Examination of Witnesses (Question Numbers
880-899)
RT HON
ANDY BURNHAM
MP, MR DAVID
BEHAN AND
MS HAZEL
HOBBS
7 JANUARY 2010
Q880 Dr Naysmith: We have heard from
a good number of witnesses and have seen evidence to indicate
that there is a significant unmet need for social care services.
This is also related to the earlier point that there are much
better services in some parts of the country than in others, but
the question is that apparently the Department of Health does
not have any idea of exactly how much unmet need there is. Why
is this not properly monitored, and what will you do to find out
more about it?
Andy Burnham: That is a very important
question. We do have an idea. I think the up-to-date figure is
that there are about 300,000 people with substantial needs.
Q881 Dr Naysmith: That is a bit of
an estimate, is it not?
Andy Burnham: It is, but one must
also acknowledge that it is a product of the system that I described.
There is responsibility at local level for eligibility criteria
and the levels of support provided. That fluctuates according
to political decisions. It can then affect levels of unmet need
in any particular community. I take on board the point you make,
but it is a feature of the current system that levels of unmet
need can fluctuate according to local decision-making.
Q882 Dr Naysmith: But we hear there
are some authorities that do not even keep a record of people
who have unmet needs; they do a very quick assessment and just
tell people that they cannot do anything for them.
Andy Burnham: I do not want to
second-guess what the Committee will say about that, but I do
not find that acceptable. There is a statutory requirement to
keep people safe. Authorities need to be on top of that. I would
have thought that not just in practice but morally it is right
to ensure that an overview is taken of levels of unmet need in
the community because it can affect all public services, not just
council services but also the NHS. We see levels of unmet need
rising potentially if we do not reform the current system. The
estimate is that the number of people with unmet needs will go
up to 400,000. I agree with you. A huge driver of this reform
is that we do not leave that level of vulnerability out in the
community and then do not have an adequate way to address it.
Q883 Dr Naysmith: But you recognise
that it must be recorded properly so it can be assessed?
Andy Burnham: Yes. I give a personal
view here. This is the responsibility of councils and obviously
I am not here to dictate to them how they do their job, but the
thrust of what we say in the Green Paper is that there needs to
be a more national approach to these important matters in terms
of both assessment and entitlement. It follows that there is a
standard approach to how we deal with it based on the need we
identify through that process.
Q884 Sandra Gidley: We have had a
good deal of evidence about poor quality residential care and
Gerry Robinson's recent television series seems to confirm that,
although obviously that is only a snapshot. Why is there still
so much poor residential care? Are under-funding or staffing issues
to blame? Have you made any assessment of where it is going wrong?
Andy Burnham: Standards vary across
the system. As an MP I can recall some appalling cases of failure
in care homes in my constituency. On the other hand, the recent
CQC survey found that on the whole the picture was pretty good
and the vast majority of care homes and institutions provided
a good standard of care. I am sure the Committee has those figures.
The picture did not show deterioration but an improvement. I agree
there are some institutions where there are appalling failures
and unacceptable standards. Some years ago the government introduced
the Care Standards Act which provided a framework that did not
exist before, but these are issues about which I worry a lot.
You may have heard me say before that through my grandparents
I had personal experience of the care home system. It was not
acceptable. I worry about the investment in the social care workforce.
I believe Sir Jeremy Beecham in talking about domiciliary carers
told you that in many cases people were paid at or close to the
national minimum wage. Clearly, they do not have the opportunities
that exist in the National Health Service. For me, it is not necessarily
the case that operators are negligent or uncaring but we have
a system that is struggling to cope and when that happens standards
may not always be what we want them to be. I hope we are building
a consensus between the parties that we must reform the social
care system and find a way both to spend better the money we put
in to support vulnerable people and, if we can, bring in extra
money to raise the standards in our care service. The poor standards
to which you refer are I believe more a product of stretching
resources ever-more thinly with local authorities having to be
tougher with providers about the fees they can provide. We have
to reverse the situation and improve the overall offer.
Q885 Sandra Gidley: It is probably
fair to acknowledge that there has been some improvement in standards
but it has been slower than a lot of us would have liked. Obviously,
if some providers can provide a service one wonders why others
with similar money cannot. The Care Quality Commission has taken
over from CSCI. How will that new system measure quality rather
than do just a tick-box exercise that some of the previous systems
have been?
Andy Burnham: To give some figures,
77% were good or excellent in 2009 and that was an increase from
69%. I do not want to sit here and appear as though I have a downer
on those providers. I do not.
Q886 Sandra Gidley: I understand
there has been an improvement.
Andy Burnham: That is a fair point.
It means that about one quarter is not achieving those levels.
Rightly, you ask why they are not. They should be. To go on to
the new system of registration, obviously the idea is that it
takes a more in-depth look at care quality standards across any
institution. We are bringing forward the regulations to set up
the details of that process, but the aim here is to increase the
powers of the CQC to tackle those areas where there are serious
failings. To go back to my constituency experience and the old
CSCI system, I was disappointed by the approach which was almost
a slap on the wrist; there was a sense that the powers were not
as tough as they might be. When we talk about the care of elderly
or vulnerable people we need pretty tough powers to intervene
and sort things out and obviously that is part of what we are
trying to do.
Q887 Sandra Gidley: The former chair
of the Care Quality Commission, Baroness Young, told us that there
was a clear "gradient" in quality between for-profit
and non-profit providers. Do you accept that social care providers
could be putting profit ahead of quality? Is there any way that
the state can achieve a reasonable balance between the two?
Andy Burnham: I cannot speak for
them all but I hope not. I have no ideological objection to the
mixed market in social care that we have. There are excellent
private, voluntary or charitable providers; there are excellent
in-house or council providers. I do not believe that their status
should necessarily determine the quality of service they provide.
If there are examples where people clearly put profits and margins
before care or the basic job they are paid to do that is fundamentally
unacceptable. Clearly, the CQC is looking closely at that issue
and were it to take action against any organisations where that
could be proven I would back it wholeheartedly.
Q888 Dr Taylor: I want to ask about
the Green Paper consultation. When and how will you be publishing
the outcome? Are you allowed to tell us anything about the outcome
of the consultation now?
Mr Behan: I believe it would be
inappropriate to disclose the detail of the outcome of the consultation.
The contract for the analysis of the findings is with Ipsos MORI
and we expect a report from them soon. Our expectation is that
we will publish the outcome of the consultation later this year.
Q889 Dr Taylor: You say "soon"
and "later this year".
Mr Behan: We have contracted with
Ipsos MORI. We had over 28,000 responses and ran 37 stakeholder
events across the country, so we have a mass of feedback from
a wide range of organisations that we are analysing. We have asked
Ipsos MORI to undertake some of that high-level analysis for us
and are receiving weekly reports from them on the progress of
the work, but later this month we expect to get the final report
from them. We will then use that to inform the work we are undertaking
in producing the White Paper. We would expect to produce the outcome
of the consultation in accordance with Cabinet Office guidelines
on responding to consultation later this year. That is the process
we have been pursuing in the consultation and what we have had
back. It has been a massive response. Responses have been sent
in by key organisations. Over 24,000 that have come through are
in the form of electronic consultation and massive information
has been generated by our consultation events and the road shows
held throughout the summer and earlier part of the autumn.[1]
Q890 Dr Taylor: Were you surprised by
the extent of the responses? Looking at the consultation questions
I must say I regarded them as rather uninspired but somehow they
seem to have inspired interest.
Mr Behan: I believe there is huge
interest in the work and consultation. This is an issue that touches
the lives of many people. It became clear from the consultation
that the case for change, which we set out in May 2008, has largely
been accepted. I am thinking of the people who have given evidence
to the Select Committee in this inquiry. Many people have argued
that the case for change is accepted given the growing number
of older people because of the aging of our society and the increasing
number of younger people with disabilities who will require care.
The case for reforming the system and developing it has largely
been accepted. When people were drawn into the consultation and
responded to the events I think they began to engage with some
of the issues and key dilemmas. The very first key dilemma was
to do with a national system and people began to engage with that
and express a view. We have been delighted with the response.
Like all these things, we wish we could have penetrated more organisations
and people but the response has been fantastic. In terms of electronic
communication I believe it has been the greatest response that
government has ever had to any of its consultation. The quality
of what we have received from key stakeholders and organisations
has also been very high.
Q891 Dr Taylor: Therefore, our impression
that the big care debates had a rather low profile is quite wrong?
Mr Behan: To be truthful, I think
it is. There has been a fantastic engagement. When we have conducted
regional events road shows have been held on high streets. I have
been on a number of them, as has the Secretary of State. Thousands
of people in Newcastle came down the Haymarket and contributed
to the show. They stopped, filled in questionnaires, spoke to
people on the stall and engaged in the debate. We have used very
different techniques from those traditionally used by government
to engage a broader range of people and we are very pleased with
the response, but penetrating a wider range of groups beyond the
normal stakeholders and people who were using services is one
of the key challenges.
Andy Burnham: I did go along to
one of the sessions described by Mr Behan. The people we employed
to do this had a wonderful team who were very passionate about
the issues. They were just off the street meeting and talking
to people, capturing some incredible stories and reflections from
members of the public who were out shopping or on their lunch
hour. This happened up and down the country. It was well beneath
the radar of this place, but some fantastic work was done. The
extent to which they became inspired and enthused by what they
were doing was wonderful. They captured an enormous amount of
stuff just off the street.
Q892 Dr Taylor: So, the outlook for
translating these splendid words into action is quite good?
Andy Burnham: When I took on the
job I made this my top priority. I believed that the reform of
social care in this country was long overdue and we could not
flinch from it any longer. I made it my mission to get the Green
Paper published. Bear in mind that these are complicated and difficult
matters. As we all know, there are good reasons why politicians
do not want to touch them and probably in the past the issue has
been "it's all too difficult". I do not believe we can
carry on like that. When I was Chief Secretary to the Treasury
I kicked off the process in the spending review with the department
looking at the reform of care and benefits. I wanted the Green
Paper to be published and it was. I was very pleased by the level
of ambition in the Green Paper, although I acknowledged that there
were weaknesses in it. I referred to one of those in answer to
the Chairman. I want to create unstoppable momentum for a bill
in the next parliament which fundamentally reforms the funding
of social care in this country.
Q893 Dr Taylor: We were given the
quotation "unstoppable momentum" and from what you have
said you appear to have achieved it. It is encouraging.
Andy Burnham: I am not sure yet.
Bear in mind that we are going through the replies. I have indicated
that I want to publish the White Paper this side of a general
election. I believe that social care should feature prominently
in the top issues of the general election. I would encourage the
Wyre Forest Independent Party to include it in its manifesto at
the coming general election. I am not sure it has yet had its
conference and decided on the matter. I want to make it one of
the top issues so the country can debate these matters and there
can be a clear expectation outside of that general election that
the next parliament will legislate on the reform of social care.
As to the White Paper, it may be that opinions move on and people
will take a different view, but the departmental team led by Mr
Behan is a wonderful body of committed people. They have done
fantastic work on the Green Paper to bring us to this point. If
the White Paper can follow the very high standard of the Green
Paper it will provide the basis for reform of any kind that any
party chooses to make. That is what I am trying to achieve.
Q894 Dr Taylor: We can expect the
White Paper and the responses before an election, so your staff
must work pretty quickly. That is hopeful and encouraging.
Andy Burnham: This issue is like
Lords reform; it is bedevilled by momentum or lack of it. I do
not know whether colleagues want to come on to talk about the
Personal Care at Home Bill, but very much at the heart of that
measure is momentum. We have talked about it and decided to get
on and do it. That again is a key part of the momentum we are
trying to build. We are now going to take it forward.
Q895 Charlotte Atkins: You mentioned
weaknesses in the Green Paper. One of them can be identified as
lack of focus on mental health issues. One of the problems in
mental health is that it fluctuates and therefore it is quite
difficult to provide social care. Having said that, if mental
health problems are picked up early there can be a huge saving
to the state and it can give people who have mental health problems
a real chance in future to overcome them. Where do you believe
mental health fits into the social care agenda?
Andy Burnham: It is critically
linked, is it not? I would encourage you to look at the Green
Paper alongside the New Horizons document that came out last year.
One of the things about government is that it takes an issue and
deals with it in a very focused way and can often miss some of
the broader picture. But inevitably the media representation of
these issues talks about the elderly having to sell their homes
and other things and the costs of growing old and does not, frustratingly,
give due prominence to adults with disabilities who are an equal
part of the Green Paper. Obviously, those challenges can be mental
health, physical disabilities or sensory impairment. There is
a slight frustration there. It is not so much a matter of deficiency
in the Green Paper as some of the debate it inspires focuses almost
exclusively on the costs and care needs of growing old and not
enough on supporting adults with disabilities throughout their
lives.
Q896 Charlotte Atkins: It is not
just adults. There should be intervention almost at school level
where mental health problems start to emerge. In my local area
we have an excellent drop-in centre called Room 21 within Leek
High School where youngsters can come and discuss their issues.
There does not appear to be a general focus on how to pick up
these issues early.
Andy Burnham: I would debate that.
We have the Improving Access to Psychological Therapies programme
which in some areas has a particular focus on young people. There
are such services for young people, but the criticism you make
is a fair one.
Q897 Charlotte Atkins: There is some
excellent work going on but it is not sufficiently general.
Andy Burnham: Is it sufficiently
connected to other things we are doing? I think you are right.
This was an area that had not been properly prioritised but through
the work that has been done under the Improving Access to Psychological
Therapies programme we are beginning to put in place preventative
mental health services around the country. There was fairly good
progress on it last year and some PCTs focus particularly on services
for young people. An excellent piece of work is the Young Minds
manifesto. I acknowledge the need to connect all of these different
things, but the Green Paper is not condition-specific; it talks
about people with all social and personal care needs.
Q898 Chairman: On the need to reach
a consensus, clearly this morning you have made a pitch to get
consensus with the Wyre Forest Independent Party. Are you likely
to be holding any discussion with other political parties about
the content of the White Paper to try to reach a consensus on
the issue of funding of social care?
Andy Burnham: I would welcome
any such discussions. I said when I began that these issues are
so fundamental and touch so many lives that you cannot carry out
reform in a heated, polarised way. There has to be a settled consensus
in the country that whatever option is chosen is the right one.
Inevitably, we should properly have discussions with the other
parties to see how much we can agree and what is the difference
of opinion. Can one reform so far and then have different views
about the rest? When I say I want to make it an election issue
that is not overtly to politicise it in an unhelpful way, but
it is right that the country hears the debate about social care
and that the election lifts it up and recognises that the country
is growing older and this must be a big priority for any incoming
government. I believe that to be a healthy part of the democratic
process and the parties should have their arguments at that level,
but I would welcome any approach beneath that to discuss things
on a more consensual basis.
Q899 Sandra Gidley: I want to return
to "unstoppable momentum". You appear to believe that
the Personal Care at Home Bill was part of that, but other witnesses
before this Committee have regarded it as more of a diversion
hastily cobbled together which cuts right across the Green Paper.
Would it not have been better to wait until all the responses
were in and you had something that was complete and coherent?
Andy Burnham: I hear what you
say, but let me give you my version of it in which I believe passionately.
Social care does not stand still because we have a green paper.
Putting People First was an attempt to put some oomph behind
direct payments, personal budgets and the personalisation of services.
That is a very good piece of work. We have the carer strategy
and dementia strategy. Phil Hope has done wonderful work on all
of these fronts. As Charlotte Atkins said a moment ago, these
are complementary; they are building the national care service
reform as outlined in the Green Paper. Putting People First
is entirely consistent with that, as are the carer and dementia
strategies. In that category I would place the Personal Care at
Home Bill for two clear reasons. You say it cuts across the Green
Paper. I fundamentally reject that. First, a national care service,
with which I began, has to end the lottery and variation and give
national entitlement. Therefore, this Bill deals with the most
vulnerable people who at the moment face a lottery. For some their
domiciliary care is fully funded; for others it is part-funded;
and for others it is free because their council makes such provision.
The most vulnerable people in our society who have probably already
paid out of their own pockets significant amounts for the cost
of their own care currently face a lottery, so this Bill begins
the process of making the system fairer now for that group and
makes it a national approach for that group. That is fundamentally
one way in which the Bill lays the foundations for a national
care service. The second very important way in which it does that
is by the linkage between the offer of domiciliary care with re-ablement
and the emphasis on building preventative services in every local
authority area that keep people active and independent for as
long as possible. In that way this Bill builds the vision of the
Green Paper. It is consistent with all of the options in the Green
Paper because re-ablement is part of all the options. By pump-priming
the development of re-ablement services across the country we
are bringing forward the vision in the Bill. When we discussed
these issues as a cabinet in Building Britain's Future
and published the Green Paper shortly afterwards we lifted the
whole debate in government about social care and created excitement
about it. There was real willingness to move and put in place
some of the fundamentals consistent with any of the options in
the Green Paper.
1 The Department of Health has subsequently clarified
that the figure quoted should by 16,000. Back
| 
