It is pleasure to speak in the debate with you in the Chair, Mr. Cummings. I want to raise the issue of Government funding for residential and nursing care because many of my constituents have recently come to see me about it and to voice their concerns. In addition, the Sunday Express has pursued a major campaign, entitled the “Justice for our Elderly” crusade, which I applaud. I hope that it will follow today’s deliberations.
The Express has identified the fact that 70,000 vulnerable people in our country have had to pay for nursing care. A major report, the Wanless report, estimates that £29.5 billion will need to be spent on our ageing society by 2026. That is why the debate is of such interest when we think of the money that will have to be spent on that vital issue over the coming years.
The Government watchdog, the Commission for Social Care Inspection, has warned of a crisis looming for elderly and disabled people. In a damning report, it highlighted how local authorities are cutting back on services for vulnerable older people. That follows similar findings from other influential bodies that include the Government’s health think-tank, the King’s Fund, and the independent charity the Joseph Rowntree Housing Trust.
Age Concern says that it has dealt with increasing numbers of cases in which elderly people have been reassessed as no longer needing care because the local authority eligibility criteria have been tightened to meet only the highest needs. The director general of Age Concern said:
“Those receiving care at home have seen services withdrawn and prices increased, while those in care homes and their families often find themselves subsidising the pitiful amounts local authorities pay for care.”
That brings me to an important issue for my constituents, which is means-testing. Any constituent who has more than £20,000 must now pay for nursing and residential care. I find that an absolute scandal in a country that is the fourth wealthiest in the world, with the fourth largest economy. We are always hearing from the Government about the great economic achievements under the Chancellor of the Exchequer and about the so-called advances, yet my constituents have to pay for care. That is an outrage and another Labour stealth tax for those who are unfortunate enough to have relatives who need long-term care.
Can we be clear for the purposes of the record and the Sunday Express? Income-contingent payments and means-testing have been in place since the social care system was introduced in the late 1940s. When the Conservative Government were in power, social care was provided to citizens on a means-tested basis. Is he now advocating that the state fund social care to 100 per cent. and abolish means-testing?
As a Back Bencher, I can say what I like. I believe that £20,000 is a paltry figure. The Government should strive, if at all possible, to increase that threshold. In Shropshire, many people have more than £20,000 simply because of the huge increase in the value of homes.
So, the hon. Gentleman’s case is that he acknowledges that, as well as a contribution from the state, there will always need to be a contribution from the individual and that under his party the means-testing system would always continue, but that the problem is with the threshold. The campaign is somewhat ambiguous about whether it advocates no charges for citizens. Is he saying that he is after changes in threshold or the abolition of means-testing—
Don’t indeed. It is slightly unfair of the Minister to pose that question. I am merely a Back-Bench Conservative MP and it is not my responsibility to make the policies up. However, it is my responsibility as a constituency MP to draw out my constituents’ concerns to the Minister and to try to tease out what his policies are and how he will strive to increase the threshold if possible, given the fiscal situation.
Mervyn Kohler of Help the Aged said:
“We have a larger population of ageing people than we’ve ever had. Ministers insist there is no new money and we must improve the system through reorganisation. They’re not living in the real world.”
Those words are not mine, but those of a senior director of Help the Aged. I hope that the Minister takes them on board.
I come back to the Minister’s earlier point. I feel that after 10 years of socialism in our country— [Laughter.] It is debateable whether it is real socialism, but I still think of it as socialism. After 10 years of socialism, the elderly should be doing far better than they are. Let me give the Minister another example of my concern.
When the Prime Minister was elected, he said that the priorities of the Labour Government would be “education, education, education”. That is a worrying slogan. It is wonderful theatre and great for getting votes, but how is it possible for a Government to prioritise education over and above the vulnerable elderly and those who need long-term residential and nursing care? The Labour slogans “education, education, education” and “24 hours to save the NHS” took away some of the focus that is so vital in protecting the most vulnerable people who need long-term residential care.
The director of the Wanless report, who used to work for NatWest bank—a senior economist—stated that to provide better care in nursing and residential homes the Government need to come up with an extra £1.7 billion a year. That is the figure necessary significantly to improve and sustain better care in nursing and residential settings. So far, the Government have spent more than £5 billion on the war in Iraq, an illegal war that I opposed and will continue to oppose—
It is no good the Minister shouting at me. I was vehemently opposed to the war in Iraq and made numerous statements about it in my local paper, the Shrewsbury Chronicle. It is a disgrace for a socialist Government to waste £5 billion of taxpayers’ money when my constituents and their relatives are being robbed of their life savings purely to pay for something that should be free on the national health service and should be provided for by the Government.
I turn to the specifics in my constituency of Shrewsbury and Atcham. I hope that the Minister will take note of these points because I want him to remember the problems that we have. The number of people over 74 years of age in my constituency has increased by 27.4 per cent. since 1991. That is a staggering increase.
Shropshire is such a beautiful county, so many elderly people from around England go there to retire. The county therefore has a large population of senior citizens. On top of that, the increase in the number of people over the age of 74 is running at a faster rate in Shropshire than in most other counties of England. Shropshire county council has to grapple with that huge problem. I shall be interested to hear the Minister’s comments on what funding the county council receives in that respect—he doubtless has the figures to hand—but I fear that it is far too little to deal with the problem, given the growth in the number of elderly people in the county needing care. I will highlight some specific examples later.
In preparation for the debate, I met four experts from Shrewsbury who run nursing and residential homes. Mrs. Mandy Thorn, a constituent of mine, operates the Uplands nursing home in Dorrington, a little village just south of Shrewsbury. If the Minister has time, I suggest that he engage in correspondence with Mrs. Thorn, Shropshire’s leading light on nursing and residential care. She is an eminent lady from whom the county council and many others seek advice as she is so involved in running various nursing homes. He would do well to speak to her. I use her as my intellectual stable mate on such matters, and I believe that he could learn a thing or two from her.
Shropshire county council is doing well—of course it is; the county is Conservative controlled—but I praise the council and particularly its chief executive, Mrs. Carolyn Downes, and her team. The community services directorate of Shropshire county council has a three-star rating for its adult social services. Despite the lack of Government funding, it does the best it can to ensure that long-term residential and nursing care are properly fulfilled in the county. However, Government funding is insufficient to provide an equitable service in rural areas. Those are not my comments; they are the words of the men and women who run the residential and nursing homes. If the Minister continues to laugh at such points, as he has already, he will be laughing, or even smirking, at those eminent Shropshire people.
Huge costs are involved in providing care in people’s homes in rural counties such as Shropshire. I was told today by the head of the community services directorate that, in certain cases, the cost of travel to small villages in my constituency such as Snailbeach or Halfway House near the Welsh border is more than the cost of care. Yet the Government, in their great financial models, never take account of the fact that Shropshire is one such rural community, nor of the huge extra costs involved in providing care to the vulnerable in remote villages.
That will obviously be a matter of great concern to the Minister. What do the Government intend to do to help rural areas? Together with an increasing number of frail elderly people, the additional costs incurred in delivering home care services in rural areas is one of the main problems faced by Shropshire.
I am sorry to be party political, but I feel passionate about the matter. Shropshire receives the lowest funding in the country for the police, we are at the bottom of the table for educational provision, and now we are at the bottom of the table for care for the elderly. That smacks of yet another Government policy, which is that the socialists look after their own in the urban areas and in the Labour heartlands, rather than being fair to people in Shropshire and the other rural areas that happen to be represented by the Conservative party.
The increasing costs of service provision have to be passed on to the end user. Those cost pressures include employment costs—we all know how much more expensive it is to employ people—and the huge amount of bureaucracy and regulation emerging from the Government and the European Union. I saw one example of that bureaucracy when I visited the Uplands nursing home. Mrs. Mandy Thorn told me that bedpans have always been washed manually. The home has among the highest health standards in Shropshire, yet the Government have imposed another regulation. The staff are not allowed to wash the bedpans manually, but have to have a special machine to do it—it looks like a dishwasher—at a cost of £7,000. Mrs. Thorn had to buy two machines. That £14,000 goes straight on to the costs of providing care, so either the county council or the relatives of those at the homes will have to stump up the difference.
There is a huge shortage of workers in rural areas, and people such as Mrs. Thorn spend an enormous amount of time trying to find people who can do that work. Better trained and qualified staff obviously require additional pay and better conditions. It is right to have better training. However, it requires additional funds, and the owners of nursing care homes believe that the Government are not taking that into consideration. Although the Government are introducing greater holiday and pension entitlements for those who work in nursing homes—I obviously applaud that—they are not providing the county councils with extra funding to match those increased entitlements.
We are seeing increased fuel costs for home care services, and some of the increases are eye-watering, yet the homes have to take them on board. Inflation stands today at 3 per cent.—a worryingly high figure that will put more pressure on balancing the books. We know also that interest rates are rising. That will contribute to the difficulties faced by people such as Mandy Thorn. Increased inflation and higher interest rates, with more red tape and bureaucracy, will make it more difficult to provide such care.
I turn to some of the solutions that Mrs. Thorn and her colleagues have suggested. They believe that the funding for adult social care services should be ring-fenced. I would like the Minister to consider that. Why not ring-fence that funding to ensure that county councils cannot use it for any other purpose? Residential care is of such importance to the future of our country that Government funding for such provision should be ring-fenced, and county councils should not be able to dip into it to provide other services. Increased funding for out-of-hospital services, too, should go to local authorities.
I turn to the most important point—one that I am particularly keen for the Minister to answer. Mrs. Thorn told me that we need to increase the registered nursing care contribution in line with inflation and backdate it from October 2006, because the last time that that vital funding mechanism was updated was October 2005. Why has the registered nursing care contribution not been increased? Since October 2005, we have had an inflationary increase in costs of at least 3 per cent., huge increases in energy costs and other cost rises. The fact that the registered nursing care contribution has not increased since October 2005 is a scandal and the issue that Mrs. Thorn and her colleagues believe is putting the greatest strain on providing nursing and residential care in Shropshire.
Mrs. Thorn and I believe that we need properly to fund the additional costs of providing domiciliary care in rural areas—I have alluded to that already. Without proper domiciliary care and the other aspects I have spoken about, the NHS will be on its knees in a matter of days. The work done in residential care homes and nursing homes relieves the NHS of an incredible amount of responsibility and work. However, at the same time, the Royal Shrewsbury hospital is £34 million in debt and there is a major restructuring taking place. There are huge potential cuts to services and the Government do not want to have cancer specialists in Shropshire; they want people to go to Wolverhampton and Stoke. The Government are moving away the services that the elderly desperately need because they do not believe that Shropshire, with a population of 500,000, deserves to have those services and that people should go to Stoke, Wolverhampton or beyond.
There are huge pressures in relation to the lack of financing of residential care homes. I have a document that I will give to the Minister at the end of the debate and that I will be making public. The document describes a model that is roughly based on a 95 per cent. occupancy for a residential home and a nursing home. People in my constituency have produced calculations based on all sorts of expenses: wages, uniforms, food, laundry, medical supplies, bed linen replacement, training, patient activities, electricity, water, water disposal, insurance, council tax, repairs and maintenance, hire and leasing, professional fees, and subscriptions. When all those factors are taken into account, it costs approximately £400.30 to provide one individual in Shropshire with care in a residential home. Yet, at the moment, care homes receive a maximum of £292.15. That is a huge difference.
A residential care home provides a marvellous service, but receives £292 when the actual cost is £400. That is a critical situation and the people involved are in a crisis that can only get worse. However, and this is an extremely important point, those people have said to me, “What can we do? We cannot throw the person out.” Can hon. Members imagine the scandal that would be caused by a residential home throwing somebody out? Such a scandal would reverberate around the country. Therefore, care homes are over a barrel. I would like the Minister’s interpretation of how Uplands nursing home can continue to provide a vital service when there is such a huge funding gap.
Lastly, the figure for providing nursing services for a nursing home is £504.62. The maximum that may be received from Shropshire county council is £455.48, which is yet another huge difference. In all candour, I say to the Minister that there is a crisis looming, and I hope he realises that. I would be grateful if he showed some semblance of awareness of the impending crisis that is building up in this area. Can he explain how my nursing and residential care homes can continue to provide their service when there is such a huge disparity in relation to the money that the county council can give them?
I stress that Shropshire county council does a marvellous job, but it does require greater funding from the Government for this vital service.
This is an important area of provision serving some of the most vulnerable people in our communities, and it is indeed under pressure. I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate.
As the hon. Gentleman said, residential care covers a wide range of important needs, and I want to concentrate my remarks on care for elderly people and, in particular, on those suffering dementia. I will also focus on some of the pressures facing high-cost areas such as Oxfordshire.
We should stress that the growing number of older people in our society represents an opportunity, not a burden. It is a wonderful thing that so many people are living longer and it is a testament to the NHS, better housing and higher living standards. The corollary is that increasing numbers of people are living to the point where they need residential care, and more people need close care as dementia afflicts those who in past generations would have died younger through poorer general physical health or disease.
We owe thanks to all those staff in social services and care homes who work hard to provide a good standard of care when it is the failings and unacceptable abuse, as in today’s news reports about Sutton and Merton, that understandably capture the headlines. All of us who have taken up the cases of constituents and their relatives seeking care know that, all too often, families face a difficult struggle to find something suitable and find that there are barriers to the recognition of their needs for NHS continuing care.
I pay tribute to the work of the Alzheimer’s Society which, in addition to its commendable campaigning and briefing—including the briefing provided for this debate—provides invaluable help and advice to carers and their families who are often at their wits’ end in trying to get through the maze to access funding.
The report from the Commission for Social Care Inspection published last month on the state of social care in England was very balanced. It recognised increasing expenditure and progress in areas such as the continued improvement in meeting national minimum standards, better commissioning, and an increased use of direct payments, notably for older people. At the same time, there was real cause for concern in a number of areas. For example, it is appalling that at least a third of homes do not meet standards for managing medication safely and operating safe working practices. It is also alarming that a substantial number of home care services are failing standards on medication, recruitment and supervision of staff. It was also clear that in juggling the increasing demands on them, councils were having to tighten the eligibility criteria. At the same time, there were question marks over the advice and support available to clients and carers excluded from funded care.
The report concluded by highlighting five groups that gave rise for concern: those not using council services but in need of information and support; carers, relatives and friends carrying the costs of ever-tightening eligibility criteria; those who lack choice over services or who comes into their home; those whose service standards are unacceptably low; and those with special complex needs which are not being met.
Does my right hon. Friend accept that a particular problem in this area arises when a home is set up with individuals who may be catered for very well for a number of years but whose needs then become more complex and cannot be met by the home? Often, the result is a real dilemma as to who subsequently picks up the responsibility. That ought to be thought about before such institutions open. Does my right hon. Friend agree?
My hon. Friend makes a very good point. As he says, care homes have to deal with the challenge of the growing numbers of people who are living to the point at which they have what are often very acute needs. That must be part of the care planning, as he said.
The report by the CSCI and other reports confirm what our constituency experience tells us. That is that we are dealing with a crucial and complex area of care, which is modernising and trying to raise standards and to extend choice—I might add that it is doing so in one of the areas in which choice is valued—but which is under enormous pressure because of demand and constraints on resources even as they are increasing. The sector is also feeling some of the backwash from the deficits elsewhere in the NHS to the depressing point at which, as the CSCI report put it:
“A number of councils and primary care trusts are reported to be withdrawing from pooled budget arrangements”
and are “nervous” about embarking on new joint initiatives, so the danger is that things are less joined up at the very time when they all need to be better joined up, not least to address the needs that my hon. Friend raised.
I know—I hope that we all know—that my hon. Friend the Minister brings enormous commitment and real personal experience of this sector to his role. I am confident that he will have been pushing energetically the case for expenditure on the care needs of elderly people, as identified in the Wanless review, both alongside other health priorities and in the wider comprehensive spending review. We all know that not everything can be a priority and that even with our strong economy there is never enough money for everything that the public want the Government to spend money on, but I hope that my hon. Friend and his colleagues will take these remarks as my own very strong support for additional well focused expenditure in this area.
As for the implications of all this in my own constituency, I know that the Minister recognises the importance of prevention, earlier intervention and support to enable people to live independently for longer. Oxfordshire is trying to address big demographic pressures locally by moving services and resources in that direction, but that unavoidably involves a period of extra funding pressure as it tries simultaneously to meet the needs of today and to bring in new preventive initiatives that will help to meet those of tomorrow. If the partnerships for older people projects grant could be rolled out nationally and soon, that would be a significant help to authorities such as Oxfordshire.
I hope that the engagement of my hon. Friend and colleagues in the comprehensive spending review will also address the vexed question of interaction with the revenue support grant and tackle three issues in particular. The first is the need for better provision for the demographic pressures on services for older and disabled people. The hon. Member for Shrewsbury and Atcham referred to that. The county of Oxfordshire predicts a 14 per cent. increase in the number of people over 85 over the next four years, and over the same period a 22 per cent. increase in the number of adults with significant learning disabilities. Those are real pressures that the authority has to try to plan to provide for.
Secondly, on the question of the interaction with the revenue support grant, I hope that the Government will consider the need to reflect adequately the impact of high staff and property costs, which result in very high prices for care homes in our county. I am advised that they are 19 per cent. higher in Oxfordshire than in other county council areas. The third issue is the impact of increased costs in meeting the welcome improvement in the quality of care homes that the national minimum standards are bringing about.
May I underline to the Minister the importance of bringing in a fair, consistent and comprehensible national system for deciding who obtains NHS funding for continuing care? As he knows, the shortcomings of the existing system are totally unacceptable, with carers and relatives, who are often stressed themselves, having to negotiate complicated criteria that obscure eligibility and then find their way through the complaints procedure, and all too often ending up having to take legal action.
As my hon. Friend will be aware, in his written answer on 30 October last year, he said:
“Responses to the consultation”—
the national consultation that took place last year—
“are currently being analysed with a view to publishing the Government’s response to the consultation in late 2006.”—[Official Report, 30 October 2006; Vol. 451, c. 166W.]
In a written answer just last Tuesday, he said that
“we are now considering the responses we received to the consultation.”—[Official Report, 9 January 2007; Vol. 455, c. 462W.]
Will my hon. Friend tell us when he expects to be able to make an announcement and whether it will address the shortcomings that the Alzheimer’s Society has identified, notably on the importance of addressing mental health needs? Those are very acute and important for the people we are talking about.
These vital questions of care for elderly people often do not receive in public debate the attention that they deserve. I think that that is partly because many of the clients, carers and families who are struggling with the system do so in isolation, and because many of the funding questions are so complicated. However, it is crystal clear from the reports of the CSCI, from the Wanless review and other reports and from the experience of our constituents that there are big and vital challenges in this sector and that the pressing care needs of vulnerable elderly people are ones that a civilised society must address as a matter of the highest priority.
It is a pleasure to follow the right hon. Member for Oxford, East (Mr. Smith), who spoke movingly about the needs of people in residential and nursing care homes. It so happens that I have an aunt in a nursing home in his constituency. She will be delighted that her Member of Parliament is concerned about these issues, although that might not be quite enough to persuade her to vote for him at the next election.
I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing the debate and on how he introduced it. By making a contribution, I am reducing, albeit marginally, the average height of Conservative Members speaking in the debate.
I hope that the right hon. Gentleman and the Minister will not take it amiss if I point out that both have served in the Treasury, and although they moved on to care and spending Departments, they must bear some responsibility for the structure and amount of money being spent in this area.
This is a topical debate because up and down the country social service departments are grappling with next year’s budget against the background of the revenue support grant announced in December. For my county, Hampshire, and, I suspect, others, it was a tough settlement. The formula grant for Hampshire will increase by 2.7 per cent., which does not cover inflation. The consumer prices index, which is relevant to the services that we are talking about, was up 3.8 per cent. in December last year.
This year’s increase follows an increase of 0.2 per cent. last year, once the ring-fenced grants that the Government abolished are stripped out. On top of that, next year’s supporting people grant has been frozen at just below the level for 2006. So far as adult social services are concerned, Hampshire receives the second lowest settlement in the country—even less than Shropshire.
With that as the background, if an authority banks further efficiency savings—Hampshire county council is efficient; it is lit up by beacons that have been bestowed on it by the Government—and then puts up the council tax by the maximum possible without being capped, there is still £10 million to be taken out of services. With education spending largely protected, the spotlight inevitably falls on the services that we are discussing this afternoon.
Expenditure on the elderly is the largest single element within social services, and expenditure on residential care is a significant part of that budget. I listened to what my hon. Friend said about ring-fencing, but the difficulty for the Government is that if they ring-fenced the amount that they think local authorities should spend on services, it would not be enough, and they would have to top it up from other sources. Many social services authorities certainly spent way above the standard spending assessment under the SSA system.
I asked my social services department how it was going to cope with the pressures that I have outlined, and the answer is as yet unclear. It is having to cope with demography, which has been touched on, and the increasing complexity and cost of many care packages, particularly for those with learning disabilities, which the right hon. Member for Oxford, East has just mentioned. My social services department said that there would be a move to help the most critical cases only, with little work done on prevention.
That is bad news for the individuals who will not get the care that they need and who may have to wait until their life really is threatened, they have a serious mental or physical illness or they are unable to carry out the majority of personal care and domestic routines. If the increasing trend of rationing services to deal with insufficient funding continues, all older people will, as early as 2009, receive care only when their needs reach the substantial or critical level. Clearly, that is not a situation that the ageing population deserve, or indeed expect. It might also be bad news for the taxpayer, who might eventually have to pick up a larger bill.
Residential care services face underlying pressures from higher standards and increased costs, both of which were touched on in earlier contributions. Increases in the national minimum wage have been more than twice the rate of inflation for several years. Fee increases have been tightly managed, but there is a real risk that supply will be lost as a result of closures, the refusal to accept social service rates or the inability to meet appropriate standards.
The Government might tell us that they have been putting more resources into social care and, to the extent that they have, I welcome that. However, as the Local Government Association’s autumn statement highlighted, general Government grant support for services such as social care has increased by just 14 per cent. in real terms since 1997-98. Yet, spending increased by 65 per cent. between 1994-95 and 2004-05, so Government funding for social care has clearly not kept pace with the demands of an ageing population.
Overwhelmingly, the extra resources that the Government have found have gone into the health service. With the prospect of insufficient Government investment for social care in the next spending period—I endorse what the right hon. Gentleman said about that—local authorities will clearly face some difficult decisions.
The Minister may tell us that efficiency savings and delivering care in a different way will bridge the gap, but that would be a very optimistic claim. Before Christmas, the leaders of 45 councils wrote to The Guardian, warning that
“services for the elderly are now teetering on the brink. The present situation is unsustainable.”
The pre-Budget report could have brought some good news, but it did not. The Chancellor put all his chips on one number—education. He could have increased education expenditure substantially, but by slightly less, and found some extra money for health and social services. However, he chose not to.
In fairness to the Government, they recognise that there is a problem and they have called for a
“shift in the centre of gravity of spending”,
“care undertaken outside hospitals and in the home”.
If that is their ambition, however, they will have to provide the resources to deliver the outcome.
At the same time as we have this downward pressure on resources, demand is increasing, as we have heard, and the number of those over 85 will double to 1.8 million between now and 2028—the demographic clock is ticking away.
The Joseph Rowntree Foundation has estimated that the number of places needed in residential care homes, nursing homes and hospitals will rise to 1.13 million by 2051, which is roughly double the number now. However, supply has been falling, not rising. If we go back some time, we may find that there are good reasons for that, and people may have been inappropriately placed in residential care—indeed, that was a constant refrain of one of the Minister’s predecessors—but any slack has now been taken up.
Indeed, in Hampshire, the county council and local NHS trusts have joined together to build new nursing homes themselves because of the decline in the private sector. The Hampshire Care Association told me that many independent providers cannot carry on, because local authorities are not covering the cost of care home fees, while others have been unable to cope with the standards. However, care homes are not closing evenly throughout the country, and the problem is at its worst in inner-city areas. Those areas in which residential care has declined the most are not those in which home care services have grown the most, and the Rowntree report sheds some light on that.
There is a further pressure, on which the hon. Member for Stroud (Mr. Drew) touched: NHS deficits have been straining relationships between health trusts and social services, as the NHS is under enormous pressure to cut discretionary spending where there are joint budgets. The pressure on social care also increased after NHS primary care trusts withdrew funding for joint projects from about half of all councils, according to the LGA report “Without a care?”
I do not think that anyone will argue this afternoon that there is enough slack in the system or that there is ample room for economies. Somebody writing in Society Guardian on 10 January said:
“Fees for all but the very top end of the private sector have been forced down to unsustainable levels and many small private sector homes are hanging on by their fingertips. It’s dispiriting to watch this choice, which suited many older people, systematically choked out of existence.”
The Joseph Rowntree Foundation estimates that care homes are underfunded by £1 billion. I will not report again what Dame Denise Platt has said, because the right hon. Member for Oxford, East has just touched on it.
Finally, I want to put some questions to the Minister. First, it is too late to do anything about 2007-08—the die is cast. However, the comprehensive spending review that is under way for the next three years is an opportunity, and we need a fresh start.
Without giving away the negotiating hand, can the Minister reassure us that part of his Department’s bid for the next three years is a step increase in funding to eliminate the underfunding of the sector and provide a realistic baseline from which to move forward for the future?
Secondly, does the Minister really believe that policy for the elderly as a whole is embedded in the work of local and regional government? To take housing, social services and transport as examples, many elderly people could be forgiven for thinking that they are somewhat marginalised.
This problem is smouldering away, and if the Government do not get a grip on it and reach some solutions soon, they will find that it has become much more extensive.
I, too, congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing a debate on this important topic. I do not think that it is going too far to say that my hon. Friend, the right hon. Member for Oxford, East (Mr. Smith) and my right hon. Friend the Member for North-West Hampshire (Sir George Young) have painted a frightening picture of the deterioration in the care of elderly people.
Let me start with the most important point that I want to put to the Minister. Unless Age Concern, all the experts in the field, the Joseph Rowntree Foundation, Members of Parliament and local authorities are all wrong, the current situation is very grave, and there is every likelihood that it will get worse. I therefore ask the Minister please to give us an honest assessment of the position. In my area, in the East Riding of Yorkshire, the number of those over 85 is increasing by more than 500 a year. The impact of that on social care spending is enormous, and I am not sure whether it is factored into any political party’s forward thinking on budgets. I hope that the Minister will address that.
In summing up, I shall certainly give an honest appraisal of the situation. However, can I ask the hon. Gentleman for some honesty too? Does he support the abolition of means-testing for social care? Yes or no? Does he accept that considerable extra investment in social care is likely to require significant increases in taxation? Would he support those increases to justify a significant expansion of investment in social care?
With respect to the Minister, I knew that I would regret giving way to him. Again the narrow partisan approach is being adopted of asking a Back-Bench Member of Parliament about something that there is ample opportunity to debate with those on the Front Bench. I was bringing out the difficulties for any political party—including the Liberal Democrats, who have little likelihood of getting into power but who none the less will, like us, wrestle with such difficulties.
This is a debate, and the Minister’s party is in power. Up to now, no party has been able to find a way to solve what is a really difficult situation. When costs are likely to spiral in coming years—we have talked about numbers and demographics—how is it possible to deal with those costs, without asking people to contribute if they have the resources to do so? If they are asked to contribute, how is that to happen in a way that does not penalise hard-working people with relatively small amounts of wealth built up over a lifetime? How can we avoid creating a disincentive to their saving for the future and a system in which they feel hard done by? The Minister will know that in his constituency, as in mine, people say that they wish they had not saved or put money away, because it is just taken from them. They feel the unfairness.
I do not have an easy, trite solution. I cannot see that we can avoid the requirement for a contribution from those who have assets towards the cost of their care. However, before the general election the Conservative party wrestled with the question and came up with a policy that involved trying to find a form of insurance, so that at least no one would have to pay more than, say, the costs of three years. That was a genuine attempt to cap the requirement and make it reasonable. People are not trying to be unreasonable.
The Minister’s stock-in-trade response, on every occasion on which I have debated with him—which I realise is quite a few now—is to ask Back-Bench MPs about their party’s policy. Perhaps I may take some time now to ask the Minister—as the Conservative party is not in power and neither are the Liberal Democrats, but his party is—not to waste the House’s time in future when we are dealing with a matter of such seriousness and severity. We are not here to make party political points, least of all to a Back Bencher.
The situation is deteriorating. A constituent of mine received a letter from Humberside Independent Care Association, the largest provider of residential care homes in the East Riding of Yorkshire, which told him:
“It is with regret that we are writing to advise you that it is our intention to introduce Third Party Top-ups to all current clients of HICA who are financially supported by their Local Authority. This year we have been faced with major increases in the national minimum wage, gas, electricity, oil and our annual registration requirements for the Commission for Social Care Inspection. We have raised these issues with your Local Authority, however the fee increases we received were significantly below the level required to cover these costs”.
The letter was sent to the son of a lady of 104 who had lived in the Albemarle home for the past 12 years. He is well into his 70s and the request is for top-ups from him and his brother, who does not live in my constituency and whose 65th birthday is coming up this year. We are asking for pensioners to pay top-up fees for pensioner parents. That is the situation that we are getting into, because the moneys coming through into the care home sector do not reflect the costs.
In the East Riding of Yorkshire, the increase in fees this year to both domiciliary care providers and care home providers was 2 per cent. That is with the minimum wage rising, last year, by more than double that, and by more again this year, and with gas and electricity costs, as the letter mentioned, going through the roof. The East Riding of Yorkshire was unable to provide more than a rise of 2 per cent. When I raised that in writing with the leader of the authority last year, and spoke to the officers concerned, I expected them to tell me—because I am used to dealing with Ministers in the House—that what was happening was the best possible solution. They did not; they said that in their view it was unacceptable and did not properly reflect the costs, but they simply did not have the resources to do so.
Perhaps the East Riding is failing to manage its budgets properly, but, as the Minister may know, after being one of the top three local authorities in the country for its financial management last year, it was this year named as the pre-eminent local authority for getting value for money and stewarding its financial resources for the good of local people. I think that that dismisses any suggestion that the Minister might want to make that the local authority is to blame for not passporting on the sums concerned. The truth is that the East Riding of Yorkshire, the council that is the best run, financially, in the country and which I am proud to say is Conservative-led, was unable to put more than 2 per cent. into the sector this year, and problems have ensued.
The situation is such that when the mother of a constituent of mine moved to the East Riding from the Isle of Wight she found that, although her new residential care home in Driffield cost £450 weekly—over £15 more than the cost of her home in the Isle of Wight—the rate set in the East Riding of Yorkshire per week is £328.80, whereas in the Isle of Wight it is £435. It is an extremely serious situation when homes in East Yorkshire have costs similar to those of homes elsewhere, but do not have the money to provide proper support.
I met representatives of the East Riding preferred providers, Verna Community Care and New Concept Care. Their staff are involved in providing support at home for many vulnerable people, so that they can lead independent lives. The care workers whom they employ work split shifts in all weathers, throughout the year, which often involves cycling between clients. Yet those carers, in the main, receive little more than the minimum wage. That is the base situation. The providers are unable to see how they can maintain what they do with the expected deterioration in the situation.
The right hon. Member for Oxford, East mentioned an article in The Guardian about the dropping of fees to unsustainably low levels. As that article said:
“Alternatives to residential care are not in much better shape.”
I wonder whether the Minister will comment on another statement from the article:
“Nonetheless, services for older people remain inadequate, are often unreliable and always done on the cheap.”
Does the Minister deny that? Does he see a rosier situation? Are all the experts and commentators wrong? That is the kind of honesty we could do with. The article comments on the Wanless report and its recommendation of a 1 per cent. shift of spending through GDP. That gives rise to all the issues of taxation, including the fact that the Conservatives, and I personally, believe that if tax rates are set too high the tax take eventually goes down, as opposed to the simplistic economics so often used by Ministers which suggest that reducing the tax rate necessarily means less coming in. It is a tough balance to get right.
I sympathise with the hon. Gentleman’s argument, but should the service be universal, or should it be capped at a certain income level? It always worried me that when we had free social care we had the ridiculous situation in which millionaires in the Cotswolds received free social care. I thought that that was rather an anomaly. Does the hon. Gentleman agree?
I agree entirely. The current situation, however, as the Minister and the hon. Gentleman will know, creates resentment in people who do not have great means, and who feel that they are penalised for the efforts that they have made during their life to live thriftily, as they were brought up to do, and to stand on their own two feet. With respect to my hon. Friend the Member for Shrewsbury and Atcham, the Government are not really a socialist Government. They claim to be as much on the side of striving, hard-working people, who are doing the right thing, as the Conservative party is. Their behaviour often belies that, but philosophically they are, I think, as attached to that view as we are. Therefore we need to consider the provision of decent funding, in the next few years, within the tight financial situation, so that we can at least meet the current costs of care. We also need to examine the thresholds, to create a fairer system that rewards hard-working people—strivers who made sacrifices and decided not to go on holiday so that they could put money away for the future.
For the record my hon. Friend may want to consider—I hope that he will agree—that the difficulty in establishing fairness arises because there are effectively three categories of people: those who do not have the means during their earning lifetime or at any other point to set aside funds for the future, and who need support; those who have had the means to do that and who have made provision, which creates the need for a fair balance; and those who had the chance and chose not to. That is where much of the resentment arises in the debate. As long as we have those three categories in mind we can proceed.
Absolutely. I hope that the Minister will address that because we need a fairer system that provides for those in need. Is there room in the system now? Notwithstanding the long-term difficulties, the wastefulness of this Government is legendary. Never has so much money been spent to so little effect in the history of British government. I imagine that they stand in great comparison with global government. It would be hard to find anyone who has wasted so much—£20 billion on an NHS IT system that does not work.
As for the situation locally, spending on the NHS has doubled—[Interruption.] If the Minister will allow me. Spending on the NHS has doubled, yet in the East Riding of Yorkshire, where there is no funding for domiciliary care or care home provision, NHS beds are being closed. In my constituency, every single NHS bed in community hospitals has been closed. It is proposed that there should be some only in Goole and Bridlington, an hour and a half or two hours’ drive away, which means a round trip of three to four hours. We have a topsy-turvy world in which the Government are not delivering. With efficiency savings and better Ministers, there is ample room within current expenditure to look after older people and provide a better NHS.
I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing the debate on this important subject, which, sadly, is often neglected by the press and sometimes by this House. Older people, particularly those in residential care, are often forgotten people. The sense of abandonment that those people sometimes feel has depressed me greatly in the past when visiting nursing and residential homes, particularly at Christmas. There is a case for families to have more of a responsibility for looking after their elderly. We need to have an honest debate across parties about the ageing population.
I want to pick up on the point made by the right hon. Member for Oxford, East (Mr. Smith) about poor medication management. That really should not happen. We seem to have gone backwards because many pharmacists used to go into nursing homes, and that should have continued under the new pharmacy contract, but because of other pressures, the PCTs do not seem to have commissioned those services. Will the Minister look into that so that we can have a system that is a bit more joined up? That welcome step would make savings in long-term drug budgets.
The right hon. Member for North-West Hampshire (Sir George Young) gave a solid overview of the situation in Hampshire. I, too, represent a constituency in Hampshire, where the pressures are acute. There are about 440,000 care home residents in England and Wales. The Office of Fair Trading study, in May 2005, showed that 35 per cent. of residents have to pay a top-up payment, which varies from county to county. Social service departments fund at different levels in different counties so top-up rates differ between counties. That is counter to the Government’s agenda for choice: many people feel that they do not have a choice as there is little provision available at the price set by local authorities. That is a concern.
Councils have been slow to acknowledge rising costs and to react to the cost burdens on care homes, which means that, on funding, homes are the piggy in the middle between the Government and councils. They face particular problems, some of which have been highlighted. Although nursing homes receive the registered nursing care contributions, they do not always cover the costs. Although the Government’s measures for better training, regulation and protection for older people are welcome—we cannot argue with those measures—the costs of those changes have increasingly fallen on homes and the social care system, which has been underfunded to an extent.
It is not only homes that are caught in the middle. Individuals and families are also caught in the funding battle between health and social care. Nowhere is that more evident than in the prolonged battles that families have to go through about continuing care criteria. It is a disappointment to many of us that there has been a delay in producing national standards. Previously, we had local criteria, which differed. The biggest problem is that the criteria are very subjective. Families have found decisions difficult to understand and many have been open to challenge in the past—there was the Coughlan case, for example. I have supported families in cases in which the description, on paper, of the person being refused continuing care was exactly the same as that of Ms Coughlan. I do not see how we can continue with a system that allows that to happen.
There was a right of appeal to strategic health authorities, which has been moved and is centrally administered. A gentleman—he asked not to be named—who has chaired those appeals came to see me. He told me that people used to be able to exercise their sense of fair play and common sense and take an overview of the situation, but he is concerned that the procedure has been translated to a tick-box exercise and that there is now no flexibility. He felt that perverse decisions were being made. Why has that system been centralised despite the claims that decisions should be taken more locally?
People cannot understand why somebody frail and elderly suddenly becomes part of the social services system, which is means-tested, rather than the health care system, which is free at the point of delivery. As we move care closer to home, which most people welcome, that problem will increase because people who consider themselves to be ill and in need of health services that would usually be provided in hospital will increasingly be means-tested. Although there has been an increasing amount of money available for care packages, because of their complexity the money has gone to fewer people with greater, complex needs.
I want to discuss the Association of Directors of Social Services and Local Government Association review of social services finance in 2005-06. The report goes into some detail about efficiency savings that have been made and the areas that experience the most pressure. The report highlights that
“older people and physical/sensory services are projecting above budget spending of £18 m and £19 m respectively, with other service areas contributing to meet pressures through efficiencies.”
The report goes on to say that the
“financial challenges facing councils and the real difficulty in achieving a shift in emphasis to prevention when there is increasing demand for intensive social care across all adult services”
has led to an increase in fees above the rate of inflation. It also points out that the
“loss of preserved rights income and residential care allowances are presenting significant cost pressures”
in about a third of councils, and that
“an emerging and growing financial burden is being met by authorities in the form of support to other people … without access to funds.”
The report states that
“just under one quarter of authorities are now experiencing a growth in demand for this type of support”,
and, most worryingly, that
“46 per cent. of councils have experienced a reduction in Primary Care Trust funding, or a reduced inflationary uplift.”
As services move from the acute sector to social care, the money is not following. I have asked about this locally. Social services departments feel that their burden has increased but their funding has not.
It would help if we could merge health and social care budgets. Welcome moves have been made in that direction but I was concerned by the comment made by the right hon. Member for Oxford, East that councils were withdrawing from this system. As care is being transferred from the NHS to the social care sector, will the Minister tell us how the money is being tracked? How can there be more public scrutiny of the process so that we know that when services are transferred the funding is also being transferred? The money is not there at present and that is a concern. We all know about the pressures on the NHS. The Secretary of State has said that the books will balance next year, but there is not the same focus on social care. Cynics among us probably think that the situation I have mentioned has had something to do with that.
The pressures are affecting other areas of care. As has been mentioned, eligibility criteria are being affected. I shall draw my comments to a close slowly, but I have spoken for only nine minutes.
Seven out of 10 people now receive support only when their needs are substantial or critical. Are the Government happy with that situation? What will be done to ensure that people can receive support at a lower level? Such an approach may prove to be more cost-effective in the long run.
I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this important and topical debate. He is a tireless campaigner on behalf of his constituents. We regularly hear from him in this Chamber, and he has consistently called the Government to account for the state of social care not only in his county, Shropshire, but across the country. He made a useful reference to the challenge that the Wanless review has set for all of us in political life and to the data that it published. This is one of the most challenging and known about issues that our political generation have to deal with.
My hon. Friend made a helpful reference to the Sunday Express campaign. Lucy Johnston, one of the journalists in this area, has been working particularly hard. My hon. Friend also covered the rurality and sparsity factor that can affect the provision of residential care. That aspect is notably illustrated by the hon. Members who are taking part in this debate, although it is important to note that some of the most acute problems are also being experienced in inner-city, urban and suburban areas.
I was taken by the compassionate speech made by the right hon. Member for Oxford, East (Mr. Smith). He made good use of the briefing from the Alzheimer’s Society, for which it is to be congratulated. Equally, the speech by my right hon. Friend the Member for North-West Hampshire (Sir George Young) will be one that many will want to return to as this debate unfolds in the coming months and years. He made a compelling case by reference to the local conditions that he encounters in Hampshire, particularly the supply and demand challenges and what is required for the dignity of older people.
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) was able, in his customary trenchant style, to challenge the Minister on a number of areas. Whoever the Government were, we would be calling them to account for the big challenges that now face us all.
This is the second time that the Minister and I have met in Westminster Hall to debate this subject in recent months. That is a mark of its closeness to the hearts of all our constituents, which is unaffected by which party we represent. The Minister was trying to tease out of some of my hon. Friends whether they were articulating party policy while they were standing up to represent their constituents. While we go through a fundamental policy review, it is important to note that the speeches of my right hon. and hon. Friends should all be taken as very worthy submissions to the public services improvement group policy review, co-chaired so ably by the former Secretary of State for Health, my right hon. Friend the Member for Charnwood (Mr. Dorrell), and Baroness Perry, a former chief inspector of schools. I shall certainly forward them a copy of the Official Report of this debate for that purpose.
Long-term care funding is one of the greatest challenges. In the previous debate that I mentioned, which was secured by my hon. Friend the Member for St. Albans (Anne Main), the hon. Member for Romsey (Sandra Gidley), who has of course been able to represent her party again today, branded her party’s policy of so-called free personal care as dishonest—that is not a word normally heard in this Chamber—and effectively suggested that those who write the Liberal Democrat manifestos behave in that way. It was one of the most amazing admissions that I have ever heard in Parliament.
The Minister failed to offer any policy on long-term care funding at that time. The issue has been dodged by the Government. As we know, in 1997, the Prime Minister—then Leader of the Opposition—famously bemoaned the fact that people had to sell their homes to fund their long-term care. Yet, in power, Labour has failed to introduce any meaningful policy to combat the problem. Moreover, more people are trapped in the blighted situation that the Prime Minister identified, and the threshold has not remotely kept pace with house price inflation in the intervening period, particularly in the areas that are most adversely affected. The Government have not even given a substantive response to the Wanless review of social care.
At the last election, the Conservative party was the only party to offer a real policy of long-term care funding. Labour brazenly promised to
“continue to provide healthcare free in long-term care establishments.”
Health care is NHS care, as everybody knows, and would remain free under the governance of either of the two parties of government on offer in this country.
Is my hon. Friend aware that the closure of beds and community hospitals means that there is an increasing tendency to send patients who are recovering and in need of health care to nursing homes and care homes, where they have to pay for their own recovery? This Government are not even delivering at that basic level.
The point that my hon. Friend makes only shows the exacerbation of the problem with which we are all seeking to grapple. The Labour manifesto completely failed to address the issues of health and social care costs linked to long-term care. I hope that the Minister will be as candid about those who write his party’s manifesto as the hon. Member for Romsey has been about the people who write her party’s manifesto.
I think that there is already enough on the record from the hon. Lady.
The only foray that the Labour and Liberal Democrats have made into care funding is the increasingly discredited policy of free personal care that their coalition has introduced in Scotland. I hope that the Minister will take the opportunity to comment on the experience in Scotland, where so much of the provision has been disappointing to say the least. Those who are charged with providing it say that they have not got the money that has been passported for that purpose.
The Government’s failure to solve the problem of the division between health and social care is well documented. The right hon. Member for Darlington (Mr. Milburn) pledged to demolish the “Berlin wall” in 1998, but it took until 2005 for the Minister for Immigration, Citizenship and Nationality, who was then at the Department of Health, to announce a joint White Paper
“designed to deliver integrated health and social care systems”.
That was merged with a health White Paper to produce “Our health, our care, our say”, which contains few substantive measures on closing the gap between health and social care funding. The initiatives that it does suggest are now under threat because of the massive NHS deficits. The temptation to shift costs on to local authorities has been too hard to resist for many primary care trusts, and the county councils network has expressed grave concern about this area. The impact on Wiltshire county council of the NHS removing £3 million from its income one day before this financial year started was widely reported. In July, the Local Government Association found that seven out of 10 local authorities in areas with an NHS deficit have been affected. It is fair to suggest that the Labour Government have failed to address—let alone solve—the question of how we fund care.
I move on to continuing care funding. During our previous debate I highlighted the shambles in respect of the attitude to NHS continuing care. A new national framework was pledged by the Minister of State, Department for Transport, in December 2004 when he was at the Department of Health. Despite promises that it was due for publication in early 2006, it did not go out to public consultation until June 2006, and the consultation ended on 22 September 2006.
It is worth noting that the Department of Health has a bad habit of holding consultations over the summer months, when people are away. I am sure that the Minister will wish to deny and dispel any idea that such an approach was intended to bury the consultation.
As the right hon. Member for Oxford, East said, the latest national framework newsletter from the Department states that it is currently analysing the contributions received and will publish the Government’s response in due course. It goes on to say that it aims to publish the Government’s response in late 2006 and will publicise the publication via the website and its usual contacts. As it is now 2007, it must be fair to ask the Minister to tell us when the Government will respond and, more pressingly, when the framework will be published. It is now already two years behind schedule.
I shall bring my comments to a close, Mr. Cummings, at the end of the slightly shortened time available to me.
It is vital that we have a straight response. We should not overlook the fact that many of the issues tie into the palliative care area, which is also a failed promise in the Labour manifesto. I look forward to the Minister’s response to the challenges faced by all our constituents.
I congratulate the hon. Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this debate on a public policy issue. I notice that the Conservative party is as split as we are on whether this is a socialist Government, but perhaps we could debate that on another occasion.
I pay tribute to my right hon. Friend the Member for Oxford, East (Mr. Smith), the right hon. Member for North-West Hampshire (Sir George Young) and the hon. Members for Beverley and Holderness (Mr. Stuart) and for Romsey (Sandra Gidley) for trying to engage in some of the serious non-party political points that we must address as we deal with the agenda.
The first point is that older people in this country are entitled to be treated with dignity and respect. They are a generation that worked hard to build this country, and a fundamental sign of a civilised society is the way in which it treats older people. That should unite the House.
My right hon. Friend the Member for Oxford, East referred to the disgraceful report on Merton and Sutton primary care trust and the way in which, at the beginning of the 21st century, people with learning difficulties have been treated in some NHS establishments in that area. We will not tolerate such abuse, non-professionalism and exploitation of people with learning disabilities, and we will certainly take firm action as a consequence of that report. Dignity and respect for older people and also for people with disabilities must be at the heart of a civilised society.
I share the view of hon. Members on both sides of the House that social care needs higher status and greater priority in public policy and debates about the future of this country. I make the point to hon. Members, who did not refer to this, that in the pre-Budget report the Treasury identified social care as one of the great challenges facing this country and one that we have an obligation to address. The Government’s recognition that it is a crucial issue that we must face is an important step forward.
I will not give way because I do not have enough time. I will try to give way towards the end if I can.
There have been significant major advances with year-on-year, real-terms increases in resources for local government, and improvement in the performance of many adult social services departments, which is a credit to the staff on the front line and the leadership. It is good news that more people are living longer, and that they continue to live in the community rather than in institutions, and consequently have higher quality and fuller lives. However, as hon. Members said, we must face up to real pressures. Demographic challenges are indisputable and undeniable, and we as a society have a responsibility to face up to them. Older people are living longer, and disabled people are living fuller and longer lives. There are also rising expectations in what the public expect from public services and in quality of life.
We welcome the recommendations of Sir Derek Wanless for a sustainable funding model for social care. We do not agree with every detail of his recommendations, but it makes a major contribution to the debate. Wanless rejected the notion of free social care being a desirable or realistic way forward.
We are arguing forcefully—I shall not reveal the details in this debate—with the Treasury about the importance of a good settlement for social care under the comprehensive spending review. Equally important is the need for all politicians, with the public and charitable sector, to engage in a discussion about what a fair new settlement would be for social care and the responsibilities of the state, family members and citizens. We need a new deal to reflect a new settlement in the demographic realities of the 21st century. We must also be willing to look at reform of social care. It is not just about money. We want more personalised services, and greater control for those who use services and their families, with individual budgets and direct payments. We must do more to raise the status of staff in social care on the front line, and we must look at a greater synergy between the NHS, local government and the voluntary and independent sectors. The hon. Member for Romsey and other hon. Members referred to that.
As my right hon. Friend the Member for Oxford, East said, we must also look at the lessons from the partnerships for older people projects—the POPPS pilots—in which we are focusing resources on preventive, early intervention services in mainstream support for older people to enable them to lead a better quality of life and to make better use of public resources.
I shall not reiterate the points that the hon. Member for Eddisbury (Mr. O'Brien) made about the concession by the hon. Member for Romsey that the Liberal Democrats misled people about free personal care at the general election. That was frankly the most extraordinary admission I have ever heard in the House.
The hon. Member for Shrewsbury and Atcham clearly cares about older people. However, he and his Back-Bench and Front-Bench colleagues are disingenuous about where they stand on the key policy issues concerning older people and their families throughout the country. They are disingenuous because they were the architects of and presided over many of the problems in the current system, and because of the policies that they now advocate in the House. At every opportunity they voted against extra investment for public services and now have an economic policy that would lead to serious cuts in public services.
The hon. Gentleman talked about ring-fencing funding, but the Conservative party says that we should not have ring-fenced pots of money, but should devolve to local level and allow local decision makers to control budgets. He also said that the Government were wrong to prioritise education, and I look forward to him saying that in his election literature at the next general election. Conservative Members want to redirect resources, but they want to redirect them from the poorest and most socially deprived areas to more affluent areas.
The hon. Gentleman said that care services should be free on the NHS, but he knows that much of our debate today was about social care, not NHS care. He said on the one hand that it should be free, and on the other that it is all about thresholds and that he was not advocating free personal care.
The hon. Member for Eddisbury, who speaks for the Conservative party on such issues, questioned the Scottish system and whether it is right. He opposes the Scottish system because it is unrealistically offering free personal care, and it is not working. He is being honest in saying that the Conservative party is not advocating what many commentators and journalists are suggesting—that it should all be free.
Conservative Members oppose service reconfiguration in every community and portray that as cuts, but it is often about redirecting resources from the acute NHS to investment in social care. The Local Government Association, which is Tory-controlled, said before Christmas that there is enough money in the system, but that it is in the wrong place and that what the Government need to do with local delivery mechanisms is to shift resources from acute NHS care to social care.
All I would say to Conservative Members is that they should engage in an adult and mature debate without misleading people that they are on the side of free, personal care, that they would abolish means testing and that they did not create the current system. They should not imply that, nor that they have not consistently voted against sustained public investment.
On continuing care, Conservative Members are right in saying that we need to clarify the issue as soon as possible; we also need to get it right. We have had ombudsmen’s judgments and court judgments, but it is important when we produce guidance that we get it right so that it creates stability in the system. It is true that on occasions local health organisations have not fulfilled their responsibilities to acknowledge that what is being provided is health, not social, care. We need to ensure that the new guidance reflects that.