Examination of Witnesses (Question Numbers
920-939)
RT HON
ANDY BURNHAM
MP, MR DAVID
BEHAN AND
MS HAZEL
HOBBS
7 JANUARY 2010
Q920 Dr Taylor: That is reassuring.
Obviously, you have moved away from constant disability prevalence
and incidence which the department has tended to use in the past?
Mr Behan: We have.
Q921 Charlotte Atkins: You ruled
out funding social care entirely from taxation as that would mean
a significant tax increase for working age people. Should you
not ask the public first before you make that assumption? To go
back to the point I made earlier about people with mental health
difficulties and those with disabilities who are of working age,
it is not just an issue of working age people funding those who
are elderly and are post-retirement age.
Andy Burnham: We have asked people
their views; they guided the debate somewhat in the Green Paper.
It has not stopped a good number of people telling us that they
thought they should have had that as part of the available funding
options. People have told us that and obviously we shall consider
it in future, but to make reform happen you must take things forward.
The work done by the King's Fund and others has established the
principle of partnership here. The state should provide so much
and the individuals should contribute. I believe there is a consensus
out there among the political parties of some kind that social
care should be a partnership. We are very conscious that it would
not be right to ask the working age population to bear all the
costs of social care. The test set by Mr Behan and his team was
that this reform should be inter-generationally fair, if that
make sense; it should be seen to be a fair reform that works across
generations. Bear in mind that with the bill since the Green Paper
we have increased the tax funding. You can argue about how you
set the level of tax as opposed to individual contributions in
any system. We believe that the principle that the individual
should make a contribution is the right one and it should not
be funded just through general taxation. That is a view to be
challenged, but experience from other countries shows that that
is how most fund social care. I believe the Committee heard evidence
to that effect.
Q922 Charlotte Atkins: But why does
your version of a partnership not include the idea of matched
funding which Sir Derek Wanless suggested as a way to encourage
people to save for social care costs?
Andy Burnham: Essentially, as
a 50-50 partnership?
Q923 Charlotte Atkins: I believe
he suggested a state contribution of 66%, so it would be a bigger
contribution from the state.
Andy Burnham: Obviously, that
is a reasonable point. It is always a question of affordability
and we can realistically do without creating a system that would
not be sustainable in the long term. The work in which I have
been involved in government is as good as I have seen in terms
of the quality of thinking behind it and the long-term perspective
that officials apply to it. One always wants to do more but one
must make it affordable and sustainable. I hear what you say.
Maybe a true partnership would be 50-50 or, as you say, an even
greater contribution. It is a balancing act and a matter of getting
help to those who most need it and giving help to those on the
lowest incomes by providing universal entitlement. Those are trade-offs.
You could provide less support to the most needy either financially
or in terms of their condition and then raise the entitlement
for everybody. That would be a political choice but these things
must really be considered in the round.
Q924 Charlotte Atkins: A political
choice was made in 1948 with the creation of the NHS. Why should
it be different for social care?
Andy Burnham: First, it is a different
issue. People accept that they have more personal responsibility
for living their lives and the things they do in life, for example
getting round the house. I believe people accept that they have
a greater responsibility for themselves in that way, whereas healthcare
is something they cannot do for themselves. A family can do social
care for somebody; as an individual you can do it yourself, whereas
with healthcare often you cannot do it because you need experts
and a different way of providing it. It is a different area and
it lends itself more naturally to a voluntary or partnership approach.
My vision in terms of the reform very much adopts those principles
of the National Health Service that we cannot let some people
face the catastrophic costs of care. It may be one in 20 or 25,
whatever the figures tell us. It is not right to leave people
to face catastrophic costs which any amount of informal care cannot
deal with. Going forward and thinking of affordability, life has
moved on fundamentally from that post-war settlement. I would
look at my own family and describe it in this way. Whereas my
grandparents and lots of others in the North West did not in that
era own their own property, my mum and dad do. There has been
a big change from then to now in places like the North West. My
parents were not university-educated; they did jobs that might
be described as ones requiring manual skills. They own their own
property outright in a way that their parents never did. That
applies to many in my own constituency. Figures show that those
over the age of 45 hold 80% of the total net assets of the UK
in terms of property. Enormous sums of money are held by the over
65s. It is a changed world for the older population today. Even
those who in the past never did own their own homes now do so.
Having a discussion with them about how some of that income and
wealth can go towards creating a fairer system for everybody is
not unreasonable.
Q925 Dr Naysmith: Ms Hobbs, the government
has suggested that disability benefits might be reformed by being
incorporated into social funding. Can you explain briefly what
these benefits are for, who receives them currently and what the
rationale might be for integrating the two systems?
Ms Hobbs: The two main benefits
paid to older people on account of disability are Attendance Allowance
and Disability Living Allowance known as AA and DLA respectively.
Both benefits are paid to help with the extra cost of disability.
Attendance Allowance is not assessed and paid on the basis of
somebody's medical condition or a particular diagnosis but the
extra help needed for personal care. The big difference between
the two benefits is one of age. You can claim Attendance Allowance
only after age 65 whereas DLA is available to people who are disabled
right from childhood. That allowance has an extra element that
is paid on the basis of mobility if people need help getting around
outside the home.
Q926 Dr Naysmith: How is the eligibility
for disability benefits assessed? How does that relate to eligibility
assessments for social care, and will that not cause a bit of
a problem?
Ms Hobbs: As the Green Paper said,
the two systems have a very different history and different bases
of assessment. Disability benefits generally go to a much wider
group than social care, so in England there are 1.4 million people
who receive attendance allowance and a further 625,000 pensioners
who receive DLA. The assessment process is largely a paper-based
one; it is administered centrally by the Pension, Disability and
Carers Service, an agency of the DWP. People generally fill in
a claim form by post, phone or online these days. The assessment
looks at a whole range of things and picks up mental health issues
as well as physical constraints. It will ask people about help
they might need to get dressed and so on. There is some commonality
there and my colleague Mr Behan may wish to say more about the
process for assessing social care. The assessment asks about some
of the same things but the outcome is different. Benefits are
paid at set amounts and are nationally consistent. The process
is much more one of determining whether somebody meets particular
criteria in which case that individual receives the same amount
of benefit. There is a relationship between benefits and the way
local authorities deliver social services. The two organisations
work together but the eligibility criteria are different.
Q927 Dr Naysmith: Disability benefits
can be described as passport benefits which entitle claimants
eligible for other entitlements to make a claim if they have the
first benefit. Can you explain how that works and tell us whether
people will lose out if the passport benefit is removed?
Ms Hobbs: That is right and it
is certainly one of the areas we have picked up in our discussions
with voluntary organisations and representatives of disabled people.
At the moment Disability Living allowance and Attendance Allowance
are used as a passport to a wide range of help, not just within
the benefits system. It can range from things like help at leisure
centres. The Blue Badge scheme is often mentioned. DLA and AA
can be used as a passport to a whole range of help. In this context
there are two issues about which we are most concerned: first,
the fact that it acts as a condition for the receipt of carer
benefits. If somebody has an informal carer, in order to receive
carer benefits the person concerned must be caring for somebody
who is receiving certain rates of DLA or AA. Second, people can
get top-ups on their income-related benefits if they are disabled
and receive DLA or AA. The most common example is Pension Credit.
People may get a severe disability premium on top of his or her
pension Credit. In the Green Paper we have said that if decisions
are made on a funding settlement that change the way benefits
work at present we shall want to look at a range of options to
replicate the help that people currently receive and find a different
and appropriate way to build that link. For example, in April
of this year new arrangements on the pension side will come into
force. They are designed to give extra help to carers. That has
a different link in place; it looks at whether somebody is caring
for 20 hours a week or more. That can be certified in a whole
range of ways by a health or social care professional. If changes
are made to benefits the important message is that we would look
to replicate the help in a different way.
Q928 Dr Naysmith: You can understand
why this has been one of the most controversial aspects of the
discussion and why people are concerned about it and it must be
sorted out properly. We as MPs have lots of people writing to
us about it.
Ms Hobbs: I am sure your postbags
have been busy on this issue. Very clear messages have been sent
out which we hope have allayed some of the concerns that have
been expressed. First, we have said that nobody who is currently
receiving benefits will lose out; he or she will continue to receive
the same level of cash support. Second, we have ruled out any
changes to Disability Living Allowance for people under age 65.
I believe that has helped to explain the position to people. We
are not talking about taking help away from people without replacing
it with something else. We want to make sure that the new national
care service provides the same kind of help to the same people
in appropriate ways.
Q929 Dr Naysmith: Mr Behan, is there
anything that you want to add?
Mr Behan: As Ms Hobbs says, the
basis of the assessments in social care undertaken under the fair
access to care services criteria looks at people's needs. One
of the essential differences in the assessment of benefits is
the issue of risk. You could have two people who need help with,
say, washing and dressing but the risk posed for one person might
be different from that posed to the other. I go back to your very
first question about the availability of informal carers. In a
sense they identify some of the differences between the two assessment
systems, but the vision in the Green Paper is of an integrated
assessment system that draws together assessments undertaken under
the benefits system and those undertaken under the care system.
Andy Burnham: The proposal is
to have an independent expert group to develop the integrated
assessment that takes stuff from the benefits side and the local
authority side.
Q930 Sandra Gidley: We have just
heard that disability benefit reform has been ruled out for those
under 65, but that still leaves older people. Why does age matter
in this?
Andy Burnham: For the reason I
gave just a moment ago. Obviously, we are looking at a reform
that deals with the cost of growing older. The DLA system as I
understand it is a different benefit; essentially, it is one that
recognises that disabled people do not have the same earning potential
throughout their lives. There is very soundly-based research that
often they receive about 70% of the average income of somebody
else. That system works for that reason and it does a different
job; it is compensating people because they have not had the same
earning opportunities, whereas the costs of growing older are
different. People work throughout their lives and develop assets.
As they grow older they have care needs. I believe there is a
consensus that there should be some kind of partnership between
the individual and the state to deal with those needs as they
get older, hence the difference.
Q931 Sandra Gidley: But there are
a number of allegations of age discrimination in social care.
Will not the abolition of disability benefit for older people
just compound that?
Andy Burnham: I certainly hope
not. We made a very powerful statement and we hope that social
care and the NHS will be subject to the provisions of the Equality
Act by 2012. That was not necessarily an easy thing to do. It
is not a token statement but a very important one. As we are an
aging society it is absolutely right that we should have equality
of treatment for all people. I agree that vigilance on this very
issue is required, but the principal argument is that this is
what we should do. In terms of the age range proposals in the
Green Paper our legal advice is that they are not discriminatory
in any way.
Q932 Sandra Gidley: Even taking into
account the proposed change in legislation?
Andy Burnham: Yes.
Q933 Sandra Gidley: Mr Behan, Professor
Ruth Hancock told us that 86% of older people receiving disability
benefits receive no social care services and less well off people
are more likely to claim these benefits. Would not any proposed
changes penalise such people by focusing all the resources on
the very high-dependency cases currently served by the social
care system? Obviously, if you are trying to prevent people from
having more acute needs later that seems to be a bit of a problem.
Mr Behan: No. As a result of the
consultation officials in the Department of Health and the Department
for Work and Pensions continue to have exactly these debates about
the distributional effects. In essence what we have accepted is
that Attendance Allowance is used by some people to make arrangements
to be supported often outside of the social care system and the
support does maintain their independence. That is the root of
the answer given earlier by Ms Hobbs about no one losing out and
ensuring that in any future system that support continues to be
available. We have taken cognisance of the fact that Attendance
Allowance is used to provide a low level of support. We continue
to work on the "distributional effects" of the changes
proposed.
Andy Burnham: I believe you have
taken evidence from Imelda Redmond to the effect that some people
receive benefits and council support; some receive either one
or the other; and some receive neither. That is the essence of
the problem here: there is one system looked after by Ms Hobbs'
department that has one way of looking at things; we have a different
set of criteria that councils and local authorities apply, and
in the middle there is a level of unmet need. The essence of the
reform is to match money to need and reduce the level of unmet
need.
Q934 Sandra Gidley: Is the idea to
help people who probably do not get what they should get from
the system at the moment?
Andy Burnham: What we are trying
to do is match resources to need in a better way.
Q935 Charlotte Atkins: A good deal
of fear has been created on disability benefits. You have said
there will be no cash losers but is not one of the issues in relation
to Disability Living Allowance and Attendance Allowance that they
are not means-tested and therefore people see it as a sort of
buffer? There is real concern about any change in that system.
People know that they have the Attendance Allowance and Disability
Living Allowance and they are not means-tested in any way. What
would be the transitional arrangements? What do you plan to do
if you look to change the system? A huge amount of fear has been
created, some politically generated, and this is perhaps your
opportunity to make it clear to people that this is not at risk
and any transitional arrangements will not put them in a situation
where they will have to be means-tested for these sorts of benefits?
Andy Burnham: I agree that some
very vulnerable people have been frightened by scurrilous and
unacceptable campaigns. All they have said is that benefits will
be withdrawn but they have not explained the situation. It is
not as if it is to be taken away. That is fundamentally unacceptable.
We can only have this debate about reforming social care if there
is a measure of moderation in the language of all parties; otherwise,
we will not get past first base and it will raise anxieties. The
bodies interviewed have said that there are anxieties among their
wider membership which I fully understand. Do not raise those
anxieties unnecessarily by misrepresenting the reforms as I think
the Conservative campaign has done. It is one thing to disagree
with the principles that we are building here; it is quite another
to suggest that the benefits are taken away and nothing comes
back. You say this is my opportunity to explain it. The only reason
for doing this is better to support more vulnerable people. We
are not on a Treasury mission to take it away; we are intending
to do a better job of looking after vulnerable people in our society.
We believe that we could do a better job if there was a more integrated
approach between the benefits side and the social care side. In
doing that we believe we can empower those people and give them
greater control over their lives. It is deeply disappointing to
see these kinds of campaigns being run. I do not mind meeting
any of those bodies who say that there is concern among their
members and ask us to tell them more about it. Legitimately, we
felt that the "no cash losers" side of the reform was
an important thing to say because those are fair concerns and
people need answers to that question, but it is quite another
to have "take away your benefits" campaigns.
Q936 Charlotte Atkins: Can you guarantee
that in future no one who qualifies for disability benefits under
the current system will receive less under the new one?
Andy Burnham: At the time of reform
I have said that no existing recipient of DLA or AA will receive
any less cash support, nor will they lose any control over their
ability to spend that. To say more than that is to second-guess
the White Paper. At this stage a Green Paper looks at different
ways of doing it. I am not being evasive or reluctant to tell
you what we have in mind; it is simply that we are not at that
point. If all parties are serious about reforming social care
in my view we cannot completely exclude from it Attendance Allowance
because then you are not building a solution that is a full reform
of the system; you are not providing even a sticking plaster.
Either the Conservative Party is a proper player in this reform
and wants a serious debate about it or it mounts cheap, scurrilous
campaigns running up to the election. It must choose which it
wants to do.
Mr Bone: I am certainly not here to indulge
in party politics; that is not the purpose of this Select Committee.
I think the Secretary of State said that effectively there would
not be any losers in terms of existing recipients within the system.
That implies that of those people who would qualify in future
there will be winners but also losers, so in some circumstances
people will be worse off in future.
Q937 Chairman: I thought the Secretary
of State said he would be second-guessing the outcome of the White
Paper if he went into any detail about the future, which is quite
a reasonable thing to say in the circumstances.
Andy Burnham: Earlier Charlotte
Atkins asked whether the partnership option should be set up.
Should not the minimum entitlement for everybody be set higher?
That is a very fair question. That is a policy choice, is it not?
You could set the minimum entitlement for everybody at or above
the level at which people could not receive either AA or DLA.
You could make that choice, but please do not say I am implying
anything. We have not made those decisions.
Q938 Mr Bone: Secretary of State,
I did not mean to put words into your mouth. Having listened to
what you said I thought that was the implication of it. I now
understand what you are saying is that no decisions have been
made on that point.
Andy Burnham: Of course not. We
have had a Green Paper and consultation. I have said that we are
working towards the White Paper when the government will make
firm proposals for reform, but we are not there yet.
Q939 Dr Naysmith: You want to bring
cash benefits into social care and replace social care services
with cash payments. Would it not, therefore, make much more sense
to transfer responsibility for social care from the Department
of Health to the Department for Work and Pensions?
Andy Burnham: It is true that
the changes are happening more on our side in many ways, in that
more and more social care support replicates cash benefits. There
is a merger going on here, is there not? It is this side that
is coming closer to the other. Perhaps a weakness in the Green
Paper was that the principle of cash control which would be absolutely
embedded in the national care service was not sufficiently explained.
We have to deal with the fear that someone's benefit will be removed
and given to the council. We want to build a system that carries
forward all of the empowerment that comes with a cash benefit
and plants it at the heart of the national care service. That
means in the interim seeing further progress down the route of
direct payments. Some 3% of overall spend on our side is currently
in direct payments. Some councils are much further down this route
than others. We want everyone to see the direction of travel and
get on with it. This side is merging more towards that side rather
than vice versa.
| 
