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Westminster Hall

Thursday 10 November 2011

[John Robertson in the Chair]

backbench business

Social Care Funding

Motion made, and Question proposed, That the sitting be now adjourned.—(Mr Vara.)

2.30 pm

Sarah Newton (Truro and Falmouth) (Con): It is a pleasure to speak under your chairmanship, Mr Robertson, as it will be to speak under Mr Bone’s chairmanship later. I thank hon. Members for coming along to the debate. Given the importance of the debate in the main Chamber on armed forces personnel, the level of support in this Chamber shows how important this topic is to our constituents and to people throughout the country.

The question of who pays for care has vexed politicians for decades. There has been no shortage of good ideas, based on evidence garnered from the many Government reviews and commissions over the years, but there has been a failure in political will, resulting in only limited action being taken. However, demographic change and its impact is now an issue moving rapidly up the political agenda. All parties have signalled a desire for a long-term, all-party solution to the care crisis. It is clear that now is the time for us to take action.

During the debates on the Health and Social Care Bill, there was little dissent from the view that the integration of health and social care is a good thing. In the Budget debate, there was no opposition to NHS money being given to councils to integrate services. The Care and Support Alliance, made up of more than 52 major organisations representing older and disabled people, those with long-term conditions and their families, has come together to support reform. Polling evidence from ICM last year showed that 62% of the public saw care reform as one of the most important issues for the Government to focus on, and more than 50% of people felt that political parties were not doing enough to work together to improve care for older people. There is therefore a clear mandate from the people whom we represent to work together to find solutions to the problems.

The coalition Government clearly understand, and are committed to reform. They set up the Commission on Funding of Care and Support under the leadership of Andrew Dilnot, who was supported by Lord Norman Warner and Dame Jo Williams. Their report, published in May, described the care funding system in England as “not fit for purpose” and needing “urgent and lasting reform”. From our constituency work, we all know that there is great uncertainty and that people are worried about the future, but most people are realistic. Just as they know that they should save for their old age, they know that they will need to make contributions to the cost of their care in later life. They crave a clear path, set out by the Government, that shows them how the costs will be fairly borne—how they will be divided fairly

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between themselves and the state. Above all, people want to be relieved of the fear and worry about the availability and quality of care as well as how they will pay for it should they need it.

Penny Mordaunt (Portsmouth North) (Con): I congratulate my hon. Friend on securing the debate. Does she think that our constituents are also ambitious about what they want care in the future to look like, and that the challenge for the Government is not just about finding ways to fund what currently goes on, but about considering how we meet the massive unmet need in dementia care, for example? I am thinking of bathing facilities and all the other things that we want our constituents to have but that too many of them do not have access to at all.

Sarah Newton: My hon. Friend makes an excellent point about the fact that there is inconsistency across the country in the quality and type of care available. The best care, which some people experience, should be available for everyone. We all want that for our constituents. As people in their 50s grow older, they will have far greater demands, which will be different from those of the generation now in their 90s or over 100. They will be looking to technology and innovation to come up with a range of services that will support them in leading life to the full, and in living healthily and productively as part of society, for as long as possible, so I agree with my hon. Friend’s point.

We know from our debate in this Chamber last week on the quality of care that elderly people experience in some parts of the NHS and from other care providers that the vast majority of people of all ages want elderly people and people with disabilities to be shown far greater kindness and respect. The commission says that the main failings of the current system are that it is confusing, is perceived to be unfair and is unsustainable.

Glyn Davies (Montgomeryshire) (Con): I thank my hon. Friend for allowing me to intervene, particularly as I have indicated that, unfortunately, I cannot stay for the whole debate, which I had wanted to do. I hope that we can emphasise the point that as people are living much longer, it is an exponential curve. The incidence of dementia and Parkinson’s disease means that the need is far greater than a simple look at the graph would suggest. The cost is going to just take off. We need a Government policy that deals with that and recognises the huge changes that we will face.

Sarah Newton: My hon. Friend makes a very good point, reminding us that people are living much longer, because the causes of mortality that prevented people from living so long in the past—especially cardiovascular disease and some cancers—are now more survivable, so people suffer from other conditions, which are sometimes far more complex to live with and to treat, especially diseases such as dementia and Parkinson’s. The fact that people are living well into their 80s and 90s and beyond 100 presents new challenges for the NHS and a range of other services—indeed, for society as a whole—so my hon. Friend makes a very good point.

The commission goes on to say that most people are unable to plan ahead to meet their future care costs. Assessment processes are unclear. Eligibility varies according

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to where people live, and there is no portability if people move between local authorities. The provision of information and advice is poor, and services often fail to join up. All of that means that people and their families often do not have a good experience.

Neil Carmichael (Stroud) (Con): My hon. Friend is absolutely right in what she has said. One of the key tools is integrating the NHS with social care, so that we can have a much more seamless approach to caring for people, and they understand where they can go for support. I am talking about breaking down the unnatural barriers between local areas, as well as about the funding that is necessary and a more transparent understanding.

Sarah Newton: I am sure that that is right. It is certainly a point that the Dilnot commission and people who have responded to it have made. They are very supportive of the Government’s plans to integrate social care with the health service.

It is a major worry for most families that they cannot protect themselves against the very high costs of care. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) pointed out, looking after people with dementia can involve very considerable costs. However, the availability and choice of financial products to support people in meeting care costs is limited.

Fiona Bruce (Congleton) (Con): Does my hon. Friend agree that one of the highest priorities for the allocation of funds should be to support those families who care for elderly relatives at home? They often make great sacrifices and incur great costs. We must ensure that we give them the recognition and appreciation that they deserve, and one way in which we can tangibly do that is by ensuring that they have clear access to support from funds. Often, a very small amount of funding can make a big difference to those families and can ensure that they are able to continue caring for their relatives in their own homes for much longer. Should we not be treating that as a priority?

John Robertson (in the Chair): Order. That was a very long intervention.

Sarah Newton: My hon. Friend the Member for Congleton (Fiona Bruce) makes her point very passionately, as she always does, in standing up for the family. Of course, it is the family who take full responsibility in most cases for the care of elderly people, but we must remember that the funding of adult social care is also available for adults living with disabilities. Families are the foundation of all care at the moment. I am sure that, with the Government’s support, they will continue to be the core building block of the care system. She is quite right to raise that issue so that we can all show appreciation for the huge army of people who are quietly getting along each day to provide invaluable support to their loved ones.

The commission made a series of key recommendations. I cannot do justice to the report in the time that I have available, but to help our debate, I will summarise them briefly. The major one is to cap the lifetime contribution that an individual needs to make to adult social care

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costs to £35,000. Not everyone will be able to afford to make a personal contribution, so the commission recommended that means-tested support should continue and that the asset threshold for those in residential care, beyond which no means-tested help is given, should increase from £23,250, as it is today, to £100,000. Those who enter adulthood with a care and support need should immediately be eligible for free state support.

The commission also recommended reconsideration of the existing benefits that support the elderly. People should contribute to their living costs, which the commission estimated as between £7,000 and £10,000 a year. It recommended that the Government should urgently develop a more objective eligibility and assessment framework and that they should encourage people to plan ahead for later life with an awareness campaign, and develop a major new information and advice strategy to help people when the need for care arises. Carers should be supported by improved assessments, which should take place alongside the assessment of the person being cared for. Finally, the Government should review the scope for improving the integration of adult social care and other services, such as NHS services and housing, to deliver better outcomes for individuals and better value for the taxpayer.

The commission’s report was met by a broad coalition of support from a wide range of stakeholders and was warmly welcomed by all political parties. That contrasts with the acrimonious debates on the issue during the general election campaign. Since the report’s publication, the Department of Health has committed to consult on the recommendations and to consider other important recommendations proposed by the Law Commission.

The Government have recognised that they must take urgent action to address the current funding issues. While real spending on the NHS has risen by £25 billion since 2004, spending on social care for older people and adults with disabilities has simply not kept pace. Figures from the Department show that over the past four years, demand has outstripped expenditure by 9%. Since the coalition came to power, it has clearly understood that that balance in expenditure is wrong. Money for the NHS has been redirected to councils so that they can spend more money to support families, elderly people and adults living with disabilities to live independent lives. Additional money has been allocated for a range of support to enable people to remain safely in their own home and for adaptations that prevent accidents and illnesses that lead to people having to spend time in hospitals.

Heidi Alexander (Lewisham East) (Lab): I congratulate the hon. Lady on securing the debate. She is talking about the additional resources that have been given to councils from the NHS budget. Will she reflect on the scale of cuts that local authorities are dealing with when setting their overall budgets? Does she feel compelled to comment on the claim that that is giving with one hand and taking away with the other?

Sarah Newton: The hon. Lady makes a fair point. We all understand that local authorities have had to make some major decisions about the allocation of resources and their priorities in serving their communities. I am proud of my council in Cornwall, which did not cut one penny from adult social care funding last year. In fact,

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this year, that funding could increase by £3 million or £4 million, although the council has not yet finalised its budget. It is very disappointing that some councils—although not all—have not used the money for such important purposes. It is estimated that approximately 7% has been cut from adult social care budgets across the country.

We have begun to see the effects of the withdrawal of the key services that the money should be funding, and which have been designated to prevent health problems among older people. The withdrawal is contributing to a far greater pressure on hospital beds. Delays in the discharge of people from hospitals are significantly higher than they were in the same months last year. Over 75% of delayed transfers for acute care are for people aged 75 and over. Research by Age UK and WRVS will be published in the next month or so, and it will provide evidence of the impact of councils not using the additional funds that they have been given by the Department effectively and of the additional pressures that that has put on hospitals and families.

Penny Mordaunt: Does my hon. Friend agree that whatever the size of a council’s budget, we need to ensure that it makes best use of the money? Some poor commissioning practices have gone on, discriminating against independent providers such as the Alzheimer’s Society and Age UK, which not only do a better job at a lower cost, but can rely on enormous amounts of volunteer and carer support and a whole raft of other stuff. We must ensure that there is a level playing field for those people.

Sarah Newton: I agree. My hon. Friend makes that important point extremely well. Local authorities and the NHS have had a silo mentality on commissioning. Undoubtedly, funds that could have driven up the quality and choice of care to support people have been wasted. I hope that the reforms that the Government are setting in train will overcome those issues. When the health and well-being boards come into play, if they link up properly all the providers in a community and set the agenda for commissioning services to improve health outcomes, they could have a powerful impact and achieve some of the things that my hon. Friend has highlighted.

In this debate, when we are talking about the budgets of the NHS and of local authorities, we must never forget that it is families who care for their grown-up children with disabilities or for elderly family members. Informal carers provide more support than any Government could ever afford to pay for. The most recent research from the charity, Carers UK, estimates that there are more than 6 million carers in the UK. The care and support that they provide to help people remain safely in their own home are valued at a staggering £119 billion per year, which is far more than the annual cost of all aspects of the NHS. Support to carers must be central to the future provision of services. It is informal carers, families and, in the majority of cases, women who worry most about cuts to services that enable them to help and care for their elderly and young family members.

Who pays for care is just one of the questions that the Government’s reforms of social care must address. There are issues of quality and regulation of services, training and pay for those working in this sector, as well as

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choice. The Government’s reforms need to look at finding solutions that work for different generations. Young people who will be saving for their old age and auto-enrolled into pension schemes could be incentivised to make an additional contribution each month to an insurance policy that will pay for their care later in life should they need it. The package of reforms developed by the commission has been welcomed by the financial services industry, which sees opportunities to develop new products to enable people to pay for their contributions towards the costs of their care.

The Dilnot commission’s package of reforms to support families in their caring responsibilities will require an extra £1.7 billion a year—a figure that will rise with an ageing population. Whether or not the commission’s reforms are implemented in part or in entirety, it is clear that more money needs to be found for social care and NHS integration. While I do not underestimate—I am sure none of my colleagues in the Chamber do—how difficult it will be to find that sum during this Parliament, constructive ideas have been given to the Treasury on how that spending commitment could be achieved without increasing taxation or borrowing more money. Consideration should also be given to removing the upper age limit on national insurance contributions, which could raise £3 billion a year, and to further reform to pension tax relief for higher-rate taxpayers.

Fiona Bruce: Should consideration not be given to reviewing the planning regulations when families seek to build extensions to their homes? There are far too few multi-generational homes in this country, yet there are some pedantic planning regulations to which local authorities strictly adhere without recognising the wider value to the community that such extensions can bring.

Sarah Newton: That is a good point and it should definitely be considered by those responsible for reforming planning policies.

We all have an important role to play in building momentum for change, contributing constructive proposals and trying to build consensus for vital change. I hope that this debate provides the Minister with a welcome opportunity to hear the concerns and constructive ideas of hon. Members from all parts of the House as he develops his White Paper.

I was particularly pleased when the Backbench Business Committee allotted me this date for my debate. It is the eve of Armistice day, when we remember all those who have served their country and made the ultimate sacrifice. As there are so few survivors remaining from the first world war, our thoughts and prayers naturally turn to those who are serving in conflicts around the world, particularly in Afghanistan. Many of us will also be thinking of the survivors of the second world war. There are some 11.7 million people living in England today who survived the second world war, and they make up 22.5% of the population. We owe a great debt to that generation for our freedom and for the way of life that we enjoy today. Rationing ended in the 1950s, so that generation really understands what an age of austerity means. For those of us who were born after the war, it is our turn to show not only our respect for them but that we have not forgotten their sacrifice. We must take care of them as they grow older.

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Over the 50 years in which we have enjoyed peace in most of Europe and a growth in prosperity, we have singularly failed to make preparations for the care of that generation. The welfare state was a great post-war legacy. However, there are gaps in funding in the main provisions—the NHS and pensions—as increases in life expectancy have been consistently underestimated. It is essential that we make lasting reforms to the welfare state so that it can deliver on the promise made to the generation that created it.

2.52 pm

Barbara Keeley (Worsley and Eccles South) (Lab): I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on securing this debate and on the way in which she opened it. I am sure that we all agree with her final comment about caring for those who served in and lived through the second world war. It is important that we not only debate social care here, but ensure that a much wider debate on the current and future funding of social care takes place across the country.

The Dilnot commission was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support. No one here today will be able to go into too much detail about the report, but I should like to talk about some of the things that the report confirmed, including things that have been repeatedly said about social care for years. These are some of the key points. The current adult social care funding system in England is not fit for purpose and needs urgent and lasting reform. The current system is unfair and unsustainable. Without reform, it will deliver ever poorer outcomes for individuals and families. The funding of social care is inadequate—people are not receiving the care and support that they need. Indeed, there is an unacceptable level of variation in eligibility for services; we have 152 different adult social care systems. For a number of years, care has been rationed through the fair access to care system, but that system is now seen to lack transparency, consistency and clarity. Assessments for care are not portable. Given the variations in eligibility, the problem causes frustration and worse than that when people needing care have to move to a new local authority.

The provision of information and advice is poor quality and very limited. People struggle to find financial information and advice, and there is little information and advice for carers. While there are significant overlaps between funding streams for housing, benefits, the NHS and social care, the systems that administer them are not joined up, which means that we do not have integration, that we have poor co-ordination and that people have to suffer multiple assessments. Perhaps worst of all—Andrew Dilnot rightly drew attention to this—the system is so complex and difficult to understand that most people do not plan for or think about the future provision of care that they may need. I am sure that many right hon. and hon. Members will have had cases of constituents who thought that social care was free and were shocked when they discovered that it is not and that they will be faced with paying the costs of care.

All those points are a disturbing appraisal of the system of care and support on which millions of people depend because they are frail, elderly or have a disability

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or long-term condition. We have known about all those problems for some time and I have spoken out on these issues since I came into the House in 2005, with a variety of different people filling the role that the Minister now occupies.

In 2009 and after much consultation, my party brought forward plans to establish a national care service. Given the pressing needs of those people with the greatest care needs, we also passed the Personal Care at Home Act 2010 to provide free personal care at home for the 400,000 people with the greatest care needs. It was not a perfect solution, and I do not think that anyone thought that it was, but it would have provided financial peace of mind to 400,000 individuals and their families.

My party’s proposals were treated as political footballs during the general election campaign. There were some regrettable political attacks on the proposals for social care, which was unfortunate.

Glyn Davies: Does the hon. Lady not accept that the way in which those proposals were treated before the last general election was massively damaging? I was not a Member of Parliament then, but I was ashamed of some of the language that I heard coming out of the House. It is wrong to attribute the matter to any particular party. If we are going to deal with this issue properly, we have to set aside that sort of language because it serves no purpose and damages our reputation with the public.

Barbara Keeley: Indeed. As ever with interventions, that was almost the next thing that I was going to say. I was going to say that the whole incident was unfortunate. I am chair of the all-party group on social care and I want to see a consensus built in this Parliament to take forward a solution to the funding of care and support, so I very much agree with the hon. Gentleman.

We must set our minds to the fact that, this time, the debate must be different. We need to build consensus across the parties and across the country. The need for a solution is more pressing than ever. We know that requests for support are increasing. In 2009-10, there were 2.1 million contacts from new clients to social services, an increase of 4% from 2008-09 and of 8% from 2004-05. We also know that many hundreds of thousands of people never have their needs assessed.

At the Health Committee this week, I asked a question of the president of the Association of Directors of Adult Social Services about levels of unmet need. He seemed unable to quantify it. How can we plan for provision of social care if we do not know the levels of unmet need? Research by Age UK showed that 82% of local authorities now provide care only to those with “substantial” or “critical” needs. I am glad to say—I think that the hon. Member for Truro and Falmouth also has a council in her constituency that is perhaps doing a bit better—that my own local authority, Salford city council, is among the 18% of councils in the country that still provide care for those with “moderate” needs.

I welcome the commitment of my Labour council colleagues to try to meet the needs of the more vulnerable members in our communities. I understand how difficult the position is, but I value all those councils that are rightly taking the decision to protect social care. We know that vulnerable people in other areas are not so fortunate. Recent studies by the Office for National Statistics and the Economic and Social Research Council

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Centre for Population Change have looked at the issue of unmet need for social care. The centre concludes that, regardless of the data source used

“there is significant unmet need for care among older people.”

It gives the example of a group of people aged over 65 who needed help with bathing. Of that group, 66% were not receiving any help with bathing. That example was based on 2008 data. Since 2008, we have had front-loaded cuts to local authority budgets, which will have caused greater levels of unmet need.

My hon. Friend the Member for Lewisham East (Heidi Alexander) referred to local authority budget cuts and now the Association of Directors of Adult Social Services has reported £1 billion of cuts to social care budgets in 2010-11, with a similar or greater level of cuts being predicted for next year. What impact those cuts will have is of concern to us in Parliament.

The NHS Confederation reminds us that when people’s needs for social care are not met, they turn to the NHS. The NHS Confederation says that that will mean increasing numbers of unscheduled and emergency admissions to hospital, as well as delayed discharges from hospital. Indeed, recent figures from the Department of Health show that the number of delayed discharges from hospital was 11% higher in September and October this year than in the same two months in 2010. Clearly, delaying discharges from hospital is an expensive solution to the problem of inadequate social care. Indeed, the NHS Confederation says that, without reform, the NHS will ultimately buckle under the pressure of demand from patients who need social care.

The problem of unmet need is getting worse and of course much of the extra burden will fall on unpaid family carers, many of whom are already overburdened. I will cite two examples of unpaid family carers that Carers UK has told me about.

One is Eric from Lancashire, who has cared for his wife, Diane, for 20 years. She has multiple health conditions and needs constant support. Eric had to give up work 15 years ago to care for her full-time. When his local council provided 10 hours of support each week, Eric could get out of the house, have some time for himself, do the shopping and even do some volunteering with local charities. Earlier this year, however, council cuts meant that Eric and Diane’s care package was cut in half, despite the fact that Diane’s health has not improved. Eric is worried about his own health, because he needs to use all of the time that he has free from caring for Diane, which is now only five hours each week, to run basic errands, and he no longer has any time for himself. We can all imagine how difficult that must be.

The second example is of an unpaid family carer who is in perhaps an even more difficult situation. Joyce, aged 58, cares for her husband Robert, who is 71 and has dementia. She gave up work as an accountant four years ago to care for Robert full-time. With their savings and Robert’s military pension, they are over the means test threshold for local authority support. Robert is doubly incontinent, and easily confused and distressed, so he cannot be left alone. Just to go to the supermarket, Joyce has to pay £12 an hour for a sitter. For longer breaks, she has to pay £18 an hour for specialist care. Paying for a day of replacement care or for a weekend away means that costs escalate, because Joyce has to pay for multiple care workers and even a nurse. It is important

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to note that the charges that Joyce is paying have risen by 20% during the past four years. Joyce gave up work to care for Robert and her only income now is from the carer’s allowance of £55 a week. She knows that residential care, when Robert needs it, will cost thousands of pounds a month, which makes her very fearful of the future.

I said earlier, and I think that it is the case, that there is clear agreement that our social care system is no longer fit for purpose and that reform of the funding system is overdue. However, the important point is that none of the people I have referred to in those examples would be helped with their current issues by the Dilnot report’s recommendations, because they offer little for overburdened family carers who are caring for people at home.

A report by the Strategic Society Centre suggests that the “capped cost” model recommended by Dilnot will pose a dilemma to policy makers and could create resentment among family carers. Carers such as Joyce save the state many thousands of pounds by providing informal care. However, when the person they care for enters residential care, they will still be liable for the first £35,000 of care costs. That does not seem fair.

The recommendations of the Dilnot commission are an important step on the path to reform, but we must look widely at what is needed. We must focus on the gap in funding, which exists under the current system as well as in the projections of future funding needs. We must also have the widest possible debate on the options that are available. It seems that there is a problem in getting a debate on these issues that is wide enough to build the consensus that Members from all parties have talked about in Westminster Hall today.

I know that the Minister who is here today is involved in an engagement exercise and that leaders from the care and support community are helping to lead those discussions. However, I want to ask whether and how we can debate this issue more widely. There are 6.4 million carers who have a stake in the issue. There are 1.6 million staff who work in the provision of social care, which is more than the number of staff in the NHS. We should perhaps not be surprised that those people find it harder to be in contact with MPs and Ministers to give their views. They do not have the time in their busy and pressed lives to go along to consultation events; it is very difficult for them to do so. It says much about the isolation of carers and of the staff who work with people who need care that they have few opportunities to get together and put forward their views and comments, so it is our job to find out about that, and to talk to and build a consensus with those people.

After the launch of the Dilnot report, the all-party group on social care asked how the public debate on future funding of social care would develop. We asked a Health Minister—it was Earl Howe, as the Minister who is here today was unable to attend that meeting—whether Andrew Dilnot and the other commissioners could continue to play a role, and whether the secretariat for the commission would continue.

In July this year, I, as the chair of the all-party group on social care, and the chairs of 11 other all-party groups associated with social care wrote to the Prime Minister, the Health Secretary and the Minister with responsibility for social care, who is here today. The MPs and peers in those all-party groups stressed the

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need for action. We asked the Government to accept the urgent need for reform, but we also asked them to provide resources to support meetings across the country to promote the debate on social care, facilitated by members of the Care and Support Alliance, which is the umbrella group of more than 50 charities that represent older people, disabled people and those with long-term health conditions, as well as their families.

As we have already heard today, the future of social care is of national importance and it should involve the millions of people who depend on social care and the staff who provide care services. Can the Minister tell us what resources the Government will allocate to promote the debate on social care, including providing support to the members of the Care and Support Alliance to run meetings and take the debate forward?

Finally, can the Minister update us on the level of commitment that he believes exists in the Government and more widely to take forward the issues that have been raised today, and to take action to deliver what we said in our letter to the Prime Minister and others we want to see, which is a fairer system of charging for care that is matched by a financial settlement for local authorities so that they can deliver that fairer system?

3.6 pm

Neil Carmichael (Stroud) (Con): Thank you very much, Mr Robertson, for calling me to speak. It is a great pleasure and honour to speak in a debate such as this, and I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate to bring the issue of social care to our attention. As she said herself, the debate is also extremely timely, because tomorrow, of course, is Remembrance day and it is absolutely right that we remember those who achieved so much for the cause of freedom and for this country during the world wars and indeed afterwards.

I want to echo the point made by the hon. Member for Worsley and Eccles South (Barbara Keeley), who is the chair of the all-party group on social care. She made the point that we need to think very carefully about social care funding and that it is important to take an all-party approach to it, because it will affect many people for an extremely long period. We are talking, obviously, about elderly people, but everybody gets old and this is a long-term policy, with long-term implications.

We have to embed a set of policies—a framework, really—that can last, because one point that keeps coming up when we discuss the funding of social care is that we do not really know how to plan and we do not know, as individuals, what sort of structures will be in place; consequently, many individuals do not plan. The Government have a huge opportunity effectively to create the reasons why people can plan for their retirement and, as they arise, their care needs.

As other speakers have suggested, Dilnot makes it clear—or at least, implicitly clear—in his report that the sort of measures that he is talking about, including the ceilings that would apply before people have to pay for care and so on, will effectively create a situation where people are planning financially for their forthcoming care needs. We need to remind everybody of that when we discuss this issue in increasing detail, as a White Paper and so on arrive on the table.

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In my constituency, I visit care homes quite frequently and I have often been asked to meet people who have just celebrated or are about to celebrate their 100th birthday; a huge number of people in my constituency reach that age. When I first started visiting them, it was really quite an honour, because members of my family never get to 100—although, obviously, they are going to.

Kelvin Hopkins (Luton North) (Lab): The hon. Gentleman could be the first.

Neil Carmichael: That is very kind. [ Interruption. ] Hon. Members are all very optimistic.

Glyn Davies: It might be a good point to throw into the debate that, a fortnight ago, I visited a woman who was having her 108th birthday. The interesting thing about her—I think it contributed to her longevity—was that she had been a member of the Conservative association ever since she was allowed to join in 1928.

Neil Carmichael: Well, we certainly have experience in our Conservative association back at home. An interesting thing about my constituency is that I came across somebody who was 106. She wanted to make a complaint and she came up to me at some speed. I did not think it was anything to do with the care she was getting, and it was not: she had received a birthday card from Her Majesty the Queen every year for the past six years, but unfortunately she had received the same one each year, and she wanted a different one.

As that story shows, we have an ageing population, and that brings challenges, of which dementia is obviously one. More and more people are experiencing dementia, not just because they have it but because a family member has, and that can be just as challenging. We need to prepare the ground because an increasing number of people have dementia.

Mrs Helen Grant (Maidstone and The Weald) (Con): One million people will have dementia by 2025. Does my hon. Friend agree that this terrible disease must have a proper place in any funding review or funding reform?

Neil Carmichael: That is exactly the theme I was about to develop, so I will simply agree with that excellent point.

In my constituency, we are promoting the “Write it Down” campaign. If somebody thinks they or a member of their family is getting dementia, but they are not quite sure, it is a good idea for them to write down sequences of events, because that will trigger a recognition or an acceptance that they or their loved one are forgetting things. The campaign is gaining quite some traction in my constituency, and I recommend that hon. Members promote it in theirs. Gloucestershire is getting quite a lot of accolades for the campaign, and families are successfully using this tool to diagnose dementia, which, we should remember, is not an easy thing to do.

I want to talk briefly about carers. Their role has been mentioned, and rightly so, because they do an enormous amount, and their numbers are huge. A fact that is sometimes overlooked, however, is that a lot of carers are surprisingly young, and some still go to school. We need to bear that in mind.

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Kelvin Hopkins: The hon. Gentleman is making an important point. In my constituency, I have been visited by a group of people with young family members who suffer from dementia. A number of people develop dementia when they are quite young.

Neil Carmichael: Absolutely. I take the point that young people can also have dementia—that is certainly true—but the point I was making was that young people are caring for people once they return from school. That is a measure of the challenge we face in dealing with the role of carers, so the Government have to think carefully about the structures around carers and about the ability to give these people appropriate support and respite.

Barbara Keeley: It is good for us to be concerned about young carers, but is the hon. Gentleman concerned about the loss of education maintenance allowance? When I talked to the young carers project in my constituency, it told me that all but one of its young carers had been receiving EMA, and they were really afraid that they would lose all their incentives to stay in education. There is therefore an issue about support for young carers.

Neil Carmichael: This is certainly becoming a surprisingly wide-ranging debate. We have thrashed out the issue of EMA very carefully and thoroughly in the House of Commons—indeed, those of us on the Education Committee produced a useful report on the subject—but the Government have to think about wider issues in connection with post-16 education and so on. However, that is a separate issue; the important point here is that people who are going to school are carers, and I want the Department of Health to register that.

Another important aspect is the number of people with Parkinson’s. That problem is increasing all the time, and it is right that we focus our attention on it. The reason I mention such difficulties—not to the exclusion of others—is that it is important that we think carefully about personalised budgets so that people get tailor-made provision that they are happy with, and so that we join the NHS up with social care. I made that point in an intervention on my hon. Friend the Member for Truro and Falmouth but I want to repeat it, because part of the answer is to ensure that fewer people end up in hospital, and we can do that by ensuring that the social care structure spots problems before they become serious or overwhelming and prevents problems from starting in the first place. If the social care system dovetails completely with the NHS system and is accessible and transparent, people who need care, and families with members who require care, will feel they are being properly listened to.

Glyn Davies: Let me make a point in the form of a question. It touches on several of the issues that my hon. Friend has just mentioned, and particularly on Parkinson’s disease. Does he share my concern that once people enter a care home, there is not the same awareness of the need to look for dementia or Parkinson’s disease as there is outside? There is not the same awareness of the onset of those diseases, because people are deemed just to be elderly, when in fact they are suffering from an illness.

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Neil Carmichael: That is a good point. Earlier I mentioned the problem of diagnosing difficult illnesses —I obviously focused on dementia, but there are others. My hon. Friend is exactly right.

One theme that I have been picking up in care homes in my constituency is that increasingly, people do not enter care homes until they are older and actually need care because of their various illnesses. The pressure on care homes is therefore intensifying as a result of the changed profile of the people going into them. That has obviously put pressure on care homes’ finances, and there are differences between those that are supported by private provision and those supported by local authority provision. We need to explore thoroughly the question of the funding arrangements for care homes, and that should be part of the process that we get involved with as we move towards the publication of the White Paper.

My hon. Friend the Member for Portsmouth North (Penny Mordaunt), who is now out of the Chamber, mentioned commissioning, which is critical. Local authorities need to commission with a huge amount of sophistication, and they need to be fully aware of how to specify what they are commissioning for. The one good thing about the county council in Gloucestershire is that it is embracing the personalised care theme vigorously, but I would like to make one point. All personalised care is excellent if it is properly specified and funded, but we must be sure that the assessment process is fair. I constantly seek reassurance that that will be the case.

In my remarks I have signalled two general points that I think are important. First, we need to think long-term. We do not want a party political dingdong about this. We need carefully considered, thoroughly researched and above all well-meaning outcomes in the provision of care for elderly people, because we are setting foundations that should, I hope, last decades. Secondly, we must not think of the issue in terms of various silos providing care, while we hope for the best. We must be more holistic. As people grow older they will want to get access to different things. They do not want to be channelled by various bureaucratic systems. They want, effectively, to consider their options and decide for themselves, and they hope that when they cannot decide for themselves there will be a mechanism, in their family or through advocacy, to enable them to maximise the quality of their life for as long as possible. In the end, that is in all our interests. First and foremost we must create a system that people recognise as decent, fair and honourable.

3.21 pm

Kelvin Hopkins (Luton North) (Lab): It is a pleasure to serve under your chairmanship this afternoon, Mr Robertson, and it was also a pleasure to hear the speech by the hon. Member for Truro and Falmouth (Sarah Newton). She referred to me, unusually—because I think that I am the only hon. Member here who was born during the second world war, and I survived it, but only just: we were evacuated shortly before a V1 landed on our house and blew it up, but nobody died. Fortunately I was with my grandparents in Leicester at the time. We are concerned about elderly people who fought in that war and now are either in care or being cared for in their own homes.

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A headline in The Daily Telegraph of 28 October read, “Misery for millions as elderly care funds cut”. The Telegraph is not a newspaper of the left. It is normally supportive of the Conservative party, and I would hope that that is the basis for some sort of consensus, because we can all agree on this. I do read the Telegraph and find it very useful, and quite a good newspaper at times. I have no particular dislike of it, and it is spot on in that headline.

Importantly, it has been observed on more than one occasion that we do not care enough for our elderly people. Our attitudes to the elderly in Britain are not good, especially compared with those of some minority communities that have come from abroad, which have a kind of reverence for elderly people. Perhaps I would say that, because I am not as young as I was, but I think they value elderly people in a way we do not.

In some circumstances elderly people are regarded as a bit of a nuisance. I have some rather horrifying quotes from Professor David Oliver, who is senior lecturer in elderly care medicine at the university of Reading and secretary of the British Geriatrics Society. He said:

“Not long ago, a senior doctor walked onto my ward, turned to a nurse and laughingly asked: ‘How do you stand working with all these crumblies?’”

That kind of attitude is utterly poisonous. On another occasion a senior doctor said

“he was spending too much of his time ‘market gardening’—ie, looking after cabbages (old people)”.

Those are dreadful things to say, and people who say them should not be around elderly people. We must make sure that the people who look after elderly people have compassion and empathy, and a bit of reverence for people who have spent their lives working in society and contributing. I raise those incidents in a sense to shock us all into realising that in many instances we are not doing right by our elderly people.

That said, I know that there are many people who do wonderful work. I had two local authority care homes in my constituency and I visited them on several occasions. They had devoted staff, whom the residents loved; they thought they were really cared for. The visiting professionals all said that the care homes and what went on in them were first class. They have both been closed down, essentially forced to close by central Government. It is wrong that we should forcibly encourage local authorities to close local authority care homes and send the residents to private care. Some of the people who left may well have gone to Southern Cross homes—some of those that are now being criticised by the Care Quality Commission. We are not doing right by our elderly people, and we must do more.

As to costs, some 12 years ago the royal commission on long term care recommended that all care should be free of charge—free at the point of need, like the national health service. It was not a unanimous recommendation because, I think, the Government of the time, rather mischievously, made sure that one or two members of the commission brought out a minority report opposing free long-term care. Since that time Ministers have time and again said, “Oh, it wasn’t unanimous, therefore, implicitly, we don’t have to do that.” I took a different view, and tabled early-day motions in two successive Parliaments, calling for the

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Government to implement the recommendation for free long-term care. That did not happen; it was all about cost in the end, but I still believe that is the way forward. The costs involved would be significant, but in the scheme of things not an enormous amount.

I am the chair of the support group in Parliament for the National Pensioners Convention and Andrew Dilnot came along to present his recommendations to us two or three weeks ago. He is quite brilliant, frankly. His analysis and what he has come up with are first class. That should be the minimum default position, which any Government should take. I would like to go further than he went, but I think he is realistic, and, thinking that pushing Government to spend will be hard, wants to find the fulcrum point at which they might accept his idea. What he did was brilliant. The National Pensioners Convention, like me, believes that care should be free at the point of need, like the national health service, but Dilnot has come up with a fine scheme.

The National Insurance Act 1948 recommended that there should be a capital limit, which I think was £8,000 at the time. The minimum amount of capital that people could have was £8,000. If that is indexed forward it comes to a figure of between £250,000 and £300,000, so when Dilnot talks about £100,000 he is way below what would have been the case if we had simply indexed the figure forward. What we have now is disgraceful.

One result of what we have is that working-class people who managed, through saving and struggle, to become owner-occupiers are now having that little bit of equity in the family taken away from them. The wealthy do not have to worry. They have plenty of equity, and to look after granny when she has dementia they can perhaps take a little cash out of their overseas account, so it will not be a problem. However, for working-class people who have bought their home and become the first owner-occupiers in their family—and perhaps all of us would support in principle the idea of owner-occupation, if at all possible—that is being taken away from them. Many people in my constituency bought their council houses. I was not in favour of selling council houses, but it is just those people who now find that their capital has been taken away to use to look after granny. Typically, the grandchildren who would have inherited that equity and gone into owner-occupation will now not be able to do so.

People have come to my surgery and reluctantly admitted that they are keeping granny at home deliberately because they are desperately fearful that if she goes into a care home her house will be sold, the equity will be lost and their children will not be able to get into owner-occupation; there are no council houses to rent and they will be forced into private rented accommodation, and will have a much poorer quality of life as a result. That is the reality—it is actually happening. Those admissions are made reluctantly, because it is not something people want to say. Granny—it is usually granny because women live so much longer than men—may be suffering, and not getting quite the care that she should have, because she is staying at home. In the best of all possible worlds we all want to stay at home for as long as we can, and it is right that we should do so, but even care at home is not up to scratch.

I have examples, as I am sure others do, of care companies that look after elderly people in their own homes. The carers sometimes are not kind and are a bit

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impatient. The elderly person has to get out of bed when they turn up and go to bed when they turn up, and is sometimes left sitting in a chair all day with stale sandwiches on a plate beside them, not being able to do anything—not even go to the toilet. We are not getting the care even when we have paid-for carers coming in, so a radical change is needed. We must not only pay for care but ensure that it is good care, and that the people who deliver it are caring, compassionate and professionalised.

I spent much of my life before Parliament working as a research officer for the major public services trade union, Unison. In the past, many care home staff would have been Unison members, but the private care homes are not unionised. In my constituency, when one of the care homes I mentioned was privatised—closed down—I had a difficult conversation with the senior officer at the local authority, who eventually, after an hour, said: “We are doing it to cut costs. There will be fewer staff, they will not be in unions, and they will have shorter holidays, lower pay and poorer conditions of work. We can get the costs down.”

Damian Hinds (East Hampshire) (Con): Does the hon. Gentleman agree that it can be difficult to find people who want to be carers, whether in the public or the private sector, at home or in a care home setting? Perhaps we need to find new ways, beyond just unions, of elevating the status of the job as a profession or occupation, in the same way as social workers are now considering creating a college of social work.

Kelvin Hopkins: I agree absolutely about elevating the status, but we do that first by having the carers professionally trained, ensuring that we get the right people to begin with, having them properly paid and having staffing at the right level. If someone is looking after too many patients and cannot cope, either in a hospital or a care home, the patients do not get proper care. In most areas of life, as quality improves we want higher productivity, which means a lower level of labour intensity, but in this area we want more people working, with each care person or nurse looking after fewer patients, to ensure that everyone gets the care they need, rather than having one junior nurse looking after a large room full of elderly people and not being able to cope late at night.

In the past couple of weeks we have heard some distressing stories about elderly people in hospitals not getting the care they need. We will all be elderly one day, and some of us might finish up in care because we might not have extensive families to care for us. I do not like the idea of being in pain and suffering at night and not being able to get anyone to help. I am physically fit and doing well at the moment, but we shall all be old one day. People are suffering in that way now, and the only way to deal with it is to ensure that we put in sufficient resource. I think there are people around who want to do these kinds of jobs but they will not do them if they are going to be overworked, undertrained, underpaid, and treated badly by private companies or care managers in hospitals.

Jane Ellison (Battersea) (Con): I am intrigued by what the hon. Gentleman has said about the barriers to entry into this work. I have been following the fortunes and recruitment patterns of a care home close to me in

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my constituency, which is struggling to get local youngsters to apply. We have talked through all the reasons for that, and the home thinks there are some cultural barriers. The hon. Gentleman made reference earlier to the different attitudes of people from different backgrounds and different parts of the world, and I think there is a cultural barrier to young people entering the workplace and spending their life giving care to older people. We have to admit that and address it.

Kelvin Hopkins: Possibly there is such a problem, but most of the care workers in the homes I was talking about were caring mature women. They had a genuine affection for the people they were looking after, which was wonderful to see. The residents liked being there, the care workers doted on them and the professionals who came in were full of admiration for what was going on. We have to replicate those conditions for all of us in one way or another. Perhaps we need to look at ways of recruiting people, but I believe there is compassion in humans and there are people who would do these jobs if they were treated with the appropriate respect and given the support, pay and conditions of employment we would expect. Unison has long been supportive of this kind of thing, campaigning against the privatisation of care and in favour of free long-term care.

Andrew Dilnot has gone a long way in the right direction and I applaud what he has done, but we have a lot more to do beyond what he has said. I hope that some of what I have said has rung a few bells, and that the Minister, and indeed the Opposition, start to take the issue much more seriously, and look after elderly people as they should be looked after.

3.36 pm

Tony Baldry (Banbury) (Con): I am very pleased to be able to take part in this debate as co-chair of the all-party group on carers, and I have a couple of simple requests for the Minister.

It is crucial that all political parties—both Government and Opposition—work together on the White Paper on social care. We have been waiting for the document for some time, and I understand that the Government have committed to introducing it next spring. It would be very helpful if the Minister cheered us all up in his concluding comments by confirming that there will be a White Paper on social care in spring 2012. He will make us all the more happy if he can confirm that it is the Government’s intention that the document will introduce proposals to ensure that we are able to deliver sustainable long-term funding to tackle the existing care crisis and provide for growing demand.

We must recognise the scale and nature of the growing demand. The Department for Work and Pensions produced a wonderful report earlier this year called, “Number of Future Centenarians by Age Group”. Someone is either a centenarian or not, so I do not know why the DWP has to classify them by age group: it is one of those wonderful “Yes Minister” things. The report forecasts that 11 million people alive today will live to 100—a huge number. However, the number of working-age adults who will suffer from age-related conditions will rise by almost a third over the next 20 years. It is predicted that between now and 2030, 30,000 more people over the age of 80 will be living in the typical shire county of Oxfordshire, which is the equivalent of

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a town the size of Bicester being added to it. From 2025, the population aged 60 and over in the county is expected to be greater than the population of under-19s, including students. In a county such as Oxfordshire, nearly 70% of people aged 85 and over are living with a long-term illness, and the Medical Research Council’s cognitive function and ageing study shows that 26.5% of men and women between the ages of 80 and 84 suffer or experience age-related dementia. At over 85, the figure suffering from age-related dementia goes up to 68.5%, which is a significant increase. That means that the number of carers is expected to rise from 6.4 million today to 9 million by 2037, which is a substantial increase.

That is all against a background—in the House, we have discussed this in a number of debates since the general election, and I will not read out the speeches I have made in the past—of local authorities having to deal with serious financial circumstances, which has led them to increase charges for care services and raise eligibility criteria. The percentage of councils providing support to those with moderate needs has decreased from about half in 2005 to less than a fifth, as eligibility criteria are raised to substantial or critical needs only.

If he has time in his concluding comments, will the Minister update the House on what his Department considers to be the impact of the Sefton ruling in the High Court yesterday? The ruling seems to indicate that it is unlawful for local authorities to freeze care home fees unless they have consulted care home managers fully and properly assessed the risks of decisions to care homes and their residents.

The vice-president of the Association of Directors of Adult Social Services and others have calculated that the ruling will add a substantial amount to local authorities’ budgets, which have already been set for this year. We have some fairly tight figures for both local authorities and for care homes.

The Minister of State, Department of Health (Paul Burstow): The key point in the High Court’s decision was the consultation. That was also a finding in the Birmingham case earlier this year, when the issue turned on whether the consultation was adequate and whether the authority had had due regard to various statutory duties. The issue now for local authorities is to satisfy themselves that they have had proper regard to the matters that the courts have directed them to consider.

Tony Baldry: That is a helpful update for the House, and I am grateful to the Minister.

Barbara Keeley: Does the hon. Gentleman share my concern—this may be the theme that he is developing—that there is a conflict between localism, the removal of ring-fencing and ensuring that a local authority delivers adequate social care? I find it hard to see, when exhortations are clearly not working with local authorities, how we can ensure that some authorities do not just cut their social care budgets to the bone and give people inadequate services. It is quite clear, with £1 billion in cuts this year, that they are not doing as the Minister would like.

Tony Baldry: I see the situation rather differently from the hon. Lady. Local authorities such as Oxfordshire are committed to delivering good-quality social care for elderly people. The challenge for them is to ensure that

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the increasing number of elderly people, often with increasing needs, receive appropriate care, whether at home or in residential care. A tight budget presents them with a significant challenge, but it is a challenge to which they are committed.

I appreciate that the hon. Lady comes from a unitary authority, but for two-tier authorities in shire counties such as mine, social care is now their most significant contribution. Increasingly, schools and education are running themselves, so authorities are going to be judged on the quality and the way in which they deliver social care.

Kelvin Hopkins: One thing that concerns me is local accountability. In a sense, the hon. Gentleman is making an argument for more local control, because democratic local accountability means that people in a local care home will have immediate recourse to elected local representatives, rather than having a simple national scheme such as the national health service. Perhaps if the national health service had more local accountability, we might not see some of the things that are happening at the moment.

Tony Baldry: I am not entirely sure where the hon. Gentleman is going with that point, so if the House will excuse me, I will not follow him down that particular line.

I do not think there is any lack of local accountability as far as the national health service is concerned. The Oxfordshire joint health overview and scrutiny committee is meeting today and will consider, for example, possible service changes at Horton general hospital in my constituency. The committee will, I am sure, vigorously interrogate the senior management from the Oxford University Hospitals NHS Trust and from the Oxfordshire and Buckinghamshire PCT cluster.

In the debate on social care, we must not underestimate the burden or the toll on carers of the task of looking after elderly people with age-related difficulties. Carers UK has found that carers providing significant amounts of care are twice as likely to suffer from ill health as non-carers. In 2008, a survey of heavy-end carers showed that more than half of those caring were in debt, and nearly three quarters were struggling to pay household bills. A large number of carers, about 1 million, have given up work or reduced their working hours because of caring. The peak age for carers is between 45 and 65, which is often the age at which they would be at the peak of their training, skills and career experience. That can be a cost not only to the carer, but to businesses and employers as they lose key people who have to care for relatives.

We have seen some excellent organisations such as Employers for Carers, which was set up by Carers UK and seeks to bring together numerous employers, generally larger ones, to promote flexibility and workplace support for employees juggling work and care, but that is not always possible for small and medium-sized employers. There is also a cost to the NHS. Sometimes, if we are not careful, there is a trade-off between the quality of social care, the provision of sufficient beds in nursing homes and residential care homes, and the need to prevent delayed discharges and bed blocking in hospitals. We had a debate on that not long ago, to which I contributed. In Oxfordshire, we are grappling with the

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issue of delayed discharges. If we are not careful, the cost to the NHS of delayed discharges will be significant, particularly at a time when more and more hospital treatments can be offered as elective day treatments. Generally, people are spending less time in hospitals, so delayed discharges add particular cost to the NHS.

Barbara Keeley: I thank the hon. Gentleman for giving way again; he is being very generous with his time. Does he have any thoughts on the point that I made earlier about the Dilnot commission and the £35,000 that must be paid out by the individual in the shared-costs model, which does not recognise informal care? He is making the point that people are giving up work to become carers, which has a huge financial cost. They may be struggling to pay bills but, even so, when their loved one goes into a care home, they will still have to pay £35,000. There is no recognition of everything that they have done that has helped the state save money. Does he agree that that is not fair?

Tony Baldry: We all have to recognise that there is only so much, on a cross-party basis, that Ministers will be able to do in the White Paper, which I hope will come out next spring. If the White Paper contains a sustainable funding process for residential care, we will all consider that to be a substantial step forward. We must not forget, however, that a number of issues will still be relevant to carers, particularly because, in order to maintain costs and keep them down, most local authorities are trying to keep people at home for as long as possible. For example, in my constituency and in those of many of the other Members who are present, it was previously the case that frail, elderly, but mentally alert people lived at home, but that has become increasingly true of people with age-related illnesses such as dementia or Parkinson’s, and it will continue, because however much the funding for residential care is increased, there will still be that population at home.

Another point that I want to reinforce to the Minister—I am sure that he will take it on board—is that a number of organisations concerned with social care are in consensus in supporting the recommendations from the Dilnot commission, particularly the recommendation on protecting families from catastrophic care costs by capping lifetime care bills because, at present, families coping with long-term conditions can face bills of tens or hundreds of thousands of pounds to pay for home and residential care. There are fears of unaffordable bills forcing families to provide round-the-clock care, and two thirds of carers end up spending their own income to pay for the care of the person for whom they care.

Those of us on the all-party group on carers welcome the Dilnot commission’s clear recognition of the need for additional resources for social care, to overcome an historic shortfall and to recognise the growing demand. We need a new national system of eligibility and portable assessments to create a more standardised system across England and to remove some of the uncertainty that families face as they deal with different systems in different council areas. We also need a new awareness, advice, information and advocacy strategy, to help families plan for care and access private, state and voluntary sector support. I think that there is strong consensus on those points, and I hope that the Government will adopt the proposals in the forthcoming social care White Paper.

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Sarah Newton: My hon. Friend has been incredibly generous in giving way, and I am grateful to him. He is making an important point and I would like to underline it. As we have heard, the scale of the challenge facing the Government is so immense that we need short, medium and long-term solutions. At present, the Government face the challenges of deficit reduction and of other huge reforms taking place in our country, but it would be welcome if they set out in the White Paper a direction of travel and suggested proposals that could be achieved in the short term and that addressed some of the issues while not seeking to solve the whole problem all at the same time. We would take a paced, building-block-type approach.

Tony Baldry: I agree entirely with my hon. Friend, but I think that we have all slightly lost track of the number of Green Papers, discussion documents and other things that we have had in relation to social care. What will be really important next spring is that we get a White Paper that has a summary that everyone can understand and that makes it very clear what will be the basic system for funding residential social care for the future. I think that that would be greeted in the House by a quick rendering of the “Hallelujah Chorus”.

Following my hon. Friend’s point, if the White Paper can set out the direction of travel for the rest, that would be good news. What we have seen all too often in the past is a discussion paper that concludes that the issue is so huge and so difficult that we have almost lost the will to live. Spring 2012 has to produce a White Paper with a clear commitment to the funding of long-term residential care, and then direction of travel for the rest is important.

Finally, I agree with the need to enhance the status of care workers. In my experience, the model adopted by many residential care homes has often been to recruit people from the Philippines or eastern Europe. The deal was that they came over, got trained, were often paid the minimum wage and, having been trained, worked in the national health service. Because the Government, perfectly understandably and quite rightly, are capping immigration from outside the European Union, it is no longer possible for nursing homes and residential care homes to recruit from the Philippines or outside the European Union, so we have to enhance the status of care workers, both in the NHS and in residential care homes.

On my patch, I have suggested to the chief executive of the Oxford University Hospitals NHS Trust—I am glad that he has responded positively—and others that we should consider setting up in Oxfordshire one of the new Government’s work academies, specifically for care workers. We need to ensure that far more people see care and working in the care sector as a valued profession that makes a real contribution to society. It needs a career path, with a national vocational qualification, training and proper involvement from further education colleges. The issue is of as much interest to the national health service as it is to residential care homes, because if those care homes have sufficient care workers it will be easier for discharges into them to take place. Moreover, we often need to ensure that the NHS has sufficiently well-motivated and well-qualified nursing care assistants. I hope that we will begin to see centres of excellence around the country that will train people as care workers,

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to ensure that we do not find ourselves in difficulties because nursing homes and residential care homes have to close because they cannot recruit qualified staff.

John Pugh (Southport) (LD): Would not the consequence of that be that care homes would have to pay better wages than they do at present? The hon. Gentleman has mentioned people from the Philippines. I had some in my constituency who were allowed to stay provided that they were paid for their qualifications, but the care homes refused to do so in some cases.

Tony Baldry: The management of any sensible care home will want to ensure that it invests in its staff. It has a duty and responsibility to do so. It has to play its part in ensuring that it, like any employer, helps with the required skills, qualifications and training of those people. This is an important issue and one that we have to get right if we are to have proper levels of care in the community, of residential nursing home care, and of care in the NHS.

3.57 pm

Heidi Alexander (Lewisham East) (Lab): I wanted to speak in this debate because I have had two specific personal experiences in the past couple of years that have led me to think that finding a way to fund elderly care in this country is probably one of the biggest challenges that we face. I wish to take a few minutes of Members’ time to share those experiences, which I hope will underline to the Minister the urgency with which the Government need to act.

Before I became a Member of Parliament, I was a councillor in the London borough of Lewisham and can honestly say that the worst meeting I ever had to attend was when the council was reviewing the eligibility criteria for adult social care. At the time, we were looking at whether we could sub-divide the category of “substantial care needs”, which are really serious needs for which people need help. It is about basic human dignity, so it was a difficult thing to consult on at the time. Hundreds of people attended the council meeting and I remember being almost moved to tears by some of the testimony that people gave about the support that they received. I am pleased that, that year, my local authority of Lewisham chose not to do away with funding substantial care needs. It still funds such needs, although in the current economic and financial climate, Lewisham has had to increase considerably the charges for care packages.

I realised at that time that adult social care in this country is woefully underfunded. It constitutes such a large proportion of local authority budgets that, in the present climate of huge cuts to local councils, they are faced with very difficult decisions about how they can fund care provision, while setting a balanced budget elsewhere. I am concerned, as I said in my intervention, that the so-called extra money being diverted from NHS budgets into adult social care is not really extra money at all. When the large cuts to the budgets of local authorities are taken into account, that money is merely being used to prop up what was already being done. For example, from my local authority experience, I know that out of a £270,000 million revenue budget, Lewisham

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council spends approximately £100 million every year on adult social care. If it has to find £80 million worth of cuts in the next three years, it has to take some very difficult decisions about how to make all that work.

My experience in Lewisham also told me that in this country we do not fund the sort of preventative care that is necessary to avoid having higher care needs later on in life. I urge the Government to consider how we can provide more preventative support, so that we do not have huge outlays further down the line. As people get older, their care needs become a lot more complex. If we can intervene earlier and provide the right sort of support, perhaps we will not have such high expenditure further down the line.

I said that I had two personal experiences that led me to take part in the debate. My other experience is very personal. Last year my nan passed away, after suffering with Alzheimer’s for a number of years. She spent the last years of her life in a care home. My hon. Friend the Member for Luton North (Kelvin Hopkins) spoke earlier about the experience of working-class people and what it means for them to pay for their care. My nan was a working-class woman. She worked very hard all her life and saved hard to buy her own home. She never went on a foreign holiday. She was very frugal with her money. She ended up having to sell her home, which was worth about £140,000, and using the small amount of savings that she had to pay for her care. There is obviously a limit on how much money one has to pay for such services. Her estate was worth in the region of £23,000 at the end of that process, but my family paid more than £100,000 for her care. The local authority picked up the costs of that care towards the end, because all her savings had been used. I think it would break her heart to think that what she had worked hard for all of her life did not get passed on in any significant way to my father, to my aunt, or to her grandchildren.

Sarah Newton: The hon. Lady has highlighted another illusion in the system: the illusion of the separation between the so-called self-funders and others. There are very, very few people who end up fully self-funding their care. Most people deplete their resources and end up having to be funded by local authorities. We must not always see the issue in black and white. Of those who self-fund, about half go on to require support from local authorities.

Heidi Alexander: The hon. Lady makes a very good point and I agree completely that there is not a clear distinction between self-funders and local authority-funded clients. I reiterate the point made by my hon. Friend the Member for Luton North about how wealth is inherited in our society. My family, perhaps unwisely, have not planned greatly for their retirement. My dad is a self-employed electrician. I think that he was planning to use some of the money that came from the sale of his mother’s house to fund his retirement. He does not in any way begrudge the money that he spent on my nan’s care towards the end of her life. I do not begrudge it. She had fantastic care in a fantastic care home, and that is completely right. However, I know that he feels that the system is perhaps not really fair. He asked me questions about people who play the system, and whether people transfer homes into somebody else’s ownership so that they do not have to pay.

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Kelvin Hopkins: There is the seven-year rule about tax on gifts. Many of the more acutely aware middle-class people with accountants transfer the ownership of their property long before they die, so that they never have these costs imposed on them.

Heidi Alexander: That is precisely the point. Families are asking questions about how this can happen. We need to have a fair system so that people know what to expect to pay for their care in later life, can have some peace of mind about it, and do not think that somebody else, who perhaps has a better knowledge of the system, can play it in a way that means that they do not have to pay out in the same way.

Barbara Keeley: My hon. Friend is speaking very well from her own personal experience about an issue that affects the whole country. Last week, one of my constituents questioned why he will have to pay all but £28,000 of the value of his father’s home—which, in Salford, was not a costly home—to pay for nursing care. He thought all along that nursing care should be paid for because it is nursing. He still does not understand it and is very distressed. I wonder if that example, and the example raised by my hon. Friend from her own experience, suggests that we need to get out there with this debate so that people do understand it and so that everybody is in the same place—as has been said, not just middle-class people who can plan, and people who have accountants—and knows what it might cost them and how to go forward and plan for it.

Heidi Alexander: I agree completely. I go back to what I said at the start of my contribution, which is that this is one of the biggest challenges we face as a society and as a country. We can talk about the crisis in the eurozone, international terrorism or climate change, but how we plan for the needs of our ageing population is incredibly important. It may not be the sexiest debate out there, but we need to get people talking about it so that they can understand and contribute to how we should legislate on this issue.

In conclusion, I was at the event that the Minister attended earlier, which was organised by the Greater London Forum for Older People. It was a packed Committee room, and I heard the Minister say that this Administration will not be the Government who do not face up to this problem, grasp the nettle and tackle it. I urge him to honour the commitment he made to the pensioners in that room. For far too long, we have not tackled this problem. I fear that it will be placed in the “too difficult” box. We have already heard the hon. Member for Banbury (Tony Baldry) talk about the need to publish the White Paper in the spring. I think the Dilnot commission report talked about a White Paper in December, so I put it to the Minister that perhaps we are already a little behind that timetable. The key issue, as I was discussing earlier with my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), is to have a Bill in the next Queen’s Speech. Will the Minister commit to that today? If he and the Government were to say that they will legislate on this matter in the next parliamentary session, that would be a sign that the Government take the issue seriously and that we can tackle the problem, which has, for too long, eluded us.

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4.9 pm

Margot James (Stourbridge) (Con): It is a pleasure to serve under your chairmanship, Mr Bone. I must apologise to you and to the Front-Bench spokespeople. Unfortunately, I will not be able to stay to the end of the debate. I apologise, but I have a pressing engagement in my constituency this evening.

I would like to begin by congratulating my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing a Backbench Business debate on such an important topic. Several speakers have alluded to the crisis in care funding at the moment and to the service being chronically underfunded. I want to throw some light on why I think that that has become the case.

Age UK reported earlier this year, in June I think, that spending on adult and social care rose by only 0.1% between 2004 and 2010. Crucially, during that period the numbers of older people needing care expanded significantly, to say nothing of those in other generations who also need care. The number of older people aged over 65 increased by 7.7%, while the number of very elderly—the over-80s—increased by 11.6%. While the care budget for older people was static—rising by 0.1% in real terms, to be precise—the numbers requiring that care have expanded, and that rise is continuing. It is interesting to note that, at the same time, other budgets were rocketing: spending on the NHS increased by 27%, on the police by 20% and on schools by 12%. That is salutary, because we can see how older people’s care has been treated and valued over time. We arrive at the point where—I agree with everyone in the Chamber—it is not enough. Most councils have therefore been under pressure in that area for a considerable length of time, which precedes the public spending review of the past 12 to 18 months. Most have responded to the challenge by tightening the eligibility criteria for the provision of care at home and by making far more use of private providers.

The situation in my borough of Dudley exemplifies the problem. I have visited approximately 10 private care homes in my constituency, and I apply my own inspection criteria—crudely, whether I would have willingly allowed my mother to be cared for in the home. We are fortunate in Dudley—certainly in my part of it, Stourbridge—with the overall quality of our homes, but the fees paid by the local authority for people to be looked after are imposing on the good will of the management and staff in the homes.

The local authority pays roughly £380 per week per resident, but for the past three years there has been no increase in the fees, while those homes have had to contend with rising costs including for fuel, food and even, to a certain extent, staff. So private homes are struggling; if they are small or family-run concerns, the show has been kept on the road with an enormous amount of dedication and hard work. The result is that self-funding residents are often charged significantly more than the local authority-funded residents. I have consulted Age UK, which has consulted lawyers, about whether cross-subsidisation can be proved, because that would be against the law. However, it is difficult to prove, although it strikes me that the discrepancy is so high that some homes must be using the fees of self-funding residents to cross-subsidise the local authority-funded residents.

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The care at home situation is just as bad. The proportion of local authorities providing care to people in moderate need fell from 36% in 2004 to 21% in 2010. I do not doubt that the figure is still falling. That must surely be a false economy, because the less care provided to those in moderate need, the greater the speed at which they will develop substantial needs. In some ways, the home care sector is in worse shape than the residential sector. What I mean is that, in my own borough, the transfer from public to private provision appears to have worked less well for older people who need care at home than for those in residential care. Like the hon. Member for Luton North (Kelvin Hopkins), I have received a steady stream of complaints from the recipients of such home care, and the complaints are always the same, even though the providers might be different. There is a constant change in carers and no consistency of personnel, with a great variation in the standards of care provided, as well as in the kindness and compassion.

Kelvin Hopkins: I am interested in and sympathise greatly with what the hon. Lady is saying. Recently, I spent a day touring with a district nurse professionally employed in the national health service, and I saw the care and compassion that she gave to all her patients, whether it was re-bandaging or dealing with people suffering from cancer, and so on. The contrast between that professional, publicly employed person and what I hear about some of the private providers with inadequate staff is great.

Margot James: I have considerable sympathy with the hon. Gentleman in the context of home care. I find quite a few of my constituents bemoaning the rapid transfer from the local authority staff who used to provide care to the private sector. I am often in favour of bringing in the private sector, but it has to be done carefully and intelligently, and with proper checks and monitoring.

Another point, also made by the hon. Gentleman in his speech, is that carers come at very different times, without any consistency or reliability; they often come too early to help someone get to bed and too late to help them get up in the morning. In too many cases the service is patchy, inconsistent and fundamentally unreliable, and something needs to be done. Perhaps the business model needs to be looked at. It cannot be beyond the wit of an employer to employ more people at certain times of the day. That is probably the only answer, which means that more money might be needed, which I appreciate is a vexed question in the current climate.

I agree with other hon. Members that the Dilnot report is an excellent contribution to the debate, but it has some drawbacks. First, Dilnot has commented—perhaps not in the report but I have certainly heard him in speeches made about the report—that residential care means-testing is the biggest cliff face across the entire gamut of social care policy. Savings of more than £23,250, including the capital tied up in your home—68% of householders aged 65 and over own their homes outright, without a mortgage, so we are talking about a lot of people—disqualify people completely from funding support. No banding, no scaling up or down, only one figure, below which people receive 100% funding support

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and above which they receive nothing. In response, people have had to sell their homes. We have heard some sad examples, in particular from the hon. Member for Lewisham East (Heidi Alexander), and listening to several contributions I have appreciated the difficulty for people from a working-class background who have struggled and saved and whose assets are small in total. I will make a point about that.

People who are fortunate in their health will not need residential care and will not have to sell their home. For people who need residential care and have no assets and nothing to lose, that is okay as well. However, people who own their own home and need residential care are at a striking disadvantage to others of their age group. That is why I appreciate Dilnot’s broad strategy to cap an individual’s contributions to the care needed and to raise the threshold at which people become eligible for support. More work remains to be done, however, to identify the actual figures deemed fair and affordable for the taxpayer to fund. Raising the threshold to £100,000 is a bold move, but is it affordable? I do not doubt that that conundrum is on the Minister’s plate, and there are more problems with the cap.

Kelvin Hopkins: Dilnot pointed out that £100,000 is a crucial point at which the cost starts to take off, and his proposals would cost £1.7 billion a year, which is not a great deal in the scheme of things. After that, it starts to rise more rapidly. A £100,000 threshold would protect many people, such as my hon. Friend the Member for Lewisham East (Heidi Alexander) and her family.

Margot James: I thank the hon. Gentleman for his intervention. It is true that a £100,000 threshold would provide protection, and I hope very much that we can afford that element of Dilnot’s proposals. That threshold would provide a huge amount of help and protection for just the sort of cases that he and the hon. Member for Lewisham East mentioned.

Turning to the cap that Dilnot recommends, I believe that it should be rethought. He said that it should be between £25,000 and £50,000, beyond which no one should have to pay. Although my suggestion would introduce some complexity—I accept that that is a disadvantage—we must consider a scale on the cap that is linked to people’s assets. A one-size-fits-all approach, whether it is £50,000 or £25,000, does not reflect the huge variation in house prices throughout the country. The average house price in Dudley borough in my constituency is £145,000, but the average house price in Greater London is £420,000, so for families in my constituency, and perhaps in that of the hon. Member for Luton North, the cap on care represents a third of their assets, whereas for families in London in a house with an average value it represents little more than 10% of that value. That is unfair, and I hope that the Minister and his team will look at ways in which the problem can be overcome.

I am afraid we will to have to ask more of people who have seen the value of their home spiral over the last 25 years. I trust that with better use of resources, and thanks to Dilnot and the Government’s commitment to seek a cross-party solution to the vexed problem, we will no longer have to ask people to sell their home to fund their care. However, if we cap the amount that people must spend on care, we may have to ask them to

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remortgage part of the value of their home to contribute to the overall cost that Dilnot recommends. I cannot see a magic pot of £1.5 billion in the Government’s credit balance, so we must be realistic in what we ask them to do. Asking people to remortgage part of the value of their home to contribute to their care is not as bad as the current system, which requires so many to have to sell their home and to invest so much of the proceeds, if not all, in residential care costs.

In conclusion, the reaction to Dilnot has not been as favourable among health and social care managers as it has been among those of us, including organisations outside Parliament, who campaign on behalf of older people. They fear that they will have to find money from their cash-strapped adult and social care budgets. As the other main activity outside residential care is home care—I have described a situation that is far from satisfactory, as have other hon. Members—they fear that there will be less money to fund home care if they have to implement the Dilnot report to fund the higher cost of residential care. I share that concern.

What else can be done? I have said that I do not expect the Government magically to conjure up £1.5 billion in the serious and perhaps worsening economic situation. We must find a better way of managing our resources, and that money must probably come from one of the only protected areas of Government spending—the NHS. Hon. Members have mentioned that the Government have diverted £1 billion from the NHS to social care, and that has been well received, but I do not believe that it goes far enough. NHS spending has risen hugely in the past 10 years, and 27% for the six-year period does not cover the half of it. It does not cover the private finance initiative costs, which have been astronomical.

Too many older people in hospital would be better managed in the community. We have heard about bed-blocking, and that occurs in Dudley borough. People are waiting for residential care places, but the funding is not coming through to meet the need. That funding should be reconfigured more substantially in favour of community care. Many experts who know more about the NHS than I do—the King’s Fund, some hospital consultants and so on—recognise that we have too many hospitals. I am not saying that there is an easy answer, and no one wants hospitals on their patch to be closed, least of all me, but there may be a way of utilising that space and resource more effectively. I urge the Minister to discuss that with the Secretary of State to see what can be done. That would be a more fitting tribute to the Dilnot inquiry than trying to implement every detail in his report.

John Pugh rose—

George Hollingbery (Meon Valley) (Con) rose—

Mr Peter Bone (in the Chair): Order. I intend to begin the wind-ups at 5 o’clock. Two more hon. Members wish to speak, and it is now 4.26 pm. I do not know whether this has been mentioned, but the Leader of the House has attended the debate, which shows its importance.

4.26 pm

John Pugh (Southport) (LD): I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on securing this debate and on introducing it so lucidly. I do not know whether any hon. Members, apart from me, attended an event in the House earlier this week

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called, “Preparing for Old Age”, and organised by Age Concern and the Prudential. As I went in, I picked up various brochures with rather grim titles such as “What to do when somebody dies”, “Paying for care costs”, “Insuring against ill health” and “Coping with dementia”. I looked in vain for something called, “How to have fun in your 90s”, but there seemed to be nothing about that.

We are fortunate to have a Minister to respond to the debate who has a distinguished record in this area, both when in opposition and as a Minister. My reputation in this area has been somewhat more ignominious. I was in Richmond house for the first time when, as leader of the Liberal Democrat group on Sefton council, I was summoned with other party leaders for a dressing down by the then Minister, Lord Boateng, subsequent to a law case that had gone against Sefton, which was not an uncharacteristic event.

We were taken to court by, I believe, Help the Aged, because we took the view that we could resource care needs only according to the resources that the Government had allowed us. We lost the case, and went to Richmond house to explain our side of the story. We were called into a room and waited patiently until the Minister breezed in, gave us a dressing down, told us how tough the Labour party would be with councils henceforward, and sent us on our way. The interesting point is that the press release hit the streets even before we had left the room, so clearly it had been written considerably prior to the event.

Later, when I became leader of the council, I rationed the number of care homes, which were rather more expensive in the public sector than in the private sector, and found that my Labour opponent—he is now the distinguished deputy leader of Liverpool city council—had gone to the press and engineered a photograph showing a 100-year old resident with a placard saying, “Please do not close my home, Councillor Pugh”. Unfortunately, we did close it, because it had been endowed to the local authority and was unsuited for its purpose. It was costing us twice as much to run, as indeed were some private sector homes then.

Only the other day, Sefton council had a judgment against it when the freezing of care home fees was ruled to be unlawful. It is a balanced council with three parties in the cabinet. The managing director of the solicitors who took the case against Sefton council said,

“There is every reason to believe other councils are doing exactly the same as Sefton.”

Sefton responded by saying that the court was merely critical of some elements of the process. Sefton is a borough with the 13th( )highest proportion of people aged 65. The bulk of its controllable budget—it has many contracted-out services—is taken up by social services. Sefton unexpectedly had £30 million up-front costs to find by way of savings. It is completely unthinkable that that could be done without eliminating other departments and without affecting social services in some way. Funding social care is a difficult problem. That is what I have learnt.

Kelvin Hopkins: We hear constantly about the difficulty of funding. The amounts we are talking about are very small in the overall scheme of things. The £1.7 billion for Dilnot would be less than half a penny on the standard rate of tax—that is the equivalent. Free long-term care for all would be 2p on the standard rate, which is

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what my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) cut the standard rate by before the election. We are not talking about massive amounts. I have spoken to many groups, and if I ask, “What do you prefer—the fear that you could have your house taken away to pay for granny’s care or paying 2p on the standard rate?” time and again they will all say, “2p on the standard rate”.

John Pugh: We all accept that, whatever it may amount to in the round, it is hard for local authorities to meet their care costs within current budget constraints. It is hard for NHS hospitals that suffer because of people who should not be staying there, who they recognise ought to be in care, but it is sometimes cheaper to keep them in the hospital rather than anywhere else, which is not in the hospital’s interest. It is hard for families who have the job of fulfilling caring responsibilities, which can conflict with employment, and it is difficult if they live at some distance from their elderly relatives, as they tend to these days. It is particularly hard for the individuals in need of care and who have increasing costs set against diminishing resources. It will not get any easier for the reasons hon. Members have already rehearsed: an extension of what we might term our declining years; the demographic bulge that we have all spoken about; many carers are taking up their responsibilities at an age at which they are not in, let us say, the first flush of youth; and in terms of social policy we are discovering that neither community nor personalised care are cheap options.

Nevertheless, society has made some significant achievements. Since the great Liberal Government of the early 20th( )century, the state has underwritten the fundamental problems that used to afflict old age—poverty and infirmity—by providing a safety net. When that reform was introduced, there was the presupposition that families would continue to accept responsibility for elderly members—they usually did—and that people would also look out for themselves to some extent. The old age pension was a mechanism to ensure that they could do that, and people had the opportunity to take still more precautions via provident societies and so on.

However, we have moved on and today we have two central problems. I do not think I have heard other problems apart from these. The fundamental problem that has been cropping up in this debate is that, assuming the system meets basic needs, which I guess it does at the moment, there is the capacity of those needs to become so severe that they can wipe out people’s inheritance, and many people regard that as not in the order of things and not how things should be. There is the other problem, which has not been touched on to the same extent, but I get it in my constituency: a sense of injustice about what might be called the free-rider problem. People have told me that they have saved for their old age, and as a result they feel that they have been penalised, because people who have made no effort to save, or who have blown the money prior to reaching an age when they might need it, get the benefits that the savers are to some extent denied. Those two problems seem to linger around the system.

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George Hollingbery: Perhaps the problem is even deeper. People in my constituency surgery do not just say that they think others have had a free ride; they say that they are actively advising younger people and their families not to save for old age, because it is no longer worth doing so. Plainly, the system is stacked so far to the advantage of those who do not save that people should not save at all.

John Pugh: The hon. Gentleman has usefully illustrated my point. We can argue that the state does not have a duty to preserve a family’s inheritance, notwithstanding the valiant defence of inherited wealth from the hon. Member for Luton North (Kelvin Hopkins). In normal circumstances, that is an unusual stance for him to take.

Kelvin Hopkins: I was defending the small amounts of inherited wealth for relatively poor people, not the vast amounts inherited by very wealthy people. I would substantially reduce the threshold for inheritance tax, but my party would not agree.

John Pugh: We might dispute the borderline between the wealthy people who do not deserve it and the not so wealthy who do, but we have a system in this country, unlike in Germany, where the family has no legal obligation, and we ought to be alert to that. We have already heard in the debate about how some families, in seeking to preserve their inheritance, actually support their elderly relatives, which sometimes is a laudable and desirable outcome. On the free-rider problem, we can argue that, in allowing a reasonable level of retained capital prior to benefits, there is a reward for people if they show a degree of providence. Those who have more than that and therefore do not benefit to the same extent might regard themselves as not simply provident but fortunate.

I am not certain that Dilnot fully addresses the problem. It is too dramatic to say that people have the choice of dying or destitution, or dying before destitution or whatever. Realistically, the option that most people fear is the reduction of their resources to the level that they become solely dependent on the generosity of the state. It seems to me that that is what Dilnot seeks to avoid or prevent. It attempts to deal with the problem that Members have spoken about, which is the total wipeout of a life’s accumulated family resources. The issue is whether Dilnot’s proposals to cap people’s costs have produced a scheme that is both affordable and socially just. It can be argued whether, if someone is vastly wealthy, the cap ought to apply to the same extent.

Whether Dilnot is affordable is not a question that is easy to answer. Does it depend on front-end costs being picked up by adequate and affordable insurance schemes? It depends on the insurers being willing to offer such products. I have spoken to insurers who would prefer to offer annuities or suchlike arrangements, and who question whether they will be in the market to provide the products that Dilnot requires. The other issue is what counts as front-end costs, because we exempt things such as hotel costs. It may be some appreciable time before people get to Dilnot’s benchmark of £35,000, or, if they take out insurance, premiums may be higher than we currently imagine. Asking whether Dilnot is affordable is like asking how long a piece of string is. As the hon. Member for Stourbridge (Margot James) illuminated in her speech, it depends on where we set the lines.

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Certainly, what is more affordable to Government is likely to be less attractive to individuals and their families, or might be more problematic for insurers. However, the one thing that we all accept, if we ever redesign Dilnot, is that there is a genuine need for cross-party consensus to work out what blend of insurance risk Government and individuals can support.

That is another point we must consider, and perhaps we have not quite got there yet. I understand the cynicism about what the Treasury may or may not be prepared to do, but before it works out what it can afford, we need a degree of consensus concerning what the state’s role should be on this issue. We need to know not only about the state’s detailed implementation of the policy, but what the purpose of the state is in this business. We must look at how we intervene, and at how we wish to intervene.

4.40 pm

George Hollingbery (Meon Valley) (Con): It is a pleasure to serve under your chairmanship, Mr Bone, and I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this important debate. Had I not come last in the roster this afternoon, I would—of course—have made a philosophical, wide-ranging and sparkling speech on the philosophical implications of the Dilnot report. Hon. Members will be glad to hear that I am not going to do that, and I will restrict myself, if I can, to a few small points that have not yet been covered in any great depth. I apologise for being absent from the debate for an hour, but next door to the Chamber the Surviving Winter appeal was being launched. The appeal transfers the winter fuel allowance from those who do not need it to those who do and, if I may make a quick plug, anybody who would like more details about it should speak to me after the debate.

Some difficulties over the local funding of care for the elderly need to be pointed out, and I know that the Minister will have seen the submission to the process by Hampshire county council. My hon. Friend the Member for Stourbridge (Margot James)—who unfortunately is now leaving the Chamber—talked about private citizens having to pay more than the county council for care, and that view is supported in a letter that I received recently from Mr Winterton-Smith, who wrote to me at great length about the difficulties he faces in financing care for his mother.

I looked up some statistics. Market research by Laing and Buisson in “Care of Elderly People UK Market Survey 2010-11” estimates the average weekly cost of nursing care in the southern home counties, which includes Hampshire, as £787. On average, Hampshire county council’s nursing care beds cost £650 a week. That is a difference of over £5,000 a year for the private carer, and it is a substantial gap that needs to be looked at.

Hampshire county council’s submission shines a spotlight on the number of self-funders in the southern counties, and in Hampshire, nearly 60% of those who receive elder care are self-funders. One imagines that the funding pattern could become enormously complicated if some parts of the country need massive cash inputs to deal with people converting from self-funding to being funded by the state. I point that out in passing because I was asked to do so by Hampshire county council, which I am partially representing today.

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I was always attracted to the insurance model; it seemed to be a way of providing for future care in a proper way. Unfortunately, however, it looks as if that model is too complicated for institutions to price properly, and even the guarantee provided by Dilnot does not provide sufficient certainty for insurers to enter the market in any real number. The Joseph Rowntree Foundation and the International Longevity Centre have pushed forward insurance models, but Dilnot speaks about the market and explicitly rejects such models as stand-alone solutions. He believes that insurance models can be part of a solution and that some schemes will help, but the overall model is rejected.

Policy Exchange—not the favourite think-tank of Opposition Members, I know—published a report last year entitled “Careless.” I have spoken widely about countries such as Germany and Japan that have partially insurance-funded models of care, but are beginning to struggle with the implications of rising costs, and such models are beginning to look unsustainable. The Policy Exchange report gives a figure of £106 billion for the full cost of replacing care that is provided throughout the community, both privately and publicly, to those who need elder care. All sorts of perverse incentives might arise in a system that provided universal care. People who now provide care for nothing would, quite understandably, not provide it in the same way as they used to. The sum of £106 billion is a frightening figure to consider. I have no particular basis on which to back up that number, however, but I merely cite it from that report.

We have talked a little about the link between adult social care and health spending, and cross-departmental spending. When I was reviewing the literature, I noticed a reference to a spat that occurred in County Durham when the local PCT spent money on gritting the roads. It did so because it felt that it was a good way to prevent accidents and stop people needing adult social care. To me, that made a great deal of sense. The council, however, got into the most terrible trouble; all sorts of newspaper articles said that it was foolish or idiotic and did not know what it was doing. The harsh reality is that trips and falls cost the health service money, and they cost many elderly people their independence, and later their freedom.

The council’s decision is exactly the sort of thinking that led to what I will happily call the excellent Total Place initiative launched by the previous Government. That agenda has real potential to provide some of the funding that we require to solve the problem of care for the elderly in the long term. Breaking down the barriers between Departments, and pooling spending to deal with complex objectives, are ideas that the coalition must pursue if we are to make real inroads into solving problems such as the care of older people in times of increasing complexity and tighter spending.

Sarah Newton: My hon. Friend makes an incredibly important point. Does he agree that we have huge unmet housing needs for the ageing population, and that we have not thought about the types of homes that would most appropriately enable people to live comfortably at home? By planning services in a particular location, all the aspects that impact on whether people live healthier and longer lives could be better developed and delivered.

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George Hollingbery: I am grateful for that intervention, which leads me neatly into my next point, which is always the danger of briefing one’s colleagues about what one might say, then being called last in the debate.

There could be a great deal of entrepreneurial thinking on cross-departmental spending and other areas that do not immediately seem relevant to social care. As many of my colleagues will know—including the hon. Member for Lewisham East (Heidi Alexander) who is a member of the Select Committee on Communities and Local Government—I am slightly obsessed with planning and I have become an appalling anorak since I came to Parliament whenever we talk about planning. I believe, however, that there is potential in the planning system to mitigate costs. If, when designing new communities in major and strategic development areas—6,000, 7,000 or 8,000 houses at a time—we plan properly for the needs of older people, and build the right sort of accommodation and adaptable homes that can be used in future and adapted later, people will be able to stay in their community and be close to their support networks. If such centres are built near shops, supermarkets and hairdressers, people can carry on living in the same place for a long time. By then moving a few hundred yards out of their house into one of these facilities, they can leverage the asset that they have grown over the years and look after themselves more efficiently.

In short, this issue is not only about adult social care or Department of Health budgets: we need entrepreneurial thinking across the public sector to ease the problem. I hope that the Minister will encourage all his colleagues across Departments to do just that.

4.47 pm

Liz Kendall (Leicester West) (Lab): It is a pleasure to serve under your chairmanship, Mr Bone, and a pleasure to follow the thoughtful speech by the hon. Member for Meon Valley (George Hollingbery). I agree with many of the points that he made and I will come on to discuss them. I also thank the hon. Member for Truro and Falmouth (Sarah Newton) for securing this debate, and all other hon. Members who have spoken.

I will begin not with how we are going to fund the future system of social care, but with the “crisis in care” that older and disabled people, and their carers and families, are experiencing. Those are not my words but those of the Care and Support Alliance, which is an alliance of 52 major organisations representing older people, disabled people, their carers and families. It is important that we are clear about the state of the current system and the scale of the task we face. It will mean difficult decisions for all political parties.

I will begin with a point that has already been made by several hon. Members. Under the current system, there are substantial levels of unmet need. Although the Association of Directors of Adult Social Services is right to say that that need is difficult to quantify precisely, the King’s Fund has estimated that the unmet need gap in the current system is around £1.2 billion.

Those unmet needs are increasing. To a large extent, that is because of our ageing population. That is a good thing, but it means that more people are living to a very old age with one, two or perhaps three long-term, chronic conditions, such as dementia. We simply have

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not seen that in the past, and it is happening at a time when budgets for both the NHS and social care are being squeezed and they are not changing sufficiently fast to meet the changing needs of our population.

However, unmet need is also growing, because councils are tightening and restricting their eligibility criteria for services. Eight out of 10 councils now provide services only for people with substantial or critical needs, and as my hon. Friend the Member for Lewisham East (Heidi Alexander) said, those are people with very real and serious care needs, not simple needs. “Substantial” means very serious needs.

Mencap says that 83% of councils are meeting only substantial or critical needs for adults with learning disabilities. That is up from 73% only one year ago. Nine out of 10 councils have increased their charges for both residential and domiciliary care. Many councils are restricting the time allowed for home visits. Help At Home, one of the biggest home help providers in Leicestershire, told me at my surgery last Friday that Leicestershire county council is paying for blocks of 15 minutes of care, down from 30 minutes previously. It told me that if the carers go just over that, the council rounds down the time for which it will pay. That is causing huge problems, first and foremost for older people. In many cases, it is simply impossible to get an older person up, washed, dressed and fed in such a short time. It is also causing a problem for staff who, once unpaid travel times are taken into account, are not even earning the equivalent of the minimum wage in the course of a working week. As a result, Help At Home is losing staff and finding it very difficult to recruit new staff, which the organisation simply has not experienced before.

It is clear that one of the fundamental reasons for tightened eligibility criteria, increased charges, and reductions not only in preventive services but in services such as day care centres is the cuts to local council budgets. The Government say that they are providing £2 billion of additional funding for social care in the course of the spending review period. The Association of Directors of Adult Social Services says that the reality is that social care spending has been cut by £1 billion this year, with even bigger cuts likely next year. Analysis by the House of Commons Library shows that, according to Department for Communities and Local Government figures, there will be a real-terms cut of £1.34 billion to adult social care in the Government’s first two years once inflation is taken into account; £1.3 billion is being cut from social care spending for those over 65.

The figures are based on the assumption that councils receive every single penny of the money that the Government say is being transferred from the NHS to local councils. In many cases, that is happening, but I have been told by several leads for adult social care that they are not getting all the money, and that that applies particularly to money for carers. The reality is that local council budgets are being cut by 27% during the spending review period and that that will have an effect on adult social care, because social care budgets are the biggest discretionary spend for local councils.

The Government say that there is no reason why local councils should end up cutting social care services because of the cuts in council budgets. I just point out

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that the Government have readily said that councils need extra money to pay for weekly bin collections. I ask hon. Members to reflect on that sense of priorities.

The consequences of the decisions are being felt by older and disabled people, who, as my hon. Friend the Member for Lewisham East also said, have been denied the up-front preventive services and support that could keep them healthy and independent in their own home. Older people, whether that is the old old or people aged 65, like my father, do not want to be reliant on any kind of help. They want to be independent. Our goal is not to be dependent on any kind of help from the state, but to live independently for as long as possible. However, the help and support that people could receive to achieve that independence is not happening. The consequences of the cuts and decisions are being felt by families and carers. Many hon. Members have talked about the pressures on carers, many of whom are at their wits’ end struggling to make ends meet, at grave risk to their own physical and mental health.

Something that has not been mentioned in the debate is the fact that the consequences are also being felt by businesses and the wider economy, as companies lose the skills and experience of carers who are forced out of the labour market because there is not enough affordable, good-quality and flexible social care to allow them to stay in their job. That problem will only get worse as people are required to work longer before they retire, and care longer at the same time.

The consequences are also being felt by taxpayers, as older and disabled people end up using more expensive hospital services when they do not need to. Several hon. Members have rightly said that delayed discharges from hospitals are up by 11% in the latest month for which data are available compared with the same time last year. That is because we are not getting the right system in place, which costs us all more in the long run.

I want to be clear: I firmly believe that we can make far better use of existing resources if we genuinely bring together health, social care services and other services such as housing and shift the focus not only more towards prevention, but much more towards a personalised service. I am grateful that the hon. Member for Meon Valley talked about the Total Place work under the previous Government. We must begin to see all these local budgets as one pot of money that can be used.

Hon. Members will have many good examples from their constituencies of ways in which preventive services have saved money. One example from the time of the previous Government is the partnerships for older people projects, which brought together health and social care around individuals’ needs. Overnight hospital stays for people in the projects were reduced by 47%; accident and emergency attendance was reduced by 29%; and once all the other services such as occupational therapy and physiotherapy were taken into account, £2,166 less per person was spent, so there is huge potential.

Even if we get those big shifts in the way in which services are run, more funding will be needed for the system in future. That is why the Labour party has offered cross-party talks on the proposals set out by the Dilnot commission. As hon. Members have said, there is widespread, although not total, consensus in favour of the commission’s proposals. We are serious about engaging in meaningful talks on the Dilnot proposals as a step towards a better system in future. We have set

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aside our experiences before the last general election, when very unhelpful comments were made, which wasted an opportunity for cross-party consensus.

If talks are to be serious, meaningful and successful, four key things need to happen. We have written to the Secretary of State setting them out, and I will outline them now. First, all relevant Departments must be engaged in the process. Securing agreement on the funding and implementation of the Dilnot proposals goes far beyond the remit of the Department of Health and the Health Secretary. The engagement of the Treasury is particularly important in the process.

Secondly, we have suggested that there should be an independent chair for cross-party talks, as we believe that that would make a successful outcome more likely. Thirdly, we think that an agreement is far more likely to be reached if there is transparent access for all parties to policy advice and information. We have suggested having an independent secretariat to provide equal access to the negotiating teams as required. Finally, we have requested that the leaders of the three main parties meet to agree a clear timetable for talks, with a view to securing a successful outcome and a joint statement before the publication of the White Paper next spring.

I think that many organisations representing users of social care and carers would agree that such steps are vital. If we are serious about cross-party talks to get all parties to sign up to big future public spending commitments, the talks need to be serious, and they need to have a serious process. I need not say this: such an agreement will be extremely difficult and challenging to reach in our antagonistic and combative political environment.

Kelvin Hopkins: I am listening with interest to my hon. Friend, but I am slightly concerned that there might be—if one likes—a conspiracy between the Front Benchers of the different parties to keep down expenditure rather than do what is needed. It might mean the Labour party saying, “We are going to have to spend more,” and raising the revenue to pay for it.

Liz Kendall: I am under no illusion about the scale of the funding challenge to meet the needs of our ageing population. Funding the current, unfair and ineffective system of social care will cost £12 billion by 2025. The Dilnot proposals, on top of that, cost more than £3.5 billion. Dilnot is an important step that we want to have genuine talks about, but it will not solve the entire problem that we face about the future of social care. Yes, we can make a big difference by looking at how we join up health, social care, housing and other spending, but there are clear implications for all parties in taking the matter forward, and we all need to be aware of them.

Barbara Keeley: My hon. Friend is making a good argument, and I am heartened by what she is saying. However, if the implications that she has just helpfully outlined exist, the debate has to be taken out to people. If there are implications for taxpayers, they have to know what they are. Many Members who have spoken today have said that it is quite clear that people do not understand or plan for care, and then the costs hit them. The debate out there, in addition to the essential cross-party talks, is important.

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Liz Kendall: I could not agree more. The deal must not be done behind closed doors. There has to be a discussion between political parties, but most importantly, there has to be a discussion with the public—not just the current users of the system and their carers, but people who are not in the care system and younger people, who are working now and who will have to understand the issue. We have to have a full and proper debate.

John Pugh: During the previous general election, we all had a number of hustings meetings. Whenever the topic cropped up, a theme that came across forcibly from all members of the public was that they wanted the parties to discuss the issue together and that they were rather saddened by what happened immediately before the election.

Liz Kendall: I was not a Member of Parliament then, but from my own experience in hustings, I think that people feel let down when such an important issue becomes a political football. The hon. Member for North Norfolk (Norman Lamb), who was the health spokesperson for the Liberal Democrat party at the time, did not engage in that kind of behaviour. I do not want to go over old ground.

We need to discuss the matter, but it will be difficult. We all know what politics is like, and how parties use things to get at the other side. The issue will not be easy—it is about public spending and implications for individuals. What will they and taxpayers have to pay? We would be kidding ourselves if we thought that the issue would be an easy one.

I agree with all hon. Members who have said that the issue is one of the biggest challenges that we face, even if that is a cliché. We all think about it for our constituents and in our own families. I think about it, as many other hon. Members do, for myself, as I hope to live to a ripe old age. It will be a difficult challenge, but I hope that today’s debate shows that we are at least prepared to engage with the difficult issues to take the debate forward.

5.4 pm

The Minister of State, Department of Health (Paul Burstow): I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate. By doing so, she has demonstrated the breadth and depth of her interest and expertise, and the breadth of interest across the House, in the issues. Such debates are not always as well attended as this one. As you rightly noted, Mr Bone, the Leader of the House also attended for a while to listen to our deliberations, which speaks volumes about the importance that the Government attach to the issue.

I am delighted that so many members and officers of all-party groups took part in the debate. This is the second time this week that I have had the pleasure of the company of the chairs and other officers from a number of those all-party groups. Earlier in the week, I hosted an event in the Department of Health with APG chairs to discuss with them their thinking about the way in which we need to respond to the challenging agenda and to input into shaping the White Paper that we will publish—in answer to the hon. Member for Banbury (Tony Baldry)—next spring. When I was asked at the

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meeting, I confirmed that we are aiming for April—that is what we mean by spring for this purpose—and I can reconfirm that today.

I very much agree with the remarks of the hon. Member for Worsley and Eccles South (Barbara Keeley), which were echoed in many contributions in this debate, about the need to have cross-party discussion and secure a cross-party agreement. One reason why we need to do that is that social care law has been very overlooked and neglected. The Law Commission report that came out this May quite rightly pointed out that our social care legislation has evolved over 60 years in a haphazard and piecemeal way. The confusing legal system is one of the reasons why social care has such a complex system, and why so many judicial reviews take place. We need a consensus to secure a legal reform that will last the test of time.

First, I would like to respond to some of the points made about the current situation of social care funding. I find it heartening that some of the points rehearsed in the debate acknowledged that the fragility of our social care system is not new—it did not start 18 months ago but is the pattern of many years, which we, as the coalition Government, are trying to address now.

I am not going to deny that things are tough, or that no council has had to make difficult decisions; it has not been an easy time for anyone. Difficult decisions have had to be made across Government because of the economic situation that we currently find ourselves in. However, the funding landscape is not as simple as I think some would like us to believe. The headline story of a Government intent on slashing social care services no doubt makes good copy, but it is not borne out by a closer examination of the facts.

In the previous spending review, which we announced last October, we provided an extra £7.2 billion over four years up to 2015 to protect social care, partly through councils and partly through the national health service. The aim was to alleviate the potential pressures on the adult social care system in what would be a challenging overall funding settlement for local government; that point has been rehearsed quite clearly by a number of colleagues in this debate.

We recognised that this year would be particularly tough. We have front-end loaded the funding for the first two years to insulate social care from cuts to local authority budgets, on which I will amplify a bit. Combined with a focus on efficiency, we believe that the additional funding that we have provided will enable councils to protect people’s access to care services. That is not just our view but the Local Government Association’s view, put forward in its submissions to the spending review. The King’s Fund also said in its report, “Social care funding and the NHS”, that central Government have put enough money in to protect adult social care services, provided that there are rigorous attempts to improve efficiency.

However, as the hon. Member for Leicester West (Liz Kendall) and other hon. Members have said, spending is falling. Budget data collected by the Department for Communities and Local Government from local authorities suggest that social care budgets are around £200 million lower than last year, which is a reduction of just over 1.5%. However, it is not inevitable that reductions in spending lead to cuts in front-line services. The hon. Member for Worsley and Eccles South quoted the

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Association of Directors of Adult Social Services, which had an interesting survey of their members that was published earlier this year. Boil it down a little further and what we find is that for every £1 that has been saved or taken out of spending in social care by local authorities, 70p can be attributed to efficiency savings. It is not about taking services out from the front line, but service redesign.

Yesterday, the Local Government Association released a prospectus inviting councils to take part in its productivity programme for adult social care. It said that there is scope for efficiency. In its foreword it said that if councils develop plans in line with policy objectives such as prevention and personalisation, they will minimise the impact of reduced funding for the front line, which is why I welcome the work that it is doing to recruit councils to its programme. From there, best practice can be shared with other councils to ensure that they are not making bad decisions when it comes to their budget choices.

Barbara Keeley: I understand the issues about efficiencies and the need to make changes such as the move to personalisation. However, from my experience—as I have said, I am in a local authority that is protecting social care—efficiency savings have caused our primary care trust to give up active case management for people with long-term conditions. Personalisation of personal budgets has meant that Age UK has not been able to conduct similar active case management for older people or to run drop-in centres for carers of people with dementia. Sometimes the change and the churn also cause loss. We have not touched today on the reorganisation of the NHS, but that has had an impact on things, too. I understand that we are in a system in which certain changes are good but can result in a loss of services that really impacts on people.

Paul Burstow: I am not seeking to hide or resile from that. What I am trying to do is demonstrate that the picture is not uniform or consistent. I want to quote some further evidence that supports that point of view, but first let me make it clear that of the £900 million that the ADASS survey identified as having been taken out of social care spend, 70p in every pound came not from cuts in front-line services but from service efficiencies and redesign. That very point was made by a number of hon. Members in the debate.

Heidi Alexander: The Minister is talking about efficiency savings within adult social care services, but would he accept that as every day goes by, demand for those services is increasing because of the needs within the existing population? May I press him a little more on the point made by my hon. Friend the Member for Leicester West (Liz Kendall)? Does he not think that his colleagues should be making greater protestations about decisions taken within local authorities? Rather than focusing on the bins, as my hon. Friend said, we should be talking about the needs of the elderly population and perhaps giving local authorities a bit more direction. Will the Minister tell us his views on that?

Paul Burstow: I do not believe we should micro-manage the decisions of every local authority. We should not dictate to local authorities about how to manage their resources. One message that came from local government

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before the election, which we, as a coalition, have responded to, was the desire to remove ring fences from budgets to give councils maximum flexibility. Total Place is exactly what that is about. It is about using budgets smartly to meet local needs in the best way to fit the community’s circumstances. In the past, such flexibility was constrained by the number of ring fences.

I have also picked up on some scepticism in the debate about the additional funding that is being provided through the spending review for adult social care via the NHS. There was some question as to whether or not that money was getting through. Of the £648 million for this year, nearly half has already been transferred—we know that from surveys that we have conducted—and agreements are in place to transfer the remainder. As to the reference to the money for carers, that was not part of this social care transfer; it was a separate requirement under the NHS operating framework. I am more than happy to debate that at a later stage, but right now I need to try to cover the main points in this debate.

Both primary care trusts and local authorities are positive about the development of these particular funds. They have seen them as a lever for more joint planning and co-operation. The feedback that we have had to date shows that the money is being spent on what it was intended for—prevention and rehabilitation, re-ablement, early supported hospital discharge schemes and integrated crisis response services. I am saying not that the money is a panacea but that those funds are making a difference in the communities in which they are being used smartly by the NHS and social care organisations. Times are tough and I am not going to pretend otherwise. Although I can present a relatively positive picture nationally, there are areas where cuts to front-line adult social care services are really beginning to bite.

Although some councils have coped with the cuts by tightening their eligibility criteria, it is not fair to suggest that that started in May last year. The trend started back in 2005. The way in which councils define and apply eligibility criteria is not consistent from one borough to the next. We will address those issues of definition as part of the review that we are taking forward in the White Paper.

Kelvin Hopkins: Even squeezing at the margins means that more people will suffer and not get the care that they need. In other fields we spend more freely, relatively, and yet we are squeezing in this area. The Minister said that 70% of the cuts in spending is to deal with inefficiencies, but 30% is real front-line spending, which means that some people are suffering.

Paul Burstow: I am trying hard to be reasoned and respond positively to the points that have been made. I am not trying to dismiss things. I am not making a speech that pretends that everything is perfect. I am trying to engage seriously with the real problems that local authorities are having to grapple with. I am also trying to set out that there are different ways of doing things. Some councils are choosing to do things differently and in ways that allow them to protect the quality of the service and the outcomes for the individual. That is the test that is most important to me.