I beg to move, That the Bill be now read a Second time.
This is a significant moment for the House, as it means that the long overdue reform of the funding of personal and social care in England is at last under way. Before we go any further, it is important to focus our minds on the people whom the Bill is intended to help. It will provide support to more than 400,000 of the most vulnerable people in our constituencies, including people with advanced conditions such as Parkinson’s, dementia, Alzheimer’s and motor neurone disease. They are people with the greatest needs, who require intimate personal care in all aspects of their daily lives. In many cases, they will already have paid significant sums out of their own pocket towards the costs of their care as their condition has deteriorated. Their families and carers will have faced considerable pressure in recent times as they have battled to get the help that they need, or sought to balance the demands of their own lives with looking after a loved one. Therefore, today, we are rightly focusing on those with the greatest needs, and on making their lives and the lives of their families and carers a bit easier.
I am grateful to the Secretary of State for giving way so early in his speech, but I must ask him why we are debating this Bill now, when we are in the middle of a consultation and waiting for clarification on what is going to happen with the National Care Service in England. Are we not jumping the gun a little by introducing just one part of a much grander scheme, which would be better debated as a whole?
To make this excellent Bill work better, we need to ensure that we can fund adaptations to homes—such as adapting baths to showers and installing stair lifts—quickly. Will the Secretary of State meet me and representatives of the Royal British Legion and the Soldiers, Sailors, Airmen and Families Association to discuss the problems involved in getting this through, to ensure that the people who need those adaptations do not have to wait months and years for them, and that there is no discrimination between privately owned and publicly owned housing?
I am grateful for the hon. Gentleman’s kind words about the Bill. The Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope), would certainly be happy to have the meeting that he has requested. In a moment, I will talk specifically about help in the home and about spending on the adaptations and technology that might help people to live at home. Too often, there has been a divide over spending health resources in that way, and the Bill seeks to change that. I appreciate what the hon. Gentleman has said.
In addition to helping those who need care at home, the Bill will help those who are at a low point in their lives and at risk of needing long-term care—for example, people who have recently had a fall, an accident, a serious operation or a bereavement.
The Secretary of State mentioned that the provisions would benefit 400,000 people. The risk assessment that comes with the Bill makes it clear, however, that if we take those already getting reablement provision out of the equation, only 100,000 extra people will benefit from free personal care through the Bill. Does he agree that that is the correct figure, rather than 400,000, because the vast majority are already receiving help through the means-tested system?
In a moment, I will break down the precise figures on those who will benefit from the Bill. On reablement, it is important to say that these provisions will fund an expansion of reablement services, and we estimate that an extra 130,000 people will be helped through the use of a more preventive approach to social care, and a more intensive period of support when they are at a low point in their lives. I will come to the figures that the hon. Gentleman has raised in a moment, and show him that the 400,000 figure is a real one.
The Bill will provide powers for people to receive intensive support to prevent them from developing more serious needs. It will help them to remain healthy and independent in their own homes, and to extend their quality years of life. In helping these two distinct groups, the Bill therefore has two clear purposes. The first is to end the lottery in home care for the most vulnerable people in our communities. Today, help for people at home with the highest needs varies according to their postcode. The second is to make the existing system fairer now and pave the way for a bigger reform of social care in the next Parliament. Focusing on reablement and building a stronger preventive element into the system will provide a bridge to the forward-looking National Care Service that we seek to create.
The hon. Member for Bournemouth, East (Mr. Ellwood) was right to say that the Bill needs to fit into the grander plan, when it is eventually published. Is he not missing the point, however, that there are people struggling now, and that they cannot wait for the White Paper or for the Bill that will follow in the next stage after the general election? We have to do something to help those people now, and that is what the Bill is about.
My hon. Friend makes a very important point, and I pay tribute to him as a former care services Minister for the work he did to take forward social care, particularly the improvements we have seen in the personalisation of care services in recent years. He is absolutely right that the story of social care reform is that this House has flinched or backed away when it has all got too difficult and has found a reason to put off the reform of the system. That is why today is so significant—we are at last facing up to the unfairnesses that exist today and we are focusing clearly on the people with the greatest needs, who in my view deserve a better deal than the one they currently receive.
I wonder whether the Secretary of State could explain to the House how he sees the Bill forming a bridge to a longer-term reform in the terms in which the options were presented in the Green Paper. The underlying proposition of the Bill is that free personal care should be provided to people at home. The Green Paper had an option of taxpayer-funded free personal care within it and the Government expressly ruled it out as being unfair in placing too great a burden on people of working age.
I repeat what I said a moment ago. The measure paves the way for a major reform of the system in two ways. First, it is fairer in terms of funding. The people we are talking about will in the vast majority of cases already have paid significant sums out of their own pockets as their condition has deteriorated. Any reform we are talking about in social care is about spreading that burden of the costs of care more fairly and not letting those who are dealt the hardest hand of cards in life and who face the greatest needs bear all the costs on their own. That was the principle that underpinned the creation of the national health service and we believe that the same principle should be valid here.
The second point I would draw the hon. Gentleman’s attention to is the focus on reablement and prevention. It is very important that we find a better way of investing in people’s good health—investing the resources we have on the health service side and in terms of council funding—to create a more forward-looking preventive system that is geared around promoting people’s independence and good health and supporting them to stay at home. For those two clear reasons, I say to him that the Bill is a bridge towards the National Care Service that we wish to see.
Sixty-three years ago, this House voted to create the NHS to end the unfairness whereby people with the greatest needs faced the highest costs and the people who had the least were in danger of going without their needs being met at all. Today, the same unfairness exists in social care. If someone happens to develop dementia in old age, rather than cancer or heart disease, they are yet to find the “freedom from fear” that was the promise of the NHS. That was an enduring unfairness, which until now this House has failed to address. It becomes more and more evident as people live longer and we can no longer afford to ignore it.
In being able to cross that bridge, there is obviously always the tricky issue of financing. There is some disquiet in local government that it is local councils that will have to find the bulk of this funding. In my own local authority in Croydon, 5 per cent. efficiency savings were secured—even better than the Government’s target for it—so how can we cross the bridge with respect to that particular financial issue?
The hon. Gentleman is right to mention funding because it raises real challenges both at the national level and for local authorities, but he is not right to say that councils will be asked to find the majority of the funding. I have re-prioritised my budgets within the Department of Health to find the majority of the funding necessary. We are clear, however, that efficiencies and the potential for efficiencies have been identified within social care in local government that will enable local authorities to make a contribution to the costs of this care. There is already evidence from around the country that a stronger focus on prevention and reablement can help to save local authority resources in the long term.
As I said, the first aim of the Bill is immediate action for 280,000 people with the highest care needs, including those with advanced dementia, Parkinson’s and other conditions. It does that by lifting the restriction in the Community Care (Delayed Discharges etc.) Act 2003 on the period of time for which councils can be required to provide free personal care for people living at home.
We know that many people want to remain in their own homes if possible. A 2004 survey found that most people expressed a preference for staying in their own homes, 62 per cent. with care and support from family and friends and 56 per cent. with care and support from trained care workers. Only last month, in its “Findings” series, the Joseph Rowntree Foundation concluded:
“Older people most often move to a care home as a result of crisis, with no preparation and little or no planning. Most do not choose to be there.”
Currently an estimated 80,000 older people in greatest need receive free personal care, but 40,000 pay part of their own costs and 50,000 pay all their costs. An estimated 90,000 younger adults receive free care, while 20,000 pay all or part of their own costs. The Bill will end that lottery, and remove the enormous and unfair financial burden on such people and their families.
Those figures answer the question asked by the hon. Member for North Norfolk (Norman Lamb) a moment ago. The Bill will provide free care for some people who are currently paying all or part of their costs, and it guarantees that all members of that category will receive it in the future. As the hon. Gentleman knows, under the current system a local authority could change the eligibility criteria and, at any point, bring some of the people who currently receive free care into the ambit of charges.
It is probably unlikely that a local authority would change the criteria to remove free care from those in the most critical need—given that we are discussing that category. Will the Secretary of State confirm that approximately 110,000 additional people, on top of those who currently receive free care—both younger and older adults—would benefit from the Bill, and that the 400,000 figure is not an accurate reflection of the number who would benefit?
Let me break down the figure for the hon. Gentleman. Currently, 170,000 people receive free care. It is important that he acknowledge that the Bill will safeguard their position in relation to charging in the future. A further 110,000 people are funding either all or part of their own care; the Bill will exempt them from charges. A further 130,000 people will benefit from the extra investment in reablement. That will be a recurring benefit, depending on who needs reablement in any given year. The Bill represents a significant step forward for all members of that category.
Let me give the hon. Gentleman a real example: that of an 89-year-old woman from Lowton, in my constituency. She lives alone in a one-bedroom flat. She is no longer independently mobile, is unable to prepare meals or manage her own personal care, and has impaired hearing in both ears. Relatives want her to be supported at home for as long as possible. They say that she would be devastated if she had to go into a care home. She has four visits during the day and one later in the evening, with two staff attending all visits to ensure safe moving and handling. The cost of the care package is approximately £500 per week, or £26,000 per year. As a result of the Bill, her care will be free.
I am still confused about what the Secretary of State considers to be the purpose of the Bill. He seemed to argue at the outset that it was to give free personal care to those in greatest need, but he must surely know that many of those in greatest need have made substantial financial contributions and then go into long-term residential care. He appears to be offering nothing to them. In what way are they any different from those who receive care at home?
Let me repeat that the Bill has two purposes: to make the existing system fairer now, in the recognition that we cannot solve all the problems in advance of a major reform, and to prepare the ground for a more fundamental reform of social care in England which would encompass everyone, in all care settings. As I said a moment ago, it is important to create a system that helps people to live independently. In our view, that is the right way to create and reconfigure the system. I am surprised that the shadow Health Secretary is seeking to pick holes by asking, “Why aren’t you doing everything now?” Surely it is right to do something now to help people in the greatest need, whose families are facing the greatest pressure as they seek to attend to their care needs, rather than to nit-pick by saying, “If it isn’t a complete reform, it’s not worth having.” Our argument is that it is worth having, but we are also committed to reforming social care in the next Parliament, and I wonder whether the Conservative party is prepared to make a similar commitment.
May we briefly pursue the costs issue? As I understand it, the Secretary of State is expecting local government to find £250 million a year from savings. What discussions has he had with other Departments that are also asking local government to make savings, and what will be the cumulative effect of his demand for £250 million along with those other Departments’ demands? Also, how do they expect local government to find that money—or is that why a 4 per cent. increase in council tax is one of the measures in the pre-Budget report?
The hon. Lady raises a fair point. She rightly asks where the efficiencies will come from. My hon. Friend the Minister responsible for care services has been working with colleagues in local government on a use-of-resources guide, which clearly demonstrates how further savings can be found within social care, particularly by funding prevention services and helping people stay independently in their home. I will come on to an example from the Isle of Wight, where a Conservative-controlled authority has successfully invested in prevention and reablement, and thereby saved considerable sums of money. I shall not do so now, but I could cite examples of Conservative authorities that are doing the opposite—they are cutting social care. The hon. Lady asks me to update the House on where the savings can come from, which is a fair question, but we have identified that.
I believe that when the right hon. Gentleman was a Health Minister he made the point that the vast number of people in all our constituencies who work very hard on a voluntary basis to support families and friends save the state enormous amounts of money, and I wonder whether his analysis puts a value on that. More importantly, what support is he proposing to give to these individuals who are spending enormous amounts of their time to help relatives?
I agree with the hon. Gentleman’s point: informal carers save billions of pounds that otherwise would have to be met by state-provided support. The actual figure has been costed by Carers UK and others, and it is huge. [Interruption.] My hon. Friend the Minister says that the sum is £80 billion. Carers do not see their care in monetary terms, however; they would always look after their loved ones.
Let me explain to the hon. Gentleman what is squarely my intention in respect of carers in reforming the system and bringing forward the National Care Service. We will always have to depend on their love and support for their families, but we can do better in making their life more tolerable, such as by letting them call down the support when they need it, rather than when the system says that they should get it. It is a fundamental part of any reform of social care that we provide to the many informal carers in this country the kind of back-up and support that makes being a carer tolerable and that allows them to balance that with all the other demands on their life. For me, that is a crucial aspect of creating a higher quality care system.
The Secretary of State’s comments will be extremely helpful to my constituents in Braintree. Each and every week I meet one or two people who give a lot of their time, and who ask me, “Can the state do more to help me, not on a financial basis, but on an enabling basis?” If the Secretary of State could give me one or two examples of how his Government will do that, that would be helpful.
I can give a very specific example. The hon. Gentleman may know that last year we asked primary care trusts to fund respite care for carers and for breaks, and I believe it was the first year that that requirement was included in the operating framework. Some analysis has been done, not least by the Princess Royal Trust for Carers, on whether that has been fully implemented around the country. I have been considering whether we can strengthen the language relating to that commitment as part of this year’s operating framework.
That is a very direct example of how the health service is moving into supporting carers more directly—I think that was the point that the hon. Gentleman wanted me to answer—and it shows the specific, practical support that the health service can give. Hon. Members will know, if their constituencies are like mine, that respite care is under-provided for and that there is more we can do to give people those little breaks that make life tolerable. That was why we included that funding requirement in the operating framework of the NHS, and I assure him that we will be repeating it when the framework for next year is published.
My right hon. Friend might need to have a think about this point and come back to me on it. The Bill works by amending the Community Care (Delayed Discharges etc.) Act 2003, which provides that when somebody is discharged a carer’s assessment also has to be carried out. If that assessment indicates that a carer needs additional support, within the framework of what we are doing today will we also fund the support of that carer?
We will certainly look at the detail of what my hon. Friend is saying. My initial response is that that would be included as part of the overall care plan that the individual would receive, but I shall respond to him in detail on that point to ensure that the carer’s needs are properly taken into account.
Currently, all personal care at home is potentially a means-tested service; local councils can determine the amount people have to pay within national guidelines. Community care assessments are carried out to determine the level of a person’s needs, based on the criteria laid out in guidance. Nevertheless, levels of support vary widely across the country, so this Bill is about creating a fairer system. We want to ensure that the support goes to those who need it most. It is estimated that of those who will benefit, some 60 per cent. are in the middle quintile of the income distribution of the general population, about 30 per cent. are in the second quintile and about 10 per cent. are in the bottom quintile.
Can the Secretary of State clarify his intentions on attendance allowance? He will know that when Scotland introduced free personal care, £30 million of attendance allowance was cut from the Scottish budget, and that got in the way of our being able to deliver our service. However, I believe that he intends that existing claimants in England will continue to secure their attendance allowance. Why the difference between Scotland and England?
I am sorry to say to the hon. Gentleman that this Bill does not deal with the reform of benefits. We debated that in the House last week, and the hon. Gentleman would have received very full answers to those questions had he been here. This Bill is not funded by the reform of attendance allowance or disability living allowance.
The beneficiaries of extending free personal care as proposed in this policy will be those on middle to below-middle incomes relative to the overall population. We believe that that will have a small, but positive, redistributive effect.
I shall give way in a moment, but this is an important point. The Bill answers one of the key issues identified by the 1998 royal commission:
“The Commission conclude that doing nothing with respect to the current system is not an option. It is too complex and provides no clarity as to what people can expect. It too often causes people to move into residential care when this might not be the best outcome. Help is available to the poorest but the system leads to the impoverishment of people with moderate assets before they can get any help.”
The Bill is a direct answer to that criticism.
The intervention by the hon. Member for South Thanet (Dr. Ladyman) draws attention to an important aspect of the Bill and perhaps to a gap in it. When the legislation that this Bill amends was introduced in 2002, the Secretary of State at the time argued that it would bridge the gap between health and social care. However, if this Bill is inadequate in bridging that gap in the way that was inferred by the hon. Gentleman—the gap also applies to support for organisations that might facilitate or enhance care at home—it is surely premature and would have been better as part of a bigger Bill to take advantage of the opportunity to do exactly what the hon. Gentleman said and what was heralded with the introduction of the earlier legislation.
I understand the hon. Gentleman’s point, but I believe that the Bill does exactly what he is calling for. It will drive further integration between health and social care. It will encourage the health service to spend more of its resources on supporting individuals in the home. In that way, it will help local government, which has too often been faced with a very difficult job in balancing resources at a local level to give people the support that they need. I do not say at all that this Bill is the final answer and the whole solution—it is not. We have said that it is a partial step that will move the system forward and make it fairer today, as well as make it more preventive in character. It is worth doing for those reasons, but I agree that we need more fundamental reform. We would look for support from the Opposition to reform the system more fundamentally. I believe that the demographics of the country now demand it. If we do not reform the system soon, the unfairnesses will grow year by year. I do not think that any of us would want to contemplate that prospect. Typically, the people who require personal care services are over 75 years old, live alone and are generally in poorer health. This measure is not just compassionate; it is progressive.
The second aim of the Bill is to help another 130,000 people by encouraging reablement support after a fall, when their health deteriorates or following a period in hospital. Reablement might mean adaptation to make a person’s home wheelchair-friendly, the use of technology such as alarms or electronic pill dispensers to improve safety, or physiotherapy and personal support to help people learn how to perform daily tasks after illness or injury.
This legislation is not required to provide reablement services. However, we are clearly linking it to the support provided to people receiving free personal care, as it will be a gateway to that support. We want to place the emphasis at all times in spending public money on encouraging prevention—on putting prevention at the heart of the system. We think that that is the correct link to make. If we are to consider somebody for free personal care in the home, we should first give them the opportunity of an intensive period of support. There is good and growing evidence from around the country that that support can reduce people’s reliance on care and support down the line.
I am grateful to the Secretary of State for his clarification that the purpose of the reference to reablement in the legislation is not to provide reablement when people leave hospital after an operation, for example, but to make it a condition of their subsequent receipt of free personal care that they have accepted such reablement services. Would that apply to those who would currently receive free personal care on a means-tested basis—that is, would all those receiving free personal care be required to comply with that?
Strictly speaking, the Bill provides the local authority with discretion to provide that support, but that is clearly the direction in which we want to see care services develop. In answer to the hon. Member for Beckenham (Mrs. Lait) I used the example of the Isle of Wight, and it is an instructive example. It shows that by investing early on and supporting people better when they need it most, long-term reliance on care and support can be reduced.
I am grateful to the Secretary of State for giving way again. Does he accept that there are some cases in which a requirement of reablement would not be appropriate? For example, someone in their last days needs personal care but it would be entirely inappropriate to go through some false process of reablement that would not benefit that individual. I am concerned that councils might be in a position where they might exclude someone in those circumstances.
The hon. Gentleman makes an important point. There are some people for whom reablement, or intensive support, would not be appropriate. He gave as an example people who receive palliative care, and that is obviously true for them. Nobody would want anything in the Bill to place pressure on people or put them through a process that they must and should not go through. The regulations under the legislation will make that clear. Of course, the measures should not deny such people any support should they qualify under the relevant terms.
We believe that by investing in reablement we can prevent emergency admissions to hospital, prevent people from ending up in crisis situations and help people live independently in their homes for longer. I have mentioned the Isle of Wight a few times. It has had a 40 per cent. reduction in residential care placements since it introduced free personal care in the home. That work is already going on in other places and showing its worth. The Wirral is also taking a lead on investment in reablement services. Let me give an example.
A 77-year-old woman who had been dependent on carers for two years was admitted to hospital for aortic valve surgery. She had got used to doing very little for herself; she was sleeping downstairs and was using a bowl of water in the lounge and a commode to meet her personal care needs. On discharge, she received three visits a day from the home assessment and reablement team to help her with personal care and meal preparation. The team helped her to practise using the stairs and encouraged her to undertake daily tasks such as opening the curtains, putting on the washing and making her own lunch. Over six weeks, the number of visits that were required gradually decreased, and she is now living happily and independently without any intervention from social services. Such inspiring examples show how we can help people to regain independence and how we can spend public money more effectively.
In that way, the Bill aims to enable people to retain their independence, as well as aiming to reduce costs and prevent ill health. It will help to ensure that people remain economically active by providing the support and control that families and carers need to balance work and caring. We want to build on the work that many councils have already begun on prevention and intervention to support people in living independently in the community. The Bill encourages, but does not require, councils to offer a reablement package. The offer of free personal care and better use of resources will push authorities to bring in alternative models of care and will embed prevention and reablement, all of which have been shown to be more cost effective and to offer better outcomes. That approach could help authorities to generate by 2013 the £250 million that early estimates suggest will be the additional cost of free personal care. It will reduce the cost of care for individuals, including those who continue to fund their own care, and will help people to stay independent. By extending a hand to those with lower-level needs, we can help to reduce isolation and help to keep people active. In doing so, we can prevent people from slipping to the point at which more intensive care and support are required.
There has been a great deal of speculation and misinformation about how the Bill will be funded, so I shall take this opportunity to explain our approach again in the clearest terms possible. The measures we are proposing will cost £670 million in the first full year, which will be provided entirely from the Department of Health budget and by local government. Some £420 million will come from the Department, and the remainder will be met by local authorities. That funding, along with the scope for further efficiency gains, will be considered as part of the normal spending review process. It is right that councils should play their part alongside central Government in helping to deliver the commitment on free personal care. We will be consulting on the distribution mechanism for local authorities. I repeat that it is completely incorrect to say that any of the money will come from cutting disability benefits or from cutting cancer research or any other important research.
Will the £250 million from local government be a one-off cost or a recurring cost year on year? I note that some of the money will come from the Department of Health’s research, development, marketing and consultancy budgets. Will those be recurring or one-off costs, and is all this in the pre-Budget report?
Local government efficiency is in the pre-Budget report, and it is a recurring cost; but the savings are also recurring. It is about spending public money better than we do at the moment. As the Joseph Rowntree Foundation acknowledged, too many people are pushed into residential care as a result of crisis, when actually with appropriate support they could be helped to regain independence. If we help someone to regain independence at that critical moment in their life, it is good not just for that individual but for the public purse, because it means that people do not require care in a residential setting in the long term.
My hon. Friend the Member for Poole (Mr. Syms) made a good point, which I am afraid the Secretary of State has not properly answered. In the pre-Budget report, the £250 million efficiency saving is scored as a reduction in residential care costs, but it is treated as a saving from local government that contributes to the overall level of efficiency savings. It is not disclosed in the PBR as additional expenditure elsewhere. Furthermore, from what the Secretary of State says, in 2010-11 there will on the face of it be a £210 million transfer from the NHS line in the departmental expenditure limit to the Department of Health line. That has not happened. Why not?
The savings identified in the pre-Budget report will remain with local authorities and can then be used to meet their contribution towards providing free personal care for those with the highest need, as we have said all along. Of course, there is an incentive for local authorities in the form of the extra resources I have found from central budgets in my Department, but as I said a moment ago, we believe that by making that investment we can make savings down the line. We believe that giving people intensive support at home can reduce overall costs to the public purse, as one of the hon. Gentleman’s local authorities—the Isle of Wight—has discovered. Perhaps he should take a trip there and cheer up a bit.
I encourage the hon. Lady to look at the Bill’s impact assessment, which proposes a number of options for the distribution package. We are consulting on the best distribution mechanism. Obviously, there are always strong views in local government about whether a package should be needs-led or per capita. We shall want to work through those issues with local government—[Interruption.] My hon. Friend the Minister is nodding. There is time for the Local Government Association to feed in its clear views, as I am sure it will, and we shall pay close attention to what it says.
The consultation on the regulations makes it clear that the sum available is finite—it will not be increased—yet the impact assessment makes it very clear that there are considerable uncertainties about total costs and the total numbers of people who may benefit and qualify for help under the Bill. If the cost is significantly more, what will happen? If the sum is finite, who loses out in those circumstances?
As I was saying to the shadow Health Secretary, there is discretion for local authorities under the Bill, but we have costed the Bill and we are absolutely clear about the people we expect to benefit from it. We are confident that the costings we have given will pay for the benefits that I have described this afternoon.
The Bill is about putting more money into the social care system now. I do not think that anyone in the House seriously disagrees—unless I am about to discover otherwise—with the fact that the measure is much needed, prudent and fair. It is targeted on those in England with the highest needs who face the highest costs. As I said earlier, many people have had to use their own funds to pay towards the cost of their care.
Reform of care and support is fiscally responsible in the long term. Failure to reform will lead to huge unmet need and pressure on public finances and public services in both the NHS and local government for years to come. The demographic pressure is rising. Year by year, more people will come into a care system that cannot fully cater for them. When the NHS was created there were eight working adults for every retired person. Today there are four. By 2050, that will figure fall to just two. We can expect that by 2026 there will be 1.7 million more adults in England who need care and support.
One in five of us will need care that costs less than £1,000 during our retirement. One in five will need care that costs more than £50,000, and in the worst cases the cost can exceed £200,000. We cannot predict our risk, so it is hard to protect ourselves against it. That is why we need a reform that shares the costs and risks of care and does not leave those in the most difficult circumstances facing catastrophic costs for care. The need for bold, far-reaching reform is undeniable. That is why we propose to create a National Care Service, and why we will bring forward a White Paper in the new year.
This is a major reform and, although it is essential, it will take time to deliver.[Interruption.] I hear the hon. Member for Hemel Hempstead (Mike Penning) say from the Front Bench that it has taken time. We have not done nothing for the past 11 years. We have introduced major reforms to social care in England. We have introduced the dementia strategy, the drive towards personalisation and direct budgets, the Putting People First reform. We have had the prevention for older people pilots, which have laid the ground for the present reform. It is not as if we have been doing nothing. We have been taking steps to improve the system.
I did not hear whether the hon. Gentleman agrees that a fundamental reform in the next Parliament is necessary, but I shall be interested to hear whether he has the courage to commit to that. People have waited long enough. We are not saying that we have got everything perfectly right, but we have the courage and the confidence to introduce a Bill. In the interim we are introducing the Personal Care at Home Bill, recognising that those with the greatest needs cannot wait and should not be asked to wait to receive greater fairness. The Bill is not the whole answer, but it is a bold first step, and I commend it to the House.
I am sure the House is grateful to the Secretary of State for taking so many interventions with a view to our understanding not only the purpose of the Bill, but how it is intended to work. Although it is a short Bill, considerable complications arise from it.
The debate on the principles of the Bill takes place in the context of the Government’s Green Paper and the reform of social care and support. There are two topics that hon. Members across the House would not want to leave out of account in considering how we should reform care and support for the future. First, we must continuously look beyond organisation and funding issues to understand the quality of the service being provided to people at home or in residential care homes. The Care Quality Commission report a fortnight ago on social care made it clear that a considerable proportion—about one in four—of care providers are not yet meeting the good or excellent standards that we would expect for ourselves or our relatives.
Four hundred were poor.
But many were only adequate, as the Minister with responsibility for care services knows very well. That is not a party political point. We need to ensure that quality is as good as any of us would expect for ourselves or our relatives.
The second thing that we need to do is well understood but not always achieved: we must be sure that we have the social care work force available to make that happen. That is affected by the esteem in which social workers are held, and by factors in the social care sector. It is not a well-paid sector, and it is rarely at the forefront of the public’s mind when it comes to understanding what provides value in the community. However, it does provide important services on which we depend greatly. The presence of that work force is important, and it is important that we support it. I say that because in these debates we tend to focus on funding and organisation, but we must always look beyond that.
The Secretary of State, in his introduction to the Bill, said something that I echo: for 12 and a half years, which just happens to be the length of time that the Labour Government have been in office, the Government have failed to bring to care, support and long-term care funding the long-term structural reform that they repeatedly promised. It was in 1997 that, for example, Mr. Tony Blair said that he did not want to live in a country where older people had to sell their homes to pay for care. Some 13 years later, that is still precisely the situation.
Just after the 1997 general election, the Labour Government established the royal commission on long-term care, which reported in 1999. The Secretary of State said that this Bill was the direct response to that, but perhaps I have missed something, because my recollection was that a Labour Government had rejected the central recommendations of that royal commission.
I shall deal with that point if I manage to catch Mr. Deputy Speaker’s eye later. First, I want to deal with the issue, constantly replayed by the Conservative party, that people have to sell their homes when they receive care. They have to do so because Conservative councils consistently fail to tell people that the money was given to those authorities to put a charge on people’s properties so that they could be sold, if necessary, after their death. If Conservative councils actually told them about that, many more people would keep their homes.
The hon. Gentleman seems to be squirming because of the simple fact that Labour made a promise almost 13 years ago which has not been kept, and 45,000 people a year end up selling their homes to pay for their care. Many of them are already in long-term residential care. The issue is not whether their property is sold at the time that they enter care, while they are in care or, even, after they have died; for them, the issue is that they wanted everything that they had worked for, saved for and accumulated in assets throughout their whole lifetime not only to provide them with financial security, but to be a heritable asset for their families, and that simply has not happened.
I have not really begun yet, but I shall of course give way in a minute.
I find the situation very strange, because over the past decade Scotland has increasingly demonstrated that a policy of free personal care is unaffordable. Indeed, colleagues from other countries in the United Kingdom are present, and owing to the circumstances in which the policy was applied in Scotland, it has cost a great deal more than the authorities intended and they have had to cash-limit it, introducing therefore just the kind of unfairness in terms of access against which the Secretary of State now rails. Furthermore, the policy does not meet the accommodation costs of those in long-term residential care, so those costs have also escalated. The policy has not made people feel the intended sense of financial security.
Those are all the reasons why a Labour Government said for many years that free personal care, as Scotland has offered it, is simply unaffordable in England and cannot be supported. I do not dispute that we supported that conclusion, because I made the same point myself. Indeed, a Government Green Paper published as recently as July said that to pay for the costs of care out of general taxation would impose an unreasonable burden on those of working age; that it would have a major, further distributional impact between generations and on those who continue to work; and that the Government therefore ruled it out. In July, as far as we were concerned, the Labour party was continuing to rule out free personal care, but in September the Prime Minister got up at the Labour party conference and said that he wanted to offer free personal care paid for out of general taxation.
There is no sense in which the Bill constitutes a bridge between the current position and the options in the Green Paper with which the Government are proceeding. They are talking about three options: the partnership model with universal care and a third of it paid for up front, a comprehensive insurance model, or an involuntary insurance model. Under none of the three models in the Green Paper would those with substantial or critical care needs have all their needs met out of general taxation.
The hon. Gentleman is not making a fair point. In any scenario under the reform options in the Green Paper, people with the greatest needs would receive more help than they receive today. I am not saying at this Dispatch Box that this Bill is the perfect reform, but I am saying that it will get more help now to the people who would be most helped under any more fundamental reform of the system. The point that he is missing is that those people have already had to dip into their own pockets to a significant degree to fund the costs of the care they are receiving. Our argument is that we should make it fairer for them now.
As regards Scotland, this is not the same proposal—it is about targeting help on people with the most critical needs, not paying for free personal care across the board, as is made available in Scotland.
This is interesting. I understand the Secretary of State’s point, but this is not an interim proposal towards long-term reform. It is perfectly okay for the Government to say, “This is something that we would like to do on its own terms. We think it is justified.” I will go on to examine whether it is the appropriate priority for the resources to be used within the care and support context. However, it clearly cannot be construed as a bridge to any of the other proposals. Otherwise, the structure of support that would be offered would be intended not to provide free personal care but to provide for people with substantial or critical care needs some of their care for some period of time—or a proportion of it, such as a third or a quarter—free, universal and up front. That would be the logical corollary of the options set out in the Green Paper.
The proposal does not seem to bear any examination as a substantial measure of long-term reform. It prompts a question that the Secretary of State and I argued about last week. Surely it would be better for the Government to be clear about what they think the structure of long-term reform of care should look like, and for us to do the same, before the point at which this House is asked to spend a considerable sum of money, and to put in place legislation in a very particular form, without our having even seen what the Government’s longer-term legislative intentions are and our having had the chance to set ours out in the same way.
Is the shadow Health Secretary comfortable with the fact that for people with the most critical care needs, their care is a lottery, with some receiving all their care paid for, and some part funded? Is he saying that it is not worth making this change so that at least the most vulnerable people get care according to their needs, not their postcode?
The Secretary of State is asking me to anticipate the rest of my argument. We have made it clear that we see a case for enabling people to have greater certainty. That is why at our party conference my colleagues and I proposed—[Interruption.] Every time we ask the Secretary of State to answer a question yes or no, he always gives us a long answer, which is never yes or no. I do not see why I should be any different.
We want to give people the opportunity to create greater certainty and to meet their costs. The question is what is the best way of doing it. In their Green Paper, the Government put forward options that include using disability benefits, forcing people to take insurance, or giving people the opportunity to take out insurance. We, for our part, made it clear at our party conference that we wanted to develop the opportunity for people to take out insurance but did not think it right to do that for every care need.
As I have said before, there is a good argument for offering people the opportunity to take out what we regard as affordable insurance not only for long-term residential care costs that place their home at risk, but for critical care needs, because the costs of care for those who are means-tested tend to accumulate and can deprive them of their assets. The Secretary of State must know that those are people who have significant cash assets and whose home is not at risk at the point in question. There may be a realistic and affordable opportunity to allow them, too, to offset their risks through insurance and have the certainty for which they are looking.
Will the hon. Gentleman concede that given that the average cost of care home fees is about £26,000 a year and that most people who go into care homes spend a little over two years there, his proposals for insuring against care home fees would effectively mean that for every one person who benefited, at least another seven would have invested in an insurance policy and got no benefit? The policy will require him to set the cost of care homes, set the quality and standards of them even more rigorously, and set eligibility criteria for those who go into care homes.
As the hon. Gentleman has asked me that, I shall turn to something that I was going to say later. I agree with his last point: of course the policy will require there to be an objective assessment of need to enter long-term residential care, otherwise insurance providers would run the risk of people choosing to go into residential care when they did not require it. However, I do not agree with his interpretation of the numbers. I have set out clearly that we are operating on the basis of people paying about £8,000 at age 65. There is then a considerable period before the average point at which people enter care, which will allow that fund to accumulate. As he says, about £25,000 or £26,000 is the current figure per year, for just over two years on average, which means that there will be a cost of about £50,000 a person for the one in five who enter long-term care—£10,000 per person insured—to be funded by the approximately £8,000 that they originally paid in, which will have accumulated more over a period of time. I am grateful to the hon. Gentleman for allowing me to make it clear that the numbers are straightforward.
Will the hon. Gentleman concede that, just as the criticism of the Bill is that it is a partial solution with the potential for perverse effects, exactly the same criticism can be applied to his proposal? It could end up affecting behaviour and pushing people in a direction that might not be the most rational for them as individuals.
I understand that it is important for us not to have a perverse incentive that means that people who should be in long-term residential care are not, and that they are instead being looked after at home in ways that are not necessarily in their best interests. There are clearly worries about that. Many families and individuals make the decision for their older relative, partner or spouse to be in long-term residential care most reluctantly and when it is in their best interests to be there. We should not create an ideological fixation on people not being in long-term residential care. We should operate on the basis of what is in the best interests of older people themselves.
Equally, I agree with the hon. Gentleman that we should not seek to create a perverse incentive for people to be in long-term residential care because there is not adequate support in the domiciliary context. That is why, as I have just said, we should consider the opportunity of extending the voluntary insurance concept to critical care needs in domiciliary care. In the circumstances that we have described, with an affordable insurance market to meet the costs of long-term residential care, insurance providers will have an incentive to help people stay at home rather than go into long-term residential care, so we can begin to create the broader insurance system that I understood underlay one of the Government’s options in the Green Paper. To that extent, although we clearly have problems with the Government’s Green Paper, we have not said that we are not prepared to use it as a basis on which we can develop our own proposals. We have already done so, and we helpfully added to the proposals at our party conference, as I described.
The Bill is very short. It contains only one substantive clause, containing a number of amendments of previous community care legislation. As I shall explain, I fear that it has significant flaws and that there are significant unanswered questions. Of course, it is undercosted and as yet unfunded. Essentially, the local government component is simply to say to local authorities, “Here is this additional statutory obligation. By the way, you’ll find the money for it won’t you?” Local government has been through such a process many times before. The Government seem to be engaging in double counting. On Wednesday of last week, they were telling local authorities to achieve those efficiency savings and scoring them as part of the reduction of the deficit; this week they are presenting legislation that scores the same efficiency savings but then tells local authorities they have to spend them. They cannot have both.
We need clarity on the future of social care. The Secretary of State keeps asking whether our intention is to reform social care after the election, but why is he so fussed about that if he is confident of being in office then? He clearly is not. There is something deeply ironic in saying, after 13 years of a Labour Government who have not achieved the reform of social care, “It’s about time a Conservative Government who are committed to the reform of social care came in.”
We have had 13 years in which hundreds of thousands of older people have had to sell their homes to pay for care, contrary to Labour’s promises; 13 years of rising costs and, as the Office for National Statistics has demonstrated, falling productivity in social care; and 13 years of decreasing council-arranged care, when the proportion of people with moderate and lower care needs has been falling. Now, months before a general election, having said for 13 years that providing people with free personal care was unaffordable and unattainable, the Labour Government say it is their priority; and now, lo and behold, they suddenly say that they can find the money, starting in October 2010. It all fits into the same pattern that we heard so much of from the Chancellor in his pre-Budget report—make the Government virtuous, oh Lord, but not yet.
My hon. Friend, with typical, measured and moderate understatement—the sort of understatement that he personifies—is making the charge against the Government that the Bill is political. I would go further, and I hope he might join me: is this not about vulnerable people staying in their home, but about one vulnerable person staying in his home—namely, the Prime Minister in Downing street?
Does the shadow Secretary of State agree that if there is a March election, as is rumoured, the Bill will hardly be on the statute books, never mind implemented? What is the point of talking about this Bill now, when as he knows, we need a real reform?
The Minister tempts me, but I will not do so. The hon. Member for Leeds, North-West (Greg Mulholland) asks about a March election. For that to happen, it must be called at the end of February, but the consultation on the regulations on this legislation will conclude only on about 23 February. Clearly, the Bill is more about propaganda for a general election than the delivery of social care reform after it.
None the less, we are debating the structure of care reform. There are two serious problems with some of the options presented in the Green Paper. First—I will not go on at great length about this because we debated it in Opposition time last Tuesday—there is serious difficulty with the Government’s intention to integrate disability benefits into the National Care Service funding. Of course, the Government did a U-turn last Tuesday and completely changed the proposal to integrate for current benefit recipients. It is fascinating that the Government are now proposing that over-65s who receive attendance allowance—let us say £60 a week on average—and disability living allowance should have that money taken away, so that it can be given to the local authority and then given back to them to spend in exactly the same way.
Apparently that will happen with no loss in transaction costs in the process. That is absurd. We know why the Government have ended up in that position. Under pressure, they did a U-turn but, to put it gently, it has left them looking very exposed.
For the longer term of the introduction of the reforms, the Government intend to integrate those disability benefits to pay for the up-front, universal entitlement to care. The effect would be to take away a cash benefit that recipients can use to meet a range of needs and costs and to substitute a care package. From our point of view, that remains unacceptable. We need to buttress and strengthen the right to control, and to personalise, care services, and continuing access to a cash benefit remains important for that to happen.
In response to the Secretary of State’s statement on the Green Paper in July, I said that it is important to reach a common assessment of need—one that informs the non-means-tested cash benefit and the means-tested or insurance-funded social care entitlement. As with the extension of personal health care budgets, care users need the assessment process overall to become simpler and more integrated, for the resulting budgets and assessment processes that arise to be applied flexibly to meet their needs, for there to be a choice of providers, and for the assessment of need to be portable, as people will inevitably move around the country.
Yes. In simple terms—I shall repeat the language I used—I am talking about an assessment of need; it is not an assessment of entitlements. Of course, entitlements will depend, nationally, on a cash entitlement on the one hand, but on the other on a local authority’s decision and discretion about what it provides for what level of need. However, a single assessment of need seems to me to be perfectly understandable. Perhaps the Secretary of State should explain that to his former colleague, and I will come to what the noble Lord Warner said in another place in due course.
The second problem we have with the options in the Green Paper—
According to the Secretary of State, the Bill is supposed to be associated with the Green Paper and to be a bridge to it.
I am grateful to my hon. Friend the Member for Eddisbury (Mr. O'Brien) for reminding me that the noble Lord Warner said:
“We need a more bipartisan and coherent approach than is provided for in this Bill…I am resigning myself to the fact that many of us will have to try to make the Bill more sensible and realistic about costs and funding arrangements”,
and I agree.
“Good places to start would be some national rules on service eligibility criteria to avoid a postcode lottery and making local assessments of individuals portable to other areas.”—[Official Report, House of Lords, 26 November 2009; Vol. 715, c. 541-42.]
So the idea of portability of assessment is rightly being pursued in the other place.
The second difficulty with the Bill is that the Government just do not seem to have an idea of how many informal self-funders there are. The Local Government Association, in its response to the Bill, said:
“We are concerned that the actual number of beneficiaries (and therefore costs) could turn out to be very different from the Government’s estimates. The Impact Assessment which accompanies the Bill provides little reassurance. We are particularly concerned that the estimated number of people with high care needs who self-fund their care may be too low.”
Counsel and Care said, similarly:
“We need to see exactly who will be helped as a result of free personal care at home. To this end, the following areas require further definition…what are ‘critical’ as opposed to ‘substantial’ care needs, what ‘personal care at home’ will cover in full, when the NHS should step in and fund the care.”
Age UK said:
“We would like clarification about the definition of personal care at home, especially when services described may be better delivered outside the home or where personal budgets are currently used to deliver similar outcomes. There is significant uncertainty about the true costs of the proposals as we do not know how many people who do not currently receive services might come forward.”
That is why we cannot have any confidence about what the cost of this Bill will be. By their own admission, the Government have nothing other than a gross estimate—a generalised estimate—of how many people are receiving informal or family care, or who are self-funding but not using council-arranged care. The evidence from Scotland demonstrates that large numbers of those people start to become claimants of free personal care if it is offered to them.
The Bill appears to be unfunded. In the explanatory notes to the Bill, which sometimes explain and sometimes do not, I was astonished by a sentence in paragraph 17:
“The Government’s view is that the Bill has little overall effect on public sector manpower and public expenditure.”
So £670 million—on the Government’s estimate—is of little effect. Convert that figure into dollars and we really have arrived at a billion here or a billion there. Soon that adds up to real money, but that does not seem to matter to the Government.
Where will that money come from? In response to an intervention, the Secretary of State seemed to be completely unable to explain why, in last week’s pre-Budget report, what should have been represented as a £200 million transfer from the NHS in England into the Department of Health’s expenditure simply does not appear in the Red Book. I am astonished that the Secretary of State could not explain that. He was at pains to mention the “myths” about where the money would come from, so perhaps he can explain where it will come from. He has been quoted as saying that some £60 million of it will come from “lower priority research projects”. Which are these lower priority projects? Which such projects did the Government see fit to fund in the first place?
I have seen a long list of research projects, and the Government used to make considerable play of the fact that they had increased the NHS research and development budgets. Which advertising campaigns will the Secretary of State stop to pay for this Bill? Will it be tobacco control, the current swine flu campaign, next year’s seasonal flu campaign, the sexual health campaigns or the Department’s contribution to “Frank”, the drug campaign? And which local authority activities will contribute the £250 million? On the face of it, the Government are arguing that it will come from a reduction in residential care home payments, but the impact assessment does not suggest that anything like that number of people will switch from residential care. The Department think that only 2,700 people would transfer from residential to domiciliary care.
Nor does the Green Paper offer a credible way forward in relation to insurance funding. The compulsory process is not really a basis for consensus because, in effect, it would just transfer into compulsory insurance something that would, to all intents and purposes, be just a taxation per head. Compulsion and tax amount to much the same thing.
There is no evidence in the impact assessment that any of this has been thought through. All that is included by way of costs is the Government estimate that it will cost £1,000 per person, made up of 30 hours at £30 an hour. But Governments wishing to provide additional services have to think about the inclusive costs. They cannot say that the marginal cost of trained staff is £30 an hour, because they have to think about the average costs over the long run. They have put marginal costing in the assessment on the basis that, magically, all those staff would be available from October 2010. We know that that will not necessarily be the case.
It is important to be clear about what we want to see forming part of this consensus. I do not wish to give the impression that we oppose everything about this Bill—or its purposes. We have made it clear that we need a much more preventive focus on the shape of social care for the longer term. The NHS and local authorities can and should come together to deliver better preventive services. Those should not be confined to reablement, and the measures that often work best—as we have seen from examples—are telecare, telemedicine and home adaptations, for example, which are being done early rather than just waiting until people have had falls or operations and have to be discharged home.
Much of the care given to the elderly in their own homes is by relatives, who are often excluded from being paid for undertaking that service. Is there not a danger that some of those relatives will use the Bill as an opportunity to withdraw and allow their contribution to be picked up by paid people? Is there not an argument that spending money on respite care for relatives might be a cheaper and better option than paying for the salaries of staff caring in people’s homes?
My hon. Friend makes a very good point. We need to guard against the risk of diminishing the contribution that informal and family care can make, as that can often give the care recipient the greatest sense of security and well-being. That is why my right hon. Friend the Leader of the Opposition and I have been so keen on the extension of emergency and planned respite care. The money that the Princess Royal Trust said had been allocated by the Government has not all got through, but it is important that it is used for that purpose. The big picture, as I was saying, is that, wherever possible, we have to give care recipients and their families the opportunity to use personal budgets to help to make that happen. The Secretary of State talked about direct payments, but they are used in a very small minority of cases—some 4 per cent. of total adult care recipients. That is a very small start. It is important that we develop the concept of personalisation and bringing those budgets together to make it happen.
Returning to the costing of reablement, the hon. Gentleman described costing as taking place on the basis of a certain number of hours multiplied by the number of people who will benefit. Is it his understanding, as it is mine, that there is no assessment of the cost of adaptations or of equipment, telecare and so forth, which may well be a fundamental part of the package of reablement to enable the person to remain at home? That appears to be out of the equation.
Yes, the hon. Gentleman is absolutely right—there is no reference to that. Indeed, this is one purpose of the proposals that we have been discussing for some years: creating a public health service that operates with dedicated funding for public health from within the NHS, and, indeed, local authorities working together.
More recently, the hon. Gentleman’s party has joined in with the concept. Of course, this is precisely where we can begin to consider some of these programmes: the benefits accrue not only in the community at large and to those families, but to local authorities and the NHS, which makes a good case for investment on the part of the public health service as it is not simply confined to the question whether it offsets hospital admissions. That is often the narrow basis on which the NHS judges these things.
We have seen programmes such as a telecare programme in Scotland that achieved savings of £11 million from 7,900 older people and an improvement in their reported quality of life; a community alarm service in Birmingham that showed a substantial return on investment and reduced residential care need; and telecare schemes for frail older people in north-west Surrey, which showed that telecare focused on safety and security reduced the number of people entering residential care by 11 per cent. in the fifth year after implementation.
Those are not necessarily reablement examples. It is important for us to consider these preventive opportunities on their merits, through evaluation, and to implement them as part of a proactive public health service. I am surprised at the narrowness of the Government’s approach to reablement alone. I am also uncertain as to why they see it as necessary to link access to free personal care to an obligation previously to have agreed to a reablement process.
As I mentioned, partnership is clearly a necessary part of the consensus that we now need to pursue. From my point of view, that includes local government. Frankly, central Government should treat local government as a partner, which means consulting on such approaches and saying to local government, “On average, across the country, you are paying 40 per cent. of the cost of adult social care. We will treat you as a partner and discuss how we will reform this for the longer term, recognising that council tax payers and their elected representatives provide a substantial proportion of the funding, and in many local authorities more than 50 per cent. of the funding, for social care.”
In those circumstances, it is outrageous that the Government published a Green Paper in July and then said something completely different in September, the implication of which was that local government would simply have to pay up or be taken to court.
Surely my hon. Friend is not suggesting that the Secretary of State has neither sought nor received representations from local authorities? It is inconceivable that he would move ahead with such speed without showing that diligence, for, as my hon. Friend suggests, this will have considerable repercussions for local authorities of all political flavours.
Just to help my hon. Friend, I should say for the record that he speaks in an ironic fashion—and so the record will show. I do not know whether the Secretary of State had any choice in the matter, and I am not sure that the Prime Minister intended that local authorities would have much choice.
The consultation has gone out. It is not about whether the Bill should be introduced or its principles; nor is it based on its economic modelling. It is not based on the underlying argumentation. The consultation is based on a practical question: if the Government are to distribute money for this purpose, is it best to do it on this measure of need, or that measure of the number of older people with particular characteristics? That question is perfectly reasonable; it just assumes that local authorities have no say whatever in whether the service should be provided or how they should exercise discretion about it.
It seems to me that a consensus is available, if the Government wish to proceed on the basis of consensus. There is a consensus on the necessity for prevention and preventive processes. Therefore, we agree that reablement should indeed form part of these proposals, but it should not be the only preventive measure. There is a consensus on personalisation, but much more needs to be done. We see access to cash benefits as an essential part of that. There is a need for partnership—in our view, a partnership with local government, with discretion for local government in deciding how council tax payers’ money is used. That is essential. The Green Paper itself says that if elected representatives are to decide how council tax payers’ money should be used, they must have some discretion in that. From our point of view, that partnership should also include the opportunity for people to protect their home and their assets through a voluntary process of insuring against those risks.
Does the Bill provide any of those things? Not too many. I say that the Bill might be flawed because its stated purpose is to provide free personal care beyond the six-week point. I did not notice the Secretary of State explaining the Bill in these terms, but let us get to this point. The Government are proposing virtually to abolish consideration in Committee, so we might as well have some of that debate now.
The Government propose the abolition of the six-week limit on the time during which free personal care can be provided at home. Simply removing the limit would allow free personal care to be provided to people whether they were at home or in long-term residential care, but the Government have introduced a further restriction in clause 1(2), whose effect is that this will not apply
“to a person living in accommodation that an establishment provides to the person together with the care”.
The effect of that is to exclude people living in long-term residential care who receive both accommodation and care together.
The Government argue in the explanatory notes that the restriction means that people living in care homes will not get access to personal care. I put a perfectly reasonable question to the Secretary of State, which he did not satisfactorily answer: why are people who go into long-term residential care with high care needs to be discriminated against in this way, compared with people who stay at home? None the less, we shall leave that question on one side.
For the sake of argument, let us say that there is a legitimate distinction to be drawn. However, the Government then say, “But people who live in sheltered accommodation or extra care housing are not to be excluded.” We have arrived at the position where they say, “Why is this so?” On extra care housing, the explanatory notes state:
“The accommodation and care provided in such accommodation are not provided together but under separate arrangements made by the individual.”
Fine. We know what is going to happen, do we not? As soon as legislation of this kind is introduced, large numbers of care services providers that currently make provision by way of a single contract with people—one that provides accommodation and care together—will suddenly find it necessary, no doubt for business reasons, to provide different, separate contracts for accommodation and for care services.
Providers will say to the Government, “If people are in extra care housing and they have two contracts, one for care and one for accommodation, they are eligible for free personal care that pays for their personal care needs. I am a care provider. I have a contract for accommodation and a contract for care services. I want exactly the same services provided to me.” For the life of me, I cannot see how that evident flaw in the legislation can be reconciled. At best, we will end up with an enormous distortion to the care market, with large numbers of care providers recreating their services so as to distinguish between accommodation and care.
I am keen to help the hon. Gentleman reconcile that point, because I am keen to promote extra care accommodation. With extra care accommodation, the individual lives in their own home, as either a tenant or the owner of that property; they do not live in somebody else’s home and receive care. If it were possible for people to change the premise on which they lived in residential care in order to achieve the same objective, they would have been doing that all along, in order to avoid having the value of their property taken into account when their care needs are assessed.
No, I am sorry, but I just do not accept that that is the case. I have visited extra care accommodation, and it is perfectly clear that many people are there on the basis of tenancies. The whole point of extra care is that as the years progress, so the accommodation that people live in can shift in that complex. They might begin living in their home, as it were, in extra care housing, but as time goes on and their care needs become critical, they may find that adaptations are made or they might even move to different accommodation in that extra care development. The point is that it is perfectly obvious that people who are trying to access free personal care will restructure their arrangements in order to try to make that happen.
I think that the hon. Gentleman is talking about a specific type of accommodation—usually a retirement village—where, instead of buying a particular property, people buy an equity stake that allows them to move around. However, in the vast majority of extra care accommodation, people are either leaseholders or tenants in a wider property. If he doubts me, I am quite happy to take him round a whole slew of such properties, so that he can see the benefits of extra care and become a convert to such accommodation.
I am sorry, but the hon. Gentleman completely misunderstands what I am saying. I am not disputing the benefits of extra care housing. What I am disputing is the fact that, in their contrivance that free personal care will be available to people with critical care needs who live in extra care housing, the Government, whether intentionally or not, are creating a potential loophole for people who are currently in long-term residential care, who would not be regarded as being in extra care housing. They will inevitably restructure their arrangements at the point at which they enter care in order to make themselves eligible for free personal care, by distinguishing the accommodation element from the care element. The Bill does nothing to prevent that from happening. That seems to be an obvious flaw in the legislation.
The Bill is not well thought through, but is it well costed? Let us have a look at its impact assessment, which has one or two obvious flaws. On page 2, it manages to state that the average annual costs and benefits are exactly the same—£670 million—even though the total benefits are calculated as being £454 million more. Given that the Government are arguing—on the first page of the impact assessment—that the total benefits are greater than the costs, one would have thought that the average annual benefit would therefore be greater than the cost. That might be a simple error in how the impact assessment was transcribed, but as the care services Minister, signed it and the error was on page 2 of what he signed, he might also be able to explain why that should be the case.
It is also estimated in the impact assessment—based on what evidence we do not know—that 10 per cent. of the flow into residential care will switch to home care. On page 15 of the impact assessment, the net flow into residential care is stated as being 178,000 older people a year, 10 per cent. of which would be 17,800. However, in the table calculating the costs by reference to the number of people who would access free personal care, the figure referred to by the Government is not 17,800 a year, but just 2,384. Such a large difference in the number of claimants would mean an extra £77 million a year to provide free personal care that has not been taken into account.
In calculating the benefits of the policy in the impact assessment, the Government admit that most of the cost is a straight transfer payment from taxpayers for the benefit of those who have previously paid for care themselves. The calculation of the benefit of that is based on two elements. The first is the equity assumed to be gained by transferring cost from the general population to older people who fall into, on average, lower segments of income distribution in the population; therefore, there is a distributional equity gain over the population as a whole. Unfortunately, the calculations in the impact assessment are mathematically incorrect. They also use the upper weightings of the Treasury Green Book, rather than the mid-point averages. If those two things were corrected—the mathematics and the use of the mid-point averages—the overall benefit of that element would be reduced to zero.
The second element is the assumption that people benefit because they would pay extra for certainty, in the same way that they pay extra for the certainty reflected in an insurance premium. In the impact assessment, the Government use US health insurance as a proxy for UK personal care insurance. They therefore assert that the medical loss ratio on health insurance would apply equally in this country to personal care insurance. Both points are wrong. There is no justification for making the assumption that health insurance is treated by people in the same way as personal care insurance. We know that that is so here, because we do not have a market for social care insurance; as things stand, people are not willing to pay for that certainty, whereas large numbers of people are willing to pay a premium for medical insurance in circumstances where, frankly, they often do not need to.
The difference between health insurance and personal care insurance is perfectly obvious, but in any case, the Government assume in their Green Paper that only 20 per cent. of people would pay voluntarily for care insurance. If we simply reduced the benefit to 20 per cent.—at the moment, the Government have assumed that everybody getting personal care would have valued it as if they had been willing to pay for personal care insurance—the overall benefit in the calculation would be reduced from £365 million to £51 million. The overall effect of reducing those benefits—the benefits that justified the cost-benefit analysis in the impact assessment—is that the total costs exceed the benefits. In addition, when the £402 million opportunity cost of raising the taxation required to fund the measure is taken into account, as it should be, the policy has a significant cost in excess of the benefit.
Of course, the care services Minister was no doubt untroubled by any of those thoughts when he signed the impact assessment on 22 November. I am sure, therefore, that he will wish to disclose in full to the House his scrutiny of the impact assessment in responding to this debate. If he does not do so, he will doubtless want to do so in response to the freedom of information request I made today, asking him what questions he asked on the impact assessment before he signed it.
This is a short Bill, but it requires amendment to become much more flexible if it is to help in the longer-term process of delivering social care reform. It needs to accommodate insurance-based solutions. Amendments are also required to make much clearer the range of preventive measures and solutions that can be provided by local authorities. As I have said, the Bill also seems to have a serious potential flaw, in that it would distort the care market. It therefore also needs to show flexibility regarding domiciliary care and long-term residential care.
Members of the Labour party in another place have been pretty critical of the Bill. Lord Lipsey said:
“There was this Green Paper process going on, and then came along what somebody somewhere dubbed the Exocet:”—
I am not sure who dubbed it the Exocet; perhaps he did—
“the Prime Minister’s conference speech in which he proposed free personal care for all at home…the suspicion is born that it owed less to a careful policy consideration and more to the natural desire of all politicians to have a nice announcement to put in their conference speech.”—[Official Report, House of Lords, 26 November 2009; Vol. 715, c. 546.]
In the same debate, Lord Warner said:
“I do not see it as likely to be a particularly useful stepping stone to the wider reforms that the Government were…engaged on. It is not thought through and, to many people, it looks like a political gimmick.”—[Official Report, House of Lords, 26 November 2009; Vol. 715, c. 541.]
The Government could of course close their ears to criticism now and use their majority to push the Bill through the House of Commons, but it would then get bogged down in the House of Lords. Alternatively, they could make time available to work with us in this place to try to make the Bill a genuine bridge towards the reform of long-term care and support, to make it enabling rather than prescriptive on the structure of care and funding, and to allow it to promote a portable assessment of need and financial support, with a continuing central role for local authorities in commissioning and funding social care services in their areas. It is clear that local authorities and the NHS must be partners in this, and that they must enable individuals to exercise greater control. The last thing we need is what the Health Service Journal described last week as a takeover grab by the NHS for adult social care, or for primary care trusts to become responsible for all the commissioning activity and all the budgets.
The Bill needs amendment and further consideration in this place. We will not divide the House on its principle, but it must be made flexible. That means it should be given time in Committee and on Report in this House not only to investigate what it actually means—the need for that is becoming more evident as we ask questions—but to amend it. The programme motion seems offensive in terms of parliamentary scrutiny. The Government seem to be making the assumption that, because the Prime Minister stood up at the Labour party conference and announced something, it should be passed through this House without scrutiny or question. The Prime Minister does not control the other place, but it is an abuse of this House for the Government to behave in that way.
The Bill is required to be considered in Committee before its Report stage, and it needs to be reported to the House in the normal way, with an opportunity for further amendment and debate after adequate further reflection. So, although we shall not divide the House on the principle of the Bill, we shall divide on the programme motion later this evening.
The hon. Member for South Cambridgeshire (Mr. Lansley) described this as a short Bill, but it seemed to require him to make an inordinately long speech. In fact, his speech reminded me of the restaurant at the end of the universe in “The Hitchhiker’s Guide to the Galaxy”, especially when he talked about the Conservatives’ proposals to pay for residential care costs by putting £8,000 into a fund that would somehow make it grow in real terms to over £50,000. In “The Hitchhiker’s Guide to the Galaxy”, customers paid the exorbitant cost of their meal at the restaurant at the end of the universe by putting one penny into a bank account which earned compound interest over an almost infinite amount of time. By the time they had reached the end of the universe, they had amassed enough money to pay for their meal. There seems to be no way in which £8,000 can be put into any sort of fund and increase to £50,000 in real terms over 20 years. If the hon. Gentleman could tell me where to find such a fund, I would be very grateful. I would certainly put some of my savings into it as soon as possible.
The hon. Gentleman was right to say that, if the free personal care that we are discussing involved the entirety of personal care, it would be unaffordable. The Bill is not proposing to provide all personal care free to everyone, however. It proposes to provide a very small subset of people with free personal care. It proposes to provide the people with the most urgent and the most serious needs with relief now. To that extent, the Bill is a first step on the road to producing the National Care Service that the Government have talked about, and which I fully support. The fact that it is a first step, however, does not mean that it should not be carefully considered, or that we should not know anything about the other steps involved. I shall make a few comments about those in a moment.
I congratulate the Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope), and the Government on some of the elements that they have identified, especially in the explanatory notes, rather than in the Bill itself, as the Bill is a rather simple mechanism designed to achieve its ends. The Government recognise explicitly the benefits of extra care accommodation, of telecare and of encouraging independent living. Members on both sides of the House ought to be able to agree that those are laudable objectives.
I have been campaigning on extra care accommodation for some time. Last Thursday, I attended the conference of the Association of Retirement Housing Managers, many of whom promote extra care accommodation. We need to recognise its benefits in reducing the cost of delivery of care and improving the welfare of older people. I encourage the hon. Member for South Cambridgeshire, who seemed completely to misunderstand the benefits of such care, to give further consideration to that mechanism of providing accommodation and care to older people.
There is one key point that I want to put to my hon. Friend the Minister. The subject was also mentioned by the hon. Member for South Cambridgeshire, and I agree with him on this. We need to understand where this first step fits into the totality of the reforms that we are ultimately going to have to agree on. I want to highlight a concern relating to the three funding models in the Green Paper that are being actively considered. They are the so-called partnership model, the voluntary insurance model and the comprehensive model. I can see how the arrangements proposed in the Bill would fit with the partnership model, in that that model explicitly says that the state will provide part of people’s personal care. I can also see how they would fit with the comprehensive model, which would involve everyone having to take out an insurance policy.
My concern is that the arrangements in the Bill might not fit very well with the insurance model. People would have to assess the risk when deciding whether to take out insurance. They would have to strike a balance and decide whether it was worth their while to take the risk, or whether they should take some of their capital and buy an insurance policy with it. When there was no free personal care and it was means-tested except for the poorest people, the risk assessment would have come out in favour of taking up an insurance scheme if one became available. However, if we say that the state is going to provide free personal care for the most needy, I worry that that might tip the risk balance the other way, and that people might decide to take a chance. They would know that, if their needs became particularly serious later in life, the state would step in, so I do not see how the proposals would fit in with the insurance model.
That is important because we need to find a way of leveraging some part of people’s personal equity into meeting the cost of social care in the future. As we have all said, free personal care provided entirely by the state would be unaffordable. We therefore have to ask ourselves how we are going to leverage more money into the process. It could be done through higher taxes, or by finding ways of encouraging people to put part of their equity into the process. My favourite way of doing it, which I do not think any party is proposing at the moment, would be to use a hypothecated inheritance tax to meet the cost of social care. Instead of getting into the rather unfortunate bidding war over who was going to do the most to reduce inheritance tax liabilities, I would have proposed keeping part of the tax back to pay for social care. We could then have provided a much more comprehensive system. Such a tax would also be progressive, in that it would be related to people’s wealth.
My hon. Friend says, as so many Members do, that free long-term care is unaffordable, but that assumption is based on the present levels of tax. If we raised taxes and redistributed a bit more, it would be affordable. It is a question of whether we decide that it is affordable, not whether it is affordable objectively.
I accept that it is objectively true that if we raised tax, we could afford it. My hon. Friend and I have had the debate many times before as to whether people would accept that level of tax increases, particularly if it were income tax or taxes on earnings. I personally do not believe that they would; I know that he is a strong advocate of the case that they would accept it if they knew that it was going clearly into social care—that is the difference of opinion we have. That is exactly why my preferred solution to the problem would be a hypothecated inheritance tax. I think that that would be far more acceptable to people at large than extra tax on earnings, but that is a debate for another day.
When the Minister winds up the debate, I want to hear how he sees this Bill fitting into the wider reform. If he cannot tell us today because he is not ready to produce the White Paper, he needs at least to give us the assurance that, when he does produce it, it will clearly say how the measures in the Bill are going to fit in.
The hon. Member for South Cambridgeshire raised some points with which I had some sympathy. One is the exclusion from the Bill of personal care costs if people go into residential accommodation. If we are going to pay people’s personal care costs if they have the most serious needs, I do not see why we would want to exclude meeting those costs in residential care. We should not go down the route of paying people’s board and lodgings, as I believe that we all have a fundamental duty to contribute to our board and lodgings, irrespective of the level of our care needs, but we should eventually meet the element of residential care costs to do with personal care. I realise that that is excluded from the Bill, but when we produce the White Paper and move on to the next stage of reform, I encourage the Minister to indicate how that need is going to be met.
Carers also need to be taken into consideration. As I said in an intervention, under the Community Care (Delayed Discharges etc.) Act 2003, anyone making an assessment of someone’s care needs also has to carry out a carer’s assessment. It seems to me that if somebody is receiving personal care in their home and part of that care is coming from a voluntary carer, and if as part of the care plan that the Secretary of State talked about, the need for that carer to have some respite from time to time is identified, I would hope that we could include the cost of that respite within the ambit of the Bill.
The issue of benefits is certainly going to be raised. I have spoken to the Minister and to the Secretary of State about my concerns. Frankly, I would deal with that by allowing people to continue to receive attendance allowance, and not reform it. I have previously described attendance allowance as the ultimate direct payment, since it is not means-tested and provides cash that can be spent however the person wants to meet their care needs, as long as they go over a particular care threshold. Because of that, it is very valuable. For people who have saved and have some income, as a result of which they are excluded from pension credit, it can be a godsend if a non-means-tested benefit is available to them.
Having said that, I understand the Government’s position that people cannot receive money twice, so if they are having all their care needs met, they cannot also expect to have attendance allowance on top of it. What we could do, of course, is continue to give people attendance allowance, but top it up to the level needed to meet their care assessments. In that way, we could maintain attendance allowance and meet the full cost of people’s personal care, which is the aim of the Bill.
I just want to put to the hon. Gentleman the thought that the benefit of attendance allowance is that it can be spent on what would not necessarily be regarded as part of a care package, but would immeasurably contribute towards somebody’s well-being. For instance, if a keen gardener became unable to continue gardening, they could pay for a gardener and enhance their own satisfaction at seeing the lawn cut, which might keep them psychologically on an even keel.
The hon. Lady is absolutely right. That is why I call attendance allowance the ultimate direct payment: it is cash to meet people’s care needs however they want to meet them—and they could meet them through telecare; they could meet them through providing money for a carer; they could even use it to save up to provide respite care and pay it to a voluntary carer or a family member. As I say, it is theirs to do with as they like; for that reason, it is an incredibly powerful benefit.
I take slight issue with how the hon. Member for South Cambridgeshire put it. If the Government chose to pass the value of the attendance allowance to the local council to meet someone’s care needs, other legislation that we have at the moment means that someone can simply ask their local council to have their care needs met by a direct payment, rather than with direct care. In other words, they would get the cash back by another means if they wanted to go through that route. My argument is: why go through that route? Why not just leave the attendance allowance in place, with all its benefits, and top it up to the level of free personal care? I hope that the Government will ultimately come to that conclusion.
In terms of how the money is to be provided to people to meet their care needs, I hope the norm will be that it should be provided in terms of a direct payment that they can spend how they want to meet their care needs the way that they want, which raises the question, of course, of how it will be assessed—whether it will be assessed by the normal processes councils go through at the moment when costing someone’s care plan, or whether it will be some sort of flat-rate payment. Although a flat-rate payment might be simple, I would certainly not want to choose that particular route.
The Government could have met their objectives in several ways, I guess. They could have had a much more complex Bill, which would clearly not have been passed before the general election, so it would not have given people in the most urgent categories of need the care that they need in the time scale that we are talking about. They could have done it as they have done by essentially putting the onus on local authorities to decide the care package. There was a third choice, which I do not know whether the Minister considered. That was to alter the criteria for NHS continuing care—bringing those criteria down to include the category of people with the most serious needs, so that the funds would effectively have come through the national health service.
The Minister has chosen the route that he has chosen for good or ill, but I would like to suggest one way of achieving flexibility in the arrangements and perhaps even a better outcome for people. At the moment, local councils and local national health services can voluntarily choose to set up a care trust to manage the care of older people, in which case both parties put money together, which can be spent as the care trust decides. That gets over the problem that there are certain legal limitations on what the NHS can spend money on. Equally, there are certain legal limitations on what local councils can spend money on, but those limitations do not exist for a care trust. If everyone has put the money in together, it can be spent in the best way possible for the people concerned.
At the moment, that is a voluntary arrangement for older people; it is not a voluntary arrangement for children, as we have reached a position where we insist on children’s trusts being created to manage the funds from all the various agencies on behalf of children. I have never quite understood why we have not gone the next step and insisted on the creation of care trusts throughout England, which would also help to leverage in some extra money, I suspect, from the national health service, as well as from local government. It would give us considerable benefits in implementing this type of care plan.
Does the hon. Gentleman accept that some councils would be better placed than others to find the money through their own provisions, so there is a possibility that these measures as presented by the Government could lead to a postcode lottery?
I certainly think that there is a risk. One of the risks could be reduced, depending on how the Government decide to distribute the money that is going to be made available. I think that it was the hon. Member for Beckenham (Mrs. Lait) who asked whether the money was going to be distributed through the normal local government formula or on the basis of need. If the Government were to choose the number of older people in a particular local authority area as a good proxy for the level of need in that area and distribute the money on that basis, I suspect that they might find that there were far fewer problems. That having been said, we all know that eligibility criteria are different in different local authority areas and charging regimes are different in different local authority areas.
The only local government funding that is not ring-fenced is funding for adult social services. That used to apply to all forms of social services funding, but the Children Act 2004 effectively took the children’s money away and put it into a ring-fenced fund. A local authority can only make up its own mind how much of its money to spend when that money is for adult social care, which is why many authorities choose to spend it in different ways.
Let me give a particularly bad example. When my local authority, Kent county council, decided that it needed to find several hundred thousand pounds to fund its own propaganda television channel, it increased charges for older people’s care. It can raid the fund and get away with it because it is a Conservative council, and because the fund is not ring-fenced. Perhaps we should consider reforming that arrangement as part of our overall reform of adult social care.
Having said all that, I should add that the Government have made it clear that the Bill represents only a first step towards the reform that we all seek—the first small part of the journey towards the creation of a National Care Service. Many questions remain to be answered, and we need to understand much more about the way in which the Bill will work once it has been implemented. However, to the extent that it delivers some urgent care for a desperately unhappy group of our constituents at this moment, and allows them to gain some relief while we deal with all these tortuous processes—
I am grateful to the hon. Gentleman for giving way just as he is beginning his final crescendo. He says that the Bill is a “first step”, thus suggesting that there are other steps to follow. Given the approaching election, and given that the first step was, in fact, taken back in 1997, when does he expect the next step to be presented to the Chamber?
The hon. Gentleman is trying to trivialise a serious issue. He may wish to visit the House of Commons Library and conduct some research on the steps that the Government have already taken in reforming social care. In particular, I suggest that he read a seminal document on the subject: “Independence, Well-being and Choice”, a Green Paper on the reform of adult social care. Modesty forbids me to tell the House which Minister was responsible for it, but it sets out exactly the action that we need to take in order to reform what the hon. Member for South Cambridgeshire identified as the key issue: the quality and level of provision of social care. How are we to make the whole process more affordable? It started with that Green Paper. The process that the Government have gone through, the consultation, the Green Paper and the “Big Care Debate”, allow us to create a structure—[Interruption]—in which perhaps—[Interruption.]
That process allows us perhaps to create a framework within which we can proceed to at least a partial consensus. Whatever we decide to do will have to last through Government after Government. Even if we assume that at some time in the far distant future the Conservative party will win a general election, the consensus will have to survive.
The Government initiated that first stage. I expect further reform to be highlighted in the White Paper that I hope we will see in the new year. I want to see a Labour Government make reform of the funding of social care and implementation of the White Paper their highest priority immediately after we win the general election in the next few months.
I am pleased to follow the hon. Member for South Thanet (Dr. Ladyman). What he said towards the end of his speech was absolutely right: the reform has to last. What worries many of us, however, is that the Bill may not be moving us in the right direction.
The hon. Gentleman raised a number of legitimate and serious concerns about aspects of the Bill, and made a number of other good points. I agree with him about the value of care trusts and bringing together health and social care organisations. There have been some exciting developments, particularly in places such as Torbay where the integration of services appears to be improving as a result of the pooling of resources.
It is good that, at long last, we are discussing this most urgent of priorities. The Secretary of State made the fair point that much had happened over the past 12 or 13 years, and it is true that in some respects the position has improved. The right actions have been taken in respect of the personalisation agenda, for instance. Useful ideas have been developed through a partnership between central Government and local authorities.
I was about to add that although some good things have happened, since the commission reported there has been inertia, and deterioration and decay of the system have affected many people. If we are honest, we will admit that we all know that many elderly people are not receiving sufficient care or—as the hon. Member for South Cambridgeshire (Mr. Lansley) pointed out—care of sufficient quality.
Over the past 12 or 13 years, we have seen an escalation in fees and charges and a tightening of the criteria. Far fewer people now access care from local authorities. All that is evidence of a deterioration of the system and a growing crisis for many vulnerable people. That is why our priority is to address the problem in a way that will last: to produce reform that is supported by a consensus, and is sustainable.
The reason why the Liberal Democrats have moved away from the position of the royal commission—we will be quite up-front about this—is connected with that question of sustainability, which was mentioned by the hon. Member for South Thanet. Given demographic change and the ageing population, the cost of genuinely free personal care for all would be enormous. We should also bear in mind the care needs of not just elderly people but younger adults. More people with substantial care needs are surviving, and the total cost of that is huge. Our conclusion is that there should be a partnership between state and individuals, rather than the state’s bearing the whole burden.
The members of the royal commission subsequently made estimates of cost which were, at the time, the equivalent of 1 per cent. above the standard rate now, and 1.5 per cent. above the standard rate by 2050. The cost may even be double that. I have asked many people whether they would prefer the fear of not being cared for in their old age or a significant increase in tax to ensure that everyone is cared for, which is the basis of the national health service.
I respect the hon. Gentleman’s position. The increase would be significantly more than that at first. There is a perverse effect that one ought to consider. At a time when public finances are very tight—this is something that the Wanless commission specifically identified—a significant amount of public money is being given to some very wealthy people who could choose to fund at least part of their care themselves. I have severe doubts about whether we would be using public money to the best advantage by giving substantial sums to the very wealthy, which would be the effect of the policy that the hon. Gentleman advocates.
We will not divide the House on the Bill; we will support it at this stage to facilitate debate. We will vote with the Conservatives on the programme motion, because it is important that the Bill is fully debated and that there are no time constraints. I shall deal with the origins of the Bill first, and then its impact and where we go from here.
The Conservative spokesman, the hon. Member for South Cambridgeshire, made the point that the Bill came out of the blue in the Prime Minister’s speech to the Labour party conference. It is stretching language to the extreme to describe it as a bridge to a comprehensive reform of the care system. If it genuinely were a bridge, the Green Paper, which took many months to produce, would have referred to a first bridge to a new system, yet it was entirely silent on this unexpected proposal. The Green Paper was long overdue, but it was deliberative and consultative—it went through the process of consulting all interested parties—and, ultimately, it was quite well received across the health spectrum, and particularly by groups representing those with greatest need. Then the Bill came completely out of the blue.
In politics, the most devastating criticism tends to come from people on one’s own side, and that is especially so when they have expertise in the subject under discussion. That is true of the comments of Lord Warner and Lord Lipsey on this Bill. Lord Warner said of the proposals:
“There has been no proper impact assessment, and no data to show how this would work.”
Lord Lipsey was, of course, a member of the royal commission to which the Secretary of State referred. He said:
“I think it is a bad policy but also a very bad way to do policy just to find a nice highlight for your Labour Party conference speech.”
That is pretty devastating criticism. He also said that it was “a bit of gimmick”, and that he hopes that the Prime Minister
“will reflect on whether this proposal is in the national interest or merely designed to achieve party political interests.”
I cannot stop myself pointing out to the hon. Gentleman that Lord Lipsey was the member of the royal commission who wrote the dissenting report that the Government adopted, and that from the date it was produced until now the Liberal Democrats have been telling us that he did not know what he was talking about.
Lord Lipsey is a Labour peer who was chosen to sit on that commission and who until now has taken a position that is entirely consistent with the Labour Government’s. The Labour Government have now chosen to move away from his position. [Interruption.] As my hon. Friend the Member for Leeds, North-West (Greg Mulholland) says, that makes this measure even more devastating.
Was Lord Lipsey not put on that royal commission at a late stage by Downing street, in order to create a minority report and thereby to prevent the commission’s findings from being unanimous, and that he is now worrying that the Government will backslide on his minority report?
I have no idea, but I would not be surprised, given the way this Government operate. One is left with the sense that this is an utterly cynical move by the Government.
Not only people such as Lord Warner and Lord Lipsey have criticised the Bill. Niall Dickson, the highly respected chief executive of the King’s Fund, who is leaving that organisation after several years of service, has said that these latest proposals
“have been hastily put together and appear to cut across the options set out in the government’s own Green Paper.”
He did not see them as a bridge to the future, either, adding that:
“After all, the government has only just finished consulting us on the very different proposals set out in that document.”
He went on to talk about the “danger of perverse incentives”, which is another point that the hon. Member for South Thanet rightly raised.
Does the hon. Gentleman agree that the economic modelling that lay behind the Green Paper might not have been made available, in part because it had to be re-scrambled and meshed with the unbridgeable announcement made at the Labour party conference?
The hon. Gentleman makes a very good point, and I suspect that his assumption may well be correct. Ultimately, this is law-making of the worst possible kind; it is from the “back of the fag packet” school of legislating. It is all about electioneering, but it is not about serious reform, which is what we all ought to be engaged in.
That has neither been addressed in the Bill, nor been addressed for a very long time. The costs of delivering care in rural areas are often much higher and, to mention just one difficulty, it is often very difficult to recruit care workers, so the hon. Gentleman makes an important point.
This whole process raises some serious questions about who is ultimately responsible for the proposal. Given that there was nothing about it in the Green Paper, did it emanate from the Department of Health or from No. 10 Downing street? How long had the team at the Department of Health been working on the proposal prior to that conference speech? Does the Minister wish to intervene, because I would be very interested to learn when that information was made known to the team working on the Green Paper? When were they informed?
I turn to the impact of the proposal. I completely support the Bill’s measures on reablement. It makes absolute sense for much more to be done to prevent ill health in the first place, and to ensure that resources are put into maintaining people better in their own homes, but are the measures consistent with the Green Paper objectives? The Green Paper stresses the need to make the
“best use of public money to provide a joined-up, consistent and fair care and support system”.
I strongly endorse that objective. It goes on to say:
“We can use the taxpayers’ money that is already in the system to provide everyone”—
not just one group of people—
“with some care. We believe that that should be the starting point”.
That is interesting, because that appears to be a very different starting point as a bridge to a reformed system. The Green Paper goes on to say that
“any system must be a partnership between the state and individuals”.
The Green Paper also rules out funding the new system from taxation as too heavy a burden on people of working age. I appreciate that the intention is not to provide care for all, but for the Bill to go in that direction appears to be completely contrary to the intentions of the Green Paper. Therefore, the Bill fails on all these tests: it is not joined up; it is not consistent with the Green Paper; it helps one group, but not all; it is not a partnership approach; and it is funded by general taxation, contrary to the intentions of the Green Paper.
The hon. Member for South Thanet hit the nail on the head, because the number of people who will benefit is much lower than the headline number of 400,000 of which the Government have sought to convince the public.
I want to deal with the potential perverse effects of the Bill. It is a partial solution, and the risk of implementing a partial solution was highlighted by Niall Dickson. Andrew Harrop of Age Concern and Help the Aged also specifically highlighted the risk that the Bill will push councils into getting people into care homes, thereby avoiding the cost of caring for people at home. According to Andrew Harrop, there is the alternative risk that councils will argue that someone’s need is not critical—that as a way of avoiding responsibility they will find that people fall below the level.
There is also a risk that the Bill will take money away from some vulnerable groups in order to give it to a particular group of vulnerable people and that we will end up with a costly and demeaning process of disputes about whether someone’s care needs are “critical”. We are likely to see a bureaucratic and time-consuming process of social workers carrying out assessments to determine whether someone’s needs are “substantial” or “critical”.
Could all this not be overcome by providing long-term care, either at home or in care homes, free of charge—just like the national health service? All the cost and the problem would thus disappear. We are talking about money and not about care at the moment.
The hon. Gentleman is right in one sense, because he is advocating a comprehensive system that applies to everybody; when we start applying a process to one group of people, we create perverse effects and bureaucracy in determining whether somebody falls into or outside a category. He rightly identifies the need for a comprehensive solution.
The hon. Member for South Thanet also accurately identified the risk of a disincentive for people to take out insurance. It is almost inevitable that insurance will be part of the overall solution that we seek to achieve—if we can build a consensus. The Bill inevitably amounts to a disincentive for people to take out insurance to protect against potential need. Who benefits from the measure? Remarkably, paragraph 5.21 of the impact assessment identifies the group that will benefit most as the “wealthiest older people”. It is bizarre in the extreme and it is extraordinary that the Government have chosen a partial solution—rather than a comprehensive one—that, according to their own impact assessment, benefits most the wealthiest older people.
There is also uncertainty about the cost and the number of people who will benefit. The impact assessment is riddled with uncertainty about the cost, and the Local Government Association has highlighted the point. First, the impact of take-up by people who are funding their own care is unknown; we do not know how many of the people who are currently funding their own care would come into the system. All we have is an estimate—that is all it can be. The Government say that they are confident that the figures are accurate, but they have no basis for that confidence. The impact of behaviour change with regard to residential care is unknown. The Conservative spokesman highlighted that the figures in the impact assessment are inconsistent with each other on that point. We do not know how many people will move from residential care to being cared for at home to take advantage of the offer of free care.
The data on the number of those who are classified as “critical” and the relative distribution of their needs and disabilities are not collected centrally, so again we have no idea how many people we are talking about. We also do not know how many people are already receiving reablement. We do not know the proportion of those who after receiving reablement would not require care. Thus, the central assumption on cost and numbers in the impact assessment is uncertain. If the Government are wrong in their assessment of the total cost, what would be the consequences? We know from the consultation paper on the regulations that there is a fixed total sum available, so who would lose out if the figures were wrong? Will the criteria be tightened even more—beyond the calculation of “critical” need? Something has to give and the Government have not said what that would be.
The LGA also raises serious concern about the potential for local government to fund its £250 million a year contribution. It is already making substantial efficiency savings, regardless of the £250 million that would be required. We know that over the past decade social care has been the poor relation of the health service in funding increases. At each spending round the health service receives a substantially greater real-terms increase than social care, and now the Government expect social care to come up with £250 million of efficiency savings to contribute to the cost of this measure. We have no way of knowing whether the system is capable of delivering that sort of sum. There is a real risk that it will amount to robbing Peter to pay Paul, taking care away from one vulnerable person to provide it to another whose financial resources may mean that they are actually better able to pay. The Secretary of State has today conceded that the total number of people who will benefit is 110,000—not the 400,000 that has been talked about. As the hon. Member for South Thanet said, the Bill benefits a very small subset of people.
On specific issues relating to the Bill, I would be grateful if in winding up the Minister would deal with concerns that some groups have about the meaning of “critical”. Will meeting just one of the critical areas, as defined, be enough to allow someone to qualify? What is the meaning of the “significant help” needed for the four daily activities? There is surely a need for greater clarity on that. Sense, the organisation representing deafblind people, refers to the fact that personal care, as defined in the Bill,
“excludes the type of communicator guide support which is so vital to deafblind people.”
That group is one of the most at risk of having to go into residential care, but it is excluded from help—surely that cannot be justified.
Where do we go from here? There are serious concerns about the perverse impact that this unsatisfactory measure could have. The most pressing priority is to put in place a comprehensive, sustainable system—one that will last, as has been said—that will guarantee care for those who need it most, funded in a way that is fair and recognising the reality of the public finances. There is an urgent need to build consensus. Any Government coming to power next year, of whichever party or parties, have a massive challenge ahead of them in resolving this issue—such a resolution is overdue. Given the state of public finances, there is a real risk that this issue will be pushed, yet again, into the long grass. Surely we should all commit now to a process to secure a consensus. It is in the interests of any incoming Government that a process is already in place to achieve that. We should establish now—we should not wait until the next Parliament—a cross-party commission with a defined remit of achieving consensus in a tight time scale. Let us just imagine how the public would react if they saw the three main parties agreeing to come together to recognise that this challenge must be faced and must be met without further delay. That is necessary and it is of acute importance, so I urge all sides to agree to a process that secures that consensus on a sustainable system that will last into the future.
It is a pleasure to follow the hon. Member for North Norfolk (Norman Lamb), who spoke of things being kicked into the long grass—I suspect that a fair bit of that is occurring on the Opposition Benches to say the least. It is disingenuous for the Opposition to say that they do not intend to vote against the Bill in principle and then to go about trying to take it apart piece by piece and rubbishing it before it can get a head start.
I thoroughly support the Bill. Of course there are difficulties and issues to clear up, but at the heart of it we need to remember that it is desperately wanted and desperately needed by many people who live in fear of their future. This House has a responsibility to respond to those concerns, and not only to consider the measures carefully, but to ensure that they are put in place.
I firmly believe that the Bill is an excellent stepping stone to the much greater piece of work that is going on. Frankly, I would have gone straight for the National Care Service and forgotten about the consultation. It feels like motherhood and apple pie to me—like the early days of the NHS—to go ahead and set something up in that spirit. We should be considering social care in the same terms as the NHS. Of course, many people in the Chamber have had the opportunity to spend a lot of time examining the Bill in detail—including how we came to the position that we are now in—but I firmly believe that we need to get back to the principle of worrying about those who, without question, will benefit from it.
With those people in mind, I want to give a few reasons why we need to buckle down and get the Bill into place. It is not only desirable, but much needed. I was a member of the nursing profession for many years before I was elected to the House of Commons and was deeply aware of those people who, without support and help at home, found themselves in hospital or in social care. There is nothing worse for an acute nurse to know than that somebody for whom they are caring could, with proper support, have been kept at home and had the comfort of knowing that they would be looked after in their own home. For the people for whom this Bill will be most helpful—those with the dementia range of conditions—entering hospital for rehabilitative care is often incredibly damaging. It is confusing and upsetting, families become upset and it is often obvious at that point that it could have been avoided. For that reason alone, and for the many patients whose cases I have in my head who could have avoided admission, I support the Bill.
I was very interested to hear the Opposition suggest that carers would step away from helping their relatives if such a Bill were passed. Frankly, I found that insulting to carers. Anybody who undertakes that work knows very well that they want to work in partnership with the care services. They want to have time to be on their own and to be able to share their experiences with friends and families, without the constant burden of caring for their loved one. This Bill will help many hundreds of people to live their lives as carers in much more certainty.
I think my hon. Friend has answered my point, in a sense, but does she not agree that hundreds of thousands of carers have enormous pressures on them because of elderly relatives who need much more care than they can possibly give and that giving more assistance to them is precisely what we should be doing?
Indeed. I thoroughly concur with those views. That would improve the quality of life not only of the person in receipt of care but of the carers.
Many authorities are beginning this work already and that is why I do not have the depressed view that we cannot tackle the problem at this point. A year ago, the previous Secretary of State, my right hon. Friend the Member for Kingston upon Hull, West and Hessle (Alan Johnson), came to launch our well-being programme in Crawley. The local authority has come together with NHS West Sussex to provide excellent care at home—not only education on eating and smoking, but a full service that includes advice on preventing trips at home. I can imagine how much better it will be when we have a more comprehensive home care service for those people.
This Bill is utterly doable. It is disingenuous to say, “We thoroughly agree with it, but we will now produce 101 reasons why we do not believe that we can move forward.” Those who will benefit from the Bill will listen carefully to those words—I shall ensure that they hear them. I hope that with due consideration of the Bill, in a reasonable and timely way, which of course we can achieve with one clause, we will move forward and get it in place. We can then move on to a National Care Service, which will be welcomed wholeheartedly in this country.
I am delighted to follow the hon. Member for Crawley (Laura Moffatt). I think that the point she was making—I hope that I am correct—was that more people need access to top-quality services to ensure that they stay in their own homes for as long as possible. I do not think that there is any argument in the Chamber about that statement. The question is how we can best get there.
I am very conscious of the question of whether the Bill is needed at all, given that the best evidence that the Secretary of State could give us concerned the work that is being done on the Isle of Wight. The hon. Lady mentioned what is happening in Crawley, and I am sure that we can all cite cases from our social services departments in which, over the years, they have become more involved in intensive rehabilitation. That shows that these services are already emerging. I often wonder why we need to pass legislation so that people can continue to provide best practice. If it is best practice, and if it is saving local authorities substantial sums of money, it is in their best interests to do it. They do not need the legislative burden that is being imposed.
Although we agree that there should be better services for personal care delivery, the Bill is next to redundant. We should be moving much more towards deciding—as my hon. Friend the shadow Secretary of State for Health pointed out and as the hon. Member for South Thanet (Dr. Ladyman) implied, too—that there are a range of different ways in which to finance the achievement of better personal care. We would be better off, frankly, doing it comprehensively rather than piecemeal. The Bill has been referred to as a bridge and as a stepping stone, but I suspect that, in the long run, it will go on the statute book and will be ignored, not implemented or will have to be comprehensively reworked, should another care Bill be proposed.
In one sense, I welcome the debate that we are having on such a short Bill—it is, fundamentally, one clause long. Most of the Opposition’s contributions have certainly questioned how effective it will be. I represent a constituency in the London borough of Bromley, which is one of the wealthiest boroughs in London. It has, without doubt, the highest proportion of retired people of all the London boroughs. The hon. Member for North Norfolk (Norman Lamb) said that the Bill will mainly benefit wealthy people, and that is highly likely to happen in my borough. Apart from three main areas where we have genuine deprivation, the rest of the borough is relatively wealthy. People in the borough will have been meeting their needs using their own resources. The flaw of the Bill is, as he pointed out, that people who have been doing that, who might be in great need—I am not saying that they are not, and I sympathise entirely with their need to get proper care—have not been cared for in the public sector, and that the costs of care will therefore run completely out of control.
I am also concerned that East Sussex—here I declare an interest, because my husband is the leader of East Sussex county council—has a high proportion of retired people. Those people are not, by any means, the wealthy retired. If whatever money that is forthcoming from the Government—from saving on ad campaigns and research money—is distributed according to the local government formula, that will penalise people in counties such as East Sussex that are already suffering because of the perverse nature of the formula. I suspect that the hon. Member for South Thanet could say the same about his part of Thanet, although it is in a very wealthy county. If the money is to be distributed on the basis of the needs of the population, I foresee some squawks from the friends in the north, because it is much more likely that money will go to areas in the south with high numbers of retired people, which are not necessarily Labour controlled—not that much of local government is these days. We foresee perversity emerging in a variety of ways in relation to this one-clause Bill.
I have been advised by a member of the Association of Directors of Adult Social Services, who is such a director, that the costings have not been shared with the social services department or with a wider audience and that the estimates of need have not been shared. Estimates are therefore a wild approximation of what the demand, and hence the cost, will be. The Government could find themselves in a position that they do not want to be in of being unable to fund the programme that they have put in place.
Another area that the Government probably have not worked through properly—my hon. Friend picked up on this point—is the sheer scale of need in relation to the professionals required to deliver the rehabilitation services that everyone is talking about. I use the word “rehabilitation” quite deliberately, as I think that “reablement” is another ghastly politically correct word and that we would be better off using a familiar one.
There are already insufficient occupational therapists. Anyone who needs, or knows someone who needs, an occupational therapist knows how long people have to wait for one. Anyone who needs physiotherapy knows how long it takes to get a physiotherapy appointment unless they have an immediate medical requirement. We can forget about psychologists, given how long it takes to see one, particularly following the introduction of talking therapies. It will take years to get hold of the professional skills that will be required to deliver the rehabilitation services that we would all like, because we have to recruit professionals from schools, get them through their training and then through what are, in effect, apprenticeships. It is almost an unfair promise to say that comprehensive services will be delivered to elderly people who are in great need, because we will not be able to get those services to such people as they need them.
I am enjoying the hon. Lady’s contribution, and I agree that there is a serious issue with providing those different professionals, but does she agree that we will have to go through that process anyway, irrespective of what reforms we agree in relation to the model for funding social care? We will have to make those changes anyway, so those points are irrelevant to the Bill.
I wish that they were irrelevant. The purpose of the Bill, if I have read the Government right, is to be able to say during the election campaign, “We will deliver to you, from October 2010, these sophisticated services,” but those sophisticated services will not exist in the volume that will be required. That is the unfairness implicit in that promise.
Bed blocking will still be an issue, and the hon. Gentleman has taken me around in a circle back to where I needed to be. Many years ago, we spent endless hours in the Chamber talking about bed blocking. We were talking about it then because assessment processes were not in place. They are now better, and although I would not say that bed blocking is gone, we are not talking about it to the same extent. Also, we now realise that once an elderly person, or someone who is not very mobile, has been in a bed for 48 hours, they will need intensive rehabilitation to get them back into their home. Some of those services are available and are better than they were, but provision certainly is not as comprehensive as the Bill promises. It has, however, shown the need for expansion in the availability of those skills, and we have not addressed that problem.
The Bill amends the very Act that sorted out bed blocking. It takes the Community Care (Delayed Discharges etc.) Act 2003 and simply says that we are going to make services do what the Act requires of them for longer than the current six weeks. I agree that the situation is not what the hon. Lady wants it to be and that we need those extra professionals, but the key thing that the Bill does is to say to people who are currently funding their own services that we will fund such services for them in future. It will take a long time to deal with her logistical concerns, but they are not relevant to the Bill.
I congratulate the hon. Gentleman on getting in a mention of the 2003 Act, which he took through Parliament, and I congratulate him on the Act. Let us not get into a long debate about how bed blocking was cured. The point remains that the Bill explicitly promises that from October 2010—only 10 months from now—people’s rehabilitation care will be provided for an indeterminate length of time, and the relevant services to do that do not exist. That is the unfairness of the Bill.
My hon. Friend makes her points extremely powerfully. It seems to me that she is worried about promises being made on this vital service, on which so many people depend, not least given the experience in Scotland, where the capacity to deliver against a promise simply was not available. Therefore, the promise could only be broken because there was not the capacity in the first place. Is that the case?
My hon. Friend is absolutely right. My mother benefited from that system when it first came in. Sadly, just after she died, the budgets had to be cut back. I have seen that situation on a practical level. We face a general election in six months, and this is yet another Bill that should be called a “shore up the Labour party vote” Bill. That is what is so distressing about this short Bill.
I want to hop briefly on to another of my current hobby horses—the programme motion, which I am glad we are voting against tonight. Yet again, we have a demonstration of how the Government have inadvertently ceded to the House of Lords legislative control over the Queen’s Speech. It is no longer this Chamber that makes final decisions on legislation, but the House of Lords. I do not find that acceptable. I was not elected to this place to give my job to the House of Lords and I very much hope that in a few months’ time when my Government come in they will reverse the process of ceding control to the House of Lords.
We all know why the current Government, and indeed former Governments, have not moved rapidly on personal care—it is horrendously expensive. If we look for a moment at the economic situation, we see that the country is accumulating a large debt. If we look at the pension situation, we see that people are living longer than ever and if we look at the care situation, we see that because people are living longer and are frail, there is potentially a large bill for the Government, local authorities and individuals.
There is no easy answer. Earlier in the debate, one or two Members suggested that we should just lump the costs on to taxation and that might do the job, but of course the British tax system tends to hit people at a lower and poorer level than is sensible. All the surveys on poverty show that young families with children fall into the bottom poverty quartiles—at least for a period, when one parent cannot work.
It would have been far better had the Green Paper in July been allowed to take its course and if we had accepted representations from a range of people and taken a decision about where we wanted to go in the future. The Government could have introduced a degree of certainty in the debate, so that both the private and voluntary sector and local authorities could plan and work to it. If we want any kind of insurance scheme to be a success, we have to be sure that the boundaries are clearly drawn—what the state will do and what individuals are expected to do.
I have the privilege of representing a constituency that is probably in the top 35 in terms of older electors. It is not unusual for an elderly couple to come to see me at my surgery about their parents who are even frailer. The problem is that the system relies greatly on carers, some of whom are very elderly and unable to lift their loved ones or look after them. It is a good thing that families care for the elderly, and it needs to be encouraged. One of the things we need to look at as a state is whether if we gave individuals personal budgets, they could use that money to pay their relatives to look after them. From my understanding of the situation in Holland and one or two other states, I think that would be a good thing.
Because of the sudden rush of blood to the Government’s head, we have a partial change that will have perverse incentives on the rest of the system. We have not managed to ascertain tonight quite what the demand will be—until the service is implemented we shall not know—and as my hon. Friend the Member for Beckenham (Mrs. Lait) said, we do not know whether there will be full back-up. A big problem in Poole is that if somebody wants to stay in their own home, they need adaptions, which sometimes need planning permission, but the budget seems to be limited so it takes some while to get the adaptions that people need. That is one of the factors that will cause a problem.
I am a little concerned about the funding, which seems to be calculated on the back of an envelope. In all my time in both local and national Government, there has been something called the magic pot, which is usually somebody else’s efficiency savings projected over a period of years. If somebody else works a bit more efficiently, we can fund a particular service in the full knowledge that if local government cannot provide it efficiently, it will have to put up council tax.
I spent longer in local government than I have as a Member of Parliament, and in my humble opinion local authorities are, on the whole, quite efficient at delivering services. They are certainly better at controlling money. They are better at dealing with a limited amount and getting what the Government want from it. It may not be everything the Government want, but local authorities manage to deliver an awful lot.
I am not sure that the measure is being properly funded. The council element is questionable, as are one or two other elements, so the problem is that we shall come back to the pinch point of eligibility. At the end of the day, if councils do not have enough money, they will use eligibility criteria that fit the funds they have. Local authorities have been capped and are expected to make savings. On top of that they are now expected to deliver a major reform, which will require a great deal of investment—for example, in physiotherapists and adaptions to homes. It will also require funding, and ultimately if the funding is not there, the legislation cannot be carried out.
Another perverse incentive is that, to some extent, the measure would discriminate against people going into care homes, which may be the best thing for some people to do. Families may try to keep someone in their own home when it is inappropriate because they do not want to burn up the value of the house by moving that person into a care home.
We need to think carefully about the measure. I am glad that my hon. Friends have said that they intend, if given sufficient time, to scrutinise the Bill fully to ensure that we have answers to some of the major questions that have been raised.
The hon. Member for North Norfolk (Norman Lamb) made a very good point; there is a lot to be said for all-party consensus. Whatever is agreed needs to be agreed for between five and 20 years. We do not need somebody coming in with their new version and reinventing the wheel. We need long-term arrangements, so it is a pity that the Government rushed off in their own direction and did not listen to the opinions of the consultees, who initially thought they were genuinely being asked and were a little upset that the Government had already made up their mind—certainly on one aspect.
My hon. Friend the Member for Beckenham made an important point about the distribution of the money on the basis of grant. Many of us have a heavy weighting of elderly, but also low grant levels, which will create a difficulty in delivering services. If the money is distributed on the basis of an older population, it would be welcome but there will clearly be losers, who might have an opinion. There are some very wealthy areas of Poole, but although many of my constituents have an asset in the form of a home that is worth a lot, their income is low—not least because people’s pension arrangements have not been quite what they expected, for various reasons.
Keeping people in their own home if they have no income or savings will be at a high cost, even if we can find enough people to run around and look after them. At present, many members of the Polish community do a great job looking after the elderly in most of the care homes in my constituency, but there will be a real problem finding people with adequate training to provide those services. In the past, as we all know, because of staff turnover and the terms and conditions both for those who work in care homes and for those who deliver care to individuals in their own home, the commitment to training has not been all it should be. If we are serious about providing a care package for people who remain in their own home, we have to increase the pay, rewards and training for those who look after the elderly, so that they receive the best care and so that caring is seen as a proper career and people do not go into it because they cannot do, or are not skilled enough to do, anything else.
The Bill is interesting and I am glad that my hon. Friends will scrutinise it fully. We have a major problem, however. This is yet another initiative that, however worthy, needs to be funded against the background of a country that is spending rather too much. Unless we get a grip on that, there will be problems in the long term not only for our fellow citizens but for the children and grandchildren of some of the people we have been talking about in the debate.
If the Bill were an emergency measure—an emergency response to a problem—it would have happened sooner. After all, the circumstances with which it deals are well established and well known. If, on the other hand, it was not an emergency measure, it should have been part of a bigger Bill, a greater plan, as was envisaged in what the Government said earlier this year, as highlighted by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) from the Front Bench and by others.
So one is left in a quandary about what the Bill is for. There are those in the Chamber who would take a cynical view. I alluded earlier to that view, my hon. Friend was kind enough to say, with irony. Some would say that it was purely a political calculation, but I like to think better of the Government than that. I cannot believe that Government Members would behave in such a low and dishonourable way. It would be certainly hard to imagine them doing so.
I want to spend some time considering the Bill on its merits, however slim they might be. My hon. Friend identified two prevailing themes that should have underpinned the legislation. He spoke of quality. If we were to break that down further in respect of care, we would talk about where care was provided, by whom, at what point and in what form. One might have hoped for a little more clarity about any or all of those aspects of care in the opening speech from the Secretary of State, but it was short on such details, as is the very small Bill itself. We are not left in any greater certainty about what is to be provided, where, when or to whom; or at least not exactly to whom, for although the explanatory notes make an estimate of the number of people affected, as my hon. Friend highlighted, this calculation is imperfect.
From even a preliminary glance at the Bill, it seems to me that it is likely to have two profound effects. One is a displacement effect on what is already being done, and the second is a catalyst effect on what might happen. Let us deal with them in turn. The displacement effect could have severe repercussions, certainly for local authorities, which are to provide much of the service on an unfunded basis. From where will they draw the money and what other services will suffer as a result of this displacement?
It is difficult for me to comprehend that anyone would want to read a newspaper during this immensely penetrating and exciting oration, but self-delusion is a feature of politics, I suppose.
The displacement effect of the Bill is likely to be serious. The House deserves a better explanation of what the Government have modelled in those terms. We heard earlier, rather alarmingly, that the consultation on the proposed legislation has been, at best, slight. None the less, it is inconceivable that the Department will not have modelled some of the effects on local authorities. I hope that when the Minister sums up, we hear more about that modelling.
There is a displacement effect in other respects. Other services that are provided to people in order to deliver the quality of care to which my hon. Friend referred may be at risk, as my hon. Friend the Member for Beckenham (Mrs. Lait) highlighted.
Equally limited is the estimate of the catalyst effect of the Bill. When I come to the main part of my speech, I shall speak about the home and care in considerably more detail, but in these preliminary remarks, I urge the Government to provide, perhaps in the summing up, greater clarity about what the catalyst effect might be.
It is surely inconceivable that people will not reorder their affairs to take advantage of the extra care. That is not in any sense a criticism. I guess it is what many of us might do in similar circumstances, but again, there is a singular absence of information about that—no obvious estimate, no modelling available to the House. I entirely endorse the sentiment expressed from those on the Opposition Front Bench that these matters need to be explored in considerable detail in Committee, which is why the programme motion is disappointing, to say the least.
The only modelling that we have is in the explanatory notes, but the calculations there—the estimates of the number of people in the main beneficiary groups and the table that forms part of that—seem to be imperfect. My hon. Friend the Member for South Cambridgeshire mentioned the mathematical imperfections. Given the displacement that I described and the incentive effect that I mentioned, perhaps the table ought to be recalculated. I hope that a pledge might come from Ministers to examine those matters more closely in the light of the contributions of various hon. Members on both sides of the House.
When I asked the Minister about the cost of individuals giving up their time—constituents in Braintree often tell me about the time that they give—the figure was some £80 billion. That represents what all our constituents collectively do by way of giving to family members and close friends. However, there is a sense of social contract and obligation that the Government should have in respect of our constituents who put in time—that is, non-financial benefits and non-financial support. Has my hon. Friend thought through these issues and the shortcomings of the Bill with respect to the non-financial support that the Government should give to our constituents?
Indeed. That very good point was made not only by my hon. Friend, but also by the hon. Member for South Thanet (Dr. Ladyman), who speaks with some authority on these matters. The hon. Gentleman asked the Secretary of State about the relationship with carers and the effect of the Bill on carers. In doing so, he was echoing the sentiments so strongly expressed when the Bill that the present Bill amends was introduced in the House back in 2002.
The then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), made it clear that the purpose of that legislation was to marry care with health and to take into account all the elements that constitute quality care—not merely the information provided by health authorities to those responsible for care, but some calculation of the various individuals and agencies that collectively comprise quality care. I shall have more to say about the 2003 Act, which has been mentioned several times in the debate, and about how the Bill marries with that precedent.
There is a legitimate difference between principle and purpose. That is not, as it might seem, axiomatic. The principle on which the Bill is founded—that of care in the home—is shared across the Chamber. The purpose of the Bill, however, is less clear. Its purpose in respect of delivering that principle is—I put it as kindly as I can—questionable, because although the Secretary of State claimed in its defence that it was paving legislation, when challenged repeatedly through interventions and by the Opposition Front-Bench spokesmen, he conceded, quite generously and certainly openly, that further legislation would be required. Indeed, he spoke of “a major reform” being necessary, but he made no attempt to suggest that this Bill was that major reform; he said merely that it anticipated the major reform that was essential to satisfy the principle and to deliver the objective that all Members share.
I am listening in awe to my hon. Friend’s great speech, which is clearly schooled by the great compassion that he has for his many constituents who find themselves in difficulty. One thing of which I am sure he is conscious is how the Government did not make their case that there was a bridge between the Bill and the Green Paper process, which had legitimised so much of the debate to date. Does he therefore agree that it would be appropriate for the Government to provide time for amendments to be made to the Bill to widen its ambition and ambit, not least so that we can put it into the context for which he argues on behalf of his constituents?
I am grateful to my hon. Friend for his intervention, because he, as a Front-Bench spokesman on these matters, knows far more about them than I do. He is right that I am, however imperfectly, a champion for my constituents’ interests, particularly my most vulnerable constituents, for the cause of the most vulnerable lies at the heart of Conservative passion; for a core tenet of Conservatism is the elevation of the people: the responsibility that the fortunate have for the less fortunate.
On my hon. Friend’s intervention, it seems to me that the Government have two options: either they can do as he invites and make the Bill bigger, build on its slim elements and create the major reform that the Secretary of State acknowledged was necessary; or they might choose, as a result of this debate or further reflection, to withdraw the Bill, continue the process that they began earlier in the year, recognise that bigger legislation is the best way of proceeding with these matters and acknowledge—I suppose rather grudgingly, but it would be to their immense credit if they did—that this Bill was a gimmick and that the subject deserves more.
Let us assume that there is a White Paper in the new year; that there is a discussion about it; that a consensus begins to emerge; that a new Government are elected, perhaps, in May; and that they come to the House with a much wider social welfare reform Bill, which would take the best part of 12 months to go through. That would mean that the wider reform of which the hon. Gentleman talks would take, with the best will in the world, approximately 18 months. Is it not reasonable for the Government to introduce this small measure, which will help some people with the most serious needs between now and the conclusion of that process 18 months hence? He seems to argue for doing nothing for those people who need help now, while we carry on debating the issue for perhaps another 18 months.
If we were having that debate at the beginning of the life of a new Government, or at the end of the first term of a new Government, that might be a reasonable point. But, as the Government have been in power for a considerable time, it is odd that this Bill should emanate at this juncture. As I have said, I try not to be cynical about these things, but a more sceptical person than I might argue, “Better a Bill that works later than an imperfect Bill now.” If the hon. Gentleman’s scenario came to pass, it is not only likely that the best bits of this Bill would be included in that legislation, but that, more significantly, proper consultation with all the interest groups, local authorities and representative organisations of those most affected by the legislation could and would take place. That process would inform the Bill, which as a result would change and develop.
I see the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope) in his place. I know him well because I shadowed him in another life, as it were, so I cannot believe that he does not find persuasive the argument that we really need to think again about the Bill. We need to measure its likely effects in terms put by various third parties. I shall refer to them later, because thus far it has not received an uncritical reception from the groups that I just mentioned. We need either to flesh it out, as my hon. Friend the Member for Eddisbury (Mr. O'Brien) proposes, or to withdraw it and start again.
I say to the hon. Member for South Thanet that the people most affected want a Bill that is best, a Bill that works for them; they certainly do not want a short-term measure that has to be either amended or replaced rapidly with something quite different.
Does my hon. Friend agree that another consequence of the Bill taking effect and disappointing people is that it, in its production, it will inevitably raise expectations considerably among vulnerable people? If they find that those expectations are not met, will they look with favour on further discussions—cross-party or otherwise—about the future of social care?
That is where I began my speech—by reaffirming the point about the desirability of quality. The Bill must deliver quality care. Those expectations will be for just that kind of care, and quality care often manifests in the contribution of a range of agencies and individuals bringing in all kinds of different skills: the holistic approach that one had every hope might spring from the Green Paper consultation, a White Paper and well considered legislation. One disadvantage of proceeding now is exactly the false expectation to which my hon. Friend draws our attention, and its consequences in terms not just of disappointment, but—I go further—heartache.
The hon. Member for South Thanet (Dr. Ladyman) said that we should support this—by his own admission—small measure in the overall architecture of care, be that domiciliary or residential care, and my hon. Friend effectively replied that we do not oppose it, but we do question it. First, we want more Committee time to question it; secondly, in response to the points made by my hon. Friend the Member for Beckenham (Mrs. Lait), we need more capacity. This is about the quality not just of the offering, but of the promise that can be delivered—if that is what is on offer—in October 2010. If that quality of promise cannot be kept, the damage done to vulnerable people will be so cruel as to be not worth thinking about.
The shadow Secretary of State said that the issue was not just funding or organisation, but quality. My hon. Friend’s intervention leads me to conclude that the problem is not only about quality, but—to go further than the shadow Secretary of State—about organisation and funding, because some the Bill’s effects may be perverse. We agree with its principle, but its too limited nature may of itself be detrimental to the principle that we share.
“To have a right to do a thing is not at all the same as to be right in doing it”.
The Government certainly have the right to introduce this legislation, but I am not sure that a politician of the distinguished status of the Minister of State, the hon. Member for Corby would want this Bill on his record when he could have a much better Bill if he did the thing properly.
I thank my hon. Friend for affording me just a few moments. Does he agree with me and, I am sure, other Members—at least on the Opposition Benches—that the part of society under discussion is a particularly vulnerable one to, as it were, monkey around with, and that we face a particular demographic challenge that such hasty legislation does nothing whatever to combat?
Yes. As long ago as 2002, when the Community Care (Delayed Discharges etc.) Bill, which this Bill amends, was introduced, the then Secretary of State pointed out exactly that. In introducing the Bill, he said:
“Ours is an ageing society. We should not fear but celebrate that. However, it poses formidable challenges for our key public services in providing better, faster care to higher standards”—[Official Report, 28 November 2002; Vol. 395, c. 501.]
based on the desire for older people to have independence, not dependence. That is the principle that I am describing as the one on which we all agree, supplemented by an absolute determination that such care should be of the highest quality and provided from the best sources—that we get the who, what, when and where questions right.
To that end, I will focus briefly on the principle of care at home. In doing so, I want to draw attention to the time of year at which we debate these matters. As we approach Christmas, it is appropriate to remember Charles Dickens, is it not? Chesterton wrote that
“in everybody there is a certain thing that loves babies, that fears death, that likes sunlight: that thing enjoys Dickens.”
It is that part of us that also loves home and cares about the most vulnerable. Dickens himself wrote:
“Home is a name, a word, it is a strong one; stronger than magician ever spoke, or spirit ever answered to, in the strongest conjuration.”
For me, the concept of home is at the heart of civilised life. This is much more than speaking about housing. To talk of housing is one thing; to talk of home lifts us on to a different emotional plane. Home stands at the bright centre of our lives; home is where lives start and end. It is where we return to at the end of each day, and where we hope to return to at the end of all our days. It is right that people should be enabled to live in their homes for as long as they possibly can and that we should provide adequate support in order for them to do so. My hon. Friend the Member for South Cambridgeshire referred to quality in respect of care. For me, that is intrinsically linked to the security, certainty and familiarity associated with the home, all of which contribute to care in all kinds of ways that are supportive not only of a reasonable quality of life but a reasonably healthy life.
Ministers might claim—as indeed they have, not entirely convincingly; in fact, I do not think that they themselves are entirely convinced—that the legislation before us attempts to enable people to return home at the end of their days, or to stay at home. However, the Bill’s purpose is both limited and contradictory. It contains just two clauses, and that paucity of content reveals its true purpose. It is not intended to address the substantial reasons why so many people are forced from their homes and into care, but simply to help one person to stay in one home. That person is the Prime Minister, and the home is 10 Downing street. I have to conclude, reluctant as I am to do so, that this is, in essence, a political Bill fired by partisan interest. I know it is hard to credit, but I think I have to say it. It is fired by partisan interest rather than by a genuine desire to introduce meaningful legislation.
That is not to say that Ministers do not care about these matters—of course they do. Members of this House across the party divide care about these issues because they encounter them in their constituencies day by day. No political party has a monopoly on care or concern, or on decent people. However, it does Government no favours when they put that genuine concern to one side to pursue a narrowly political interest.
That is my intention. The hon. Gentleman has spoken very eloquently, as he is wont to do. We have met on many occasions to debate many different topics in the past, and his erudition is there for us all to admire. He spoke eloquently about the importance of the home. Given that these proposals are about providing free personal care at home, I assume that I can look forward to seeing him in the Aye Lobby later this evening.
I talked about the principle of the Bill being right, but I made it absolutely clear that I thought that its purpose was at best unclear and possibly worse, and suggested that it might have unintended consequences that were the negation of that principle. On that basis, Mr. Deputy Speaker, you would hardly expect me misguidedly to follow the hon. Gentleman into the Aye Lobby and encourage the delusion—I am being generous in using that word—that lies at the heart of the Bill. I cannot believe that it is wicked, so it must be deluded.
No, because I retain my sense of optimism, as I think I have made perfectly clear in this all-too-brief contribution. That optimism leads me to conclude that it is just possible that the Ministers responsible for the Bill, and those who follow them on the Government Benches, will be persuaded by the case made by my hon. Friend the Member for South Cambridgeshire and others that it could be improved—that, with reconsideration, it might grow into the bigger piece of legislation that we all acknowledge is necessary and that, indeed, the Government heralded in their Green Paper just a few short months ago. It is not the principle that is wrong—it is the Bill.
I am hugely persuaded by the possibility that the Conservatives, of whom the hon. Gentleman is a very eloquent representative, will support a comprehensive Bill on a National Care Service in future, as he has just said that he would like to see a much bigger Bill. May I take it from his remarks that the Conservative party is pledged to support the creation of a national care service in future?
I try never to make policy on the hoof, as a matter of principle, but when I do, I try to ensure that it is in those areas for which I have Front-Bench responsibility.
In response to the hon. Gentleman’s question, there is clearly a need to rethink this area of public policy; that is widely acknowledged. It was acknowledged in the Green Paper and identified by my hon. Friend the shadow Secretary of State in his speech. The reconsideration of this public policy area must take account of five criteria: first, a proper assessment of need, which means an assessment in terms of numbers and the character of that need; secondly, the views of all the organisations affected, by which I mean representative organisations, charitable organisations and local authorities; thirdly, a consideration of the implicit dynamism of this subject, because need changes rapidly and it is multi-faceted, so it requires the involvement of all kinds of specialists and skills, as my hon. Friend the Member for Beckenham described; fourthly, some estimate of cost, which is sadly lacking in the Bill, not least because the consultation necessary to come to firm conclusions about cost has been imperfect or non-existent; and finally and fundamentally, a wraparound consideration of our societal objectives in respect of care.
This is a big debate that has been taking place for many years, and views on it have changed, developed and evolved. However, I think there is a growing consensus that where possible, care is best delivered in the kind of secure and familiar circumstances that the home exemplifies.
On the basis of those five criteria, I would be happy to consider where we might go further, but as I do not have specific responsibility for this matter I offer them merely as a point of discussion.
I am glad to find that my hon. Friend has been paying such close attention to areas outside his own brief that he has articulated party policy very adequately. He made a serious point, on which the Minister sought to challenge him, about the question of consensus. I think there is a mood in the House that we need to try to establish, where we can, a consensus on the way forward on an issue that we can all see is coming down the track not just for our political generation but for those who succeed us.
Does my hon. Friend agree that it would be quite interesting to get an invitation from Ministers to join them in a round-table discussion that might identify areas of consensus, and that we would be happy to accept it? Given the Minister’s challenge to him, would not a good start be for the Minister to accept that if the Government amended the Bill to include our home protection scheme, that would protect not only the people whom he seeks to protect—a small number, according to the hon. Member for South Thanet (Dr. Ladyman)—but those whom we seek to protect, who are fearful because they might have to sell their homes to pay for long-term residential care?
The Minister has positive form in that respect. It was his willingness to listen and learn that allowed him to shape Government policy on skills largely around my analysis, as he knows. I retain high hopes, and that optimism is borne out to some extent by the title of the Government’s consultation paper, which, as my hon. Friend knows, was “Shaping the Future of Care Together”. That is consensual by its very nature. So it is more in sorrow than in anger that I point out that after the promising beginning of a Green Paper to open up discussion, we have ended with a Bill on the back of a party conference speech. As the Minister knows, the Bill’s narrow scope directly contradicts the wider focus of the Green Paper.
I noticed that the hon. Gentleman failed to take up the offer from his party’s spokesman to support an amendment to the Bill that would incentivise people towards residential care rather than living in their own home. I assume that he did not pick up on that offer because, like me, he wants incentives that keep people living longer in their own homes.
I listened closely to my hon. Friend the Member for South Cambridgeshire—I was having a cheese sandwich at the time, but I like to follow these things from near or far—and what he actually said was that an insurance model might well incentivise insurance companies to enable people to stay in their homes. That is far from the parody that the Minister paints. The insurance model that the Government identified as a possibility in the Green Paper could well be constructed to incentivise insurance companies to bring about exactly that outcome. I do not take such a limited view of the options the Government described in the Green Paper as the Minister has come to. He has done so rather hurriedly, given that it was published only recently.
It is clear that the No. 1 priority identified in the Green Paper is that we need more joined-up working. That has been touched on by contributors on both sides of the Chamber. The Green Paper states:
“We need services that will keep people independent and well for longer...through better joined-up working between health, housing and social care services and between social care and the disability benefits system.”
As you know, Mr. Deputy Speaker, I have a long-standing interest in disability issues, and I wonder about the proposal that disability benefits should be redirected to local authorities to provide care. I wonder whether we are thus caught on the horns of a dilemma, on the one hand trying to provide more personalised care and on the other depersonalising the benefits system. Joined-up working necessitates proper discussion with local government and a proper assessment of how it will do the job that the Bill gives it.
The Green Paper mentions services
“fully joined up between the NHS and the new National Care Service.”
However, I have heard nothing this evening to reassure me about the information provided by the health service to care services, or about the role of third-party organisations such as Headway, which helps many brain-injured people and with which I have been involved for many years. It allows people with acquired brain injury, often suffering from serious disability, to stay in their own homes. They are frequently younger people, whom we should not exclude from our considerations tonight.
I notice that the Minister freely acknowledges that. It is important that the views of organisations such as Headway be taken into account. Mechanisms must be put in place to ensure that the support given to people in Headway houses, which provide support for carers as well as the young people affected, is properly accounted for in the Bill. I hope the Minister will say something about that area of policy.
The Green Paper also states that the benefits of a joined-up service are that
“people receive more appropriate care in the right setting, reducing costs, improving outcomes and ensuring that services work together to keep people healthy and active wherever possible.”
I am not convinced that the Bill will ensure any of that. Its single substantial change will be made out of context and out of place and is born of short-term, limited and arguably political ambitions. As the King’s Fund has warned, the Bill makes the Green Paper’s proposals “incoherent”. Age Concern and Help the Aged have spoken of the need for
“fundamental reform of the entire care system”.
I and the Opposition Front Benchers anticipated the need for such a root-and-branch reform as a result of the Green Paper and the discussions it provoked. The Learning Disability Coalition has argued that the Bill contains “perverse incentives” that will prevent people from taking advantage of the most appropriate care.
Surely we need an holistic approach, as my hon. Friend the shadow Secretary of State said, with an emphasis on more preventive care to ensure that more people stay in their own homes. That means that we must be sceptical about any plans for cuts in disability living allowance and attendance allowance, or any redirection of allowances into the care system that takes place without proper discussion and consultation with representative organisations.
I invite the Minister to answer one or two further questions. Will he clarify the marriage between the care budget and the various allowances that will feed the process financially? Will he say something about the estimates he has made of the displacement effect on local government? Will he draw a clearer picture of the effect on wider services that my hon. Friend the Member for Beckenham mentioned? My hon. Friend the Member for Eddisbury, the shadow Minister, in summing up, will add to and amplify those questions, and he will of course have cleverer ones of his own, but speaking with an appropriate degree of humility on a subject of which my only knowledge is derived from representing the interests of my most vulnerable constituents, I ask the Minister, at least as a starting point, to deal with those fairly fundamental doubts.
T.S. Eliot wrote:
“Home is where one starts from”,
and as I have said, it is also where we frequently return for care and support. The objective of facilitating more personal care at home is one that will be widely shared across the House, but it requires far greater consideration, and more careful reflection and proper planning, than is suggested by the Bill. To work, the measure must work well, and to do that, it must be carefully conceived and properly considered. We owe those who will be most affected by the Bill nothing less than that.
It is a pleasure to follow my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes), who not only entertained but educated us in relation to the Bill. He orated to us in a way that we are now accustomed to, and has an intellectual status that we esteem and aspire to.
It is noticeable that this has almost been a Tory debate in the last hour or so—in fact, I cannot see one Liberal Democrat Member, although a couple of Labour Members have wandered in and out. I am, I believe, the third consecutive Conservative speaker—
I have woken the Liberal Democrat Member up and I am delighted to give way to him. No? He has nodded back off again.
As a representative of Bournemouth in Dorset, the issue of looking after the elderly, who are some of the most vulnerable people in our population, is pertinent. However, as my hon. Friend the Member for South Holland and The Deepings pointed out, it is about not only the elderly, but younger people—it is about those who are not able to look after themselves. Society therefore requires some form of safety net and security so that we can ensure that people have the type of care that we would all expect to receive in the same situation. At this point, I pay tribute to those who work in the care and support sector—not only the professionals, but the volunteers, including the many family members, who tirelessly devote many hours, days, weeks and years to looking after those who are close to them and important to them.
Winston Churchill talked about the importance of the safety net that society requires to capture those people who fall in their station in life, whether that is their own fault or otherwise. I should like to make a more modern analogy—the community that we are in is like those penguins found in Antarctica. When the sun is shining, we go about our business, enjoy ourselves and act as part of the community; but when times are tough and the storms come in, the penguins gather round in a tight-knit circle. In fact, they move around ever so slightly to keep those in the very centre warm and to ensure that those on the outside are exposed and vulnerable for only a very short period. That is exactly how society should work. When we require care, we are surrounded by the warmth of our community and its support, be that from the voluntary or private sectors or the state, to ensure that we can weather those difficult times. That is why one aspect of care is prevention—it is not always about what happens when care is required—but that is entirely absent from the Bill.
Like many right hon. and hon. Members, I have been exposed to the care and support requirements of our community through my work as a Member of Parliament. Clearly, the confusing system that we have does not make it easy for those requiring access to care to ensure that they have what they expect. That was highlighted when I visited Douglas House in Boscombe in Bournemouth, which serves 16 severely disabled adults. It is a fantastic unit, and I pay tribute to those who work there. They are dedicated to looking after those severely disabled adults.
Unfortunately, forgetting the idea of choice, the Government want to close the centre down and push its residents into the community. I have not got a problem per se with the concept of allowing those involved, including parents, to decide to move someone who requires care into the community. However, those 16 families very much want to keep that place open. I understand that moving those who are currently at Douglas House into the community would cost five times more per person. I do not understand, if we are pushing the idea of choice, why the Government are telling Bournemouth and Poole primary care trust that it cannot keep Douglas House open.
I plead with the Minister to consider this. We have handed in a petition of more than 10,000 names to No. 10, but we have hit a brick wall. I reiterate that this is the desire of parents with children in that facility. We are not listening to the requirements and needs of those people, and that will cost the taxpayer more.
We need to recognise the importance of upgrading our care offering, and I am saddened by the fact that so few hon. Members are in the Chamber to debate this important subject. Their absence may be linked to the size of the Bill, because there is not much in it to debate. Every single hon. Member who has spoken has added things that they would have liked to see in the Bill.
The Secretary of State began by saying that the Bill is a great stride forward in the move to reconcile the care package provided in the United Kingdom, but the two minuscule clauses are simply election posturing. As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has pointed out, we will have an opportunity in Committee and in the other place to make this Bill into something of which we can be a little more proud. As it stands, it does not reflect 10 years of hard work by any Government.
The development of care policy by the Labour Government has been a story of procrastination. Back in 1997, the royal commission on long-term care was set the task of looking at the system and recommending a series of changes. It was not until 2008 that we had a six-month engagement process. That was useful, but it was a long time after the initial commission made its recommendations. We then had the Green Paper, “Shaping the Future of Care Together”, issued this year, with big statements about a National Care Service. It was a bold and radical proposal to shake up the care and support package available. Then we had the huge announcement by the Prime Minister at the Labour party conference of his intention to include a Bill in the Queen’s Speech. In total, it has been a 13-year process, in which progress has been slow and which has not reflected the urgency that this subject requires.
The hon. Gentleman has referred to royal commissions and Green Papers. However, he has not mentioned the dramatic change in social care that has taken place on the ground, in the move towards personalised care and personal budgets. Perhaps he could say something about how that move is linked to the Bill.
I am not going to digress from my examination of the changes that should have taken place. We are here to debate the Second Reading of a Bill that is very small and does not do justice to the length of time that the Government have had to change the system, or to the sound work in the Green Paper. Many people who have done all that work and participated in consultations on the Green Paper will look at the Bill and ask, “Is that it?” They will be severely disappointed unless the Bill is radically changed in Committee or in the other place.
The exchange between my hon. Friend the Member for South Holland and The Deepings and the Minister was interesting. My hon. Friend was pondering which way to vote this evening. I hope that more of our hon. Friends will turn up to decide that, otherwise this will be a short debate. The question for the Minister is whether he would be willing and open enough to accept amendments tabled in Committee and in the other place to build on the opportunity provided by the Bill, separate to other initiatives on the ground. That, I think, is the test for the Minister himself. He is shying away from even looking at me now, so I suggest that the answer—
The Minister says that he is writing copious notes. Well, it would be nice to get an indication, either now or in the winding-up speech, of whether this Government are open to amending the Bill to beef it up and make it something we can respect.
We are debating the Bill on Second Reading, which happens to fall three months before a general election. It looks like there has been a dash for policy and a rush to put a tick in a box, so I have to ask the Secretary of State, in his absence, whether he was constantly last in the queue when the Prime Minister was doling out time for Bills to be debated in Parliament. How many Parliaments have we had to go through before finally reaching the Second Reading of such a Bill? We now seem to have a concession: a small Bill squeezed in just before we go to the polls. That is a shameful exercise, I am afraid, considering the deterioration of the service, which has been remarked upon across the Chamber—the fall in the coverage of care and the rising costs of it over the past decade.
The timing of the Bill is certainly questionable. It is also questionable in relation to the Green Paper, because we are midway through a wider consultation on the aspects of social reform. My intervention—the first the Secretary of State took—was to ask why we are having this Bill now. He could not give me a clear answer; he could not acknowledge the fact that the Bill is part of an electoral cycle, rather than solid policy being put forward.
Also, we have to ask ourselves what is not in the Bill. It is thin on substance and there is little to disagree with, but there is little in the Bill in the first place. The costs of the Bill have not been outlined at all. Perhaps we will get more clarity in the winding-up speech. We have had the pre-Budget report, which included a black hole in the finances. We now have a Bill that includes a black hole in the finances. It is vague about how local authorities will foot the bill without having a knock-on impact on other services.
It is worth reminding ourselves what personal care means. It is personal hygiene, such as bathing, continence management and assistance with eating; personal assistance, such as dressing and so forth; and simple treatment. It does not include nursing, which is not seen as part of personal care. The Labour royal commission on long-term care, which reported in 1999, recommended that long-term care should be split into living costs, housing costs and personal care, and that personal care should be available after an assessment and paid out of general taxation. Most of the recommendations were accepted, but not that one concerning personal care. The reason cited was that there were not enough resources.
It is peculiar that we have just had a huge recession—the biggest since the second world war—and suddenly finances seem to have been made available.
In the light of those comments, does not my hon. Friend find it rather strange that the explanatory notes state:
“The Government’s view is that the Bill has little overall effect on public sector manpower and public expenditure”?
Yet here we are, talking about the resources that will be required to put through what at the moment is a flimsy, unfunded Bill. We know that the costs will be much greater than the Government are willing to admit.
I am grateful to my hon. Friend for that intervention. Perhaps it is timely that the Secretary of State has returned to the Chamber, because he might be able to clarify the exact cost to the Exchequer of this Bill—not just the up-front costs, but, as my hon. Friend suggests, the funding requirement for the extra staff who will be required to implement what is proposed here. That is not clear at all.
The next big document that the Government produced—a number of years later, in July 2009—was the Green Paper entitled “Shaping the Future of Care Together”. Having digested that document, I have to say that there are many interesting ideas in it. It puts together a wide array of issues, and a number of pieces of the jigsaw are there. However, the Government have chosen to take just one piece of that jigsaw and promote it today, completely missing the wider context of what else is happening in care.
That Green Paper, which I hope the Secretary of State might be willing to look back at, points out that the current system is based on legacy and calls for bold reform, such as that which created the NHS. By changing things in incremental steps and limiting the objectives, things will begin to overlap and we will end up with a confusing structure. Rather than heeding the advice of the Green Paper, we are ignoring it and just coming out with another little building block to add to the confusing layers that we already have.
The scale of the problem is evident. We are all living longer. It is estimated that, by 2026, 1.7 million adults will expect care in one form or another. One in two men will expect some form of care as they get older, and two in three women will have high care needs. The problem will not go away. The type of care available will also become more complex, as advances in science are made. People’s expectations will increase, yet what we have today is confusion over funding. Wide variations of care are offered, with standards differing from council to council across the country. That is another example of the postcode lottery, but I do not see how the Bill will challenge that.
Money is not always appropriately spent. As I mentioned earlier, so much more effort could be invested in prevention, rather than in a cure. The current system is effectively a means-tested structure, so savings are used to pay for care. As has been reiterated time and again, we now see a requirement for people to sell their property in order to pay for the care that they will need. That is scandalous.
Labour’s big idea was the creation of the National Care Service, which was to be
“a universal and sustainable system which empowers people to live their lives the way they want to”,
providing access and support to people regardless of location; an easily understood system with agreed levels of assessments across the country, based on personal circumstances and recognising individuals’ ability to pay, and all fully co-ordinated with the NHS and, of course, fair and affordable. That is a bold statement. That is radical. That is what we should be working towards in this Bill.
My hon. Friend will have noted, as I did when he was quoting the Green Paper, that it included remarks about recognising people’s ability to pay. The proposal in the legislation before us is that people with higher care needs should be given free personal care regardless of their ability to pay. The principles for the National Care Service that the Government set out in the Green Paper are therefore not the principles on which they propose to legislate.
I am grateful to my hon. Friend for that clarification on one of the many issues that will undoubtedly be scrutinised further in this Second Reading debate, as we highlight the Bill’s shortfalls.
On cost, the funding proposals are completely vague. This has been stated already, but the care requirements or needs of the average 65-year-old will probably be around £30,000 over their lifetime. In reality, that amount could be only £1,000, but in other cases, extra care—more detailed and more complex care—is required, the cost of which can reach £50,000.
The Bill has two simple clauses. The first concerns the removal of the six-week limit on the provision of care offered for free, while the second is almost just a tidying-up exercise, linking Wales with England. It really is a pathetic Bill, considering where we are in the whole process of designing a new care system, costing around £670 million, as my hon. Friend the Member for South Cambridgeshire said. The Secretary of State’s claim is that the Bill is the first step towards a National Care Service. What a shame that we do not have the other steps, and that we are only now debating the initial stage, when we could have done so much in the past 10 years.
The Bill guarantees free personal care for about 280,000 people, although that figure requires clarification. I do not think that anyone in the Chamber will disagree with the proposals, but, time and again, hon. Members have pointed to what is missing, and to what a missed opportunity this is. Attached to the Bill is, of course, another consultation, on proposals for regulations and guidance. All this is coming out in the lead-up to the general election that is just around the corner.
It is interesting to read the research paper on the Bill produced by the House of Commons Library, which is a neutral body. On page 10, it provides comments from other organisations and agencies. Andrew Harrop, the head of policy for Age Concern, stressed:
“It will be essential that councils are properly funded to provide this care so that there is not an incentive for them to push older people into care homes or claim that their needs are not critical enough to warrant free care at home.”
Jane Ashcroft, chairman of the English Community Care Association,
“queried why the Government had not introduced the policy at the same time as the green paper on social care.”
Consumer watchdog Which? viewed the Bill as “a missed opportunity”. Lord Lipsey, a former member of the royal commission on long-term care, is quoted as saying:
“I think it is a bad policy but also a very bad way to do policy just to find a nice highlight for your Labour Party conference speech.”
Those are voices that we should respect. They are critical of the Bill, saying that we should think again on these issues.
I think that we all agree that an advanced, civilised society needs a fair, accessible and compassionate care and support system that allows people to live their lives to the full and meets the needs of people as they grow older in an affordable way. The Government have proved that there is some vision, as was highlighted in the Green Paper, but the Bill is far from having any vision at all. The Government have woken up to the urgency of the need for reform very late in the day, despite gaining a head start more than a decade ago when they were prompted by the commission to go in this direction.
This is a timid Bill, and it falls short of many people’s aspirations, including many in the industry. In the introduction to the Green Paper, “Shaping the Future of Care Together”, the Prime Minister says:
“What is now needed is a major debate about the challenge we face and the options for addressing it.”
I would hardly call what we have had today a major debate. We have been denied that, because nothing major has been put in front of us. The Bill is not properly financed. It comes without a proper impact assessment. It gives little clarity on how the provisions will dovetail with the NHS, and provides no indication of how many extra staff will be needed. It is a pathetic piece of the bigger jigsaw set out in the Green Paper.
On top of all this, we have a programme motion—which we have yet to talk about—that will limit the amount of time for debating the Bill. Proper debate might just add to the Bill, either in Committee or in the House of Lords. This is a rushed Bill, and it represents a missed opportunity. It has very little chance of getting on to the statute book. It has just one aim, and that is not to help the vulnerable people across Britain but to help a vulnerable individual in No. 10. If this is the best that Labour can muster after a decade to help those in need of care in Britain, it is proof—if any more were needed—that Labour has run out of ideas and that it is time for a general election.
It is a pleasure to follow the powerful contribution of my hon. Friend the Member for Bournemouth, East (Mr. Ellwood). I will also begin by describing the confusion surrounding the Bill. As many Members have said, the Bill is part of a much bigger picture. I hope that the House will forgive me if I lighten the tone by sharing a feature of the Smith family’s multi-generational Christmases, following the evocation of Dickens in the speech made by my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes). The Bill is a bit like one of those mystery jigsaws. We start with a bit of sky and a bit of grass, but we have to fill in the rest as best we can because there is no picture to guide us—
I follow on from the Lord Lipsey quotation already given:
“What has gone wrong is that in the middle of the consultation… the prime minister has declared that it is government policy for people with severe care needs in their own home to be paid in full”.
I will come on to what we all think about that principle, but to try another analogy and to bring back the idea of homes, this is like trying in a consensual way to build a community of homes that will withstand the future, only to find that on one plot in the street there is a jerry-built shed which might well shelter some in a storm but which has not been made with the care and forethought that the whole project requires.
Considering that we are looking for a White Paper in 2010 to follow the Green Paper that came this year, it is not enough simply to say that we need something rather than nothing—that something will do in the place of everything. We cannot hide the haste of a piece of legislation that, as ably noted earlier, has only two clauses and yet has been 12 years in the making. That is not the way I or many people outside this place would expect to go about such weighty matters as personal care at home—raising false expectations on the back of something that might turn out to be very poor quality. I shall return to that.
Of course I join colleagues in welcoming the concept of personal care at home and, for many people, the concept of personal care at an affordable or zero price for those who need it. Nobody wants to be pushed out of their home; nobody wants to face high costs at particularly hard times and in emergency circumstances; nobody wants to be dependent on others or, indeed, on impersonal caring environments; nobody wants to lose any dignity; and nobody wants to be uncertain or to be the victim of a postcode lottery. However, we must be cautious in what we do from that position.
I said in last week’s debate, tangentially on the Green Paper but specifically on the continuation of the attendance allowance and the disability living allowance, that we must proceed with clarity on those issues, because we are dealing with a section of society that is often very vulnerable, but for the same reason we must go with caution. We rather randomly concluded in last week’s debate that we should not approach the topic with heightened political emotions, but it is equally important to get it right. It is important not to get it wrong for the same reason as given last week—the size of the question ahead of us. There is still a demographic bomb ahead of us, so the scale of getting this wrong is important. As many Members have pointed out, the scale of the task is, frankly, unknown, but the scale of getting it wrong looms ever larger as an exponential problem ahead of us. I am afraid that putting one small piece of the jigsaw in place is simply not enough in this case because of that characteristic.
I entirely agree with my hon. Friend. Does she agree with me that in large counties such as Norfolk—a great county that both she and I represent—with disparate communities in both rural and urban areas, a one-size-fits-all solution will not work, because some councils will be able to afford the provision and others will not?
I thank my hon. Friend for his contribution. I will come to what our local authority has had to say on this matter, as I have had conversations about it. He is right that the aspiration to end the postcode lottery may well be laudable, but the practicalities of getting it right are far harder.
I will now deal briefly with costs and how the proposal might work, on the basis of the bare detail that we have been given so far. I cannot resist noting a comment made from the Government Front Bench earlier that the proposal will be subject to the “normal spending review process”. It is a shame that the Secretary of State has disappeared again, as I wanted to put it to him that it is a shame that we have had no comprehensive spending review to help us determine how it fits into the bigger picture, in terms not only of the health budget but of where our country is going.
The Secretary of State has told us that the Bill will require a contribution of £420 million from his coffers and a further £250 million from those of local authorities. As has been suggested by my hon. Friend the Member for South-West Norfolk (Christopher Fraser), and also by my hon. Friend the Member for Beckenham (Mrs. Lait), the co-ordination that the policy demands from local authorities is one of the main problems that we face. Informal discussions in which I have engaged with Norfolk county council, the local authority that I share with my hon. Friend the Member for South-West Norfolk, suggest that the council could incur a cost of £5 million. Perhaps the Minister will confirm that that could add up to £250 million if spread over an appropriate number of authorities on an annual basis. It should be borne in mind that Norfolk has already had to squeeze £15 million of efficiency savings out of next year’s budget.
Does my hon. Friend agree that whenever the Government present a new policy or a new Bill to the House, the cost of implementing that new policy or Bill seems to fall on local authorities, which are having to make saving after saving? Is she still unaware, as I am, of the total efficiency savings that the Government are asking authorities to make over the next year and beyond?
I share my hon. Friend’s perplexity. I know that my local authority will struggle to find more money in addition to the efficiency savings that, because it is a scrupulous and forward-thinking authority, it has already had to identify. Moreover, much of the work that that forward-thinking authority has tried to do will be imperilled, including some of its work on prevention in this very policy area.
My hon. Friend the Member for South-West Norfolk will know that, thanks to the Government, Norfolk is currently subject to local government reorganisation, which means that a particular burden falls on our local authorities and also those in Suffolk and Devon. That involves a cost for which central Government refuse to foot the bill. Having said that we must take this action, they then say, “We will not give you any money for it and, what is more, you had better not raise council tax to finance it.” That is an enigma wrapped in a puzzle wrapped in any other Churchillian quote that Members may choose to employ—
Indeed—and still with no picture on the lid.
I want to make one more point about costs before I deal with other aspects of the Bill. According to answers given to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the Government’s contribution is not connected with whatever action they want to take in relation to attendance allowance and disability living allowance. I am almost tempted to ask, “If that is the case, why?” Either the Bill is connected with the Green Paper and therefore connected with those benefits, or it is not. That is another question that the Minister must answer.
Let me now raise the issue of fairness. I believe that the worst risk posed by the Bill is that it endangers real reform. It pays for what is, on the overall scale of things, almost a minor reform, and it potentially helps people who are not the poorest in society. As my hon. Friend the Member for South Cambridgeshire pointed out, that principle is not in the Green Paper. The Government seem to be operating on the basis of two entirely different principles, at a time of soaring national debt. It is not as if there are spare pounds floating around that can be thrown any which way.
Nowadays we must be particularly careful to scrutinise any item of public spending, and Members are wary of poor quality. Many of us welcome the idea of free personal care at home, which is a wonderful principle, but the poor quality that we risk with legislation such as this may be the enemy of the people whom the Government—and we—are so keen to help. Other Members have already spoken about the aspect of quality that I wish to dwell upon: the staffing implications of these measures. My hon. Friend the Member for Beckenham made the point very strongly. In an intervention on her, the hon. Member for South Thanet (Dr. Ladyman) said that we must find staff to make this change happen anyway, but that will not necessarily be the case. It is much easier to find staff to operate a well planned, well oiled and well funded system than it is to find adequately trained staff to operate a system such as that planned for October of next year, which, frankly, looks like a black hole at present. The Royal College of Nursing says:
“It is essential that those with the highest needs receive the highest quality of personal care. With only 10 months until these measures come into force the RCN is concerned that there may not be sufficient numbers of properly trained social care staff and community nurses to meet the undoubted increased demand for care, which will follow from the introduction of these measures.”
I fully agree. There is a real risk that a hasty introduction of these measures will lead to a gap in the provision of properly trained and funded staff, which will imperil some of our society’s most vulnerable people, whom all Members wish to help.
Time and again, MPs hear horror stories on this topic from their constituents. I suspect that I have heard fewer than many other Members, but the message comes across loud and clear none the less. There are stories about carers who leave the elderly person in their care alone for most of the day, and turn up when they think that it is time for breakfast, which might be noon or 7 pm—or whatever time chosen by the carers who have been found to fill those personal care gaps. That is not a vision of personalised care; rather, it is a nightmare for many of our constituents. We risk that becoming a reality by introducing these measures with such haste.
In this debate, all Members should be focusing on the value of good care staff. I am not sure that such a hasty introduction of these measures will allow us to fit that into the system, however. Proper planning for the requisite training takes years, but this Government have done the following things to hinder that. They have let the Learning and Skills Council go bust. They have also let my local further education college become stranded with insufficient classrooms because of a capital funding crisis—I am sure many other Members’ FE colleges are in the same situation. This Government have let higher education students—some of whom may be involved in providing more specialist needs—suffer with no funding until Christmas.
Also, the apprenticeship system has been asphyxiated, and a huge variation in training has developed—in the experiences that people are able to access, in whether red tape holds them back and prevents them from training properly, and in what places can be promised to younger people seeking training or to older people seeking to do their best for society. That is our current training picture, and we must ask ourselves how it will affect the system that the Minister is looking to have in place in 10 months’ time.
I am tempted to conclude by asking the Minister whether he agrees with me that the following very simple precautions would assist the Bill in its passage. It should be part of a larger reform. It should also help, rather than hinder, local authorities. It should give the Minister the opportunity to ask his colleagues to provide clarity and consistency in other sectors around this one, such as further education. The Minister might also consider instituting a licence to practise, or any other measures that could improve the safeguards in this area for vulnerable people, whom we all care about.
The sad truth is, however, that the Minister cannot agree to those simple precautions, because, as Members have already picked up, he does not know the numbers. None of us knows how many people will be involved in this system. We can estimate the number of people who pay for their own care at present, but we cannot estimate how many more will come forward when such an incentive is offered. We cannot therefore estimate the full costs of this policy, or the number of trained staff that will be required to fulfil it and make the dream that we all wish for, of proper social care and personal care in the home, become a reality.
There is a final thing that, through this Bill, the Minister is not allowing local authorities such as Norfolk county council to do. I am pleased to see the hon. Member for North Norfolk (Norman Lamb) back in his place; he is the third Norfolk Member in the Chamber, so we are doing well. The legislation does not allow local authorities to deal with the demographics of the future. An enormous squeeze is coming down the line, not only in public spending—we all are, or should be, painfully aware of that—but in the number of people who will require such care in the future, whatever the incentives to provide it or to pay for it. The numbers are the key, but this Bill contains almost none. It certainly does not contain the numbers to allow us to scrutinise it properly. As the Bill is not connected to the bigger picture, it does not allow us to look ahead to the challenges coming down the track. I can but look forward to the day when the Minister looks up and gives us that bigger picture.
It is a pleasure to follow my hon. Friend the Member for Norwich, North (Chloe Smith), because I agreed with a great deal of what she said. May I apologise to you, Mr. Deputy Speaker, and to the House for missing part of this evening’s debate? I was chairing a meeting of the all-party group on dementia. As the Secretary of State said, many people with dementia will be directly affected by what the Government propose.
I wish to start my contribution, as many have done, by applauding the Government’s intention—it is right that we should do so. There are few more important issues than social care and it is right to make a start on this, but we cannot accuse the Government, over most of their term of office, of legislating with breakneck speed on it. The Wanless report, which asked a number of important questions about social care, was followed a considerable number of years later by a Green Paper that asked all those questions again, and now we have before us a Bill that proposes to answer part of one of them.
If the Bill is even to do that, it needs to deliver on its promises, and that is where I am in entire agreement with my hon. Friend the Member for Norwich, North and with others who have made this point. If the Bill is incapable of meeting the expectations that it has raised, not least by its title, it will be a cruel deception for those who are most reliant on social care and who will hope for most as a result of what the Government are proposing to do. That is why the uncertainty over the potential demand for free social care—the Government have not set out the terms of that in the Bill, but I hope that they will do so in the regulations that will follow it—is so important. This is about the unknown impacts on those currently funding social care themselves who may subsequently approach the state for free social care, of those who will not subsequently choose residential care as otherwise they might have done, and perhaps even of those in residential care who may choose to leave that care and return home to be cared for there—as we know, many prefer such an option.
As my hon. Friend said, if we do not know what the demand will be, we do not know what the cost will be. We have heard that the estimate of the cost for the first year is £670 million, £250 million of which is expected to come from local government efficiency savings—one can only imagine the joy with which that news was greeted in town halls up and down the land. The remaining £420 million is expected to come from the Department of Health’s research and development, marketing and consultancy budgets. I refuse to believe that the Government spend anything like £420 million on the Department of Health’s marketing and consultancy budgets, so a substantial amount of the sum must be expected to come from the research and development budget. I hope that the Minister will be able to reassure me, and the House, that that will not affect the crucial work that goes on, not least in the field of dementia, where we already spend too little on research. If we do not spend a great deal more, it is very unlikely that we will find the cure that we hope for or, failing that, effective treatments, which will reduce the demand on our social care system in the first place.
If there is a gap in funding—it is at the very least foreseeable that there might be, given the uncertainty, as we have heard, about the figures—who will pay for that gap? Will it be local or national Government? I rather agree with my hon. Friends who suspect that the answer is likely to be local government, once again. We must be sure, if that is the case, that it will be given adequate support to enable it to carry that burden.
Let me say a word or two about the detail of the Bill. I agree with many who have spoken that reablement—although I am with my hon. Friend the Member for Beckenham (Mrs. Lait) on the elegance, or lack thereof, of that term—is a crucial point. It is vital that we get people back into being able to deal with their own daily lifestyle needs to the extent that we can and to the extent that they can. However, I am concerned about the practical implication of that. It seems to me to be inconceivable that in order to move to a process of helping someone with reablement, there should not first be some form of assessment to ensure that they will benefit from the process. That means that there will be one assessment to ensure that somebody is suitable for reablement, a process of reablement and then another assessment, assuming that that is appropriate, to decide whether they are entitled to free social care under the criteria.
We all know that assessment takes a long time—we all deal with constituency cases weekly that involve long-running processes of assessment, assuming that there are enough people to carry out the assessments in the first place, as my hon. Friend said. We also have to assume that we are capable of withstanding the extra pressure on the system that will inevitably be caused by the extra demand for the extra social care provision. That will include many people who have substantial care needs, but not quite the critical care needs required for the free social care, who will ask and expect to be given a reassessment. A great deal more assessment will suddenly need to be done, and if that assessment and extra demand on the assessment system are going to cause further delay, that is a concern. There will be a big step between those who are assessed as having substantial care needs and those assessed as having critical care needs, in much the same way as we experience with NHS continuing health care.
Let us be charitable, however, and assume that we can establish whom we will be paying under this scheme and how we will pay for it. We still have to answer the question of what we will be paying for. I do not want to revisit the debate that we had last week on attendance allowance and disability living allowance, but the freedom to spend the money that one receives in the way that one chooses was crucial to that debate and, I suggest, it is important in this one, too. The Minister will have seen, as I am sure many other hon. Members have, that Carers UK, in its response to the Bill, which I accept broadly welcomed it, also expressed concern about the situation of those families where family members are prepared to offer care in the home but would value assistance with other things such as gardening, shopping, transport and so on. We have to ask whether the provisions will enable such families sufficient flexibility to have what they need rather than what the Government wish to give them. We come back to the question of how committed the Government are to their personalisation agenda, to which I fully subscribe.
There are broader issues, too, about what we pay for. The Minister has heard me talk before about what is commissioned. That point applies to residential care but, in this context, it applies particularly to domiciliary care. We must consider not only how we pay for this, but, alongside that, what we are paying for. We must ask ourselves whether commissioners are commissioning the right things and whether they should, as they do all too often now, be commissioning for blocks of time—such as commissioning 15 minutes for a particular task—or whether there is a better way of commissioning good quality care. We have to ask whether it is acceptable for a different agency care worker to arrive on someone’s doorstep every day of the week, when the advantages of having someone they know and trust and for whom they can leave the door open while they take the dog for a walk are cons