Motion made, and Question proposed, That the sitting be now adjourned.—[Siobhain McDonagh.]
Before I call the hon. Member for Romsey (Sandra Gidley), I should say that a few Members have indicated their wish to speak, and I should like to bring in everyone if I can, so I ask those who participate to make their remarks clear and succinct.
I welcome the opportunity to discuss this important subject. I was moved to apply to debate the issue following the comprehensive spending review, but this is not a new issue—the hon. Member for Wyre Forest (Dr. Taylor) told me that he has been trying to secure a debate on it for some months.
A welcome 4 per cent. increase for health was announced in the CSR, which builds on the welcome investment of previous years. However, unfortunately, the settlement for local government, which is responsible for providing social care, was less rosy. The Secretary of State for Health provided further details in a recent statement to the House. He told us that the social care settlement is divided in two—the local government grant and direct Department of Health funding targeted at social care. The local government support grant will increase by £2.6 billion by 2010-11, but the Local Government Association estimated that it will cost an additional £2.682 billion simply to provide care for the increasing numbers of older people in the next three years. It also raised concerns that the additional funding could be taken up entirely by social care, despite the fact that many other services funded by the general grant are subject to financial pressures.
Direct funding from the Department will increase by an average of 2.3 per cent. a year to fund carers and the social care work force, but that funding is based on the idea that the situation will stand still. The LGA believes that the increases will not enable local authorities to meet the budget pressures that they anticipate for 2009. One south-east council claimed that, as a result of demographic and other pressures, expenditure will need to rise by 4.6 per cent. in real terms if services are not to be cut. That is a much greater increase than the CSR settlement allows for, however we might dress it up.
Many organisations have reacted angrily. Help the Aged claimed that there is not enough money in the Chancellor’s provisions to take account of the growing needs of an ageing population. It also said that the settlement grant increase will be less than 1 per cent. in future years, and that that is below the growth rate of the vulnerable population and the likely rate of inflation in the cost of providing care.
I am delighted that we are debating this matter, but will the hon. Lady make it clear, and put on the record, whether the Liberal Democrats would be committed to spending more money on social care than is spent at the moment and where she would expect any increase to come from?
It is mischievous of the Minister to attempt to deflect the point. I am raising a serious point about the relative balance of money between health and social care. [Interruption.] If the Minister listened to my whole speech, he would hear some suggestions towards the end.
Age Concern has said that the increase in investment will
“allow the current system to creak on in the short term”.
It is interesting that both France and Germany spend more than double the amount spent by the Government on care for older people. The relatively lowly settlement has come against a background of significant pressures on social care. The Wanless social care review identified considerable funding shortfalls in the current system if it is to meet people’s needs and forecast increasing needs in social care in the next 10 years, which will come as no surprise to anybody.
There have been significant pressures on social care services. The minimum wage, for example, caused cost pressures a few years ago, although I do not begrudge care workers the minimum wage; in fact, it is scandalous that some are paid so little for their valuable work. However, there is an increasing demand for more expensive, intensive care services, and the age of the population is increasing and more people are living longer. As a result, councils are left with some tough choices.
The biggest inequity surrounds the phenomenon of eligibility criteria. People might say that health care provision is a postcode lottery, but the biggest lottery in Britain is the postcode lottery for social care provision. Simply put, access to care depends on where a person lives, their income and their local authority’s charging policy and eligibility criteria.
People’s needs might be broadly categorised as critical, substantial, moderate or low. Local authorities must now ration care provision by raising the eligibility criteria. Despite the rising numbers of older people, the number of households that receive domiciliary care services has fallen by more than a quarter in the past 10 years. The LGA predicted that, by 2009, not a single local authority in the country will provide care for those with moderate needs. Many councils have already tightened their criteria and now meet only critical needs.
Services are also means-tested, and there have been steep increases in charges for people who access them. A Counsel and Care survey backed that up. It is almost impossible for older people to access support in the community if their needs are not severe. Two thirds of local authorities fund only substantial or critical needs, and Counsel and Care believes that the number of councils that restrict services in such a way will increase.
In 2007-08, 15 per cent. of local authorities further raised their thresholds and not a single authority has extended its criteria to become more flexible. Only 16 per cent. of local authorities continue to offer support services for older people with moderate needs, compared with a third as recently as 2006. Yet more worryingly, 12 per cent. of local councils provide support only for older people with the most acute critical needs. Liberal Democrat research corroborates those statistics. We found that almost one in five councils has increased provision in higher-level categories since 2003.
Low-level social care is a thing of the past—the number of households that receive low-level care has decreased dramatically. As a consequence of the fact that care is delivered to fewer households, the proportion of households that receive only one weekly visit of two or fewer hours has dramatically decreased from 42 per cent. in 1992 to 17 per cent. in 2002—the latest year for which we could find figures. The funding of low-level care needs might be a cost-cutting measure in the short term, but it could store up problems for the future—it might benefit the state if a person is happy to stay at home.
Supposedly, the thrust of Government policy has been to treat people in their homes, which, for many, is a welcome approach. However, people often get to the stage at which they need help with some practical matters if only to keep on top of things. If a person does not feel that they are on top of the upkeep of their garden, for instance, and that they cannot manage as well as they might, they might become depressed and their mental health might suffer.
As the older person is not coping, there is a risk that they will become institutionalised at an earlier stage. Research has backed that up; it is not some wild theory that I keep expounding. Age Concern and Help the Aged have done quite a lot of research to examine the impact of withdrawing the type of service that I have described, and it has shown that continued independence can increase an individual’s life expectancy and reduces the number of days spent in an acute setting or a care home.
Pressures have been even more acute over the past year, as NHS financial pressures have had a knock-on effect on social services. Even though the Government have tried to tighten up the continuing care criteria, there are still far too many cases in which there is an unseemly tug of funding between the health and the social care services. There is a feeling in many county councils that they had to take an unfair share of the burden last year and were funding services that should have been paid for by the health service.
In Hampshire, we faced particularly acute pressures. I have talked to officers in the social care services at the county council, who said, “Somebody had to pick up the bill for these people. We couldn’t go on arguing, but we feel that we ended up bailing out the health service and spending money that we didn’t really have.”
How is all this working in practice throughout the country? In Hampshire, there was at one stage a proposal to restrict the eligibility criteria to critical and substantial needs. Understandably, that caused an outcry, and the council thought again about whether there was another way of doing it. It was portrayed in some ways as though things were then fine and those needs were being funded; but in practice, many people who had had a care package for some time suddenly found that they were reviewed. A stream of people came to my constituency surgery. They had had packages that fitted their lifestyle and seemed to help, but for no reason that they could understand, part of that package was withdrawn. I do not know whether other Hampshire MPs had similar experiences, but those people all came forward at once, and it seemed to be part of an overall picture. The good news was that everyone still seemed to get something, but clearly it was hard for those who had to take a cut in services and share the pain.
I shall cite a few examples of other parts of the country where similar things have happened. In Stockport, it has been estimated that, by 2020, 27 per cent. of the population will be over 85 and a further 21 per cent. will be over 65. Stockport has estimated that it provides some sort of support for one in four of the over-65s and for half the over-85s, so more rapid growth in the number of over-85s will have a disproportionate effect on the budget. Stockport also cited an increased demand for funding by people with learning disabilities and estimated the inflation uplift for the private sector to be 5 per cent. Again, the settlement will not cover that.
People in Bristol highlighted the fact that this is not just about elderly care. One of their huge pressures came from adults with learning difficulties transferring from school. Transitions were not being fully funded, which meant that an extra £500,000 had to be spent on top of other financial pressures. Bristol also raised the issue of supporting people. That was one of the Government’s better ideas. It has been rather depressing and demoralising to see the funding for supporting people cut in recent years, so that people find it much more difficult to access support services. In Bristol, the budget has been cut by £3 million in two years—it is now £27 million—and the belief is that it will be further cut to £19 million.
In the royal borough of Windsor and Maidenhead, referrals for social care increased by 20 per cent. in 2005-06. Not only did that put extreme strain on the system, but the nightmare was exacerbated by the closure of 54 beds in local hospitals. We just cannot separate health and social care as we go into the future, because increasingly any changes in health services are having a significant impact on social care.
Somerset highlighted the problems with the number of people with learning disability increasing. It estimated that the rate of increase was about 35 people a year. That may not sound very much, but it equates to an extra £1 million a year having to be found.
This is not just about adult services; there are problems in children’s social care, too. There is an increase in the number of children with complex needs, set against the overall context of a falling population of children and young people. Nationally, the prevalence of severe and complex disabilities among children aged five to 14 is projected to increase from 0.4 per cent. in 2001 to 0.76 per cent. by 2011. We are talking about children with very complex needs requiring very expensive and detailed care packages.
Wherever we look in the country, councils are highlighting a picture of overspend, health pressures and increasing financial pressures. The overspend is not occurring because councils are out of control; they have never had a better grasp on where the money is going and what the future demands will be.
I want briefly to mention failings in the way in which local authorities fund care homes. Local authorities are supposed to pay the going rate for care, but the going rate in many areas is significantly lower than the actual price of virtually all the care homes in the area. That is particularly so in my part of the country. Relatives are therefore routinely expected to make a top-up payment to fund the difference between what the local authority will pay and the actual rate. We have the perverse situation locally in which Southampton and Hampshire pay different amounts for care homes and nursing homes, so people in adjacent rooms in a home may be funded differently. That makes a mockery of the system.
In other cases, people did not need a top-up when they entered the home, but because local authorities have not increased fees in line with inflation, the homes often have no choice but to start charging a top-up. That is an increasing phenomenon and there is a perverse consequence of that underfunding. There is growing evidence that it is having a knock-on effect on those who fully fund their own care home place, as they are often charged a higher rate than people with equivalent needs who are funded by the local authority. Clearly, by any measure of fairness, that does not meet the criteria, and it desperately needs to be addressed.
Another aspect of the pressures is that carer support is being cut. Many carers say that they could cope much better and for longer if only they had a break occasionally, but respite care is often one of the first services to be axed.
A number of things clearly need to be done if we are to live in a fairer society. I contend that most councillors, whatever their political colour, want to do their best for the elderly and vulnerable people whom they represent, but that cannot be at the expense of other vital council services. We need to consider a number of issues in the longer term, set against the background of the ageing population and the increase in the number of people with complex needs. It might be helpful if the Minister, when he sums up the debate, says whether the Green Paper will address some of these issues.
The postcode lottery of eligibility criteria needs seriously to be examined. There needs to be a fully comprehensive assessment, taking into account the ageing population, the increasing numbers of adults and children with problems and the impact of housing build in an area. Often, local government settlements are on a per year percentage increase basis, and in the south of England, where we face acute pressures for housing build in the future, funding is very often not increased accordingly. That definitely needs to be considered.
The assessments should focus on the individual, not just whatever happens to be available as a care solution. Greater clarification is needed of what the NHS will pay for. I accept that the Government have made efforts in that direction, but the continuing care criteria are still far too open to individual interpretation.
We must address cross-subsidy in care homes and set a fair independent rate. The time has come for a serious look at how better to join up health and social care, so that people do not fall through the gaps but get what they need and deserve after a lifetime of paying into the system.
I congratulate the hon. Member for Romsey (Sandra Gidley) on securing this important debate. It strikes me that some of us were in this room last week debating health inequalities throughout the country, so we are clearly on a roll. Health inequalities and care inequalities are clearly foremost in our constituents’ minds, and they should therefore be foremost in MPs’ minds.
I rise not only to say well done to the Government—I do not mean that sycophantically—for their progress, but to carry out my responsibility to highlight issues about how the settlement has been allocated. We are approaching a three-year settlement, and I shall place on record for the attention of the Minister and the Government some of the issues for cities such as Salford, which is in my constituency.
“We are facing unprecedented demographic change in this country, in common with other western societies. For the first time, this year there are more people aged 65 and over than 18 and under. We are also facing a steadily rising number of people with long-term conditions. The effects of obesity, smoking, alcohol and drug misuse, diabetes and conditions such as strokes and dementia all have an impact on individuals and families that increases their likelihood of requiring adult social care.
One of the biggest growing sectors of the population is those over 80. We know that it is older people who are the biggest users of adult social care, and particularly those aged over 70. Once people are in their 80s, the incidence of dementia steadily increases, with one in five people suffering from some form. We also know that, due to medical advances, more children and adults are surviving with multiple disabilities, requiring high levels of social care services throughout their lives. As more and more of us come into contact with social care services as users, carers or friends, relatives or neighbours, we now expect much higher-quality, flexible and individual personalised services.”
Those are not my words but the words of Anne Williams, president of the Association of Directors of Adult Social Services, in an address to the local government national children and adult services conference at Bournemouth last week. Although they are not my words, I identify with them, and I am sure that hon. Members present agree with them, too.
In her day job, Anne Williams is the excellent strategic director of community health and social care in Salford. Anne and Councillor Maureen Lea, the lead member for adult services, have assured me that relations with respective Departments are increasingly good and that partnership work with them is better than it has ever been, which is welcome. That is all the more welcome, because in Salford we start from such a low base. It is of concern that Salford is ranked 12th in the 2004 multiple index of deprivation. We are a paradox: Salford city council has been identified as one of the most improved councils in the UK, but at the same time it is struggling with the Government to build and increase care services from a low base.
Some people would call this subject boring, because we must refer to statistics, but it is important that we consider how the detail affects our constituents, so I make no apology for doing so. I shall address the issue of an ageing population. The Minister is, of course, responsible for all the areas of care, but I shall concentrate mainly on adult care today. I am sure that other hon. Members will cover the other areas.
Salford’s population is predicted to increase, and with it both the number of older people and their proportion within the population will also increase. The population is projected to increase from 215,000 in 2008 to 218,300 in 2025, and all my comments relate to those dates. During that period, the number of people who are 65-plus will increase from 33,200, or 15.44 per cent. of the population, to 37,400, or 17.13 per cent. The number of over-85s will increase from 4,300, or 2 per cent., to 5,500, or 2.52 per cent. Some may not think those figures important, but the figures represent a staggering increase of nearly 30 per cent. in our 85-plus population. The picture is similar for older middle-aged people.
The Minister has one of the most important briefs in Government. I have said that the matter is serious, but it is good to see that he has a sense of humour, notwithstanding that his comment from a sedentary position was based on fact.
The picture is similar for older middle-aged people, the percentage of whom within the population is projected to increase by 11.5 per cent. by 2025. The statistics might be dry, but they have clear implications for health and social care provision, as most needs increase with age, such as the need for sensory equipment, home care, residential care and so on. One in four people over 80 are estimated to have dementia. An ageing population will mean a shift in the type of provision needed and in the staff skills needed to deliver such care. Conversely, the number and proportion of younger adults in Salford is decreasing, which has implications for the availability of potential carers. We must pay particular attention to that. Some characteristics of an older population must be addressed.
Mr. Olner, the statistical approach is dry, but I assure you that it is important to recognise that the change in nature of our population and its needs is happening so fast and will have such an impact that the nub of the matter must be addressed.
I welcome the announcement by my right hon. Friend the Secretary of State for Health that we will receive an extra £2.6 billion. That is welcome, but we should accept that the current settlement system is unfair and that it works against those councils with residents in most need. We in Salford wish to build on the enhanced relationship with Departments and on the excellent progress made by the city council, but we need a fairer funding system.
I accept that the Minister is sincere in his passion to do better in his brief for residents across the United Kingdom, but I hope that he recognises that the system is not yet right. I hope that the forthcoming three-year funding settlement recognises that councils such as Salford wish to deliver the services needed by families in the area in a fair way. We need to ensure that the words “social justice” mean something. I know that the Minister wishes to do that, and I hope that he and the Secretary of State will ensure that the funding system is made fairer during the three-year settlement.
It is a pleasure to follow the hon. Member for Eccles (Ian Stewart), who spoke movingly about the challenges that confront his constituents. His constituency could not be more different from mine; his is an inner-city seat in the north and I have a rural seat in the south. However, the fact that we both face the same problems makes the case that the Minister needs to answer even more powerful.
I congratulate my parliamentary neighbour, the hon. Member for Romsey (Sandra Gidley), on securing this timely debate, as it is in the shadow of comprehensive spending review 2007. For some reason, the CSR will not be debated in the House—instead, we have rather more fragmented debates in Westminster Hall—but it sets the parameter for social services expenditure over the next three years.
More than half of those hon. Members who are here took part in a similar debate earlier this year in the context of residential care. Everyone who spoke in that debate made the point that social services were under extreme pressure. The right hon. Member for Oxford, East (Mr. Smith) said of this “complex and crucial” area of care that it was
“under enormous pressure because of demand and constraints on resources even as they are increasing.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 316WH.]
My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) spoke about the problems in residential care, and my hon. Friend the Member for Eddisbury (Mr. O'Brien) spoke about the absence of a long-term strategy for funding care, a subject to which he may want to return.
In that debate, I asked for a step increase in funding for social services to eliminate its historical underfunding and a realistic baseline to be provided from which we could move forward. In his reply, the Minister—I welcome him again this morning—gently rebuked us for not noticing in the last pre-Budget report that
“the Treasury identified social care as one of the great challenges facing this country and one that we have an obligation to address.”
He went on to reassure us that
“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.”
He then said:
“We need a new deal to reflect a new settlement in the demographic realities of the 21st century.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 332-32WH.]
He was right. This morning, we have an opportunity to assess the Minister’s performance, as set out in CSR2007, against those statements.
The average real-terms increase in public spending over the next three years in the comprehensive spending review is 2.1 per cent. Against that benchmark, who are the winners and who are the losers? The biggest loser is local government, at 1 per cent., narrowly below the Home Office at 1.1 per cent. No way is that a good settlement. No way is that the new deal that the Minister held out earlier this year.
The third biggest winner, after the Department for International Development and the Cabinet Office, which are both small Departments, was NHS England. That disparity in treatment under the Government between health and social services underlines my point. Although the NHS has had a 90 per cent. increase in funding since 1997, if schools are exempted—they are now directly funded by the Government—local government has received only 14 per cent., and the largest service provided by local government is social services.
I understand the political imperatives. Ministers have direct responsibility for the NHS, whereas social services fall to local councillors. How tempting it must be for Ministers to pre-empt for themselves the lion’s share of the CSR for the services for which they are accountable and let councillors take the rap for social services. It is understandable, but it is wrong. The extra 1 per cent. for the NHS, announced with a flourish by the Chancellor a fortnight ago, should, if one believes in joined-up government, have gone to the under-funded social service authorities rather than the NHS.
Does the right hon. Gentleman not accept that his comments, pointed as they are, would be more pertinent if we were starting from now? All the statistics that I and others have cited have been built up over the past 30 years. It is important to recognise that.
I am grateful to the hon. Gentleman, who may have made a valid point. He might like to consider what happened from 1992 to 1997, and see whether there was a disparity then in the treatment of the two. I hope, in return, that he will extend the gentle criticism that I have made of his Administration, that there has been a disparity—in my view, an indefensible disparity—since 1997. Even the 4 per cent. comprehensive spending review increase for the NHS is aimed much more at hospitals than at assisting the NHS to move resources into the community. Had it been the other way around, one could have had a greater partnership with the county councils, who know the communities and have good links with them.
The Government have allowed adult services a growth of 1 per cent., but they expect councillors to increase direct payments, to invest in prevention so that people can remain independent, and to phase out the use of NHS accommodation for people with learning disabilities and to help them live independently in the community. Adult social services are struggling to cope with their current responsibilities. It seems a Herculean task to respond genuinely to the challenges that the Government have laid before them with such resources.
The Minister must know what is going to happen. As the hon. Member for Romsey said, eligibility thresholds will have to be raised, care will be rationed for the most vulnerable, preventive work will be cut back, and charges will be increased or introduced—and the council tax will take the strain. If the Minister believes that health and social services are key partners in the welfare state, he will know that they need to be given roughly comparable resources. If one needs help, one is not interested in whether it comes from social services or health; one simply wants the services to which one is entitled. Policy for the past 20 years has focused on breaking down the barriers between the two—promoting joint commissioning, joint assessment, and the rest. If they are to be key partners, they must be more equal. They both need to bring something to the table.
I shall pass over the demographic clock that is ticking in Hampshire, as it is in Eccles and elsewhere—the needs of young adults with learning disabilities coming up from children’s services demanding and expecting large care packages, and parents with offspring with a learning disability who themselves are ageing.
Consultation is about to begin on the Green Paper. It will, of course, be important, as it will offer a potential overhaul of the funding of social care. However, it will not help during the next three years of the spending review. No additional resources have been added to help with the demographic pressure and the other pressures that are on adult services nationally. My county council will get less grant than others, because it is a floor authority; it will have to make economies in other services and raise the council tax to make up the difference.
I leave the Minister with a final question. Is that it? Will there be, at some point during this Parliament, an opportunity to revisit the three-year settlement announced for social services, so that we can get them a squarer deal?
I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. It is highly significant that we have heard from right hon. and hon. Members from the north and the south; we are now bang in the middle—the midlands.
I regard such debates as an opportunity to pass on advice to Ministers. I may not have a major party to make firm plans, but I like to think that what I say is taken seriously and that it remains in their brains for the future. My interest in the subject was kindled by a meeting with the chief executive of Worcestershire county council not all that long ago, when he made the stark statement that funding social care was the major problem now facing county councils. He went on to provide some of the figures purely for Worcestershire for people who are supported to live at home. The figures from 2002-03 to 2005-06 for learning difficulties, mental health, physical disability and older people have increased by 17 per cent. In 2005-06, 12 young people were moving to adult care; in 2006-07 there were 39 and in 2007-08 there are 43.
Other hon. Members mentioned an increase in the population over 65—in my county, a 14 per cent. increase over the next five years—and talked about the reasons for that, such as increasing longevity, the complexity of problems that it brings, including an increase in disability and dementia, and the fact that young people with serious illnesses can be kept alive longer.
Hon. Members who have been around for some time, like me, will remember that NHS hospitals 20 and 30 years ago were full of long-stay beds. Quite rightly, with innovative geriatricians, long-stay beds have been cut back dramatically, but shutting those beds has passed the problem from health to social care. The Select Committee on Health report on NHS continuing care, in the parliamentary Session of 2004-05, drew attention to that in one of its recommendations when it said:
“long term care responsibilities of the NHS have reduced substantially, and people who in the past would have been cared for in NHS long stay wards are now…accommodated in nursing homes”,
which meant that there had been a shunting of the work without the funds.
Other hon. Members referred to the inequitable investment between health and social care. Although one welcomes tremendously the increase in health funding, that makes it more difficult for social services, because an increased throughput in the NHS is likely to increase the work load on social services as well.
Economies that my county council are putting in place hit older people in particular. Staffing is reduced, and the terrible vacancy factor effectively reduces staff. Things like meals on wheels and rapid response teams are being attacked. One specific example of that is the cessation of in-house benefits advice, which is being passed to citizens advice bureaux. The local authority is ceasing to pay the CAB for specialist mental health advice. That matter was brought to my attention in one of my surgeries by a mental health advice worker who pleaded on the part of one of her cases. She was speaking about an illiterate elderly gentleman looking after a schizophrenic wife at home. He could not understand the benefits and finances that he was allowed and was only managing because of the advice from this dedicated worker who will now be removed. The CAB will be lumbered with all this extra work.
I want to say a word on the Health Committee report on NHS continuing care. It contains a lot of clear recommendations, and I am delighted that one of those is that there should be clarity about NHS continuing care and NHS-funded nursing care. The national framework certainly addresses that, but, sadly, there has been no change as far as we can see in the Government’s thinking about the unification of health and social care. One comment in the summary of the Health Committee report said:
“The artificial barriers between health and social care lie at the heart of the problems surrounding access to continuing care funding. It will be impossible to resolve these problems without first establishing a fully integrated health and social care system.”
At that time, the Government kicked that firmly into touch and responded as follows:
“The divide between health and social care provision, and the basis on which it is provided, has stood since 1948. To dismantle this would be a fundamental and costly change to the structure of the welfare state, which would go well beyond the scope of this inquiry.”
The Government seem to be pretty good at reorganising the health service and I would like to think that this matter will be mentioned in the Green Paper because it would make a huge difference.
We must continue to look for economies. I was delighted when the Secretary of State for Health remarked in one statement that the NHS better care, better value indicators were already producing some economies. The Disability Rights Commission feels that direct payments would be more efficient and better. With the health and social care regulator coming together, links forming across health and social care, and public health doctors being shared between health and social care, surely there is a move towards combining these things.
Finally, if one were to address health care rationing, which lots of people would like us to do, many people would think that cradle-to-grave care is one thing that should be funded, if we can make the economies on some of the unnecessary things by cutting them out with rationing.
It is a pleasure to discuss the funding of social care, which we did as recently as January. Many hon. Members who are in the Chamber today spoke then, as my right hon. Friend the Member for North-West Hampshire (Sir George Young) said. He put his finger on the central point, which is ensuring that the Government deliver on social care in the way that the Minister promised he would in January. It is worth repeating his words then, because I hope that he will address the matter. He said that he would be
“the importance of a good settlement for social care under the comprehensive spending review.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 331WH.]
The question today, which has come from hon. Members from all parties, is whether a comprehensive spending review settlement that sees increases in social care spending that are actually a full 50 per cent. below the average across all government spending, as my right hon. Friend pointed out, and a full 3 per cent. less than the real increase in health care, in any way constitutes a decent and proper settlement for social care, given the pressures itemised by so many hon. Members today and on previous occasions. That is the nub of the issue, which I hope the Minister will address. I do not believe that that is a decent settlement.
My right hon. Friend made a persuasive argument as to why Ministers would separate social care, which is not their direct responsibility, from health care, which is, leading to a grossly disproportionate settlement on each despite the pressures on social care spending.
I have two important things to say to the hon. Gentleman. First, for 18 years, was there not a separation of the amount of money that was announced for the NHS, vis-à-vis social care? Secondly, is his party committed to spending more money on social care than this Government have over the next three years, and, if it is, where is that money coming from?
The Minister has one admirable quality, in many areas, and that is consistency. The Conservative party has not run the country for the past 10 years. With respect to the hon. Member for Eccles (Ian Stewart), who mentioned the fact that the basic system was set decades ago, this comprehensive spending review offered the opportunity, with the increase in spending by the Government, to set priorities between social care and health. What have the Government decided to do? This Minister, who promised in this Chamber in January that he would fight for a fair settlement for social care, has delivered a woefully inadequate settlement for social care, which is compounding the situation, where there have been increases in the thresholds for access to care.
Another key question to which I hope that the Minister will return is his assessment of the raising of the thresholds of access to social care. In the east riding, the fear and the feeling is that we will move to a stage where the only people who receive support from adult social care will be those in care homes and those at the most severe end of the critical band. That is the position that we are looking forward to, and it is the direct human result of the failure of the Minister to honour the promise that he made in this Chamber to get a fair deal for social care. If he does not accept the analysis of my right hon. Friend of why that failure has occurred, we need him to explain why it has happened, and not to make party political points about the past and the separation. They might have been in separate strands, but I believe it is fair to say that such a discrepancy between health and social care at a time of such need has not been seen before.
I shall do so in a moment.
That has been in the context of how the Government have moved forward the policy agenda, in a way that has had broad support across the House, towards merging health and social care. They have taken forward the agenda, and I am happy to congratulate them on doing so, if the Minister is so desperate to have partisan point scoring and credit given. With the support of the Opposition, they have moved forward an agenda of integrating health and social care for exactly the reasons mentioned by my right hon. Friend: people should be able to access services in a seamless way that does not differentiate artificially because of departmental boundaries. We have supported that move and it is in that context that we have the discrepancy in funding between social care and health, and that becomes hard to justify, although we look forward to hearing from the Minister.
It is a bit rich of the hon. Gentleman to accuse others of party political point scoring. He just gave a tour de force in party politics and diminishes the argument for me. Does he not accept that we can acknowledge points in time during the process that have led to the situation in which we find ourselves, which most of us would like to see changed? The single biggest effect in my city of Salford was when a Conservative Government transferred care from the health service into the community. They did not set the structure up right, and we are now addressing that.
The hon. Gentleman has had more than his share. He does not seem to have understood—or will not acknowledge—that the comprehensive spending review offers the opportunity to make a shift, or at least to ensure that social care gets the funding that it needs within an integrated health and social care system. That has failed to be done. That is not the fault of a Conservative Government that was last in power 10 years ago, or some other Government four decades ago. The opportunity was there for this Minister to deliver on his promise made in this Chamber earlier this year to get a fair funding settlement for social care. This Minister, this Chancellor of the Exchequer and this Prime Minister have failed to deliver on that, although the opportunity was there.
East Riding of Yorkshire council has been recognised as the top local authority in the country for its stewarding of financial resources. It has demonstrated its commitment to investing in adult social care services with a 6.6 per cent. increase in the adult services budget for 2007-08, significantly higher than most other council services. It has done so because of its commitment—a commitment that I wish that we could see from the Minister—to ensuring decent social care services.
Despite that increase, what is the situation in social care in our area? Because of the increase in the over-85 population in the east riding, which is an increase of more than 400 per annum over a six-year period, the council has had to conduct a review and has decided to remove provision for those with moderate needs. It has also had to put substantial needs into two bands and only those in the upper band will now receive social care services. That was before the comprehensive spending review and its woeful result for social care.
I hope that the Minister will answer my questions and accept that the settlement will lead to a year-on-year cut in adult social care services with an impact not only on the elderly but on those with learning disabilities to boot.
I want to start by congratulating my hon. Friend the Member for Romsey (Sandra Gidley) on securing this important debate, which could scarcely have come at a more pertinent time. We have had an excellent and interesting debate, which has shown that these issues apply up and down the country and in very different areas.
“The current social care system is in crisis and needs wholesale reform”.
Those are not my words, but a summary of the situation by Age Concern. We are all aware that we have an increasing number of older people in the population of this country, and yet a decreasing number of people are receiving social care. That is a decreasing number of people receiving care at home, which has fallen by a quarter over the past 10 years, and a decreasing number of care beds in care homes.
We have seen the recent comprehensive spending review, and my hon. Friend, and other hon. Members, powerfully—
Let me make this initial point—hold your horses, and I will let you have a go.
The comprehensive spending review clearly has not delivered enough funds to this important area. Various hon. Members have made it absolutely clear that although the 4 per cent. increase in NHS funding is very welcome, the 1 per cent. increase in social care funding is simply inadequate. The reality is that the vast bulk of the settlement over the subsequent three years is loaded into the third year, but we have a crisis now.
The reality of social care in this country is that services are often of insufficient quality. According to the Commission for Social Care Inspection, only 79 per cent. of homes for older people and 72 per cent. of domiciliary care services meet national minimum standards. Compliance with some critical standards is even lower, as only 65 per cent. of homes for older people meet standards for recruiting staff and 54 per cent. meet standards for safe working practices.
My hon. Friend the Member for Romsey discussed the concern over recent years of local authorities’ rationing care, a point that was also mentioned by the hon. Member for Eccles (Ian Stewart), and the worrying fact that the Local Government Association has admitted that by 2009 not a single local authority will provide social care any longer for those with moderate needs. If we consider those moderate needs—that is a euphemistic phrase—they are the sort of needs that every one of us, individually, would believe should be met for our older people. NHS continuing care does not reach a large majority of those who fulfil the eligibility criteria. Three out of five people, according to Age Concern’s estimates, could miss out on care. We have heard powerful evidence about the postcode lottery, which clearly applies more in social care than in the NHS, which is where the media regularly raise it.
We have heard of the problems with the way in which care homes are funded by local authorities, with the issues of block buying and top-ups, where relatives have to find the difference between what the local authority will pay and the cost of care charged by the home. We have also heard the scandal of people who fund their own care entirely, paying a higher rate than those afforded by the local authority. We cannot allow that to continue.
I shall be delighted to, and I shall come on to it when I finish my synopsis of care in this country.
The personal expenses allowance is £20.45 per week, which is supposed to cover toiletries, personal items and clothes. Can anyone here seriously say that that is enough?
That £20.45 limit has been mentioned by a number of organisations. However, is my hon. Friend aware that residents of homes increasingly have to pay for extra services? Sometimes they are charged for things such as physiotherapy and expected to meet the expense using that money.
My hon. Friend has made a valuable and important point.
I do not think that carers have been mentioned today. They do such an important job and save a huge amount of taxpayers’ money, but, in many areas of the country, they do not have the right or even the option of respite care. I hope that the Minister will touch on that. Although most of this discussion concerns older people, my hon. Friend mentioned children with complex needs. It is important that we bear in mind the needs of all those with disabilities who require care.
In presenting these issues, why does the hon. Gentleman not say, during the course of his narrative, that the Government have just announced unprecedented investment in support and respite care for disabled children and their families over the next three years? Why has he missed that out of his speech?
I asked the Minister to clarify what the Government are doing for carers. He has done that and, therefore, does not need to do so in his speech. However, if he wants to make more interventions, I suggest that he does so on the basis of what I am talking about.
On the 2006 Wanless review, the fear is that, once again, the Government are ignoring the advice that they sought, and that this will be Wanless-light, although we accept that the Government have not published their proposals yet—it is important that they say when they will do so. We fear also that the percentage that individuals will be expected to contribute will be considerably less than that proposed by Wanless, which is a real concern.
The other big issue that has been touched on today is the divide between health and social care, and just about every hon. Member has mentioned that today. We must seek to end this rather artificial structural divide. It is difficult to understand why someone who needs care gets it free in a hospital, but not in a care home, and we must address that. However, administratively, I am sure that we would all recognise that the divide causes inefficiencies and, sometimes, contradictions in what clearly are common-sense objectives shared by the two sectors.
Will the Minister comment on the situation in Northern Ireland, where those two sectors are combined? Also, there are examples of good practice, of which he will be aware, in Herefordshire and, most excitingly, in north-east Lincolnshire, where the new care trust system has been developed. We will watch those developments with interest. We need leadership from the Government, which does not necessarily mean a one-size-fits-all approach. Different local authorities need the ability to introduce different ways of integrating social and health care, and I am sure that we all agree that that is something that we should move towards.
The Minister asked me about the Liberal Democrats’ position on funding. Do the Liberal Democrats believe that the Government have older people’s care as a high enough priority? No! Do we believe that the Government’s current spending plans are sufficient to deal with the crisis? No! Do I believe that the Government are letting down older people in this country? Yes!
We will do that when we publish our manifesto and our policy at the next election. Our policy at the last election was the right one for this Parliament, which has been shown to be the case. Our policy at the next election will be the right one as well, and it would deliver better care for older people than the current Government policy. Will the Minister lay out a clear timetable for the progress of reform, and tell us when we will see the Green Paper and when we can hope for the reforms to be implemented? This crisis needs to be addressed now, and I am afraid that that is not happening.
Will the Minister address concerns expressed by many leading organisations that the funding announced in the comprehensive spending review is weighted in the third year, when it is quite possible that he will no longer be a Minister and when we might not even have this Government? This seems to be a very slow and tardy response to what everyone agrees—including him, I am sure—is an immediate problem that needs swift and decisive reform.
I am pleased that the hon. Member for Romsey (Sandra Gidley) has secured this debate and congratulate her on doing so. The debate is a little unusual, however, given that she is the Liberal Democrats’ spokesperson for this policy area—at least she was the last time that I checked—and certainly it is a rule within the official Opposition, as opposed to the opposition of her smaller party, not to seek to secure debates on our own subjects. But I shall leave that for the Liberal Democrats.
I am sure that Members on both sides of the House will support me when I say that the contribution of the Liberal Democrats in this debate, as in so many serious debates, avoids any rational approach to policy and costings and treats members of the public as though they have no memories. Let us consider what happened when the Liberal Democrats did something in this policy area in Scotland. Members will be aware of the long waiting lists and the funding shortfall that ran into tens of millions of pounds, caused by the Liberal Democrats, with the support of the then coalition Labour party.
No. The hon. Gentleman has only just had his chance.
In her speech, the hon. Member for Romsey studiously avoided that matter. I am referring, of course, to the fact that, on 31 October 2006, in this Chamber, during an intervention that I invited her to make, she, the Liberal Democrat’s health spokesperson—
I am not surprised the hon. Lady finds it boring, because we keep on reminding her of this.
One must ensure that this is on the record, the veracity of which is attested to by the fact that I could not use this word were it not inscribed for all time on the pages of Hansard. In that debate, the hon. Lady admitted that she had said that her party’s policy of free personal care was “dishonest”. Furthermore, she admitted that dishonesty is the modus operandi of the Liberal Democrat manifesto writers. It is amazing that she said that. I hope, therefore, that the Minister will not spend too much time addressing the dishonest policy of the Liberal Democrats.
I rest my case.
I hope that the Minister will now give a substantive response to the public’s concerns about the future funding of personal care and, in particular, answer for his Department’s and, arguably, his personal portfolio’s abysmal showing in the comprehensive spending review. The rate of increased funding to the NHS has been reduced by the Government. I note the reduction in the above-inflation funding increase, from 7.5 per cent. for 2004-05 to less than 4 per cent. for the coming three years. We shall wait and see whether the financial control reasserted in the NHS, which continues to run a deficit of £911 million, is anything more than cosmetic.
Furthermore, what the Chancellor advertised as a 4 per cent., above-inflation funding rise amounts to no more than 3.2 per cent. when the Prime Minister’s £2 billion cut to the NHS capital fund is taken into account. The Chancellor sought vainly to dismiss the Conservative party’s prediction of an estimated 3.5 per cent above-inflation rate. It turns out that that really was a conservative estimation of the Government’s cuts.
Financial pressure on the NHS is relevant to the debate. Throughout the sorry saga of the NHS deficit, local authority services have often borne the brunt of PCT cutbacks. In June this year, for instance, London councils alone identified extra pressures amounting to £22 million owing to front-line NHS cuts.
I shall turn to the direct social care aspects of the comprehensive spending review. The Government made three points, each of which I shall address. They were an increase in overall local authority funding, an increase in direct funding for social care and a Green Paper on long-term care funding. It is disingenuous of the Government to pray in aid the small increase in overall local authority funding—a trick that enables them to announce it many times over in each area of local authority spending. Further, Sir Simon Milton of the Local Government Association called it
“the worst settlement for local government in a decade”.
That point was powerfully demonstrated by my right hon. Friend the Member for North-West Hampshire (Sir George Young). A mere 1 per cent. increase is inadequate to meet the social services demand pressures, and it exacerbates the inequity between health and social care funding.
The Minister will no doubt tell us once again that direct funding from the Department of Health for social care for older people and support services for carers will increase by £190 million to £1.5 billion by 2010. It should be pointed out that that means an extra £32 million for 2008-09, an extra £88 million for 2009-10 and an extra £190 million for 2010-11, with no promises about what will happen thereafter. Will the funding be ring-fenced for services to older people and carers? Are the increases real or nominal? And, as my right hon. Friend said, is that it?
In the Department’s press release, it said that the money would support personalised budgets, the provision of advocacy and information services and an increased focus on preventive services to support people to live independently and to help 3,000 people with learning disabilities to leave NHS accommodation and live independently. I was particularly intrigued by the first and last claims. On the first, it was my understanding that personalised budgets cost less, rather than more, to administer. On the last claim, will the Minister tell us, first, why it was not completed by April 2004—the target that was set in the White Paper, “Valuing People: A New Strategy for Learning Disability for the 21st Century”? Secondly, is the money distinct from the £175 million of funding that he announced on 9 August to take 1,600 people with learning disabilities out of campus accommodation? It is particularly important to note that the increase in funding in no way approaches the sums needed to deliver an effective and affordable solution to stop people selling their homes to fund their long-term care.
Tony Blair said in his 1997 conference speech:
“I don’t want them”—
“brought up in a country where the only way pensioners can get long-term care is by selling their home.”
Not only have the Labour Government failed to solve that issue, but they have failed ever to address it substantively. Does the Minister agree that the 2005 Labour party manifesto, which promised to
“continue to provide healthcare free in long-term care establishments”,
is another Labour broken promise and that it deserves from him similar opprobrium to that which the hon. Member for Romsey gave her party’s manifesto claims? In doing so, the Minister must also acknowledge that our fully costed limited liability model at the previous election would have delivered a solution to the problem, that we were the only party ever to put forward a real policy on long-term care funding and that, perhaps, he could learn from us. It is a trend, and something for which he would no doubt gain great popularity with his own Prime Minister, because he seems to enjoy taking whatever policies he hears us put forward.
It would be helpful if the Minister considered what has happened in Kent, which has a Conservative-run county council. The Government’s latest announcement contained a welcome U-turn on individual budgets, embracing health care and social care. Although it was clearly accepted that the Government have failed on social care in the past, the Secretary of State talked about a partnership model. The King’s Fund report, however, made it clear that Kent county council had undertaken a pilot project on the partnership model and that it wanted to do further analysis. However, the report said:
“In the end, Kent County Council found there was no appetite from either the Department of Health or the Treasury to fund further modelling on how such a scheme could be implemented, each department wanting the other to sponsor the work.”
The recent social care announcements are for a 1 per cent. real terms increase in social care budgets in local authorities, the effects of which will be additional charges for adult social services in local authorities throughout the country and a forced increase in council tax. We need individual budgets and the greater efficiency that comes from them. Importantly, the Government should not dismiss the experience of Kent county council’s pilot quite as off-handedly as they have done.
Will the Minister also explain his sad and—I dare say for him—bitter failure to secure anything substantive from the Treasury? He has spent the past 18 months giving the impression to parliamentarians, to stakeholder organisations—we have all spoken to them—and to the public that he will deliver a
“new settlement in social care”.
He said as much in January, as my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) said in his very powerful speech. On 21 February, the Minister also told us:
“We continue to negotiate with the Treasury to secure a fair and reasonable settlement as part of the comprehensive spending review.”—[Official Report, Westminster Hall, 21 February 2007; Vol. 457, c. 98WH.]
On 6 March, he wrote:
“We will assess proposals for the future provision of long-term care services as part of the long term vision of the comprehensive spending review 2007.”—[Official Report, 6 March 2007; Vol. 457, c. 1940W.]
And on 17 January, he said:
“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.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 331WH.]
Further, will the Minister explain to the House what happened to the findings of the review of social care funding, which his predecessor, now the Minister for Borders and Immigration, announced on 30 March 2006? It was a transparent attempt to fend off the Wanless review, and in announcing it, the then Minister said:
“The Department of Health will conduct a review of social care, starting from first principles on how social care is funded. We believe this is a once in a decade chance to undertake a fundamental review of social care costs.... This work will inform the Department’s plans for social care funding, which will be submitted to the Treasury as part of the comprehensive public services spending review in 2007.”
If it really was a
“once in a decade chance”,
where are its findings and why do we now need a Green Paper, as the Minister has had to announce, which will not have any impact until 2011—well after even this bottling Prime Minister will have been forced to the polls and these Ministers and this Government will be long gone? How long is the long grass into which they have kicked that vital issue?
Without the Minister’s usual rant or statement that he will take no lessons from the Conservatives—after all, the Prime Minister has led the way and announced new policies that are all the result of lessons taken from the Conservatives—will the Minister tell us exactly why he has failed to deliver that which he has promised to the House and to the public?
I congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. It is rather bizarre that as a Front-Bench spokesperson she has secured a debate as a Back Bencher, and that there is a replacement Front Bencher, but do not ask me to explain the Liberal Democrats.
I also congratulate my hon. Friend the Member for Eccles (Ian Stewart) on the way in which he began his contribution. He is right that there is a major demographic change, not only because people are living longer, but because they are developing long-term conditions such as strokes and dementia. He was also right that disabled people now have long and full lives, which is a sign of progress in our society. He also raised the issue of people’s rising expectations of care; they do not want, for example, institutionalised care, but care at home.
For the record, I shall discuss the investment that has been made, because we must ensure that we are clear about the context. Over the past 10 years, overall local government funding has increased by £28.4 billion or 39 per cent. in real terms. The Department of Health allocates a number of specific grants to the 150 local authorities with adult social service responsibilities in England, totalling more than £1 billion, and there is £68 million of capital grants for 2007-08.
The Department has also allocated £60 million for the partnerships for older people projects, £80 million for preventive technology and £60 million for extra care housing in 2006-07 and 2007-08. Since 1999, we have invested just over £1 billion to support carers’ services. As a result, there have been major advances in the care that people receive. Under the comprehensive spending review announcement, local government will receive an average real-terms increase of 1 per cent. per year, which will be worth £2.6 billion a year by 2010-11. In addition, there will be an average increase of 2.3 per cent. in real terms per year for direct departmental funding of social care. There will be an additional £2.6 billion by 2010-11 for local government, and almost £200 million additional money for social care provided through the Department.
I shall not.
I wish to make it clear that the settlement for the Department of Health, at 2.3 per cent., is higher than the average public sector growth of 2.1 per cent. That reflects genuine pressures in the system, and we need to continue to transform the service. The 2.3 per cent. real-terms settlement is in addition to the 1 per cent. settlement for local government, which is about meeting demographic pressures.
I agree with those, including the hon. Members for Romsey and for Wyre Forest (Dr. Taylor), who said that we need a more integrated approach between the NHS at a local level, local government, the voluntary sector and the private sector to create a more integrated health and well-being system in every community. We have made a number of advances towards achieving that, but we still have a long way to go. I point out to the hon. Lady that, in the next three years, the Government will invest unprecedented amounts of money in supporting disabled children and their families for respite care, key workers and transition planning. That has been warmly welcomed by the every disabled child matters coalition.
My hon. Friend raised a number of issues about inequalities in funding and so on. He also talked about the progress that his local authority has made, and I wish to pay tribute to Anne Williams and Maureen Lea for the leadership that they have provided in Salford, and to Anne Williams for the leadership that she is now providing nationally on adult social care.
On the partisan contributions made by Opposition Members, let us be clear that the Liberal Democrats currently do not have a policy on the subject, but they still say in their local leaflets that their policy is free personal care. The hon. Lady said on the record that that was a dishonest promise in their manifesto at the last election. It is completely duplicitous politics. Conservative Members talked of their policy on the funding of social care in their previous manifesto, but it is not their current policy. So the Conservative party does not have a policy on the matter either. Neither of the two Opposition parties is offering to spend more on social care than the Government are committed to spending in the next three years, and neither is committed to a Green Paper on the fundamental long-term reform of social care. That is yet another example of the Government facing up to one of the great challenges that this country faces in future health and well-being issues, which, as my hon. Friend said, is right at the heart of a socially just society.
I shall not; I am coming to the hon. Gentleman’s points now.
The right hon. Member for North-West Hampshire (Sir George Young) contributes extremely well to making the case for social care, which of course I welcome, but he and the hon. Members for Beverley and Holderness (Mr. Stuart) and for Eddisbury (Mr. O'Brien) asked, “Is this it?” Let us be clear: we have a Green Paper committing us to tackling long-term reform; we have a local government settlement of 1 per cent. in real terms; and we have a high real-terms increase in resources through the money that the Department of Health will make available to local government to reform social care in the next three years. We shall announce the details soon, and hon. Members will have answers to all their questions about what improved services that funding will buy.
In addition to all that, the Prime Minister will announce next spring a new deal for carers, building on the record levels of money that this Government have invested in supporting carers in the past 10 years. On 1 October, the Government issued new continuing care guidance to ensure that primary care trusts do not shunt the costs of continuing care on to local authorities. For the first time, we have national guidance. As I have said, the Government are putting record resources into supporting disabled children and their families.
Hon. Members do not like to hear these messages, but they are going to hear them.
I also wish to mention the appropriate use of resources in the system. There is a local authority—I shall not name it, as I do not wish to embarrass it—that is spending £300,000 on setting up a television station, while it has increased the fees for home care by £300,000. Let us be clear: some decisions being made at a local level about what matters to people need serious scrutiny in relation to local authority prioritisation.
We must all ask why social workers are now spending their whole time as assessors and box tickers rather than doing social work with people. That is not required by any legislation that this Government have passed; it is a result of the community care legislation introduced in the 1990s. When did we ever say that just because people were self-funders, they should be left on their own to navigate the care system by choosing nursing homes or home care? We never said that.
It was this Government who introduced the deferred payment scheme, which means that no elderly person going into care has to sell their home. It is shameful that the Conservative party frightens elderly people by suggesting that old people have to sell their homes when they go into care. This Government changed that and introduced free nursing care, after 18 years when people had to pay for it.
I want all-party consensus on the long-term funding of social care. That is the responsibility of grown-up politicians. We need a new system that redefines what the Government will fund through tax and what individuals are expected to pay. It must be fair and affordable. The current system is not right to meet the demographic challenges that my hon. Friend the Member for Eccles identified, but free care for all is not realistic either. Any politician who says that it is is misleading people. If we unpick the details in Scotland, we see that the system is not really free. Waiting times for services are rocketing, which proves that it is not sustainable, as the Scottish local authorities are saying. We are not wedded to any particular model at this stage. We genuinely want to open the debate to the public, and we want all parties to participate.
The hon. Lady asked what issues we need to examine. In trying to find a new system, we need to consider together what should be available to everybody, wherever they live, and what should be left to local discretion; which elements of the service should be for all, irrespective of their means, and which should be means tested, and what level of assets should trigger full or partial self-funding. Those are the big issues that we must face up to if we are to find consensus on a new settlement on long-term funding. There are no easy solutions or quick-fix wins, and there is nothing that would leave everybody happy and provide a system that is both fair and affordable.
In the new year, we shall announce the process for significant citizens juries and consultation in different parts of the country. We want all political parties to join in the debate and make a contribution, and then we shall produce a Green Paper. We will announce the time scale for that in January. It will identify for the people of this country the scale of the demographic challenge and the range of choices available for meeting it. We will then be clear about the choices that we face and the principles that should underpin them.
This Government are the first to prevent elderly people from having to sell their homes. We introduced free nursing care, and we are facing up to one of the great challenges that face the country. Despite the scale of the tight funding settlement across government, when the details are announced it will be demonstrated that the settlement for social care, to support personal budgets and a shift to prevention, will mean that we can make significant progress on the quality of services for elderly and disabled people and their families in the next three years. We will deal with the long term and put in resources in the short term, and there will begin to be significant reform of services in every local authority, so that carers and older and disabled people have the quality of support and care that they deserve in a civilised society.