one can
have national assessment and entitlement. Obviously, the question
is: entitlement to what? That takes one into the question of how
big one makes the offer. I agree with you. In recent times there
has been a lot of fashionable talk about localism and giving people
the ability to run things at local level. I believe that often
the public do not want a postcode lottery certainly for healthcare
but also social care; they want clarity about what they can expect
and they want it to be fair across all areas. I believe that the
case for national entitlement and assessment is very strong. I
am very encouraged by the stance of the LGA. When Sir Jeremy Beecham
was before you he did not argue against that. I believe that in
that context he had an issue about the word "service",
but he spoke of a national care guarantee. I welcome the fact
that local government also embraces that. As you rightly say,
because of pressure on finances councils have moved towards the
substantial or critical end of eligibility criteria in terms of
where support is provided. I was told by Mr Behan a few days ago
that only one council in the country provided support in all care
categories. As things get harder people retreat to the critical
and substantial end and that creates real unfairness and variation
across the country.
Q878 Chairman: It was reported in
last month's Health Service Journal that the government
intended to overcome poor co-ordination of health and social care
services by placing social care effectively under the control
of primary care trusts. Is there any truth in that?
Andy Burnham: I believe that story
was overwritten. I do not know the source of information for that
story. Obviously, the Green Paper talks of different delivery
structures: a national system, a part-national and part-local
system or a local system. As any green or white paper process
proceeds people test ideas and models, but to say there has been
a policy decision or decision in principle on a takeover is quite
wrong. Members of the Committee will recall when I sat on their
side of the table. I am an integrationist on health and social
care. Chairman, your esteemed predecessor convinced me of that.
Dr Naysmith will remember well the inquiry into delayed discharge.
We spoke at length about these issues. He convinced me that we
needed a more integrated system of health and social care in this
country, so I was won over then. That does not mean a takeover
by health or local government. In the coming period in the National
Health Service I would feel very comfortable about PCTs increasingly
merging functions with adult services. We already know that there
are some shared chief executives. Knowsley is one and there are
other examples round the country one can move towards integration
without it being a takeover and I believe that in that regard
the HSJ has overwritten it.
Q879 Mr Bone: Is there a danger in
executives of whatever political colour wanting to get their policies
enacted and removing powers from local government because over
a period of time local government tends to go to the opposition
parties? Therefore, if you move it to the primary care trusts
you move the policy into the power of the executive and away from
local authorities. That seems to be an attraction for every executive,
but do you not see the danger that therefore everything becomes
controlled nationally rather than local authorities and politicians
making decisions?
Andy Burnham: I understand the
point you make. I think you imply that that may have formed some
part of our thinking, but I can assure you it was not. There is
good reason for the health service being organised in the way
it is so you do not have fluctuation. When you talk about services
that are critical—often they are sophisticated in nature
or are specialist tertiary services—I do not think that
for any community they can be subject to the ebbs and flows of
local opinion; they need to be on more solid ground. When it comes
to social care there can be greater local expression, variation
and a mixed economy and that is the way it has developed in this
country. In times past when it has been difficult financially
one of two things occurs: either health and social care pull apart
and become very precious about the boundary or they can say that
they are all in this together. We have a common goal here and
we need to pool our resources. Recently, in the operating framework
we said we did not want PCTs to be "policing the boundary".
I am very clear about that. There is more evidence than when I
was won over to this particular cause. You can help social care
work together more closely as partners without it always being
seen in the context of a takeover of one side by the other.
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