Madam Deputy Speaker (Dawn Primarolo): Order. Will the right hon. Gentleman face the rest of the Chamber and address the Chair, and while I am on my

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feet, I should remind him of two things: interventions should be brief, and handheld devices in the Chamber, before or after interventions, should be used with due decorum.

Paul Burstow: I apologise to you, Madam Deputy Speaker. I have been here long enough to know that I should speak through the Chair.

I simply wanted to say that during consideration of the draft Bill, when asked, many people told us they had nothing by way of criticism of the Bill, although they saw areas where it could be further improved.

Mr Ward: I thank my right hon. Friend.

Acceptance of the principles—certainly acceptance of them by myself—is there, but as the Minister knows only too well, as I have bent his ear on the subject so many times, I have some serious concerns, particularly about the FACS—free access to care services—criteria. He will probably not know—it is a recent decision by Bradford council—that the Labour council has decided to move from “moderate” to “substantial” in respect of the criteria. It has to go into a budget process; unfortunately, this will happen. We campaigned hard against that, with a 1,700 names on a petition opposing it, but it is going to go ahead.

What was unfortunate about earlier exchanges was a certain degree of dishonesty. This thing did not happen all of a sudden three years ago. Conservative, Labour and possibly some Liberal authorities—I do not know—up and down the country were from 2005 onwards moving away from “moderate” to “substantial” FACS criteria way before the change of Government and way before the vicious cuts took place as part of the austerity programme. Indeed, it was before the recession really bit, and I regret that. What seemed to be happening was a “follow my leader” approach—“Every other authority seems to be doing this, so why shouldn’t we?” It was seen as a way of reducing the budget. What I argued, continue to argue now and will continue to argue all the way through until this Bill becomes an Act, is that this is a false economy. I have made all those points to the Minister several times, including, in detail, in a Westminster Hall debate.

I believe that eligibility is the gateway to care, but I am not convinced by the proposed savings that are supposed to be made. We worked closely with various organisations, including Scope, which has done a fantastic job of looking at the issue of working age disablement, which accounts for one third of benefit recipients. People desperately need care to live a more fulfilled life, whether it be in education or work. This is just one example—there are many others—where savings can be accrued, but taxation can also be generated if people are given just a small amount of support to become economically active.

Other charities and organisations have raised serious issues. Principles are most important, but data collection is crucial. Charities that exist to help people with Parkinson’s and other neurological conditions identified the fact that they had no idea how many people with Parkinson’s actually received social care. How can that be the case? How can that happen? Something must be sadly going wrong with data collection. Macmillan Cancer Support pointed out that free social care at the end of life needs

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to be a crucial element of any changes we are looking to make and that, if we aim for true integration, we must have proper identification of carers within their health settings. We should not wait until people are turned out of hospital and go home before identifying who is going to look after the person and provide support. Leonard Cheshire Disability provided further useful information, and I ask the Minister to look further into some of the issues it raised.

Important principles are at issue here. On the national criteria, I may not like the level, but it is important to have standardisation. On the carers assessment, we should be applauding the fantastic proposal to make carers the centre of attention, as they are so often forgotten. How many times have carers ended up being the people who need care because of the lack of support they receive? A young person I know has come to my office on a regular basis to express serious concerns about the people he was caring for, but I have seen with my own eyes that person deteriorate over the last 12 months or so as a result of the lack of support that he has received. The Bill introduces a wonderful innovation, which we should all appreciate.

I have already mentioned the principle of integration. We have the framework: the health and wellbeing boards are still in their early days, but this way of bringing together the different parts of social care, public health and the national health service is so important. The links between health and social care are crucial. I cited a case in the Westminster Hall debate of a man in his 50s who had an accident at work when reversing his vehicle. He had no seatbelt on, as he was just backing into the car park, yet he became tetraplegic. He was in Pinderfields hospital for five months. He received superb support and everyday attention, but when he went home in the ambulance, he could not get into the house because there was no ramp. He had to go away again. Then the local authority provided the money for a ramp and the hospital brought him back again, but he could not get in because it was a wooden ramp and they did not dare take him on it because that would have broken it. That is madness in this day and age, and it needs to be dealt with.

On the cap on lifetime payments, we do of course need to discuss in detail what it should be and how it should be operated, but please let us not talk it down, because an incredibly important new public policy is being put forward here, which we should applaud.

Let us try to forget what happened earlier. It was unpleasant to see and I do not think it truly represents the true passion and commitment of people on both sides of the House to improving social care for the people of this country.

7.7 pm

Mrs Anne McGuire (Stirling) (Lab): For reasons that might become clear later, I am pleased to follow the hon. Member for Bradford East (Mr Ward). Before the hon. Member for Pudsey (Stuart Andrew) drifts away, let me say that his contribution helped to address some of the issues of transition, which can sometimes get lost in this debate.

We should recognise that this issue is not unique to the United Kingdom; it is a challenge that many countries face, and the hon. Member for Arfon (Hywel Williams) recognised that, even within the United Kingdom, the

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devolved Administrations are looking at how to develop their own social care policies in the context of their own nations.

I want to recognise, as some of my hon. Friends have done, that the Bill makes some progress, but I also want to assert our right to highlight the areas where we think it is failing. That is the justification for the reasoned amendment. We could get bogged down in parliamentary procedure here, but I think it is the right of the Opposition to highlight major issues that we think should have been addressed without undermining our support for the principle of the Bill. I hope that those who think that we are being churlish will think again. It is the right route for an Opposition. Talking about being churlish, let me put it on the record that I have rarely heard an opening statement from a Secretary of State, moving the Second Reading of one of his flagship Bills, that was so churlish, so partisan and, frankly, so disagreeable.

For understandable reasons, the debate on social care often focuses on older people, yet as we have heard—from the right hon. Member for Sutton and Cheam (Paul Burstow) as well as from the hon. Member for Bradford East—a third of those who receive social care are actually working age disabled people. We sometimes overlook their needs, rights and aspirations within the wider debate. Too often “social care” and “elderly” go together, and we need to get ourselves out of that mindset, because although they look the same, I think we would all agree that a younger person’s need for support can be quite different from the support needs of those who are older. The emphasis on older people means that the terms of the debate are often not as relevant as they might be to younger people who require social care. They often want to combine that social care with a life that includes work, education and so forth, and they potentially have a different pace and pattern of life from that of older people.

It was to highlight these issues that the all-party groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler) as chair of the all-party group on local government, and Baroness Campbell of Surbiton and myself as joint chairs of the all-party group on disability, were delighted when 10 parliamentarians of all parties from both Houses agreed to undertake an independent inquiry. The hon. Member for Bradford East was involved in that.

That report was lodged earlier this year and I trust that the Minister and my own Front-Bench colleagues have had the opportunity to consider its recommendations. What came out from all the evidence from disabled people, organisations and professionals was that the current system is not delivering on basic things such as washing, dressing and getting out of the house for many younger disabled people. If social care is to mean anything to the lives of the disabled working adult, it should be underpinned by a real recognition of the importance of an independent life. So the criteria of what is important should also include how the care dovetails into other important elements of daily life such as participation in work or education.

I acknowledge that in clause 1 the Government have recognised that promoting individual well-being is not just about care. They also recognise that it is about

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“participation in work, education, training or recreation”

and

“social and economic well-being”

and

“domestic, family and personal relationships”.

However, those ambitions will not be realised unless the issue of eligibility is properly recognised and the substantial anticipated savings highlighted in clause 2 creating a preventive care system will not happen either. I fear that the national eligibility threshold in the Bill is currently set too high. In Committee in the other place, that was recognised by peers from all parties and none. It will shut out 105,000 disabled people from social care and prevent them from living independent lives with dignity.

Councils are now moving at a rate of knots towards providing social care only to those with critical or substantial needs. We cannot divorce what is happening in social care from some of the other changes the Government are introducing. We are moving towards substantial care in terms of social needs and we are withdrawing disability living allowance from people with less complex needs. We are perhaps moving to a situation where those with severe and complex needs will be taken care of and supported while those with fewer needs will not be, so there will be a double-whammy in terms of social care and the DLA transfer.

I recognise that the Government have transferred some £2 billion from the NHS into social care and into making the transition easier, but this cannot be seen outwith the context of a 33% cut in local councils’ budgets by 2014 and the chronic long-term underfunding of the social care system. Over the past three years, £2.68 billion has been cut from adult social care budgets, which is 20% of net spending, but the number of working-age disabled people needing care is projected to rise by 9.2% and the number of older people needing care will rise by 21% between 2010 and 2020.

Sheila Gilmore: On my right hon. Friend’s list of changes affecting people needing care, does she agree there is also the issue of the independent living fund which has helped working-age people? The Government have lost a court case in respect of their failure to consult properly on that. Does my hon. Friend agree that that should be looked at carefully?

Mrs McGuire: I agree with my hon. Friend and I raised that with the Minister in a Westminster Hall debate. The Care Bill does not address the role that the Department for Work and Pensions plays in supporting social care through the benefit system and the independent living fund is a classic example of that. At present, people who can pay for social care through access to the ILF do not know quite what is happening, because the Minister—as I think he said last week at the all-party group—is still considering his options.

I want to echo a comment by the hon. Member for Bradford East—I can assure him that he will not get so many mentions in any of my speeches again. He pointed to something that I think is often missed, which is that the debate often crystallises around the spend, which is not seen as an investment. I acknowledge the work done by Scope, and carried out by Deloitte, highlighting that for every £1 invested in care for disabled people with moderate needs a saving of £1.30 is generated. The figures

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are pretty staggering. There would be a £700 million saving to central Government through an increase in tax revenue and a reduction in welfare spending. This Government always tell us that they want to reduce welfare spending; well, there are opportunities to do so without doing some of the things that they are doing. There would be a £570 million saving to the NHS and local government, and £480 million would be saved by local government by avoiding the need for disabled people to enter expensive residential and crisis care.

The Minister knows that there is considerable political and organisational support for a lower eligibility threshold. The draft Care and Support Bill pre-legislative scrutiny Committee recommended that, when setting the national eligibility threshold, the Secretary of State should have regard to the duty of local authorities to promote individual well-being. The report of the joint inquiry I have mentioned also highlighted the issue of eligibility.

We in this House often talk as though we are somehow divorced from the beneficiaries of the legislation we pass, but I say to Members that we are talking about ourselves here. Any one of us could walk out of this Chamber tonight and be in need of social care tomorrow. If we want a good social care system, we should ask ourselves this question: what would we want for ourselves if we had a stroke or a car accident or fell down those marvellous marble stairs outside and cracked our head? That is the criteria that we should be using. This Bill makes small progress, but there is a lot more to be done.

7.18 pm

Anne Marie Morris (Newton Abbot) (Con): For my constituents this Care Bill is one of the most important pieces of legislation we have seen in my time in Parliament. That is because the west country attracts a lot of people wanting to retire to our very beautiful countryside. In Newton Abbot, 23% of residents are over the age of 65, compared with the national average of 16.5%. Social care is therefore a very important issue for us.

I congratulate the Government on what they have done, because they have introduced an holistic framework that sets the scene for ongoing legislation to flesh out that framework. They have listened to Dilnot and to Francis and that is very much to their credit.

Integration of health and social care has been the watchword on everybody’s lips. All Members will have come across examples in their surgery case loads of where that does not work, and I am very pleased to see the integration—the balancing provision—that we already have in the Health and Social Care Act 2012 now reflected in this Bill.

On the adult safeguarding framework, I say well done! This is crucial. This is the first time we will have had anything like this for vulnerable adults. In my constituency, I am regularly addressed by carers who are frustrated not only by the challenges of those they care for but by the lack of support they receive. The Bill will provide the answer in the form of care plans and proper assessments. It is not often that individuals come to me who have fallen into the gap between the care plan for a child and the plan for an adult, but it does happen, and I am pleased to see that the Bill will mean that that will change.

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One of the big challenges is dealing with the cost of care, and it is to the Government’s credit that they have started to look at that difficult question. How much is it right for the taxpayer to pay, and how much for the individual? This is a good Bill, but there are many things that I am sure all of us would like to see added, improved, amended or clarified. For me, one of the challenges is the role of the local authority in its commissioning and provision of care services. It seems bizarre that it should do both, because that must surely give rise to a conflict of interest. How can it commission and provide? The conflict was recognised in the NHS, and a split was introduced. It is now time to introduce such a split in this regard as well. Now that local authorities will have a key oversight role, it would be madness not to review that situation.

An important change involves the concept of true integration, and the challenge will be to identify the stakeholders who should be included in that integration. Clearly, it must involve the NHS, the local authorities and housing, but one area in which there is often no acceptance of stakeholder responsibility is that of transport. Transport to get people between care homes and hospital appointments has almost reached crisis point in my constituency, and there is huge reliance on the voluntary sector to fill the gap. There is clearly some provision for the NHS to provide that transport, but the rules are so broad that, when times are tough, transport provision becomes limited.

So who provides the transport? The volunteers in my constituency are brilliant, but they can afford only so many vehicles that are equipped to take wheelchairs, and there are only so many drivers. That issue needs to be properly addressed. In the guidance on integration that is to be given to local authorities, the NHS and other stakeholders, we must look seriously at the transport question and ensure that appropriate responsibility is taken for it and that it is properly funded. We cannot assume that the voluntary sector will continue to fill the gaps.

The assessment will form a critical piece of the jigsaw, and the Government are to be commended for trying to clarify the process, to avoid confusion and to get agreement on this. I understand their need to limit mandatory provision by a local authority to those in substantial need and above, but I fear that there could be confusion over the interpretation of the word “substantial”, and I would welcome clarification on that from the Government, in guidance or elsewhere.

Having looked at the definition of substantial need, we then need to consider who is to be involved in agreeing the care package. This is about the process of assessment, and it will be crucial for all the stakeholders to be involved. I have seen diverse levels of application in my local authorities. In some, this is very much a matter for the local authority, and it can sometimes almost seem as though a care package is being imposed on an individual. In other authorities, however, the individual, the carer, the family and the care home are all involved to ensure that the package is understood, agreed, accepted and fit for purpose. It would be extremely valuable if guidance could ensure that that always happened, when the Bill becomes law.

Having assessed the individual’s need, we need to ensure that the quality of the provision is fit to meet that need. I welcome the introduction of the new,

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almost Ofsted-like categorisation of quality, which will give us a real insight into what is on offer, and what “good” and “average” look like. That in turn will give rise to further questions. Once we know what they look like, we shall have to answer a much more difficult question: to what level should the taxpayer pay, after which there should be a personal top-up? That issue can be addressed only when we have some experience of those categorisations.

If there are to be different levels, the option of a top-up has to be real and available. It clearly exists, but I have seen a reluctance to make it happen in practice in some local authorities. In some ways, that is understandable. The contract is with the local authority and the care home, and not with the relatives or, more usually, the individual picking up the extra cost. The local authority will be concerned that, should there be a problem of affordability for the caring relatives, it would be left to pick up the bill. The top-up therefore needs to be reviewed. If it is to be available, it must be meaningful, and that might involve looking at whether relatives can be part of the contractual arrangement.

In the longer term, following the successful passage of the Bill, there is a lot more that could be done. The Bill will undoubtedly put in place the framework, and we can then begin to look in more detail at the strategies needed for those living in their own homes with support. Historically, we have asked what we should be doing for those in residential care or in hospitals, but once we have the framework, we will have the opportunity to look at a much more concrete strategy. That is something I would very much like to see.

Given the financial circumstances in this country at the moment, we can afford to support only those with substantial needs as a minimum requirement, but the Bill makes provision for local authorities to offer advice as well as providing services, and we should perhaps give more support to those who have only moderate needs. Their needs could be better explored, and they could be better championed and provided for.

The final word needs to be that change is not just about legislation. This is also about a culture change. That will always be a challenge, and it is incumbent on all of us in the House, whatever happens to the Bill, to follow it up and ensure that it becomes something meaningful in practice that will benefit all our residents, who very much deserve it.

7.27 pm

Heidi Alexander (Lewisham East) (Lab): It is a pleasure to follow the hon. Member for Newton Abbot (Anne Marie Morris), who made a measured, thoughtful speech. It is sad that the Secretary of State did not strike the same tone at the beginning of the debate. I want to speak briefly about the proposals for the funding of elderly care and express my deep concerns about the Government’s proposed changes to the trust special administration process.

I have spoken before in this place about the care crisis in this country, not least because of my own family’s direct experience. When my nan had to move out of her home seven years ago, my family had no idea what was about to happen to the very modest assets she had built up over her lifetime. My nan was not an extravagant woman. She never once went abroad. She simply worked hard and brought up her family. When vascular dementia

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took hold of her mind and her body, she could no longer stay in the semi-detached house in Swindon she had bought with my grandfather. She had to sell it. She moved to sheltered accommodation but, after a few years, she deteriorated rapidly and soon had to move to a nursing home. Before she died, she spent £130,000 on care in that home over three to four years, using up all but £23,000 of her lifetime assets. If she had known that, it would have broken her heart. She would not have thought it fair that everything she and my grandfather had worked for could not in any meaningful way be passed down to her children. My family are neither rich nor poor; we are like families up and down the country for whom the hand of fate intervened resulting in catastrophic care costs for their loved ones.

The Bill’s proposals to cap those costs and to raise the amount of money that an individual’s family can keep after paying for care should be welcomed, but we should welcome them cautiously. The cap does not cover all care costs, and the complexity of the process of valuing people’s assets and calculating their personal contribution means that many people will still end up paying very significant sums. Presenting the proposals as the answer to the country’s care crisis is disingenuous and risks spreading even more confusion about what support from the state families can expect.

If individuals are to pay less, the state will pick up more of the tab, and the financial front line in that respect will be local authorities. They are already buckling under the strain of providing social care. London Councils, the body representing the capital’s local authorities, estimates that the costs of resetting the means-test threshold, added to the rising demand for care, will see social services departments facing a shortfall of more than £1 billion in the years between 2016 and 2020. The money set aside by the Government to deal with that is inadequate. Be it this Government or the next one, we have to wake up to the scale of the financial challenge and answer the tough questions about where the money is going to come from.

I could speak for much longer about the care proposals in the Bill, many of which I welcome, but I now wish to address part 3, chapter 4, which extends the powers of special administrators appointed to failing hospital trusts. The changes are only a small part of the Bill, but they have serious implications for hospitals and the health service across the country. The introduction of even more draconian powers for special administrators will hamper the public’s ability to have their say on key hospital services and could lead to a chaotic and rushed system of hospital reorganisations that will not be in the best interests of patients or our democracy.

Grahame M. Morris: My hon. Friend is making important points about clause 118, which has become known as the “Lewisham clause”. Given the recent experiences of the length of time the trust special administrator has to consult the general population, does she think that 100 days is long enough?

Heidi Alexander: In my experience, it is wholly inadequate. The consultation period is being slightly extended through this Bill, but I still do not believe it can lead to a genuine, open and honest debate between the people trying to lead change and the public, who have a right to make their voice and views heard.

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I wish to discuss our experience in south-east London of the first ever use of the trust special administrator regime when the South London Healthcare NHS Trust was placed into administration last year. It is important for the House to understand that this process is totally different from any other hospital reconfiguration. It is a very fast process—roughly six months from start to finish—led by an administrator who is brought in from outside the organisation primarily to balance the books. The administrator is appointed to a specific failing trust, but what happened in our corner of London was that the administrator determined that in order to sort out the financial problems of the failing trust he needed to look beyond its confines, and that is where Lewisham hospital came in: a separate, successful, neighbouring hospital was told that its full accident and emergency department, its maternity service and its excellent paediatric department would have to go to solve the financial problems elsewhere.

The people of Lewisham did not think that that was very fair. The case was fought in the courts and the Secretary of State was told, not once, but twice, that he was acting unlawfully—hence clause 118; he fought the law and lost, so he is now trying to change it. He wants administrators to be able to specify and force through massive service changes at hospitals that are not part of the trust to which an administrator has been appointed. In effect, he wants to do elsewhere what the courts told him he could not do in Lewisham. When the trust special administrator regime was first legislated for, guidance was issued by the Department of Health stating that the process should not be used as a “backdoor approach” to reconfiguration. That is precisely how it was used in Lewisham, and had the law not been on our side, our full A and E and maternity service would now be closing, and half our hospital would be up for sale.

The TSA process is a brutal and rushed one. It starts with the need to save money, with questionable clinician input. When the starting point is the accountant’s bottom line, the public are understandably sceptical about whether the medical and clinical input has just been shaped to suit the desired financial end point. The speed at which the process takes place leads to shoddy and haphazard work. The administrator in south London recommended to the Secretary of State that he make decisions about Lewisham hospital based on an understanding that the whole process would cost £266 million and would take three years to implement. After the Secretary of State took his decision, it emerged, from the office of the trust special administrator, that it would cost twice that and take twice as long. The quality of the condensed public consultation was atrocious: people were struggling to find copies of the consultation document in local libraries; we had an online response form that did not even contain a direct question about Lewisham’s A and E; and hundreds of people had to stand outside packed public consultation meetings because they could not get in. That is not the way to deal with a subject that understandably arouses such passions in people. People care so much about the health service because it is often where they experience the worst and best moments of their life. They want to have their say in how their services are organised, and giving even more draconian powers to special administrators erodes their ability to do that.

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I understand that hospital services have to evolve—some services will have to close or be relocated—but to get public support for change, we have to get the process right for persuading people of the case for change. An augmented special administrator process, acting as a steamroller for the closure of hospital services, makes it less likely that those arguments are won, not more. These changes are at complete odds with the Conservative party’s manifesto commitment to

“stop the forced closure of A&E and maternity wards”.

The changes take power from the very doctors the Government say they are giving power to and could destroy trust in those who are central to leading the case for change and improvement in our NHS. For that reason, as well as others, I will be voting for the Opposition amendment, and it is why I believe that clause 118 should be deleted from this Bill as it progresses through Parliament.

7.38 pm

Mr Robert Buckland (South Swindon) (Con): When I say that it is a pleasure to follow the hon. Member for Lewisham East (Heidi Alexander), that is not a mere formality; it really is a pleasure, and it was fascinating to hear the family experience of her late grandmother in Swindon. As the Member of Parliament for some other members of her family, I was particularly interested in, and concerned to hear, that story. Clearly there is a measure of consensus about the progress that the Bill allows us to make. Although I understand and appreciate her concerns about the process that was successfully challenged in the courts in relation to her local hospital, and the detail in respect of clause 118, I do not think, with respect to her and to the Opposition, that that is sufficient for the reasoned amendment to pass tonight. I say that because I think of the thousands of families like hers who, over the years, have had to wait for change and for politicians to come up with a decision. We have procrastinated and prevaricated, and had review after review, so surely time is now up and decisions have to be made. That is why this Bill comes not a moment too soon.

I want to address an aspect of the Bill that has been dealt with by other Members: the care of adults with learning difficulties, and especially with autism. I speak in my capacity as chair of the all-party group on autism. I also declare an interest as the parent of a child who one day might fit some of the criteria of the Bill and as the parent of a young carer. I say with enthusiasm that I welcome those provisions in the Bill that relate to the assessment of young carers. They were very much part of a cross-party campaign with which my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Worsley and Eccles South (Barbara Keeley) were involved. A necessary change was made to allow young carers’ rights and needs to be assessed as well. Let us not forget that while this Bill makes its way through this House, the Children and Families Bill is making its way through the other place. We must ensure that both Bills dovetail in a way that is truly effective. In particular, I am thinking of the provisions of the Children and Families Bill that extend the education, health and social care plans to those young people between the ages of 18 and 25. We must ensure that the social care aspects of this Bill dovetail properly with the needs of those young people, because this Bill affects adults from the age of 18 and onwards.

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This is a hugely important Bill, and I want to address it in the context of the Autism Act 2009. That groundbreaking legislation was passed in this House with all-party support and following the work of my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan). I pay tribute to all Members, and former Members, who played their part in that legislation. As a result of it, an adult autism strategy was passed in 2010, which committed both national and local government and the NHS to improve the lives of adults with autism.

However, here we are in 2013, and there is still some way to go to meet the aims of that legislation. The strategy is currently under review. Ahead of that review, the National Autistic Society launched its “push for action” campaign, which identified some of the most important barriers to implementation and outlined the key challenges that adults with autism continue to face. Some of those challenges can be met by this Bill.

I am particularly pleased with clause 2, which places new duties on local authorities to prevent the needs for care and support from developing in the first place. Change in that area for adults with autism has been slow and patchy. A third of adults with autism who responded to a survey by the National Autistic Society said that they developed serious mental health problems because of a lack of services. Support at a low level can allow people with autism to become more independent, work, socialise and take part in their communities. At the same time, it can prevent an escalation of care needs.

Back in 2009, the National Audit Office found that providing such low-level services is cost-effective and helps people to avoid the use of in-patient mental health care, which costs between £200 and £300 a day. The NAO said that if just 4% of adults with Asperger’s syndrome or high-functioning autism are identified and supported, that would become cost-neutral over time.

I am glad that the right hon. Member for Stirling (Mrs McGuire), who is no longer in her place, referred to the Deloitte economic model, which quite clearly shows that for every pound spent to support people with autism and other disabilities, there is an average return of £1.30 for central Government, local government and disabled people and their families. Clear duties that prevent mental ill health are essential if we are to make the aims of the adult autism strategy a reality and to save money. I would be grateful if my right hon. Friend the Secretary of State and the Government ensured that local authorities’ understanding of prevention is wide ranging and includes the very types of low-level support that can make this prevention aspiration a reality.

Let me turn now to the existing duties of local government and the NHS. I welcome the Bill’s intention to bring together in one place statutory guidance on care and support. However, the statutory guidance that was published as a result of the Autism Act is slightly different. As opposed to the Care Bill, the 2009 Act also places important duties on the NHS. I want to ensure that those duties on the NHS are not unintentionally omitted from this Bill.

There is still much progress to be made with regard to the duty to develop a diagnostic pathway for adults with autism. I am happy to say that in Swindon the local social enterprise SEQOL has already done that, and has developed an important diagnostic pathway, which is also followed up by meetings with and assessments

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by clinicians. That has resulted in adults as old as 50 and above being diagnosed with autism or Asperger’s for the first time. The issue of what happens next will be key if we are to make this Bill, and the good intentions behind it, work for people with autism.

A common problem reported by families of people with autism is that far too often the person carrying out the care assessment does not sufficiently understand the condition or how to communicate effectively with someone on the spectrum. I am therefore encouraged by the recent amendment to the Bill to enable regulations that will specify where community care assessments should be carried out by assessors with specific expertise. Assessments for adults with autism must be covered by those regulations, because that will reinforce the obligation already placed on local authorities by the Autism Act and the statutory guidance to train those who carry out community care assessments. The NAS found that, at the moment, only just over half of local authorities have specialised training available for their staff, so, quite clearly, more work needs to be done to deal with that.

The right to advocacy is essential to enable people who find it hard to communicate to exercise their rights. I pay tribute to the work of the Swindon advocacy movement, which, as a result of its efforts and funding from the local authority, is now extending advocacy to adults with autism and Asperger’s, who have never had that support before. What often makes us parents lie awake at night is the question of who will speak for our children when we are gone. Who will be there to carry out that advocacy? This service is essential to provide peace of mind to parents and carers of sons and daughters with autism who will outlive them. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) mentioned the definition in clause 68 of “substantial difficulty”. This debate on Second Reading is about the principle of the Bill. I am sure that we will be able to iron our further details when the Bill goes to Committee. None the less, I commend it to the House as an overdue attempt to address the concerns of real people in our communities, and to help people with disabilities, including autism, lead fulfilling lives.

7.48 pm

Bill Esterson (Sefton Central) (Lab): The hon. Member for South Swindon (Mr Buckland) speaks with great passion and knowledge in support of children with autism. He made an incredibly important point when he asked who cares for vulnerable children once the parents have gone. Indeed, who cares for all those we care for once we are gone? That is a powerful and important point.

I agree with the hon. Gentleman that this debate is about the principle of the Bill. He talked about the need for action, which is why the Bill is welcome. We have an opportunity to improve services for many people, but Labour Members feel that the Bill should be more ambitious, which is why the reasoned amendment is so important, and it is what the reasoned amendment is saying. I also agree with him about the need to integrate what happens under the Children and Families Bill with what happens under this Bill. The crossover he mentioned between children’s service and adult services as children grow up is important. The Children and Families Bill and this Bill create significant new responsibilities for the NHS and local government, and the big question

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for the Government is about where the resources will come from to deliver them. I was a local councillor for more than 15 years under both previous Governments and it was a familiar story for local councils to be given new responsibilities without necessarily always being given the resources to deliver them. That is an important point about this crucial Bill.

The hon. Member for Bradford East (Mr Ward) mentioned the need for free social care at the end of life. That was an important point, but at what stage should social care be free? What do we mean by end of life? What criteria should we set? How much earlier than the end of a life should that care come? How do we fund free social care and how do we fund social care at all? That is one of the big concerns and that is why the reasoned amendment mentions our concerns about where the cap has been set.

My right hon. Friend the Member for Stirling (Mrs McGuire) mentioned the concern that the needs of disabled people may have been overlooked. The London School of Economics cites the fact that 97,000 fewer disabled people have been in receipt of social care since 2008—the figure for older people is 250,000. The LSE cites £2.8 billion as the figure required for councils to set eligibility at moderate, in the context of an overall budget spend for health and social care of £120 billion. The fact that it would take £2.8 billion to set the criteria at moderate speaks volumes about what could be done if we got this right.

My hon. Friend the Member for Lewisham East (Heidi Alexander) mentioned her family and I am going to talk about my family now. My dad cares for my mum. Let me describe my mum’s experience this year, because it is the experience of many older people and their families. In the early part of the year, she was being cared for by my dad and she gradually declined until she was rushed into hospital. I think it happened because no health professionals or social care professionals were keeping a close enough eye on her. She ended up in hospital where, happily, she received very good care. Her wish was met and she was able to go home, and the health service provided a hospital bed that she could use there.

Once she got home, the lack of service in the community became a problem again. There was not the rehab, the physio or the support to enable her to return to some kind of active life. Now, many months later, it is too late—that will not happen. My mum rarely gets out of bed any more. For many people, such an experience is all too familiar. It happens because of how social care and health have been allowed to operate over the years, with no proper integration and without people in the two services talking to each other. My parents receive a care package now, with carers coming in. My mum’s social care needs are met but the lack of proper support has meant that things are not as they should be. I do not think that my mum’s case is the worst, by any means, but it is indicative of where things are missing.

The Government have made a proposal and they have talked a lot about integration between health and social care. I remember looking at integrated health and social care teams many years ago as a local councillor and there was success then. There has been more success recently and there are good examples of health and

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social care professionals working together, but cuts to social care, in particular, mean that the money simply is not there any more.

I cited the figures earlier. In Sefton, we have seen a 40% cut in local government funding. The care managers are simply not there any more. They are not there, as Members have said, to help people in the community stay in their own homes; they are not there to help people who have gone into hospital go home again. Those situations are combining to leave a crisis in A and E—we will have that debate on Wednesday, but that is what has been allowed to develop. I am afraid that the reorganisation of the NHS during the first years of this Government, with clinical commissioning groups being created, meant that administrators and managers in the health service were concentrating on setting up new structures and not on ensuring that health services were delivered properly. These things do not happen by accident. When £3 billion is spent on reorganisation and not on patient care, that is the sort of situation we end up with. The question is what should we do. We have a proposal for a £72,000 cap on care, but my hon. Friend the Member for Lewisham East described the sum that her nan had to pay, which was £130,000. For many people, the £72,000 cap will be no help, and other Members have given the details that show that.

There are a number of ways of funding social care, one of which is to have a cap. However, let me return to the comments made by the hon. Member for Bradford East. If we are considering free social care at the end of life, or, as I said, a lot earlier than that, perhaps the time has come for Members to debate free social care as part of a health and social care service that is free at the point of delivery and at the point of need, like that which my right hon. Friend the Member for Leigh (Andy Burnham) has mentioned before. Perhaps the time has come to say that that is the ambition that we, as Members of Parliament, should have.

Tinkering at the edges will not solve the problem. The debate we must have—and it must be a cross-party debate—is about how to pay for such a service. As people get older, that is what will be needed. Sooner or later, we as legislators will have to deliver exactly that service. Anything short of that will not solve the problems; things will only get worse. I put it to Members from all parties that that is what is needed. We have made a start with the Bill and tonight’s debate, but we will need to move down the route of free health and social care and of whole-person care. That is the only way we can solve the challenge of an ageing population.

7.57 pm

Dr Sarah Wollaston (Totnes) (Con): It is a pleasure to follow the hon. Member for Sefton Central (Bill Esterson), who speaks so compellingly about his family’s experiences and sets out the case for why we must get social care right.

I welcome the Bill. It was a pleasure to serve on the Joint Committee on the Draft Care and Support Bill and I think the legislation has been greatly improved by its passage through that Committee and through the House of Lords. It establishes that we need a social care system that works around the needs of individuals, as well as the well-being principle and the vital prevention principle set out so compellingly by the hon. Member

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for Sefton Central. The Bill also consolidates a confusing patchwork of legislation that I remember coming up against in my time in the NHS. People were not sure what their eligibility was, and they could move from one part of the country to another and find that they no longer qualified in the way that they used to.

There are many things to welcome in the Bill. The hon. Member for Lewisham East (Heidi Alexander) compellingly set out the effect of losing everything in the ghastly lottery of eligibility. Setting a cap on costs and raising the threshold from that paltry £23,250 to £100,000 is very welcome. So too is the focus on better information, advice and advocacy, and the assessment and better support for carers. My hon. Friend the Member for South Swindon (Mr Buckland) made some important points about child carers and the transition from children’s services to adult services.

There is a huge amount to welcome in the Bill and I could talk for 10 minutes on why all these aspects are important. Unfortunately, we also need to focus on the challenges. The predominant challenge is demographic. Nationally 2.2% of the population are over 85, but in my constituency we got there 31 years ago. By 2020-21 2.9% of the population will be over 85, but for Torbay that figure will be 4.9%. That represents an enormous demographic challenge. We were discussing with the right hon. Member for Leigh (Andy Burnham) the reasons why age is so important in assessing need. Because of their demographics, places such as Torbay and wider south Devon face additional challenges with rurality, which means that they are under pressure like never before. Although I fully understand that we must take into account deprivation and health inequalities, unless we take sufficient account of age and need in assessing the formulae, the system will collapse.

I should point out that Torbay is not only nationally renowned but internationally renowned. As a member of the Health Committee, when we visited Copenhagen and Sweden, I ended up being shown slides of Torbay—how Torbay organises health and social care. If we look at the challenges facing Torbay, we see that it was those demographic and financial challenges that were the driver for looking at how health and social care could be better integrated and—I refer to the experience of the hon. Member for Sefton Central—how avoidable admissions could be reduced. Enormous progress has been made. Waiting times for occupational therapy have been reduced from two weeks to two days, for physiotherapy from eight weeks to 48 hours, and for urgent equipment to help keep people at home from four weeks to four hours. As a result, Torbay has the lowest hospital admission rate for elderly vulnerable people in the whole of the south-west.

Norman Lamb: I am grateful to my hon. Friend for giving way. Does she share with me the excitement at the plan for Torbay as a pioneer to bring mental health back into primary care, properly to integrate that part of patient care? We have seen in other places that this can do an enormous amount to prevent a deterioration of health.

Dr Wollaston: Absolutely. I welcome the fact that Torbay will be part of one of the integrated care pilots, and particularly that focus on mental health, as my hon. Friend says.

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Services in Torbay have been transformed through the use of care co-ordinators, so that only one phone call is necessary. There has been transformational work in sharing information and records and in rapid response to a crisis and putting prevention in place. The challenge that Torbay now faces is financial. Unfortunately, the elastic can stretch only so far before it snaps. Torbay’s funding is set to fall from £71.2 million this financial year to £63.6 million in 2014-15. Those cuts are in addition to the demographic challenges, the challenging situation in relation to children’s services, and the fact that we know that across the country 2015 is set to be a crunch year for NHS funding.

I welcome the £3.8 billion transfer for better care. We heard in the draft Bill Committee and in the Select Committee how such joint funding arrangements are the best driver to integration. A formula for integration cannot be dictated. What works for central London or central Manchester will be very different from what works in south Devon and in rural areas, but the fund will force people to work better together in a way that fits their area. That is very welcome.

Bill Esterson: Would the hon. Lady advocate a single service, and has she any thoughts on how that would operate? I am interested to hear her views.

Dr Wollaston: Indeed. It operates very well already in Torbay, but it cannot be dictated centrally. We need to get the hurdles out of the way, allow people to work together locally and facilitate that. We heard on the draft Bill Committee that joint funding streams were the best way to move that forward.

Unfortunately, in Torbay in the crunch year 2015 we will see the funding drop below 90% of projected expenditure. At that point, rather than driving further integration, it will cause systems to start to fall apart because people need to protect their own silos. That is a real danger. As the Bill proceeds to Committee, I hope we look very carefully at the effect of the funding gap and make sure that we are not setting a system up to fail. One of the problems with the Bill is that it sets up many new statutory responsibilities. Councils will have to fund care accounts, which will undoubtedly be complex, bureaucratic and subject to challenge. Councils will have responsibilities for carers’ assessments. There will be increasing numbers of eligible people as the thresholds and caps change. We will see safeguarding adults boards, more rights to information and advocacy, and for many, deferred payments, if they have not already been making those.

Once we create these additional statutory responsibilities, there will be less money to go around for the very things that are at heart of the well-being and prevention principle. That is what concerns me. Would it not be a tragedy if we set up carers’ assessments but there was no funding left for services to respond to needs? Voluntary organisations in my community can function incredibly efficiently on very little money. They do not need to be fully funded, but they need some funding. If that money dries up, I worry about how we will move forward with a genuine well-being and prevention principle.

I want the Bill to succeed. In the remaining minutes I shall touch on those aspects that I think are, sadly, still missing, which were recommended by the draft Bill Committee. One is how we calculate care costs according

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to their actual cost, not the cost to the council. For a person living in their own accommodation, it sometimes costs a great deal more to access support than it would cost a council to provide it. We need to look at that again.

There is a small but important area relating to powers of entry in exceptional circumstances for those who are subject to abuse in their own home. It would be wrong for us to ignore that possibility. Although the overwhelming majority of carers of course do a wonderful job in challenging circumstances, there are occasions, sadly, when people can be at risk from those who love them. Very often that is as a result of the intensely challenging circumstances that carers face. We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily.

Another issue is free social care at the end of life. We know that 73% of people would like to be able to die at home. In my experience working as a GP in rural areas, where that broke down for most people was as a result of a lack of social care, and the challenge of caring for somebody right at the end of their life, when they may, for example, be doubly incontinent. Until people are in that situation, they may not understand how incredibly demanding it is to have to be with someone 24 hours a day, trying to stay awake and provide the intensive support they need. Allowing everybody to access free social care in those terrible final days would be a very important step forward.

Finally, the duty of candour we have introduced for foundation trusts is welcome, but I think that it should be extended to social care.

Norman Lamb: It will be.

Dr Wollaston: I thank the Minister for that clarification. Also, an offence of wilful neglect already exists with regard to adults who lack capacity, but I would like the Minister to consider extending it with regard to those who have capacity.

We heard earlier about reconfiguration. We need to streamline reconfiguration processes. It is not right that the NHS’s valuable resources should be spent on long, drawn-out and expensive legal challenges. We know that in many cases we need to reconfigure in people’s best interests. Let us take out the party politics and get it right. Let us ensure that people have the right care and that we face the financial challenges in the NHS in a mature fashion.

8.10 pm

Grahame M. Morris (Easington) (Lab): I am pleased to have the opportunity to speak in this debate. Like several colleagues who have spoken, including the hon. Member for Totnes (Dr Wollaston), I served on the Joint Committee on the draft Care and Support Bill, under the chairmanship of the right hon. Member for Sutton and Cheam (Paul Burstow), and I also serve on the Health Committee, so I have a particular interest in this Bill. I had originally intended to make a more wide-ranging contribution, but I will confine my remarks to part 1, which deals with care and support.

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I had hoped that the Secretary of State would conduct a hearts and minds exercise in trying to selling the Bill, so I was rather disappointed that he turned it into a political knockabout, jumping straight into the most contentious elements, and clause 118 in particular, which sets out the trust special administration arrangements.

I do not think that we can consider the Bill without giving some thought to the background. Let us not forget that over this Government’s tenure, £2.68 billion— at 20% of the net adult social care spend, that is not an inconsiderable sum of money—has been cut from council budgets. Although we were talking about the principle of well-being in relation to clause 1, which I think all Members support, in practice cuts of that level mean that fewer people are getting help with paying for their care and more people are being charged for vital services, such as help with getting washed and dressed and with eating—the basic things that most of us take for granted.

I have no doubt that councils, particularly those in the north that I am familiar with, are doing their best to save money and provide services efficiently by changing the way care is provided and, where they can, working more closely with the NHS. However, the scale of the cuts means that they are being forced dramatically to reduce services and increase charges to balance the books. All the evidence that has come to the Select Committee and the anecdotal evidence that Members receive indicates that is the case.

The Secretary of State got into a little argument in his opening statement with regard to eligibility thresholds, which is a really important point. In 2010-11, 38 councils provided free care to people with “low” or “moderate” needs, and 114 provided free care only to those whose needs were considered “substantial” or “critical.” Those needs really are substantial and critical, as we can see if we look at the definitions, which are set out in the guidance. Now, however, only 15 councils continue to provide care and support to people with “low” and “moderate” needs and 137 provide care only to those assessed as having “substantial” or “critical” needs. That means that in many areas preventive services have all put disappeared. Setting the threshold at such a high level is therefore a false economy.

According to Age UK, as a result of tightening eligibility criteria, 800,000 people in the UK have a care need but are not getting any support. As my right hon. Friend the Member for Stirling (Mrs McGuire) mentioned, there is another care crisis, because a third of the total of those requiring care are working-age adults. Indeed, four in 10 working-age disabled people who receive social care say that it does not meet their basic needs, including eating, washing, dressing and getting out of the house. One in three says that cuts in social care have prevented them from working or volunteering.

Charges for vital care services, such as home help and meals on wheels, are increasing fast. In effect, that is a tax on some of the most vulnerable people in our society, people who have already been hit the hardest by benefit changes. Some Government Back Benchers talked about the need to cut the deficit. There is a need to address the economic situation, but not on the backs of the poorest and most vulnerable. To my mind, it is a question of political priorities. I am proud that my party has pledged to scrap the bedroom tax, which I think brings great shame on the coalition Government because of its impact on disabled people.

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Other Members have mentioned the consequences of price variation. I do not want to repeat those arguments, but it certainly is a factor when calculating the care costs for the cap. For example, in Tower Hamlets home care is free, but in Cheshire East—I am not sure which hon. Member represents it—it costs £20 an hour. In east Durham, the area I represent, it is about £10, so there is wide variation in costs.

We cannot improve the quality of care for older and disabled people without improving the working conditions of the 1.5 million people employed in adult social care, many of whom are on low pay and lack job satisfaction. In many cases that can lead to poor care for some of the most vulnerable people in society. Care workers do an incredibly valuable and important job, yet the TUC has estimated that between 150,000 and 220,000 of them are not even paid the legal minimum wage, and over 300,000 are employed on zero-hours contracts.

Sheila Gilmore: Does my hon. Friend agree that the problem of low pay and poor conditions, which he is outlining so well, is a concern for not only the workers, but ultimately the people receiving the care, for example because of the lack of continuity of care?

Grahame M. Morris: My hon. Friend makes an excellent point. That ties in with home care visits. The United Kingdom Homecare Association has indicated in a briefing that three quarters of home care visits now last 30 minutes or less and that one in 10 last only 15 minutes. There must be deterioration in care if carers are there for only 15 minutes. Care rationed in 15-minute slots is simply unacceptable, and I think that the House should reflect on what is happening. This is important because older people end up in hospital unnecessarily and stay longer than is necessary. There has been a 42% increase in delayed discharges from hospitals since figures were first collected in August 2012. Indeed, last month saw the largest number of delayed days in hospital ever recorded, and there were 78,400 such days in October alone. These delayed discharges now cost our NHS £20 million each month. That money could be used to fund about 1.5 million hours of home care for vulnerable older people and help to keep them out of hospital when they can be supported in their own homes.

Ministers claim that they want joined-up services, but through the Health and Social Care Act 2012 they legislated for fragmentation. Their integrated transformation fund contains no new money but is made up of £3.8 billion that is coming out of existing NHS and social care budgets. I accept that the Bill provides a framework and establishes important principles, and there are things that we can agree with. However, fine words are all very well, but we need immediate action such as the measure proposed by my right hon. Friend the Member for Leigh (Andy Burnham) to use £700 million from this year’s NHS underspend to help tackle this crisis now. We need some vision from all parties but especially from the Government parties.

I looked at some old early-day motions to see how some of these proposals were tackled in the past. My hon. Friend the Member for Sefton Central (Bill Esterson) suggested that this should be paid for through general taxation, and I agree. In one old EDM, a number of Members from all parties agreed with that principle; I see some of them nodding now. It is not such a radical or revolutionary step.

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We clearly need a wholesale change in how we deliver health and social care. We need a whole-person approach and a national care service. We need the same ethos that applied during the establishment of the NHS, which brought together disparate entities and groups into one body. We need to bring health and social care together into a single service that provides all the care an individual will need throughout their life.

The Bill has many positives, but it is fundamentally important to deal with the eligibility threshold. If it is set above “moderate”, it will do little to help working-age disabled people.

If the Minister does not mind, I would like him to clarify whether the duties of openness and transparency in the Bill will apply equally to all organisations that provide NHS services, including private contractors who provide outsourced services; he will be aware of my ten-minute rule Bill. I urge people to consider the Bill and to support Labour’s amendment.

8.22 pm

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab): I am grateful for the opportunity to speak in this debate, not least because this Bill, particularly part 1, is being followed very closely in my constituency. I am pleased to follow my hon. Friend the Member for Easington (Grahame M. Morris), who spoke very well about the issues at hand. Given the high level of interest in my constituency, I recently held a listening event that was kindly supported by Age UK Sunderland and Sunderland Carers. I wanted to find out what the people who would be affected by the Government’s planned reforms thought of them. In the time available, I will give a potted account of that discussion.

Before I do so, I want to say a few words about young carers. After concerted lobbying by Members on both sides of the House, particularly my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), we now have clauses in the Children and Families Bill providing for young carers’ needs assessments and there are clauses in this Bill covering a young carer’s transition to adulthood—a very welcome step forward. I pay tribute to the Minister and to his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who are both in the Chamber today, and to the children’s Minister, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), for listening to Members and campaigners on this very important matter. However, I would like the Bill also to include a duty on medical professionals to identify and refer young carers so that they can benefit from those needs assessments. Family doctors are by far the best placed professionals to be able to identify where a child or young person is probably providing support to their parents, and it is not unreasonable to expect them to make sure that that child or young person has their needs assessed by the local authority. I very much hope that we will see more progress on this issue as the Bill continues its passage through the House.

Turning to the main provisions of the Bill on social care, if the Minister thinks that my constituents are happy with the package we have before us at present, he is very much mistaken. People’s first question is understandably, “Will this benefit me or my family members?”, and many of them, when they look beyond the press releases at what the Bill actually says, are

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finding out that it does not. They know that only people who are eligible for care will be covered by the headline-grabbing £72,000 cap on care costs. Therefore, if the Government say—as looks likely—that only those with the most severe needs are deserving of help, very few will be covered by the cap at all. Even if they are covered, £72,000 will not be the maximum amount they will have to pay; they will also have to pay hotel and accommodation costs of £230 a week, as well as any difference between the rate the local authority is able to pay and the actual care costs. All in all, they could be looking at an extra £300 a week that does not count towards the cap. That means that, over five years, a pensioner would have to find an additional £78,000.

The situation may be different for the Secretary of State’s constituents, but I cannot think of many pensioners in my constituency who would be able to afford that kind of bill without selling their home. Of course, there will be a deferred payment option, but that is just a more expensive version of what 95% of councils do already and it will not be available until a pensioner has run down all their other assets. Assuming they do qualify and they defer five years of care home charges, they could end up clocking up an extra debt of £13,800 in interest, on top of the £78,000 charge and the £72,000 cap.

Norman Lamb: I am grateful to the hon. Lady for acknowledging the change we made in the Children and Families Bill with regard to young carers. Does she welcome the fact that we are massively extending the means-tested support by increasing the threshold from £23,250 to £118,000, which means that people with assets right up to that level will get some contribution to their care costs for the first time ever?

Mrs Hodgson: But that is only if they and their needs are eligible. In all the cases I have looked at, no one has been able to convince me otherwise.

The average price of a home in my constituency is £150,000, so someone needing care for five years could see the entire value of their home gobbled up. Whether the home is sold before or after they die is academic, because it will still need to be sold and all but £23,000 will be called on to pay for care bills and the interest on them. The only real difference I can see between that and the current system is that people will pay interest for the privilege of deferring their home sale, and that is why the Opposition say that this is nothing more than a care con. Ministers have been keen to gloss over those facts, but they cannot con my constituents, who are wordly wise and have seen straight through all the spin.

The next thing my constituents asked me at the listening event was whether the Bill will improve the quality of care that they or their loved ones can expect to receive. The issue of quality of care quite rightly hits the headlines every now and again when particularly shameful examples of the treatment of the elderly or vulnerable are exposed. Those peaks in interest only reinforce the worries people already have about either moving into residential care or becoming dependent on strangers who come into their homes on a daily basis.

There are tens, or even hundreds, of thousands of very capable and dedicated care workers out there who do what they can in an extremely challenging job and

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often on terrible terms and conditions, examples of which we have heard today. The Bill does very little to tackle the problems of long hours—or even zero hours—and those of low pay, no training and low staffing ratios that can lead to demotivation and desensitisation with regard to the dignity of the people being cared for. Ultimately, that is what brings down the standard of care that everyone who needs it should have a right to expect.

On the quality of care that people receive and the impact is has on their quality of life, I received an e-mail today from my constituent, Steve Hudson, regarding clause 48, which has been inserted in the Bill thanks to my noble colleague, Lord Low of Dalston. Clause 48 extends the protection of the human rights framework to everyone receiving regulated social care, whether they are in residential care or their own home and whether they are self-funding or in receipt of local authority support. Frankly, I was surprised that that was not the case already. As the Equality and Human Rights Commission said in its briefing, closing that loophole would be extremely beneficial in ensuring that the dignity and basic human needs of every person receiving care are at the forefront of every manager and business owner’s mind. I therefore hope that if the Bill progresses tonight, the Government will not seek to remove that provision in Committee.

The final big concern that my constituents shared with me at my listening event relates to funding constraints. It is clear to everybody that cuts to local authority budgets have a knock-on effect in the NHS, with beds, clinical staff and other resources unnecessarily tied up while care packages are put in place or even just reasonable adjustments to accommodation are made. It is no coincidence that delayed discharging is at an all-time high and costing the NHS some £20 million a month at a time when many local authorities are at financial breaking point and struggling to see how they can provide even the services they are legally obliged to provide over the coming years, let alone the kind of preventive services that they provided until recently.

Of course money is tight, but because it is tight, we should use the money we have in a smarter, more innovative way, as my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said so eloquently. That means pursuing the ideas put forward by my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Leicester West (Liz Kendall) for a whole-person care approach and the full integration of health and social care.

My constituents do not hate this Bill—they are pleased that there is a Care Bill—but they are frustrated by its lack of ambition and disappointed that the Government have watered down and cherry-picked the Dilnot recommendations so much that very few people will actually be any better off in the long run than they would be under the current system.

The Bill is inadequate and the House should decline to give it a Second Reading today, so that the Government can go away, have one of their famous pauses and come back with a version that meets the challenges that our health and social care systems will face over the coming years. Most importantly, the Government need to come back with a Bill that lives up to the hype that Ministers have tried to generate, and which does what all our constituents want and need it to do.

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8.32 pm

Jim Shannon (Strangford) (DUP): It is a pleasure to make a contribution in this debate. I thank hon. Members who have made what I would call very passionate, compassionate, knowledgeable, personal and spirited speeches.

The Bill will affect every person in the UK in some way or another. As such, it is incumbent on us to get it right. I have been contacted by a great many bodies and constituents and I have also been in contact with the Health Minister in Northern Ireland, as it is imperative for us to take into account what has been put to us by those on the front line who are providing the services catered for in the Bill.

The vast majority of the Bill’s provisions will apply to England and Wales only, but some legislate on Northern Ireland devolved matters. As the House will know, health is a devolved matter in Northern Ireland, but the Bill deals with some specific issues. One of those provisions is the abolition of the Health Research Authority as a special health authority, and its establishment as a non-departmental public body.

Another such provision relates to the enabling powers for cross-Administration care home placements. The Bill will introduce a four-way reciprocal arrangement, which will enable clients to be placed in care homes across all four UK jurisdictions. That was referred to by the hon. Member for Arfon (Hywel Williams) in relation to Wales. The Bill document is very clear about the arrangement between the four regions—it is good news—that will enable that to happen.

Other such provisions are the associated cross-Administration social care provider failure protections, which will extend across the whole of the United Kingdom. The Bill will introduce continuity of care protections for clients placed across the four jurisdictions in circumstances in which providers fail due to a business failure. It is important to have cross-communication between all four regions within the United Kingdom of Great Britain and Northern Ireland to ensure that there are protections for all.

As I mentioned, social care is a devolved matter, so the Executive and my Assembly colleagues have agreed two legislative consent motions. As Members will see from the Order Paper, the National Assembly for Wales has also passed two legislative consent resolutions in respect of the Bill. The principle has therefore been agreed, but the devil is in the detail, which comes in the Bill.

The Bill also covers changes to how care and support is funded, with planned reforms including the introduction of a cap on contributions to care costs and changes to the means test on capital limits. As social care is a devolved matter, those changes will apply in England only, but I always like to inform the House of what is happening in Northern Ireland. It will interest Members to know that the Department of Health, Social Services and Public Safety is taking forward a three-stage process to reform adult care and support. The first stage was a six-month consultation on the discussion document “Who Cares—The Future of Adult Care and Support in Northern Ireland”. The consultation concluded on 15 March and a report analysing the responses and summarising the comments that had been made was published on 14 August.

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The Department is now taking forward the second stage, which will involve the development of proposals for reform and will be subject to a full public consultation in due course. The proposals will include changes to both the type of support that will be available and how services are funded, including how people pay for residential care, which is an important issue in Northern Ireland and the whole United Kingdom.

The third stage will be the development of a final strategic document setting out the agreed future direction on the funding of adult care and support, along with the reforms required. It is likely that legislative change will be required thereafter, so the whole process will take some time to complete. However, I believe it is key to ensuring that Northern Ireland has a care and support system that is sustainable and fit for purpose for many years to come.

I ask the Minister what discussions have taken place with the devolved regions to ensure that we have a system that provides the same level of care across the board, not simply a postcode lottery. Perhaps he will clarify how he intends to ensure that the NHS will continue to be a national health service, not simply a regional health service, and that we have similar levels of care across the whole UK.

I wish to highlight an issue that Marie Curie Cancer Care has brought to my attention. At present, terminally ill people and their families can wait weeks to get social care while local authorities test their means and their level of need. That could be rectified through a duty on local authorities to process applications for local authority-funded care swiftly. We need to add a bit of zip and eagerness to the process to ensure that care can be delivered, particularly for those with cancer. Last week a meeting took place in the Methodist hall across the way, at which a shadow Minister spoke. The Conservative party also had a representative there. Everyone outlined the need for help for those with cancer, and that is one issue that really needs to be addressed. There were people from across England and Wales in that room who had specific needs because of cancer.

The situation for terminally ill people and their families is difficult, and NHS continuing health care is supposed to address it. However, local variations and the way in which CHC funding is allocated mean that few terminally ill people gain access to care through CHC, even though it is available. In this age, how can that be? In Northern Ireland, the Assembly has put in place a commissioner for older people and tasked her specifically with looking after the concerns and needs of the elderly population and highlighting their issues. I took the opportunity to bring the commissioner down to a public meeting in my constituency to give people the chance to express their concerns about residential homes, their money, their benefits and their social and health care.

Social care is vital to terminally ill people and their families. A study by the Nuffield Trust showed that terminally ill people who had access to local authority-funded social care were far less likely to use hospital care. Currently, more than 50% of people in the UK die in hospital, despite only 2% saying that that would be their preference. The National Audit Office estimated that 40% of people who die in hospital have no clinical need to be there, and that is thought to be a conservative estimate. If those people were moved to a community setting, supported by social care, they would receive the care they wanted, and it would free up hospital resources

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for people who need curative interventions. Will the Minister tell the House what progress has been made on securing fast-track access to social care for terminally ill people? Those are vital issues for the people we represent.

Although the new amendments seek to address such issues, I have been informed that concerns remain because the clause does not require local authorities to provide fast-track care for terminally ill people. If local authorities have the option to fast-track social care for terminally ill people and their families, but no incentives to do so, that could lead to a high degree of variation across the country in the availability of social care. Again, that goes back to my earlier point about whether we have a national health service or a regional health service. It is important that the service is the same across the United Kingdom, so that what people get in Scotland is the same as they get in Wales, Northern Ireland or England. I believe we should have such services everywhere, and they should not be different for anybody, no matter what their strata in life.

One major issue is the cap on care provision. Although I welcome the steps taken to alleviate financial pressure on individuals, they do not go far enough. I am joined in that belief not only by most Members of this House, but by the Royal College of Nursing, which stated,

“at £75,000 we are concerned about how many people this will positively affect. The RCN believes that too many may be left unaffected and still face agonising decisions over how to pay their care bills.”

One issue that has come to my office on a regular basis over the years is that of families and those of a certain age who are considering how they will pay for their health care over the next period. Many Members have made passionate speeches today, and it was a pleasure to have been in the House to hear them. They were also very personal speeches, and people spoke of their own relatives who have had to deal with this issue. The RCN continued:

“The RCN calls upon the Government to reflect on its decision around the figure set as the cap and to revise it to one closer to that advocated by the Dilnot Commission of between £25,000 and £50,000.”

I support that as, I believe, do other hon. Members.

Time has beaten me and I am unable to speak about the other issues that have been raised. If the Minister hears only one point from my contribution, let me be clear that we need a national health service rather than a regional health service, with the same level of care and service. That service must be affordable without people having to sell all they own to pay for their health and well-being.

8.42 pm

Mrs Emma Lewell-Buck (South Shields) (Lab): It is a pleasure to follow so many passionate and marvellous speeches, and I hope that my speech does them justice.

Prior to joining this House I was involved professionally and personally in the adult social care arena. Throughout that involvement I met some amazing, dedicated and brave people, many of whom were being denied the full service they deserved, and working in a system that hindered their ability to deliver fully what they knew their clients needed.

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There is nothing worse than having to tell a person who is already struggling with daily life because of their condition or that of a family member that, due to funding cuts, they will get a reduced service or get no service at all anymore from their local authority. My local authority, like many others, has been restricted to offering care only to those who meet the critical and substantial criteria of fair access to care. In reality, that means that an elderly or disabled person who was struggling with laundry and housework, or who was given support with daily living or to access services or employment, may no longer receive that vital support.

The Bill is a missed opportunity to make such scenarios a thing of the past because it does nothing to address the funding crisis in adult social care. That funding crisis has led to the collapse in support for those most in need, leaving many people without access to essential services. It is not only the Labour party that has raised concerns about the absence of any funding plans in the Bill; Age UK, the Local Government Association, the Care and Support Alliance, Carers UK and the Royal National Institute of Blind People share the same concerns. According to a report published today by the Personal Social Services Research Unit,

“the scale of reductions in spending and provision…are almost certainly without precedent in the history of adult social care.”

I know from consultations I have led that people in my constituency want to remain in their homes and receive care at home for as long as they can, but those people often end up suffering from chronic loneliness and isolation, receiving, perhaps, a 15-minute visit perhaps twice a day. We need to think urgently about how we can prevent people who remain in their homes from becoming socially isolated. Although loneliness may not be seen as an illness as such, anyone who speaks to people who have suffered day after day, alone in their homes, will hear that that is what hurts them the most: the loneliness. Age UK describes loneliness as the “hidden killer”. It is therefore disappointing that the Bill removes the Care Quality Commission’s existing duty to inspect and assess the way in which councils commission adult social care services. That could have been one of the few safeguards against the proliferation of 15-minute visits.

Labour recognises that improving care standards for service users means improving things for care workers themselves, and that is why we have launched a review of exploitation in the social care sector. I welcome the review, because my husband works in the care sector. He is currently on a zero-hours contract, with irregular hours and at the mercy of his employers, and is constrained by the limited time that he can offer his clients. My husband did not seek employment in the care sector to swell the coffers of those who make money from care for the vulnerable in our society; he did it because he wanted to make people happy and comfortable in their homes. My husband and I know that the benefit of improving the standards of care at home, and enabling more people to receive care at home, is that we will see fewer people in hospital and fewer residential care admissions, which are both stressful and incredibly costly.

The local authority covering my constituency is the seventh hardest hit in the country. Its central funding has been cut by an average of £262 per person. We have higher-than-average proportions of people aged over 65, over 75 and over 85. We also have more than 1,000 people

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with dementia, and a higher than average number of people suffering from long-term conditions. Between 2011 and 2012, a higher than average number of people were subject to completely new social care assessments. Our rate of permanent admissions for people to residential care is 71% higher than the national average, and we currently have just under 6,000 adult social care clients receiving a service.

The year 2020 is often described as “year zero” for council budgets. Only core front-line services are expected to be delivered, and they are expected to be delivered at a reduced level. If preventive services continue to be cut and if there continues to be an impact on early pathways to care, people will be eligible for care only when they have deteriorated to the point at which their need is urgent and their care needs are significantly more costly.

Given the situation in my constituency, it is no surprise that the fear expressed repeatedly by people in South Shields is that they will not be able to afford their care in later life. For my constituents, the measure of the Bill’s success will be whether it forces them to sell their homes to pay for care in their old age. It seems that it will fall well short, because, as my right hon. Friend the Member for Leigh (Andy Burnham) pointed out at the beginning of the debate, people will still have to sell their homes.

The Dilnot commission proposed a £35,000 cap on care costs; the Government have set the cap at £72,000. The commission proposed a universal scheme for loans to help to cover care home fees; the Government have means-tested it. That means that it will take the average person nearly five years to hit the Government’s cap. It is estimated that six out of seven people will die before receiving any help from their local councils. My constituents deserve to know the truth so that they can plan for their futures, and it is a shame that the Government are not prepared to share it with them.

The fact that money is scarce does not mean that we should withdraw from our responsibility to care for the elderly and the disabled. Our response should be to rethink radically the way in which we deliver those services. We do not need to dismantle what is already in place; we simply need to think about how the services can work better together, and how we can meet the needs of people now and the needs of future generations. More crucially, however, we need to set out plans to fund this adequately. We know that the Government have legislated for fragmentation and that health funding in areas such as mine is being stripped back. We also know that if the Government wanted immediately to address the funding crisis in our social care system, they could implement Labour’s plan to use £700 million from this year’s NHS underspend. Will they do this and do right by the people who need the services the most?

I support elements of the Bill, but I am not sure how, without explaining how our future adult social care will be properly funded, any of these proposals can become a sustainable reality. I make a plea today, not just on behalf of my constituents, but in memory of all the people I have worked with—my deceased grandmother, uncle and elderly neighbour, all of whom I helped care for, and all the strong and amazing people let down by a system that can no longer support them. I hope the Minister is listening and that he will support our amendment.

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8.50 pm

Sheila Gilmore (Edinburgh East) (Lab): Health and social care are devolved to the Scottish Parliament, so I rarely contribute to debates on those issues in the House, but one aspect of the Bill is very relevant to my constituents—the portability of care packages between England, Scotland, Wales and Northern Ireland.

My argument is best explained by reference to the case of my constituent, Neil Kenny, who raised his concerns about the lack of portability of care packages back in 2010, when I was first elected. Mr Kenny suffered a broken neck while serving in the Army. He is paralysed from the chest down and uses a wheelchair. Although he is originally from Edinburgh, he lived in London in the early 1990s, during which time he received funding for his care package from Greenwich council. In 1996, he decided he wanted to move back to Edinburgh to receive additional support from his family, but when he informed Greenwich council of his intentions it indicated that it would be unwilling to continue to contribute to his care package and that if he wanted to move he would have to contact Edinburgh council, which he did but which also said it was unwilling to support him.

The disagreement revolved around the two councils’ conflicting interpretation of the social work group Act 1968, particularly two clauses, one relating to the “authority of the moment” and the other to “ordinary residence”. This impasse continued from 1996 to 2000. In October 2000, Mr Kenny resorted simply to moving to Edinburgh, with help from his family physically to do so, and paying for his own care, which put him into a lot of debt. Although Edinburgh eventually agreed to pay for his care, he should never have had to experience such difficulties. Disabled people should be as free as anyone else to move from one local authority to another—something that simply is not possible at present, it would appear, owing to the ambiguity of the law governing this area.

When I took up the case with the Department of Health in 2011, the former Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), indicated that it would be addressed in the Government’s care and support White Paper. This was published in July 2012, but although it contained a short section on portability between local authorities in England, it made no mention of transfers between England, Scotland, Wales and Northern Ireland. When I raised the matter again in September 2012, I was told that a clause to facilitate cross-border placements would be put in the Care Bill.

Schedule 1 to the Bill makes provision for cross- border placements across England and the devolved Administrations, but this is limited to residential care and does not include community-based packages. As many people have eloquently said today, Government policy has long encouraged people with disabilities and health conditions to live in the community, integrated into society rather than segregated in residential accommodation, so the decision to facilitate the portability of residential packages and not community-based care packages is very disappointing. I wrote again to the Minister expressing my disappointment, and the response emphasised the differences in the care systems and the difficulties of applying rules across borders and suggested that officials were still working with the devolved Administrations to develop principles for how transferring community care packages might work in future.

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Given that both the UK and Scottish Governments have known about this issue for a considerable number of years, it is deeply frustrating that it has not moved further forward. The difficulty of applying rules across borders appears to have been resolved within the Bill in respect of residential care, so it is unclear why it is impossible to do the same with community-based packages. I have been in communication with the Scottish Government as well, and they have given largely identical responses to those of the Department of Health. Clearly, both recognise the problem, but have yet to give it sufficient priority to find a resolution.

I hope that I can persuade the Government to recognise the issue fully, and they have the opportunity to do so with this Bill. I shall table an amendment either in Committee or on Report to facilitate the portability of community-based care packages. Today, however, I would be grateful if the Minister provided a more comprehensive explanation of why this has not been provided for in the Bill. That is the specific individual issue that I am particularly keen to see addressed, but let me also offer a few comments and observations from the perspective of north of the border.

In today’s debate and others I have heard during my time at Westminster, a great deal of discussion on the cost of care is about the “who pays?” element. Does the state pay? Does the individual pay? At what point do we take a decision? They are all important questions, but if we spent all our time looking at the cost of care only from that perspective, what would get forgotten is the need to put additional funding into care to make more care possible.

I can look at that from a Scottish perspective because we have been part-way down this route already, albeit only a very small part, with the introduction of free personal care in Scotland nearly 10 years ago. I emphasise that the Scottish provisions apply only to a relatively small part of personal care. After people have heard all the hype about free personal care in Scotland, they tend to assume that everything about it is free, but then discover that it clearly is not. Creating even this relatively small part of care and making it “free” meant that the financing was transferred to the Government, to the taxpayer, to all of us.

At the same time, however, not an extra penny was put into the care system at a time when, as much discussed today, demand was steadily rising. If we add to the mix the difficulties of local government in Scotland—we have had six years of council tax freeze and the reduction of councils’ overall budgets—the result is that my Scottish constituency is affected by exactly the same issues as people have raised here: rising thresholds for care, for example, which mean that only those with substantial and critical needs get any care at all.

I have seen items that can be charged for going up in price. I have seen the outsourcing of many care contracts to save councils money, but at the expense of the care workers and, indeed, the care recipients. I have seen the poorer conditions that lead to the 15-minute care times that we have heard about. We see them in Scotland, which was brought home to me very clearly when my mother-in-law was terminally ill, having been a fit person up until then. The first time the care giver came I was in the house, and I thought I would go on the computer

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and do a little work. The computer had only just fired itself up when the carer popped her head around the door and said, “That’s it, I’m off now”. It was barely 10 minutes. That situation is very real.

We should talk about who pays and how we divide the payment up—I am not saying that there are easy solutions—but if we do not address the question of the quantum of resource being put into care, we will continue to have these problems. I can assure everyone that this is exactly the situation in which we find ourselves in Scotland.

8.59 pm

John McDonnell (Hayes and Harlington) (Lab): First, may I apologise to the House? I was here for the early stages of the debate and listened to the Front-Bench speakers and others, but then had to leave. Tomorrow’s announcement on aviation, and the fact that we seem to have yet another Government who want to build over a third of my constituency, means I have been at other meetings to deal with that.

I will not take up much time, but I just want to raise a couple of issues that have been raised with me by constituents, and in particular by Jonathan Kaye. I would welcome an intervention by the Minister if I have got this wrong, but Mr Kaye’s first concern is about the regulation of carers who are recruited as a result of direct payments. In my constituency, the borough has moved progressively towards direct payments, where the individual recruits carers on the open market. That is extremely difficult, but at least they have some choice. I want to be clear about whether these carers are included in the regulation system of the Care Quality Commission, as set out in the Bill. Who will inspect them, and how will their performance be monitored?

Norman Lamb: Personal assistants are not part of the CQC regulatory system. That has always been the case, including under the previous Government. We would certainly encourage personal assistants to seek to secure the new care certificate qualification, however, so as to demonstrate their care skills, but they are not part of the formal system.

John McDonnell: I think Mr Kaye would like me to press that at some stage during the Bill’s progress. His view is that they should be regulated in the same way as others, and that there should be appropriate inspections as well. I understand the difficulties, particularly in terms of family relationships with regard to carers. I understand the subtleties of that, but there does seem to be a gap in the Bill as it stands. I might want to look at that in Committee, and certainly on Report.

The second point is that I believe that in the other place Baroness Greengross or Lady Greengross—I am never sure of the titles of the bourgeoisie—moved an amendment to cover the whole range of abuse. That was partly a response to the lobbying for abuse by carers to be properly covered by this Bill. I hope the Government’s attitude is that the amendment will remain in the Bill. I am happy to give way again to the Minister if he wants to respond; perhaps he will do so later.

The third point Jonathan wanted me to raise was about assessment and reassessment. I do not know what other Members find in their constituencies, but

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I find that the process of assessment can be extremely difficult—first, getting an appropriate person who can do the assessment, then getting that appropriately skilled person to do the assessment, and then the bizarre continual reassessment after reassessment that amounts almost to harassment. Some people with severe disabilities —with permanent conditions who, to get a cure, would need a trip to Lourdes, to be frank—get reassessed time and again. That becomes worrying for them, and some individuals can lose some element of their benefit through this process.

Meg Munn: I have a great deal of sympathy with what my hon. Friend is saying. In my experience there seems to be a tendency of wanting to assess people and then reassess them, rather than putting effort into providing services for them. If we quantified the time that goes into assessment as opposed to provision, I think we would see some way in which we could shift some of these very scarce resources into helping people properly.

John McDonnell: I was with a constituent last Friday and the issue under discussion was disabled facilities grant. Again, there seem to be more assessments and more spent on assessment than on getting the work done at times. There needs to be a clear understanding of the issue of permanent conditions and how we can make sure people do not have to go through the trauma of assessment

That brings me on to the issue that was raised by Age UK—I apologise if others have raised it before—which is about the individuals who will do the assessments and the level of their qualifications and of their specialisms. My whole community has been traumatised by what happened with the Atos assessments, and I would not want to see another process implemented in the same way under this Bill. Age UK wants us to ensure that appropriate assessments are carried out by appropriately skilled and qualified assessors.

That leads me to a further point, and I apologise if others have already raised it. Part of the issue for people who have to undertake the assessments is ensuring that they have the right advocacy support. In my area, we have DASH—the Disablement Association Hillingdon—which provides excellent support and advocacy, but it is struggling, as is every other voluntary organisation in the area, as a result of local government cuts and the demands and challenges that are placed on it. It is important that, as we introduce this legislation, we look at the role of advocacy and the importance of supporting it through appropriate funding from local government and elsewhere.

I want to talk briefly about the report from the personal social services research unit. It was mentioned by my hon. Friend the Member for South Shields (Mrs Lewell-Buck), whose superb speech set out, drawing on personal experience, exactly how many of us experience the services of carers. I am not sure whether other hon. Members have gone through this matter in depth in the debate today. If they have, please will they intervene to tell me, so that I do not need to go through it again?

The report has usefully confirmed all that we have experienced and understood anecdotally in our constituencies. Even I was shocked at some of the statistics that it contained. The report was produced by the personal social services research unit of the university

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of Kent and the London School of Economics, and it is an objective assessment of expenditure and of the numbers of people receiving services from local authorities between 2005-06 and 2012-13. Its findings confirm what most of us have experienced in our constituencies—namely, that there have been

“widespread reductions in the period 2005/06 to 2012/13 in both the observed and standardised estimates of number of adults receiving state-funded social care services”.

It also found:

“Across all user groups, approximately 320,000 fewer people received local authority brokered social care in 2012/13 than in 2005/06. This represents a 26% reduction in the number of recipients of care.”

If we look at the standardised assessment, we see a

“decrease of 453,000 (36%) individuals being served”.

That reflects what I am finding in my constituency. People who should be receiving a certain level of care and who would previously naturally have received it are no longer doing so. The report goes on to state:

“Reductions in the number of clients are particularly acute for older people; 260,000 or 31% fewer older people received services in 2012/13 than in 2005/06…The standardised estimate of reduction was greater: 333,000 or 39% fewer clients.”

That means nearly 40% fewer older people are receiving services now than five years ago. The report goes on:

“Approximately 37,000 or 24% fewer adults aged 18-64 with physical disabilities received social care support in 2012/13 than in 2005/06. The standard estimate showed a reduction of 50,000 or 33%. A reduction of 30,000 (21%) was observed in the number of service recipients aged 18-64 with mental health problems.”

I find that staggering but, at the same time, it reflects what is happening in our constituencies. Why is this happening? It is fairly straightforward, really. It is a result of the cuts that local government is experiencing.

Although the report covers the period between 2005-06 and 2012-13, it emphasises that the vast majority of the cuts have been made in the past two years. The coalition Government have brought forward this level of service withdrawal over a very limited period of time. According to the report,

“our analysis suggests a drop in need-standardised net social care expenditure between 2005/06 and 2012/13 of approximately £1.5 billion…Moreover, almost all reductions in expenditure are concentrated in 2010/11 and 2011/12.”

That is a cut of £1.5 billion overall. It goes on:

“The largest reduction in expenditure levels is concentrated on services for older people”.

That again reflects the anecdotal evidence that we can bring back from our constituencies. The report suggests that there has been a £1.6 billion cut in services to older people. This is not a party political point; this is independent, objective research, which we should all take on board in the debate as it goes forward.

The report continues:

“For adults 18-64 with learning disabilities”—

there has been—

“a significant increase in observed and standardised expenditure in 2012/13 relative to 2005/6 worth just above £1 billion”.

So there has been some increase in some areas but dramatic cuts in others. Worryingly, the cuts seem to be focused on older people and those with mental health problems. The interesting thing is the point made by my hon. Friend the Member for Edinburgh East (Sheila Gilmore) and others about how this is disproportionate; it is not being done right the way across the board, and the impact on areas is geographically uneven. It appears that the most deprived areas are being hit the hardest.

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The report said:

“Approximately 95% of local authorities in England were observed to have reduced the number of older people receiving services in the period…Of these, the number of older people receiving services had fallen by 40% or more in approximately a third…of authorities.”

So this is focused on a limited number of local authorities, and again it appears that they are the most deprived. I find that extremely worrying.

Although we welcome the Bill as a first step, as others have said, Dilnot did make it clear to all of us that the social care crisis has to be addressed before we move on to other changes in legislation, or at least simultaneously. Introducing new legislation when the Government are introducing this scale of cuts will completely undermine the credibility of the new legislation. That is why I hope that as part of the debate as the Bill moves forward we can reach a consensus on not only the legislation—where I hope we can take on board some of the points made in the reasoned amendment—but on the level of investment required over the coming period if we are to support the most vulnerable in our society.

The study I mentioned is objective and it reflects what I am experiencing in my constituency surgery on a weekly basis—I believe it is the same for other Members of all political parties. The social care services in our areas are under intense stress and, as a result, people with even critical and substantial needs are not being addressed—those with moderate needs, which are still significant and should be within the system, are being ignored completely. We need to address this matter with some seriousness now and try to reach some all-party agreement on the way forward, not only on the Bill, but on the investment strategy for care needs.

9.12 pm

Julie Hilling (Bolton West) (Lab): Like my constituents, I was relieved when the Government said they would act on the Dilnot report and cap the cost of care, and I was pleased when the Secretary of State told me in this Chamber that money spent on home care would be treated as part of that cap. But the legislation that this Government introduce never lives up to expectations, and it is deeply disappointing that the Bill will still leave people having to sell their homes and does not solve the care problem facing people every day of the week. Many thousands of people will be deciding today whether or not to put their loved ones into residential homes or whether or not to sell the family home. This is a very real, very live issue.

The lack of joined-up care is also presenting big problems for our accident and emergency departments. There has been a 66% increase in the number of people over 90 being “blue lighted” into A and E, and the number of over-65s admitted to hospital with avoidable conditions has been increasing—last year, it reached half a million. Of course, we also have a problem at the other end, as we cannot discharge people because of a lack of care in place. There has been a 42% increase in delayed discharge, and in October alone 78,400 delayed days were lost, so people who are admitted, often because of the lack of appropriate care in the first place, are not being discharged because of the lack of appropriate care to deal with them when they come out.

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The Government cannot wash their hands of the problem and say that it is down to local authorities, because their drastic cuts to local authority budgets have had a drastic effect on local services. Bolton has had to find £100 million of cuts, which has meant that it can no longer give support to the nearly 2,000 people who have “moderate” care needs. They may be moderate to the decision makers, but they are still care needs; we are talking about care that enables people to stay safe and well in their own homes in the community and to lead independent lives. Bolton has reluctantly had to make cuts to day care and respite care, which is a real problem for real people.

Other Members have mentioned the financial cap and other elements of the Bill, so I will use the rest of my time to talk about the realities of home care, which do not appear to be solved by this Bill. As many Members know, I have a vested interest in the issue of care. Like millions of others, I entrust the care of my mothers to carers every day of the week. Most of the carers are lovely, but they are paid only just above the minimum wage and only for the time they spend with the person they are looking after; they are not paid at all for their travelling time. I find that absolutely disgraceful, but it is normal in this sector. I have been told that it is common for carers to be on zero-hours contracts, and I have been told today of the pressure put on workers in Manchester to work beyond 70 hours a week or else lose their jobs.

Caring for disabled and elderly people is a precious job, and the Bill does nothing to address the fundamental flaws in the way that care workers are treated, which of course impacts on the care that people receive. Yesterday, I met a woman and her 98-year-old mother—I will call them Valerie and Lilian. Valerie told me about a few of the problems she was encountering and why she had to change the care provider for Lilian for the second time. She told me about the endless stream of different care workers who do not know Lilian or her needs. One carer had written in the logbook that Lilian had already washed and dressed herself one morning. How did they know that she had washed, and why did they think that the bed jacket she was wearing was appropriate clothing?

Another carer wrote that Lilian was eating toast for her tea when she arrived. How did they think she had made the toast? Of course she was eating the remnants of her breakfast, and her tea, which was made by the morning carer, was still sitting untouched in the refrigerator. Another carer left Lilian with her food tray in her lap, which meant that she was unable to move until the next carer arrived a few hours later. It is no wonder that Lilian’s carers make mistakes. Her tea-time visit is a mere five minutes, and her bedtime visit is only 10 minutes. Lilian only got the tea-time visit because she now attends a day centre for two extra days, which freed up some money to spend on the visit.

Lilian lives in sheltered accommodation where, years ago, there would have been a warden who made regular visits. Now there is just a housing manager whose role does not include checking on the residents. Valerie told me about the strain being put on her because of the expectation that she would be available at all hours. As she said, she is nearly 70 herself. She has already suffered a stroke and cares for her 76-year-old husband. Once she has taken her own medication, she cannot go out in the middle of the night, but there is no other support.

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Valerie and Lilian’s story is just one, and a depressingly familiar one. The reality is that carers themselves are ageing and the elderly and disabled are not getting the care that they need. I was told just this morning of a carer who left an elderly person in bed in the morning when she should not have done. When the lunchtime carer turned up, the person could barely breathe. The lunchtime carer called the doctor who, after some prevarication, came out. He left a prescription on the elderly person’s table. I do not know how he thought it would miraculously be filled in or how this ill person would miraculously be able to take the necessary medication.

I have seen first hand the distress that is caused when a carer turns up more than an hour late. There is chaos when different carers turn up and do not know what to do. I understand too the realities of inadequate care. I have also experienced the unresponsiveness of the system when care needs change temporarily. Indeed, Marie Curie Cancer Care has raised the issue of the time it can take for a terminally ill person to get care. They can often wait weeks while local authorities test their means and their level of need. Sadly, some people die before they ever get any help at all.

Care should not be determined by the cheapest provider. This most fundamental service of the most personal nature needs to be provided by workers who are appropriately trained and remunerated. I hope the Minister will confirm that every home care worker will have to be trained and qualified. We entrust the care of our most precious loved ones to strangers every day of the week. The Government should use the Bill to ensure not only that our loved ones are treated properly but that the care givers are treated properly too.

9.19 pm

Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): I apologise for not having been in the Chamber for most of the debate, Mr Deputy Speaker, because of other parliamentary activities. I have found the speeches that I have listened to of enormous interest and I wanted to speak in the debate given that I am the co-chair, with Lord Rix, of the all-party group on learning disability.

I felt I owed it to Mencap and the Care and Support Alliance to, at the very least, bring out some of the points that were made in the other place, not least by Lord Rix and Baroness Hollins. Those points are dear to me, as I followed the debates in the other place carefully. I welcome the fact that we have a Bill and that we are having debates. I do not want to be too critical of the Government—not just because it is the festive season—but we have talked about many of these issues for a long time. When I read what was said in the other place, I reflected that when we talk about carers we all share compassion for and concern about their role, but that that has been the case for as long as I have been a Member of this House. I can understand that some carers are perhaps becoming a little sceptical and cynical and if we can do something about the Bill, that might perhaps help us along the way.

Above all, I want to speak about advocacy. In the Lords, the Government tabled welcome amendments that introduced a right to advocacy in respect of social care assessments and for some of those involved in safeguarding inquiries for some people. That has the potential hugely to improve the process for people who

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would otherwise struggle to be involved in the assessment and care planning process. It also provides real rights and protection for those who are suffering abuse such as that at Winterbourne View and Mid Staffordshire, and I hope to have time to return to that later.

Furthermore the measure builds, if I may say so, on the principles of the Act that I was privileged to pilot through this House, the Disabled Persons (Services, Consultation and Representation) Act 1986. Those who are still around from that period will recall that advocacy was at the heart of what the Act sought to achieve. The demand for that advocacy is still there today. Advocates support people to articulate their needs and to make informed choices, and they make the process less intimidating. They support planning and reviewing care and help people to speak out if they are dissatisfied with care or when safeguarding issues arise.

Those who receive the support of an advocate will undoubtedly be better able to engage with the range of professionals and service providers with which they come into contact, and as a result they are more likely to experience positive outcomes. Although the Government’s amendments were welcome, we seek clarity in a number of areas. I know that this view is shared by Mencap and many other organisations, although I do not necessarily speak for all of them.

The Bill deals with facilitating involvement, for example. The clause on advocacy and safeguarding states:

“The relevant local authority must…arrange for a person who is independent of the authority (an ‘independent advocate‘) to be available...for the purpose of facilitating his or her involvement in the enquiry or review”.

It is not clear what

“facilitating his or her involvement in the enquiry or review”

means and whether it is constrained in any way or subject to some form of arbitrary decision. Perhaps the Minister might clarify that tonight.

Timely advocacy at the start of safeguarding inquiries seems to me to be essential. There have been countless examples of serious abuse and neglect affecting people with a learning disability which have been overlooked for a host of reasons. It is vital, therefore, that a person with a learning disability receives the support of an advocate at the early stages of a concern being raised, and local authorities must take this into consideration. Mencap is concerned that the local authority needs to arrange advocacy only if it is not satisfied that there is an appropriate person to represent and support the adult with a learning disability. It would like assurances from the Minister that this will not become a default position for family or friends.

Some family members may in some cases have the skills and the background to be an effective advocate and may wish to do so. Others, however, will be unable or unwilling to do so, and Mencap thinks it would be highly inappropriate if those family members felt pressurised so to do. Good advocacy is delivered by individuals skilled and knowledgeable in delivering appropriate, independent and empowering advocacy, and the local authority should ensure that this is the case.

I turn to the issue of abuse. Some time ago, after the Winterbourne report, I secured a debate in Westminster Hall and I am very glad that that matter was then discussed. As the Bill makes its way through the House, we have to deal specifically with the definition of abuse.

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The Bill needs to be strengthened. Only financial abuse appears and is defined on the face of the Bill. This seems to give prominence to one form of abuse, although others clearly take place. Lord Rix and Baroness Hollins tabled amendments in another place which sought to strengthen the clause and include other forms of abuse, such as neglect, which we know is more prevalent, and also physical, sexual and psychological abuse and so on.

Responding in another place, the Minister felt that abuse was a commonly understood definition and that defining it further in the Bill might restrict the scope of local authorities’ duty to inquire. Although Lord Rix agreed with the argument that a long, exhaustive list would be unreasonable, he said surely we must ensure that

“local authorities do not suddenly think that only financial abuse is to be considered when they look at this Bill”.—[Official Report, House of Lords, 14 October 2013; Vol. 748, c. 341.]

I believe that reference only to financial abuse is unbalanced and critically makes other forms of abuse appear less relevant or important. Again, recalling the recent institutional abuse and neglect highlighted by Winterbourne View, Mid Staffs and the confidential inquiry into the premature deaths of people with a learning disability, it is crucial that other forms of abuse are set out in the Bill. They may be covered by guidance, but evidence has shown that this has not protected people with a learning disability who may well be subject to multiple abuses. I agree with the Government that an exhaustive list might be wrong and difficult to defend. However, the Bill should be amended to include reference to physical, sexual and psychological abuse, as well as neglect. It can make further reference to “other as guidance may specify”.

I am delighted to have had the opportunity to take part in the debate. We have a lot of work to do. I have great regard for the Minister who is responsible for the Bill and I think he will do a very good job, but when we look at issues like assessment, choice and the rest, we must remember that we have given promises before and we have given commitments. This time we all hope they will be real and meaningful.

9.29 pm

Liz Kendall (Leicester West) (Lab): Today’s debate has been about one of the most important issues facing Britain today: how we care for the increasing number of older and disabled people. The Care Bill is the result of the Law Commission’s review of adult social care legislation, which was initiated by the previous Government. The Opposition welcome the Bill’s emphasis on prevention, promoting well-being and new rights for users and carers.

I want to pay tribute to the work that has already been done to improve the Bill by members of the Joint Committee on the draft Care and Support Bill and by Members of the other place. It now promotes the integration of care and support with health and housing, which is really important, and requires local councils and the NHS to work together in relation to the needs of young carers and, in that regard, I want to thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), in particular, for her tireless efforts.

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The right hon. Member for Banbury (Sir Tony Baldry), my hon. Friend the Member for Blaenau Gwent (Nick Smith), my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), my hon. Friends the Members for Edinburgh East (Sheila Gilmore) and for Hayes and Harlington (John McDonnell), the hon. Members for Pudsey (Stuart Andrew), for Strangford (Jim Shannon) and for Totnes (Dr Wollaston), and my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Worsley and Eccles South all spoke about further changes that should be made to the Bill, for example to ensure that NHS staff identify carers, to support parent carers, to improve the safeguarding of people in social care, to improve the assessment process and advocacy, to ensure an effective transition of support from childhood to adulthood, to transform end-of-life care and to deal with portability, particularly of community care packages, in the devolved Administrations. I am sure that we will return to those issues in Committee.

The main concern, raised repeatedly by hon. Members today, is that the Bill does not address the fundamental issue facing elderly and disabled people and their families or put in place the really bold reforms we need to tackle the growing care crisis in England. It is true that council care budgets have been under pressure for many years, but this Government’s decision to impose the biggest reduction in any Department on local councils has the pushed care services that hundreds of thousands of people rely on to “the brink of collapse”—not my words, but those of Age UK.

Adult social care budgets have been cut by £2.7 billion under this Government. The result is that fewer people are getting the care they desperately need, particularly at home, which is the key issue for the future, as my hon. Friends the Members for Sheffield, Heeley (Meg Munn) and for South Shields (Mrs Lewell-Buck) pointed out. Frail, elderly people are receiving home visits that last barely 15 minutes, or in some cases only five or 10 minutes, as we have heard. Disabled people are being trapped in their homes, denied the basic opportunities to work, train, volunteer or have a social life that other people take for granted, a point powerfully made by my right hon. Friend the Member for Stirling (Mrs McGuire). Paid care staff on zero-hours contracts are not even earning the minimum wage, let alone a living wage, and unpaid family carers have been left struggling without the help they need to look after their loved ones, which means that their own health suffers, too. At the same time, more people are being charged more for vital services such as home visits and meals on wheels, which are up by £740 a year since the election.

Reducing care budgets by that scale hurts some of the most vulnerable people in society. It is also a false economy, because as more elderly people do not get the help they need to stay at home, they are ending up in hospital in increasing numbers, which costs the taxpayer far more. Delayed discharges from hospital have soared by 42% since the election, as my hon. Friend the Member for Easington (Grahame M. Morris) rightly said. Delayed discharges have costs taxpayers £225 million this year. That could have paid for almost 17 million hours of home care. It is spending money in the wrong place in a way that is not good for the people using the services and does not provide value for money.

Families are also paying the price. As my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said, one in three carers now has to give up work or

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reduce their hours because they cannot get the help they need to look after their loved ones, and this costs the Treasury £1 billion in lost tax revenues alone. The Bill will not solve these problems. The new rights it contains and the new focus that it places on prevention and well-being risk being meaningless as care budgets are reduced to the bone.

Nor are the Government being straight with people about their plans to reform long-term care funding in future. Any measures that protect people from catastrophic care costs are welcome, but Ministers have not spelled out the reality of their plans. They have repeatedly claimed that no one will have to pay more than £72,000 for their care, but this is not the case. People’s care costs will start to count towards the so-called cap only if they are assessed as having eligible care needs. Nine out of 10 councils provide care only for those with “substantial” or “critical” needs. If someone needs help to stay living at home but their council assesses their needs as “low” or “moderate”, what they pay for home visits will not count towards the cap.

With regard to residential care, the cap will not be based on what someone actually pays for their home care but on the standard rate paid by their local council. I see that the Secretary of State is being informed by the Minister about the reality of these plans, so I hope that he listens to more of my speech. The standard rate paid by local councils is currently, on average, about £470 a week. Government Members, as well as Labour Members, will know that many of their constituents pay far more than £470 a week for their care home, but these extra costs will not count towards the so-called cap. People will also, rightly, have to contribute towards their hotel and accommodation costs. The Government are setting this contribution at £230 a week—much higher than Andrew Dilnot recommended—and these costs will not count towards the cap either. Taking both those factors into account, it will take elderly people almost five years, on average, to hit the so-called cap, during which time they will have clocked up, on average, £150,000 for their care home bill, and much more in many cases. Because elderly people stay in a care home for about two and a half years, on average, six out of seven people will be dead before they hit the cap.

Ministers have repeatedly claimed that people will not have to sell their homes to pay for their care; again, this is not the case. The Bill puts a duty on councils to offer deferred payment schemes—care loans that will have to be paid back by selling the family home after the person has died. The loans will not be universally available, as Andrew Dilnot recommended, but means-tested. Interest will be charged on the loans, but that interest will not count towards the cap. Although the Government are raising the upper level of the means test, that will not help many pensioners on average incomes because of how the test works, whereby councils take a notional income from the remaining assets in a person’s house and add it to what they get from their pension and any savings or second pension. For many pensioners on average incomes, this combined total will take them over what their local council will pay for care, and they will therefore not qualify for any extra support.

Elderly people and their families deserve to be told the facts about the Government’s plans so that they can properly plan for the future rather than have Ministers attempt to pull the wool over their eyes. One of the

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main claims made by the Prime Minister about the Government’s reforms is that they are so clear and straightforward that lots of insurance products will emerge so that people can insure themselves to pay for their care in future. I would be very interested to hear from the Minister how many of these new insurance products have emerged so far.

Barbara Keeley: I chair the all-party group on social care and when the Dilnot recommendations were made we implored the Government to have a national debate so that all the issues my hon. Friend is raising so well could be explored. Judging by the look on the Secretary of State’s face, he needs to be given some of that information, too, so perhaps we need a national roadshow on what his Bill will actually do.

Liz Kendall: My hon. Friend makes her points diplomatically. It is only owing to the efforts of Members in the other place that the Bill includes a requirement for councils to provide people with clear information. These are huge issues for elderly people and their families. We are asking the Government to be straight and I hope that when the Minister responds he will confirm what I have been saying.

On top of everything—I hope the Minister will also address this—we learned in June that the Government will top-slice £335 million from existing council budgets to pay for the start-up costs of the new scheme in 2015-16. They propose to take money from existing users who are already desperately struggling to pay for reforms that will benefit a small number of future care users in five, six or seven years’ time. I think that many people will be astonished, particularly after the Government had claimed that all the additional costs for their proposals would come from elsewhere. I hope the Minister will explain whether I am correct in saying that that £335 million will be top-sliced from council budgets.

Labour Members will continue to focus on the reality of this Government’s actions, not on their rhetoric, and we will continue to expose their true record on the NHS and social care. Instead of making the real reforms needed to improve front-line services, they have wasted three years and £3 billion on a back-room NHS reorganisation that nobody wanted and that nobody voted for. Instead of working with clinicians and patients to make difficult decisions on the future of hospital services, they now want to give the Health Secretary unprecedented powers to impose changes without the consent of local people. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, the Government are taking away control from the very people to whom they pretend they want to give power. Indeed, National Voices—the voice of patients—says that the proposal is

“wrong in principle and counterproductive in practice”.

Instead of championing the full integration of health and social care to enable a powerful shift towards prevention and fully personalised care, as Labour proposes, the Government’s unambitious proposals bring together only 3% of the total NHS and social care spending. Instead of holding serious cross-party talks on long-term care funding reform, the Government chose to go it alone, water down Dilnot’s proposals and spin the results beyond recognition. That is why we have tabled our reasoned amendment and why I urge hon. Members to join us in the voting Lobby tonight.

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9.43 pm

The Minister of State, Department of Health (Norman Lamb): I thank everyone who has taken part in what has been a lively and interesting debate on a subject of the utmost importance for the future and for many very vulnerable people in our country. I absolutely share the view of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), on that. Incidentally, I also share her view that it is not possible to get great care on the back of exploiting low-paid workers. We have been very clear about that.

I do not anticipate having time to be able to respond to every point that has been raised—there were many excellent contributions—but I will write to hon. Members who participated in the debate so that everyone will get a full and proper response, including on the cross-border issues raised by the hon. Members for Arfon (Hywel Williams), for Strangford (Jim Shannon) and for Edinburgh East (Sheila Gilmore) among others.

The effect of passing the reasoned amendment would be to defeat the Bill, which is why the Government are so dismayed by the decision taken by the Labour party on what we regard as a Bill that will be groundbreaking in its overall impact. It seeks to modernise the law on care and support, shifting the focus from a very paternalistic system to one that is acutely personal and focused on an individual’s well-being. The Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell) and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) both focused on the important principle of well-being, which will be new in legislation, but is absolutely central to what we seek to achieve. There is also a focus on preventing ill health and—

Barbara Keeley: Will the Minister give way?

Norman Lamb: I will just finish this point.

There is also a focus on protecting everyone from catastrophic care costs, ensuring that people will no longer have to sell their homes during their lifetimes to pay for care. The Bill reforms a fundamentally unfair system, drives up standards in GP surgeries, hospitals and care homes through the new chief inspectors, adds a new statutory duty of candour so that hospitals, care homes and other care providers are open with patients when mistakes are made, and introduces valuable new rights to carers. Of enormous significance is that it signals the first ever big step, as the Chair of the Select Committee said, towards joining up our health and care systems through the better care fund, which is worth £3.8 billion.

The best description of the Bill was in a letter forwarded to me by a Labour MP, which said that the Bill is a groundbreaking piece of legislation that has the potential to make a big difference for older people. Despite that, the Labour party is declining to give it its support.

Hazel Blears rose—

Barbara Keeley rose—

Norman Lamb: I give way to the right hon. Member for Salford and Eccles (Hazel Blears).