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Care and Support (Reform)

Volume 496: debated on Tuesday 14 July 2009

With permission, Mr. Speaker, I should like to make a statement on the care and support Green Paper “Shaping the Future of Care Together”.

Last year, the country celebrated the 60th anniversary of the national health service, an idea that emerged from the post-war consensus on the need for a fairer approach to health care. Today, as the NHS has improved health and life expectancy, a new challenge has emerged and is becoming more urgent.

The challenge can be summarised in three simple but striking facts. First, male life expectancy is now 78 years, compared to just 66 in 1948. Secondly, there are now more over-65s than under-18s and, thirdly, whereas there were eight working adults per retired person in the 1940s, today there are just four. By 2050, that figure will fall to just two. So the debate that we face as a country is how to provide support, dignity and independence for all, in a care system that is fair, dependable and universal. Today’s Green Paper starts that debate.

Half of all men and two thirds of women will develop care needs after the age of 65. In many cases, their needs are met informally by the silent army of carers and family members who work so tirelessly, often under great pressure, behind closed doors. I want to start by paying tribute to their huge contribution to our society, and stressing that everything that we are proposing today must build on the solid bedrock of support that they provide.

The challenge that we face is that many more people are now developing more serious needs that demand specialist care over the long term. A typical 65-year-old can expect to need care costing £30,000 throughout their life, but that average masks a huge range. For about a fifth of people, the figure is less than a £1,000; for another fifth, it is in excess of £50,000, and for those with complex, long-term needs—such as those with dementia—the costs can rise above £200,000. So the time has come to meet this difficult challenge, and to see whether we can establish a broad consensus about the best way forward.

A country is defined by how it cares for its older people, and we need to acknowledge that as a society we can do better. We need a care system that people can rely on, that does not penalise people for their prudence and that ends the cruel lottery of older people facing financial hardship because they happen to get dementia, for example, rather than cancer. We must also address the inconsistencies—the fact that two people with the same needs living in different parts of the country can have very different experiences of care.

So today we propose a new national care service, which would correct the flaws of the present system and establish core principles on which to base this new system. Those principles are universality, simplicity, prevention and fairness. On the first, universality, people have told us that they want a universal system that offers everyone a basic package of care and support. Under the national care service, people will get the reassurance and confidence of a universal system, with the security to plan for the future, and the certainty that, whatever happens, they will get help with their care needs. For the first time, everyone, regardless of their bank balance, would get some help to pay for their basic care; everyone would get the same entitlement wherever they live in the country; and everyone would get advice and information to help them to find the care that is right for them.

Secondly, we need a system that is much simpler for people to understand and use. A new standardised national assessment would mean that wherever people lived they could be confident that they would be treated the same way, and if they moved their entitlement would not change.

It is also time to say clearly that it is unacceptable and unfair for people to be denied any help to find the right services simply because they are over the current £23,000 threshold. Under a national care service, that practice will stop. Everyone will get information and advice, giving a clear point of entry into the care system and ongoing support to find the services that they need.

People also tell us that their experience is compromised by the fractured nature of care and support. A national care service must therefore build on the progress already made to break down boundaries between health, housing and care services so that people get the seamless, wraparound support that they need. In particular, it is time to make health and social care more equal partners, so that they can work together to put prevention at the heart of everything we do. We are therefore proposing a new entitlement to six weeks’ reablement support for any older person leaving hospital with care needs as well as better co-ordination between housing and care, building on initiatives such as supported living, extra care housing, telecare and adaptations to homes or workplaces.

In this pursuit of higher-quality services, we must do more to improve the social care work force, raising their status as a profession, investing in front-line staff and sending out a clear message from this House today that we as a society place a value on what they do on behalf of us all.

Finally, there is the challenge of fairness. We need to create a system that is equitable for people of all generations and all backgrounds, and that shares out the risk and responsibility for care more evenly. Over the past 12 months, the Government have explored the full continuum of funding options—from completely private to completely state-funded. We rejected, on the one hand, a system in which everyone is responsible for paying for their own care, and on the other a 100 per cent. tax-funded system in which people of all ages contribute to the cost of the care service. In our judgment, the former would leave those on the lowest incomes stranded and those with high needs facing huge costs. The latter would saddle younger people with the lion’s share of costs for older people’s care, via higher taxes.

Instead, we are putting forward three options for consultation. The first is a partnership model in which both the state and the individual share responsibility for funding care. Everyone would get a set proportion—either a third or a quarter—of their basic care costs paid for by the state. They would then have to pay the remainder themselves. To fund this new entitlement, we will consult on plans to bring other benefits, for example attendance allowance, into social care funding. We would do this in a way that guaranteed that anybody currently receiving an affected benefit would continue to receive an equivalent level of support. There would also be a progressive element to the partnership model. The less well-off would have a higher proportion paid for, while those on the lowest incomes would continue to get all their care for free.

The second option, a voluntary insurance model, is an extension of the first. People would get the same minimum proportion of basic care paid for through the national care service, but they could then choose to take out insurance against the cost of the remaining care, through either a state-backed insurance programme or a partnership between the state and private companies. Thirdly and finally, there is the comprehensive model. Under that model, everyone over retirement age would pay into a state insurance scheme, and would then get the full cost of their basic care met by the state. However, that would mean everyone over 65 making a contribution to the system, even though they may not ultimately receive any care.

At this stage, we are talking about the principle, rather than the detail, of those models, but to give the House a sense of the likely costs, and working with a £30,000 figure for the average cost of a person’s care today, the partnership model would see someone paying between £20,000 and £22,500, although obviously some would pay a lot more and others a lot less. Under the insurance model, indicative figures suggest that people would pay a lump sum of between £20,000 and £25,000 for their cover. Under the comprehensive model, the figure could be somewhere between £17,000 and £20,000.

Under the insurance and comprehensive options, people could choose how to meet the costs. They could do so by paying a lump sum on retirement, by deferring their state pension, by paying in instalments during retirement, or by paying from their estate after death. In the longer term, we could develop a system whereby people who are still working could make regular contributions, so that they could pay their contributions on retirement.

These are radical and serious proposals. I recognise that many people care deeply about the issues that the debate raises, and we need a dignified discussion to do justice to their concerns. Such is the significance of the issues to every single person in the country that we would move forward only if a broad consensus were to develop around one or two of the options.

In conclusion, it is important that we do not flinch from this debate. A failure to act would mean a future of increasing pressure on services, a decline in the quality of care that we can offer the most vulnerable, and ever greater costs on the most unfortunate. That is not a prospect that I—or, I am sure, other hon. Members—wish to contemplate. I commend the statement to the House.

I am grateful to the Secretary of State for making a copy of the Green Paper available to me an hour ago. Of course, there has been the usual ration of leaks; in this instance, they were mostly kites flown in advance. Ministers dithered for months on publishing the document. They seemed to spend most of the time between the planned spring publication and mid-July trying to get any of their kites to fly.

The Secretary of State has been wandering around the television studios this morning telling us that the standards of adult social care have gone down and down. He tells us how cruel the lottery of support for the elderly is. He tells us how unfair it is that people are forced to sell their homes to fund their long-term care. Which Government does he think has been in charge for the past 12 years? Which Government promised 12 years ago to stop people being forced to sell their homes to fund their long-term care? Which Government rejected the findings of their own royal commission? Which Government sidelined the King’s Fund review? Which Government kicked the issue into the long grass in their 2007 spending review? Frankly, we do not need simply to start another debate. One debate always seems to roll into another with this Government. We need a decision, and we need serious, costed proposals to be the basis for that decision.

May I ask the Secretary of State where exactly he proposes that the funds should come from for the increased Government contribution to the costs of long-term care? If he is promising to provide a universal minimum care component, he must know how he will pay for it, so I have a simple question: what would be the additional cost to the taxpayer of having either a quarter or a third of basic care costs paid for by the state? I can see no evidence in the Green Paper of that crucial number. However, if Members look up page 108 of the Green Paper, when they can, they will find the following sentence:

“For example, everyone might have a quarter or a third of their care costs paid for by the state.”

There is a footnote to that sentence, and in this Green Paper, as in most Government documents, the footnote is the most important bit. That footnote says:

“For the purposes of modelling the options, we have made assumptions about the level of funding that the state would put in, but these do not reflect a decision about central government investment in care and support.”

In truth, the Government have not even published their assumptions about state funding.

When the Secretary of State comes to pay for the scheme, is he proposing to do so by cutting disability benefits? Can he confirm that he is proposing to scrap new entitlements to attendance allowance and other benefits to pay for the Government’s contribution to social care? With reference to his voluntary insurance model, if the effective premium is some £20,00-plus per person, what is the Government’s estimate of the likely take-up? By what means would the Government ensure that the risk pool is large enough to make the scheme effective? How can he avoid people opting into the system only if they are more likely to need care?

On the third option, the so-called comprehensive model, the Secretary of State surely means not comprehensive, but compulsory. Does he have any view as between voluntary and compulsory insurance? Is he in favour of compulsory or voluntary insurance?

I am sure the right hon. Gentleman will agree that we need national standards—some consistency of assessment. We have long argued for that, and of course there needs to be central Government support, but we do not need a nationalised social care service. It is surely a retrograde step to remove local government from the equation.

The Secretary of State spoke about the need for a consensus. If the Government were serious about that, they would long ago have consulted on costed options. All we have today is another document, long on options and short on costs and conclusions, published in the hope that it will see the Government through to an election, when it will no longer be their problem. That is not good enough.

Help the Aged has told us:

“The social care system is broken and . . . millions of older people are failed each year.”

Four years ago we made it clear that there needs to be a partnership approach. We made it clear that we need a system whereby people can be sure that their care needs are supported, a system that raises the quality of care provided in people’s homes as well as in residential and nursing care, reverses the decline in productivity in the social care sector, and ends the scandal of people being forced to sell their home or lose their lifetime savings simply because they are unfortunate enough to need long-term care. We will build a system that guarantees our older citizens the care and dignity they deserve.

I cannot be alone in finding the tone in which the hon. Gentleman introduced his comments disappointing. Older people watching the debate today will want not the usual slanging match, but a better and more serious debate about the serious proposals that we have put forward. They will also think that the Green Paper we issued today and the options in it deserve a hearing.

The hon. Gentleman says that that is not good enough, and suggests that nothing has happened. The Government have increased funding for social care by 40 per cent. It is fair to ask whether that would have happened if the Opposition had been in government. We have not been doing nothing. We have been investing in social care, and it is this Government who have put forward proposals to give people more control over that budget, giving them direct payments so that they can build and buy the kind of services that they want to live their life. That came from the Government, so it is not true that nothing has been happening.

The hon. Gentleman mentioned the royal commission. [Interruption.] He will recall that the royal commission failed to find a consensus about the way forward, contrary to what he said. The royal commission came up with a majority and a minority report. That, in itself, identifies how hard it is to take these issues forward. [Interruption.] There are no easy answers, and the subject should not be the stuff of straightforward tit-for-tat slanging matches in the House. We deserve a better debate about social care.

The hon. Gentleman asked me about additional costs—[Interruption.]

Order. There is far too much chuntering from a sedentary position from those on the Opposition Front Bench. The hon. Member for Eddisbury (Mr. O'Brien) will have ample opportunity over a period to express his views from the Front Bench at the Dispatch Box, but he should not do it by sedentary chuntering.

The hon. Member for South Cambridgeshire (Mr. Lansley) asked me about additional cost to the taxpayer. The foundation of our proposals is the idea that our existing investment to help people to deal with the costs of care can be better spent by combining investment in social care with disability benefits, particularly attendance allowance. That is at the heart of our proposals today.

The hon. Gentleman also asked about the estimated take-up of the voluntary option, and there is a figure, albeit only indicative, of about 20 per cent. The trade-off with a voluntary option is that because fewer people may enter the scheme, the cost would be higher; on the other hand, under any comprehensive or compulsory option, people would not have the choice but the cost might well be lower. He asked whether I favour a comprehensive or compulsory option, and I believe that the option deserves a fair hearing. However, this is a Green Paper; we are putting forward three broad options for the country to debate, and it would be wrong to force the pace of that debate. I said very clearly at the end of my statement, if he was listening, that a broad consensus would need to develop in the country around one of those options before any one of them could be taken forward.

I was disappointed to hear the hon. Gentleman rule out, so early in this debate, the notion of a national care service, or of moving towards more national standards and entitlements in care. If he reads the Green Paper, he will see that we do not propose to remove the role of local government; we say that it would continue to have a crucial role to play in delivering such national entitlement to people in all parts of the country. However, he has leapt up with knee-jerk responses to the Green Paper. He has not come to the House with a considered response to the serious issues that it raises. It is the product of three years’ work among a number of Departments, and it deserves a better hearing than the one that he has given it this afternoon.

I thank the Secretary of State for early sight of the statement and the Green Paper. The truth is, however, that it comes 12 years too late. It is this Government’s shameful legacy that they will leave office having failed to reform a system that the Secretary of State himself has described as a cruel lottery. The former Prime Minister said that he did not want

“a country where the only way pensioners can get long term care is by selling their home”.

Yet 12 years on, nothing has changed; in fact, it has got much worse. Many elderly people have been left with inadequate care as criteria for care have been tightened and charges increased. Now we have a set of ideas that cannot be implemented this side of a general election, and the real risk is that the issue will disappear again into the long grass.

There are principles in this Green Paper which we welcome. The Liberal Democrats have called for a universal entitlement, a focus on prevention and the availability of advice and support. We support the idea of an entitlement to six weeks of reablement following discharge from hospital, and we absolutely support the importance of giving carers and care workers much more respect and the dignity that they deserve. We pay tribute to their work in very difficult circumstances.

On the voluntary option, will the Secretary of State publish the assumptions about take-up to which he referred? Does he accept that with both the voluntary insurance model and the comprehensive model, there is bound to be a short-term funding shortfall? Will he rule out any increase in national insurance or council tax to pay for it? Will he publish all the costing documents? If we are to build a consensus, that is surely necessary. What happens to the current generation of retired people—those who are well over retirement age? Will they be able to make a payment into a voluntary scheme? And what about people with existing care needs? What about their circumstances?

Given the risk that the issue could be pushed into the long grass, and given that no one will have any confidence in a Conservative Government facing up to these real challenges, will the Secretary of State establish without delay a cross-party commission, in the style of Lord Turner’s pension commission, to achieve consensus and, crucially, to commit any incoming Government to urgent reform? Surely we owe it to those with care needs to stop the talking and act now.

In response to the hon. Gentleman’s final point, we are publishing these proposals today because we do not want this debate to go into the long grass.

Picking up on the welcome spirit of some of the hon. Gentleman’s remarks, I take it that he may be interested in working with us on some of these options to see whether we can build a consensus around them. I welcome his support for some of the principles and specifics, such as reablement care and the importance of the social care workforce. We do not spend enough time in this House talking about the importance of the social care workforce and how we can invest in their professional development and recognise the huge contribution that they make. They do some of the least glamorous work in our society, and yet all our families depend on them, including mine over many years. They provide services that are crucial to our families, and we thank them for it.

I reject the hon. Gentleman’s main allegation—if I may put it that way—that this is all 12 years too late. This Government have been investing in improving social care over the past decade; it is not true that we just sat back and have done nothing. We have put some £520 million into Putting People First, the scheme to give more personal control over social care funding. We were the first Government to bring in a national carers strategy, which had a whole range of measures to help carers, recognising the invaluable work that they do for the country. More recently, we published a dementia strategy, with £150 million attached to its introduction. All that is underpinned by a 44 per cent. increase in social care funding from this Labour Government. I do not think people would believe that a Conservative Government would have put anything like that level of funding into social care.

The hon. Gentleman said that I acknowledged that the current system was not good enough. I say that absolutely explicitly. I do not believe that we are doing as well as we might by older people, and I was hoping that collectively we may work to develop a consensus on proposals to do better. Conservative Front Benchers have already ruled that out, but I hope that at least we and the hon. Member for North Norfolk (Norman Lamb) can work together to address it.

On some of the specifics that the hon. Gentleman raised, the estimated take-up of voluntary options will be in the impact assessment published alongside the Green Paper. Obviously, the figures that we gave are broad, but they give an indication based on international experience.

We have ruled out increasing national insurance contributions because we felt that it would not be fair to the working-age population of today to put all the costs of care on to them. We think that a fairer approach is the partnership that underpins all three options that we have put forward.

The hon. Gentleman asked whether we would continue to deal with the existing care needs of people already in retirement. I can assure him that if we were to bring forward a White Paper with more detailed proposals, it would reflect the fact that some people would already be past the age of 65; that would have to be borne in mind.

I warmly welcome the substance of my right hon. Friend’s statement and the spirit in which he made it. As the Government take forward the debate on the three funding options that they have put forward, can he assure me that they will also continue to build on the excellent work that has been done with personal budgets and direct payments so that people receiving help with their care needs will continue to get as much choice and control as possible over the way those services are given to them?

I thank my right hon. Friend for her comments. I pay tribute to her for the work that she did when I served as her deputy in the Department of Health to introduce direct payments, which were controversial at the time but are now widely regarded as the right way to give people control and choice over the care services that they receive. I want to give her the clear assurance that any development of a national care service will take as its foundation that vision of social care, where the individual is empowered and able to bring in services to support them in living independently and having the best quality of life that they possibly can in retirement.

Order. A further 24 Members are seeking to catch my eye. As ever, I would like to accommodate as many as I can, but I am looking to each hon. or right hon. Member to ask one brief supplementary question, and of course to the Secretary of State to provide us with a pithy reply.

May I invite the Secretary of State to respond to his own challenge to rise above the party political ding-dong and recognise that if we are going to address this issue seriously, we first have to ask whether any additional Government funding is available for any of the solutions that are canvassed at the end of the Green Paper? It is the absence of additional Government funding that has prevented the emergence of consensus at earlier stages. Did he say—I think I heard him say this to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley)—that no additional funding would be available from any source for any of the funding options?

I can explain to the right hon. Gentleman that I said clearly in answer to his colleague that we would better spend the existing resources that we put into supporting people with care needs. There is no commitment to additional funding, but what we are saying is that the additional funding could be brought into the system through the range of proposals that we have put forward. The right hon. Gentleman is somebody for whom I have great respect in this area, and is a predecessor of mine in this job, so I hope that he will give the proposals that we have put forward today a hearing. I believe that they deserve a fair hearing, and as I have said, we would do a great service by older people if we could reach consensus throughout the House.

Does my right hon. Friend agree that the army of family and informal voluntary carers to whom he paid tribute at the beginning of his statement require not only support but an enhancement of the number of people encouraged to give time, energy and commitment, including in retirement, to keeping glued civil society together? Will he therefore consider issuing at the point of retirement a pack containing details of how those going into retirement and remaining healthy can get in touch with voluntary and statutory organisations that could help them to use their time and talent to the betterment of others?

I certainly recognise from my own family experience, as I am sure other hon. Members do from theirs, the intolerable pressures that carers and families face at times in trying to meet the care needs of loved ones and relatives. I say again that we are all indebted to the efforts of carers up and down the country, and that any visions for the reform of care and support must be based on the idea that families and communities continue to look after one another. A basic concept of neighbourliness and obligation to one another is the bedrock on which any system must be based.

My right hon. Friend’s suggestion is good, but we will also need to draw on the support of the voluntary and charitable bodies in the sector that provide wonderful support to older people. I will explore the proposals that he has made with that in mind.

The Secretary of State referred to the wish to see a system that “ends the cruel lottery of older people facing financial hardship” because they happen to get dementia rather than cancer, for example. I applaud that sentiment, but he must know that one of the main reasons for that distinction is that those who have dementia are considered to have social care needs, not health care needs. In all the possible options that he has set out, extra finance will be required from a person who needs dementia care. Will he look again at that distinction?

First, I pay tribute to the hon. Gentleman, who I know takes great interest in the matter and has done very good work. I recognise the basic problem that he identifies, which is that some people with dementia get some help with the costs of their health care needs but not those of their social care needs. That is essentially the point that we are addressing in the Green Paper. We want to integrate services around those individuals and, as I have said, make health and social care more equal partners in providing support for an individual. None of us can really feel comfortable with the notion that those who develop the very highest care needs through dementia or Alzheimer’s continue to pay £200,000 or more to meet their care needs in later life.

I very much welcome the clarity and certainty that the Secretary of State today offers care services users. Will he ensure that the debate on the options for payment also covers the sorts of services that should be available as part of the universal option so that individuals know who is paying for their care and what it entails? Above all, they should be in control of their care and managing their own budgets.

My hon. Friend makes an important point. I pay tribute to her as chair of the all-party group on social care and for her work on the subject down the years. She congratulates us on the clarity of the options. It would have been easier to pick up on some of the points that Opposition Members made and produce a timid and bland Green Paper, which was high on analysis and short on concrete options. With the Minister of State for Care Services, we have decided not to do that, but to put some serious options on the table, with all the risk that that entails. Very serious proposals for reform are not without risk, but if politicians are not prepared to take it, we will continue the drift and the delay, and we will not address the issues in the long term. If we are to build consensus for one of those options, there needs to be clarity about what people get for what they put in. My hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble) will see that the Green Paper spells out a clear vision for prevention, reablement and giving people the maximum ability to lead a full and independent life for as longas possible.

Much in the Secretary of State’s statement can be welcomed, particularly the sentence, “It is time to make health and social care more equal partners.” Does the right hon. Gentleman accept that, in the past 12 years, the national health service has had a much more generous deal than social care and that, in many parts of the country, social care services departments are under real pressure? Does he also accept that, whatever the option chosen, we need a step change in support for social care simply to meet the needs of demography?

I thank the right hon. Gentleman for his comments, but that is the logic of our proposals. However, unlike the national health service, the basis for funding social care will have to come not from taxation but from a partnership between the state and the individual, and the new resources will come from one of the three options that are proposed. I am grateful that he picked up on the sentence that he cited—I carefully inserted the notion of health and social care as more equal partners. It is not possible to say that they are equal partners today. Alongside the debate, we need to focus seriously on improving quality, and the calling of social care as a profession. I very much hope that someone with the right hon. Gentleman’s authority will add to that debate.

I wonder whether my right hon. Friend feels that the options that he has given this afternoon, which I appreciate, will help some of my constituents in care homes, who are being cared for by people with little knowledge of how to care for elderly people? Many of those carers have no or very little English, possibly because they are paid the basic minimum wage and because some—only some—care home owners are interested only in profit making rather than caring.

My hon. Friend makes a powerful point. It is important to send out a message from today’s statement that we want a debate about social care and its status, and to take it more seriously. We could do that if we could bring in more resources for providing services for older and disabled people. My hon. Friend makes an important point. I said in my statement, and I repeat, that carers do some of the most important work, on which we all depend, yet the message that they get from society in terms of what they are paid may not always reflect that.

Many people outside the House who have followed for many years the issue of how we pay for long-term care will experience a terrible sense of déjà vu about the statement. Will the Secretary of State please “not flinch”, as he said himself, and set out the timetable that he intends to follow for making decisions about the public expenditure implications of the proposals and, more important, for introducing his plans at the Dispatch Box?

If the hon. Gentleman will forgive me, I do not think that he can claim déjà vu because we have not previously had a Green Paper that puts serious Government proposals for care on the table. We had a royal commission, but as I said to the shadow Health Secretary, it did not identify consensus on a way forward. What I have announced today is new territory. We want a serious debate, and the hon. Member for Sutton and Cheam (Mr. Burstow) can help us build consensus. It is right that, if we can reach consensus about the debate, the subject should become a serious issue of consideration at the next general election so that the public can choose the party that has the best solution to the serious and long-term challenges.

May I associate myself with the remarks of my right hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) about family members? Taking that on board, will my right hon. Friend the Secretary of State consider a fourth option for family members, by using either tax relief or grants to support the building of granny annexes, in order to allow family members to keep the capital gain, to save the Government money and to create a far more caring culture in our country?

That is a very good point, but it is already the case that people can use personal budgets to help to offset the costs of family members as my hon. Friend describes. However, I encourage him to work up his ideas. Given that we have tabled three serious options, I am not ruling out others. As I said to my right hon. Friend, it is very important that we recognise, encourage and incentivise the role of the family community in this debate.

Care of the elderly is sometimes the hidden and often the unrecognised industry in my constituency and hundreds of others, but it cannot be delivered without a vigorous private care home sector. Will the Secretary of State recognise that the Government have their role to play in ensuring that they do not load costs on to that sector—for example, through the minimum wage or holiday entitlement—knowing that, in the decade of public expenditure austerity that we are about to enter, they have no hope whatever of recovering those costs from local authorities?

I am troubled by the right hon. Gentleman’s remarks. If he is saying that the minimum wage or the standards that we introduced in care homes in the Care Standards Act 2000 have not helped to improve the quality of care, I would take issue with that very strongly. If he is also saying that care staff should not have basic entitlements to holiday, how will being run off their feet, not getting a proper break and not being properly paid enable them to give better quality care to older people? I find the logic of his question completely wrong, but I do accept that the private care sector has a huge role to play in delivering the vision that we have set out in the Green Paper.

I very much welcome my right hon. Friend’s announcement about the national care service and, in particular, the fact that he has been so explicit about the thorny issue of costs. Indeed, one of my predecessors, Jim Griffiths, would have been proud of this reform, which is the equivalent of his type of reform. However, the announcement obviously covers reserved matters and devolved issues. What talks has my right hon. Friend had with Welsh Assembly and Scottish parliament Ministers about how the reforms will work out in Wales and Scotland?

I am grateful for the generous welcome that my hon. Friend has given the Green Paper. Obviously any reform of benefits would have implications for the devolved Administrations. My hon. Friend the Minister for Care Services has had discussions with counterparts in the Welsh Assembly and we will continue to do that. However, the proposal in today’s announcement is for England. The national care service would apply in England only, although we would encourage the Welsh Assembly to go down a similar route if it wanted to.

The Secretary of State has been very courageous with his proposals, particularly in suggesting that social care will be funded in future partly by the state and partly by private insurance. He also suggested a link with health. Does he see the future expansion of the national health service being partly funded by private insurance?

I am grateful for the hon. Gentleman’s generous comments. I know that he has proposed some fundamental options about the privatisation of the national health service. That is not something that I would ever contemplate in this role, although we are saying that the funding of care and support should be on a different basis from the funding of the national health service.

Given that this has been a growing issue for hundreds of thousands of families for at least 25 years, and given also that we should acknowledge the cross-governmental failure to grasp the nettle of long-term costs, will the Secretary of State agree to be at least as bold as William Beveridge was in 1942, when he looked at the risks facing early post-war society in a radical way and came up with ambitious programmes that, by and large, have stood the test of time?

I must pay tribute to the huge experience and authority that my right hon. Friend brings to these matters, and to his long experience of social care in this country. If he reads the Green Paper, he will find the same boldness in this debate. The issues are similar, in that we are asking people to consider whether a system of mutual support is better than the status quo. The debates that were in play during the creation of the welfare state are very much alive now and at the heart of this debate. How far we go will obviously depend on how much support each option attracts in the country, and I hope that my right hon. Friend will join us in ensuring that the debate is a vigorous one.

There are more than 6 million carers out there, including family and friends, and 1 million of them look after more than one person. Fortunately, we have in our constituencies organisations such as Crossroads, which look after the carers and recognise that they have health needs themselves. What more can be done to support those who care for the carers?

The hon. Gentleman is right, and Crossroads is a wonderful example; I know the organisation well. Of course there is always more that we can do. The carers strategy was an innovation, and it has recently been updated and comes with a significant investment alongside it. We can never be complacent about what we do to help carers. However, my basic argument today is that if we can improve the services that older people receive, we can relieve the pressure on the carers and enable them to do more.

I warmly welcome and support my right hon. Friend’s statement today, but I would say to him that this area of policy is seen by all as being incredibly complex. It is invariably individual in nature, and its complexity can leave families with the most crippling problems. Will he assure the House that everyone’s contributions to the consultation—including those of organisations representing the elderly and of families who care for the elderly—will be listened to? Will the consultation be publicised as much as possible, so that we can hear what all our people are saying?

My hon. Friend raises an important point. A positive development alongside the publication of the Green Paper will be the formation of a care alliance involving 31 national organisations representing the whole breadth of opinion in this area. We need to empower them to take the debate out to their members. My hon. Friend is also right to say that the lack of simplicity in the current system diminishes people’s understanding of the issues. We need a much clearer system in which people get more help to understand what is available to them, regardless of their background or their needs. Any proposals for reform must have that consideration very much at their heart.

I am sure that the Secretary of State appreciates the fact that, across the United Kingdom, many people are concerned about growing old and feel vulnerable when they consider what care is going to be available for them. It is certainly unacceptable to force them to sell their homes to pay for their care. Speaking of national care services, is it not imperative to hold meetings as soon as possible between the Department of Health and the devolved Administrations, Northern Ireland included?

Of course, and we will continue our discussions with Michael McGimpsey and others in Northern Ireland. Perhaps we can learn from the system in Northern Ireland, which has always had much closer integration between health and social care. The hon. Gentleman is right to say that we want a system that will prevent people from having to sell their homes; that is a basic unfairness that we want to end. The current average cost of care is £30,000, and each of the three options that we have put forward today comes in at less than that amount. That is why we feel that they are doable and that they could possibly be made attractive to people. However, it is important that we have the broadest possible debate, not just in England but across the UK, about the choices that we all face in an ageing society.

Blackpool has above-average numbers of older people and care homes, and my constituents will be grateful for the breadth of vision and the sensitivity that my right hon. Friend has demonstrated today—compared with what has been rather sour waffle from the Opposition Benches, I am sorry to say. He has talked about the need to strengthen the role of social care staff. Will he tell us what opportunities there will be in the consultation to look at issues such as greater skills for social care staff and greater flexibility for them to visit people in the given time? At the moment, for example, travel time is not included in their working hours.

On my hon. Friend’s first point, the investment in the work force is vital and the social care skill set is crucial. We have already begun work on that in the Department. Again, we want to take any new resources in the system to develop what we are doing further. On his point about the tone and nature of the debate, I think that on this particular issue we have to do better across the House than we usually do and ensure that we do not reduce the debate to a simplistic slanging match. It is important to give these issues the serious airing and hearing they deserve. We will do a greater service to older people by identifying a way forward between us that, if not ideal for everybody, at least provides a workable compromise that will make things better than they are today.

The right hon. Gentleman is absolutely right to bring these bold options before us for the longer term and to have a genuine debate, which is long overdue. Does he accept that we urgently need, right now, to look at how social services assess care and ensure that frail people, perhaps those who have suffered a stroke, are not charged for what should be viewed as health care rather than social care? That needs to be looked at for the people who are currently in care, too.

I understand the hon. Gentleman’s concern. We have been revising the guidance to local authorities. As pressure has grown on local social services down the years, they have focused more and more on people with the highest needs, leaving lots of other people who desperately need help unable to access it. In revising the guidelines, we have put more investment—an extra £500 million—into the system. Any measures in the interim would be only preparatory to the major debate we are initiating today.

The Tories oppose the national health service, so it is not surprising that they oppose the national care service. The current lottery of life, under which one in three who develop a severe condition lose everything and the rest keep their wealth intact, is unfair and should not be tolerated in a civilised society. I favour an approach of solidarity. Should we not go out and advocate the comprehensive approach, which also seems to be the lowest-cost option, and develop a groundswell of public opinion behind that option so that no future Government can ignore it?

The challenge here—my hon. Friend puts it very well—is not just about what I put in and what I get out. We all have to look at our own extended families and recognise that across them there will be a range of care needs and that we have a mutual obligation to each other within our families and to others who, as she says, can face the calamitous cost of care if they develop the most serious needs. I note her support for the comprehensive option. If she would like to go out and bang the drum for the comprehensive option, she is absolutely entitled to do so and there is a very respectable argument in favour of it. People will need illustrations of how it could be made manageable. We have set out in the Green Paper various options on how people might pay either for the comprehensive or the voluntary option—by deferring the state pension, paying through retirement or paying after death. Those are the issues to be debated. If my hon. Friend is offering to join the debate, I wholeheartedly welcome it.

Does my right hon. Friend agree that we in the House have a duty to get out there and consult people? Will he ensure that he and his team are available to receive representations from our constituents so that we know that the consultation will be full and that we will be able to stand by it?

For any MP who would like it, we would endeavour to set up a local forum in which these issues could be properly debated with informed speakers so that we can have a quality debate at the local level, too. We want to give people the depth of information for which they are looking. These are difficult issues and it is not always easy to take them on. In my view, however, MPs can play a crucial role in informing their constituents and helping them to make a choice about what they think is the right way forward not just for Crawley, but for the country as a whole.

How will my right hon. Friend’s proposals help older people in Northumberland, where the leading Liberal Democrat-controlled council has set a policy of closing all old people’s care centres and sacking all the workers in them?

I cannot say that these proposals will help in the short term, but that is not what we want to see in the future. Under any of the options that we are presenting, there will be a basic national entitlement. One of the unfairnesses of the system is that some councils withdraw money from social services in order to spend it on other priorities. That can leave some of the most vulnerable people in society with unmet needs, which should not please any of us.

The mark of a civilised society is how well we look after the sick, old and vulnerable. This Government have done much to look after the sick. People can now obtain operations when they need them rather than having to die waiting for them, so they have a chance to grow old.

I welcome the statement, which is long overdue. I appreciate the reasons for that—the Government had a lot to deal with when the national health service was left in crisis—but we must now move as quickly as possible. This is a priority for many of my constituents, and for people all over the country. Can the Secretary of State assure me that the consultation will be genuine and the strategy will be introduced quickly?

I think that the Government have put the national health service back on its feet, and that people can take confidence from that and believe that we can build a fair national care service. I take my hon. Friend’s point about the need for speed. As she said, the statement is long overdue, and I accept that people have waited a long time for our proposals. However, I can assure her that we do not intend to back off or flinch. We want to ensure that there is a good debate, leading to a White Paper before the general election. It is about time that these issues were seen as a serious matter of choice and subject for debate, as I hope that they will be during any forthcoming general election campaign.

The royal commission recommended free long-term care for everyone, paid for out of progressive taxation. I supported that view absolutely at the time, and I support it absolutely now. Moreover, opinion polling at the time showed massive public support for it—up to 80 per cent.—and I am sure that the position is the same now. I tabled two early-day motions calling for free long-term care, which were signed by more than 100 Members, mostly Labour. I can tell my right hon. Friend that I shall continue to campaign on that basis, and that I hope he will accept it as an additional option.

I welcome my hon. Friend’s contribution to the debate. Nothing rules out his campaigning for that particular option, but we have ruled it out because we do not feel that it would be fair between the generations to ask the working-age population today to continue to provide all the costs. We think that a partnership approach is fairer to all, given that many people of working age face considerable pressures in relation to housing and all the costs of bringing up families. We feel that our proposals represent a fairer spread of the burden across the whole population, but of course my hon. Friend is entitled to argue for a different approach in his constituency.

On Friday I spoke to an elder constituent who was contemplating suicide as her savings ran out. This morning I received a thank-you card from her which read: “I now feel there is light at the end of the tunnel. When I start getting anxious again I shall remember your words ‘Eat your house.’” The good thing about today’s statement is that it gives older people a better option than eating their house, and gives others a better option than using it to pay for care for the elderly. Will the Secretary of State ensure that those anxious people are informed at every stage about how he conducts the debate, rather than its taking the form of an air war, as it is already doing in the Chamber?

I strongly agree with my hon. Friend. People do become anxious about these issues. That is why I said at the outset that I hoped we could manage a better debate than we normally manage, because such an important issue deserves it.

Perhaps my hon. Friend can relay this to her constituent. Both the voluntary and the comprehensive option would provide people with a pathway to protect their assets, savings and houses in retirement. That may indeed give light at the end of the tunnel, not just for my hon. Friend’s constituent but for many other people who genuinely feel anxious and seek peace of mind in their later years.

I return to the point made by the right hon. Member for Skipton and Ripon (Mr. Curry). Staff are the key to delivering this service. If we go back to what happened in the 1990s, when compulsory competitive tendering and privatised care homes were introduced and training and other budgets were cut, we will be unable either to recruit or to retain quality staff. The one way to make sure that the system falls apart is to follow the programme that the Conservative party followed 20 years ago.

It was quite astonishing that one of the Conservatives’ proposals as a way of helping with social care was to end the minimum wage in care homes and the existing terms and conditions of social care staff. In more recent days, the shadow Health Secretary has been proposing the abandonment of national pay structures in the health service, so I think we know where they stand on these matters. Investing in and respecting the work force, and understanding how a motivated and well-rewarded work force provide a quality service to the public, has got to be at the heart of any proposals for change.

I congratulate my right hon. Friend on introducing this long overdue Green Paper, and on his obvious commitment to the subject in his presentation and answering of questions today. May I put it to him that one part of his statement is not negotiable—is not an option? He talks about improving the quality and status of care staff, and without that, we will have a framework, not a system that delivers a national care service.

I thank my hon. Friend for his generous comments. Through him, I pay tribute to the good people of Knowsley, who have led the way in this area down the years. The Minister for Care Services was in Knowsley just last week looking at the fantastic work done by health and social care staff in integrating services. They genuinely—I know we say this a lot, but in this case I mean it—offer a model for others to follow. I am happy to endorse what my hon. Friend the Member for Knowsley, South (Mr. O'Hara) says: without investment in the staff, we do not have the basis of a national care service. We can learn from how we have offered a better career progression for staff in the national health service, and transfer some of those principles to improving the social care work force. That is not to say that today we do not respect what they do; we do, but I do not believe they get the recognition for what they provide in all our communities and to all our families.

Bill Presented

Government of Cornwall Bill

Presentation and First Reading (Standing Order No. 57)

Dan Rogerson, supported by Matthew Taylor, Mr. Colin Breed, Andrew George, Julia Goldsworthy, Willie Rennie, Andrew Mackinlay, Hywel Williams and Mr. Angus MacNeil, presented a Bill to establish and make provision about the Cornish Assembly; to transfer functions and powers to the Assembly; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 16 October, and to be printed (Bill 132).