The Government have today published a White Paper on the reform of social care in England. It proposes a national care service providing quality care and support for all adults in England free for people when they need it. It represents one of the biggest changes to the welfare state since the creation of the NHS. It sets out three stages of reform. First, the Personal Care at Home Bill helps the most vulnerable, enabling us to provide free personal care in their own homes for those with the highest needs. In the second stage, we will end the local lottery in care and establish national standards and entitlements. From 2014, care will be provided free to anyone staying in residential care for more than two years. At the start of the next Parliament, we will establish a commission to help reach consensus on the fairest and most sustainable way for people to contribute to the new system. As people live longer, we need to act to give them peace of mind and the ability to protect what they have worked for. Reform will work only if those benefits are secured for everybody.
That sounded a bit like a statement to me.
The Government may be aware of the threat to the acquired brain injury education service in Evesham, which helps the rehabilitation of stroke victims, in particular, and other brain injury victims. The threat has been caused by the changing priorities of the Learning and Skills Council in relation to adult education. Will the relevant Minister talk to the Further Education Minister to satisfy themselves that the unit is either truly just an education service or actually, as it used to be, co-funded by the Department for Health and the education Department?
I am advised that Worcestershire primary care trust is looking at NHS-funded services for people with acquired brain injuries, and it is the PCT’s responsibility to commission services to meet the needs of the population. The trust has had an increase over two years of some £83.8 million and given a public commitment to ensure that the services that the acquired brain injury unit provides will be considered as part of the review. I certainly take the point that educational opportunities are an important part of the rehabilitation process.
My right hon. Friend is right to applaud the work of agencies such as those in her constituency. There are many others like that throughout the country, and our job in creating a national care service is to ensure that we design and develop services with not only users but carers at the very heart of how we respond to people’s needs. The new national care service will be free for people when they need it, and we will support families, carers and communities as a basic principle of the way in which a new national care service delivers help for people throughout the country.
Order. We have a lot to get through in topical questions, so the exchanges need to be very short and sharp.
Why did the Secretary of State not make an oral statement? Will he now rule out a death tax to pay for the Government’s national care service—yes or no?
We are debating the Personal Care at Home Bill later today, on a crowded parliamentary day, and we will have the opportunity to debate it as the first stage in our three-stage reform plan to fund social care. We will propose for social care a system that is similar to the rest of the welfare state—organised on a population basis, whereby everyone makes a contribution and everyone has a choice about how they make that contribution. We will establish a commission to advise the Government on those payment options, and the commission will be able to consider all options.
I agree, and a new national system will be up and running early next year.
The Princess Royal Trust for Carers and Crossroads Care have revealed that for the next financial year PCTs have allocated to carers only 26 per cent. of the £100 million intended for respite care. Is not the Government’s promise of respite care, followed by a total failure to deliver that care, tantamount to a fraud on some very vulnerable people? Surely it is now time to give a guaranteed right to a week’s break for the 1 million carers who work the longest hours.
This Government recognised the need to support carers better when we came into office in 1997. Before then, the recognition of, and support for, carers was absolutely pitiful. Ever since then, the Government have invested £1.7 billion through the carer’s grant to support carers, and locally people can allocate that funding flexibly. However, the hon. Gentleman is right to say that we allocated further spending to PCTs so that they could provide respite care for carers. The Minister of State, Department of Health, my hon. Friend the Member for Corby (Phil Hope) has asked strategic health authorities to identify the level at which PCTs use that funding, so that we can take further action where sufficient priority is not being given to spending resources on respite care for carers.
I know that my hon. Friend takes a keen and active interest in issues surrounding support for mental health service users and has campaigned on these issues for many years. I would like to make it clear that we do believe that service users should be fully informed about and engaged with arrangements for their own care. That is why the Department issued revised care programme approach guidelines as recently as 2008. Under those guidelines, each mental health service user should have, wherever possible, an opportunity to be actively involved in agreeing their treatment plans with their care co-ordinator. That would allow patients some say in determining what information is then made available about their condition to other parties, including carers and family members.
These exchanges are taking too long: I want to get lots more colleagues in.
We need to ensure that PCTs and trusts are accountable to local people—that is the whole basis on which we have introduced the system of decentralisation in the NHS. Improving the quality of that accountability is therefore crucial. If we have learned anything from the Mid Staffordshire debacle, it is that trusts need to be in contact with local people.
May I welcome the Government’s announcement on setting up a national care commission to look into fair funding of social care in this country? Will one of the remits of the commission be to reach a consensus, as recommended by the Health Committee’s report on social care published on 12 March?
We are delighted that we have the White Paper, “Building the National Care Service”, which will be a landmark in this country’s development of services for people in need of care and support, adults with disabilities, and older people. I congratulate my right hon. Friend on the Select Committee’s report which was a helpful contribution to the debate. I am pleased to say that the national care commission will look at how we can find a fair way to give people a choice about making their contribution to ensuring that, in future, care will be free when people need it.
This is teamwork. We have worked together with Great Ormond Street hospital, the researchers, and the hon. Gentleman, and when we work together in this House, we get results. We all wish Zach, and his mum and dad, the very best.
Do my hon. Friends recognise that in a constituency such as mine, the advent of a national care service will be greeted with enormous enthusiasm? However, do they understand the fears that if this were done on the basis of a voluntary insurance principle, it would exclude the poorest people and it would not be a national care service?
The reform of social care will work only if the peace of mind and the ability to protect savings and homes is available to everybody, whatever their income. The problem with the voluntary system of insurance proposed by the Conservatives is that as take-up of voluntary schemes is generally low, the cost is very high, so it would be out of the reach of my hon. Friend’s constituents and my constituents. That is why we are proposing a bold reform, in the best traditions of Labour, for a comprehensive national care service.
I agree with the Minister that health trusts should listen to the people. Will he tell that to the health trust that covers Clitheroe? Some £12 million was made available for a new community hospital, which the health trust stalled last year. The decision should have been made last week but it has now stalled it until September. The people want the hospital. When will the health trust listen?
Of course health trusts need to listen to people and ensure that they make local decisions to manage health provision effectively, based on delivering quality care to people and ensuring that it is done at a reasonable cost to the taxpayer.
We welcome the £50 million that is being given to PCTs for carers, but how much of it has now been spent and what benefits came to central Lancashire?
The extra money that the Government put into primary care trusts for providing respite care and other services is part of £256 million of extra resources being made available not only through PCTs but through work that we are doing nationally. At local level, we are asking every PCT to account for money spent on support for carers, and that will include the PCTs in my hon. Friend’s area.
I hear what the hon. Lady says as far as Southampton is concerned. It is important that health trusts manage their budgets, but it is also important that they prioritise the quality of care for patients and ensure that patient safety comes first. I understand that in last night’s debate, the hon. Lady’s party’s Treasury spokesman said that he would not guarantee funds for the NHS.
What plans do Ministers have for increasing expenditure on children’s and young people’s mental health? I know that the Government have rescued the child and adolescent mental health service, but it appears that demand is still far exceeding supply and a lot more has to be done.
I share my hon. Friend’s concern that young people with mental problems get the support that they need in a way that is appropriate to their needs. If we can provide more support for children who have mental health problems, we can do a great deal to prevent young people from becoming adults with mental health problems, thereby relieving pressure on adult mental health services as well. We undertook a review of the child and adolescent mental health service and are currently implementing the recommendations.
Will the Secretary of State promote the benefits and safety of midwife-led birth centres distant from consultant obstetric units when they have the right escalation and admission protocols?
I will indeed, and that is why I said to my right hon. Friend the Member for Salford (Hazel Blears) a moment ago that we would support such midwife-led units when they are what local people want. What we will not do is undermine clinically led change. The Opposition have said that they would put doctors in control in the NHS, and they go to marginal seats around the country opposing clinically led change, which is quite scandalous as far as I am concerned.
As I said earlier, it is not for us in the health service to prosecute; it is for the Crown Prosecution Service. It is for us to provide all the evidence, and that is what we always do and will always continue to do.
We continue to see a reduction in teenage unwanted pregnancy, and the changes in the curriculum will make a big difference. We continue the work, which is not just about messaging. There is no one thing that will work, but our “Contraception: worth talking about” campaign helps, and the support given to young men and women across the country to enhance their self-esteem will also make a big difference.
After 20 years of trying, we now have progress on the reprovision of Brackley college hospital, of which it happens my wife is a trustee. Yet unfortunately, the Government’s proposed route for High Speed 2 virtually bisects the proposed site. Will the Minister have a word with his colleagues in the Department for Transport? I do not wish to subvert the railway proposal, because that is a separate issue, but could he ensure that if it proceeds, there is proper reprovision of the college hospital on an alternative site?
As far as high-speed rail is concerned, we certainly need to ensure that there is proper local consultation and that local communities’ concerns are fully considered in respect of any route. If there are impacts on public provision, as the hon. Gentleman describes, we need also to ensure that alternative provision is in place so that there is no lack of services for local people.
I enjoyed immensely my recent visit to the Horton, and I pay tribute to the hon. Gentleman and all the local campaigners whom I met—indeed, the campaign spans the political divide. I was hugely impressed by what I saw. I know how much the Horton means to people in Banbury, and it is well located close to the M40. I hope that the review of services that has been going on at the Horton is concluded soon and that it can move forward into the future with confidence.