Social Care - Health Committee Contents


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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