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Reform of Social Care

Volume 530: debated on Monday 4 July 2011

With permission, I wish to make a statement on the reform of social care.

The coalition Government have from the outset recognised that reform of the care and support system is needed to provide people with more choice and control and to reduce the insecurity faced by individuals, carers and their families. By 2026, the number of people over 85 years old is projected to double. Age is the principal determinant of need for health and for care services. It is further estimated that in 20 years’ time, 1.7 million more people will have a potential care need than do today.

People often do not think about how they might meet the costs of care in later life. They assume that social care will be provided free for all at the point of need, but since the establishment of the welfare state that has never been the case. Currently, people with more than £23,250 in assets, often including their home, face meeting the whole cost of care themselves.

The cost of care can vary considerably and it is hard for people to predict what costs they may face. The average 65-year-old today will face lifetime care costs of £35,000, but as the Commission on Funding of Care and Support notes, costs are widely distributed: one in four will have no care costs, but one in four will face care costs of more than £50,000 and for one in 10 it will be more than £100,000. The lack of understanding of how the system works and uncertainty about costs means that it is difficult for people to prepare to meet potential care costs, and there are currently few financial products available to help them. This means that paying for care can come as a shock to many families and have a severe impact on their financial security.

Change is essential. That is why we took immediate action last July by establishing the Commission on Funding of Care and Support, which was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support for all adults in England. In response to its initial advice, we allocated an additional £2 billion a year by 2014-15 in the spending review to support the delivery of social care as a bridge to reform. This represents a total of £7.2 billion of extra support for social care over the next four years, including an unprecedented transfer of funds from the NHS to support social care services that will also benefit health.

Since then we have taken forward wider reform. Last November we published our vision for adult social care, setting out our commitment to a more responsive and personalised care and support system that empowers individuals and communities, including the objective that all those who wish it should have access to a personal social care budget by 2013. In May, after three years of work, the Law Commission published its report on how to deliver a modernised statute for adult social care. Making sense of the current confused tangle of legislation to deliver a social care statute will allow individuals, carers, families and local authorities to understand more clearly when care and support will be provided.

Andrew Dilnot’s report comes at the same time as the final report from the palliative care funding review, which I received last week. Tom Hughes-Hallett and Sir Alan Craft have made an excellent start in looking at this complex and challenging issue. We want to see integrated, responsive and high-quality health and care services for those at the end of life. We will now consider the review team’s proposals in detail before consulting stakeholders on the way forward later this summer. We will also consider how best to undertake substantial piloting, as recommended in the report, in order to gather information on how best to deliver palliative care services.

We are also responding to events at Southern Cross, which have caused concern to residents in Southern Cross care homes and their families. We welcome the fact that Southern Cross, the landlords and the lenders are working hard to come up with a plan to stabilise the ownership and operation of the care homes. We have also made it clear that we will take action to ensure proper oversight of the market in social care. That is why we are seeking powers through the Health and Social Care Bill to extend to social care the financial regulatory regime that we are putting in place in the NHS, if we decide that that is needed as part of wider reform.

A central component of those wider reforms will be the long-term funding of care and support. Over the past 12 months Andrew Dilnot, who chairs the Commission on Funding of Care and Support, together with the noble Lord Warner and Dame Jo Williams, has engaged extensively with many different stakeholders. They have brought fresh insight and impetus to this most challenging area of public policy. We welcome the commission’s excellent work and its final report. I would like to thank Andrew Dilnot, Lord Warner and Jo Williams for their work, which has made an immensely valuable contribution to meeting the long-term challenge of an ageing population.

The report argues that people are unable to protect themselves against the risk of high care costs, leaving them fearful and uncertain about the future. The commission’s central proposal, therefore, is a cap on the care costs that people face over their lifetime of between £25,000 and £50,000—it recommends £35,000. Under the commission’s proposals, people who cannot afford to make their personal contribution would continue to receive means-tested support, but it proposes that the threshold for receiving state help for residential care costs would rise from £23,250 to £100,000. People would make some contribution to their general living costs in residential care, but the commission suggests that this should be limited to between £7,000 and £10,000.

The commission also proposes the following standardised, national eligibility for care, which would increase consistency across the country; universal access to a deferred payments scheme for means-tested contributions; improvements in information and advice; improved assessments for carers and better alignment between social care and the wider care and support system; and considering changing the means test in domiciliary care to include housing assets. The commission makes recommendations about how as a society we can organise and fund social care. We will consider the recommendations as a priority.

The commission recognises that implementing its reforms would have significant costs. In the current public spending environment, the Government will have to consider the recommendations carefully against other funding priorities and calls on our constrained resources. The commission’s recommendations present a range of options, including on the level of a cap and the contribution that people make to living costs in residential care, which could help us to manage the system and its costs. We intend to engage with stakeholders on those issues, including on the trade-offs involved.

Reform in this area will have to meet a number of tests, including whether the proposals would promote closer integration of health and social care and increased personalisation, choice and quality; support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established as a result of the proposals; what is the level of consensus that additional resources should be targeted on a capped costs scheme for social care; and what a fair and appropriate method of financing the additional costs would be.

The Government have set out a broad agenda for reform in social care. We want to see care that is personalised; that offers people choice in how their care needs are met; that supports carers; that is supported by a diverse and flourishing market of providers; that has a skilled work force who provide care and support with compassion and imagination; and that offers people the assurances they expect of high-quality care and protection against poor standards and abuse. Andrew Dilnot’s report was never intended to address all those issues, but it forms a vital part of that wider agenda.

To take the matter forward, we will work with stakeholders in the autumn, using Andrew Dilnot’s report as the basis for engagement and as a key part of the broader picture. That engagement will look at the fundamental issues for reform in social care, such as improving quality, developing and assuring the care market, integration with the NHS and wider services, and personalisation. We want to hear stakeholders’ views on the priorities for action from the commission’s report and on how we should assess the proposals, including in relation to other priorities for improvement in the system. As the right hon. Member for Wentworth and Dearne (John Healey) and I have discussed, the Government will engage directly with the official Opposition to seek consensus on the future of long-term care funding.

We will set out our response to the Law Commission and the Dilnot commission in the spring. There will be full proposals for the reform of adult social care in a White Paper and a progress report on funding reform. It remains our intention to legislate to this effect at the earliest opportunity. The care of the elderly and of vulnerable adults is a key priority for reform under this Government, and I commend this statement to the House.

I thank the Health Secretary for the copy of his statement, and for making it to the House himself.

We welcomed the Hughes-Hallett report last week and we welcome the Dilnot report on social care today. The Dilnot report sets out important recommendations on capping the catastrophic costs of care; lifting the wealth threshold for state help; immediate free support for children with care needs on becoming adults; universal disability benefits continuing as now; a standard national needs test; and better information and advice, led by local councils.

The important elements in the Dilnot report are similar to the plans that we set out in government in the care White Paper in March last year. Our concern was and is to protect the one in 10 people who have to pay more than £100,000 for the cost of their care in older age; our concern was and is to protect hard-working people on modest incomes, who are more likely to care for their relatives and a lot less likely to get any help in doing so; and our concern was and is to protect people from the lottery of where they live, rather than what they need, determining their assessment for care and the level of support.

It should be a cause for celebration and pride that one in five of us in this country who are alive today will live to 100, and that our children are likely to spend a third of their lives in retirement. Instead, too many of us approach our older age in fear—fear that we will need care that will not be there; fear that our savings will be wiped out by the open-ended costs of care; fear that we cannot protect our families from that risk; and fear of becoming a burden or being left alone.

Today’s report from Andrew Dilnot is a starting point, but it is what the Government do with it now that counts. My right hon. Friend the Leader of the Opposition has made a big offer to the Prime Minister to put politics aside and work to see a better, fairer and lasting system of support for our older and disabled people in England. Labour is willing to talk to and work with the Government and all other parties to do so, because we know that any new system of care must give all of us long-term confidence about what will be on offer for us and our families as we plan and prepare for older age.

That requires the Prime Minister to give the lead, because discussing and agreeing an affordable, sustainable system and how we pay for it involves important parts of Government beyond the Health Secretary. It requires the Prime Minister to give a guarantee that the Government will not kick Dilnot’s recommendations into the long grass, because as Dilnot says, the system needs “urgent and lasting reform”. If the Government are serious, we are serious; and if they are serious, we need to hear more. Dilnot recommends a White Paper by December this year, so why are the Government already saying that it will be spring before publication?

Any solution is a solution only if it is available and affordable to everyone, so what assurance can the Government give that the voluntary insurance protection will be an option for all? Dilnot states that the current system is

“under extreme strain, and people are experiencing tightening eligibility and reduced care packages.”

Do the Government accept his conclusion that additional public funding for the means-tested system is urgently required?

The corporate crisis at Southern Cross is causing extreme anxiety for many people living in its homes. Do the Government accept that there is a case for regulating business standards as well as care standards, to give people greater confidence in their care?

The Secretary of State said that he would engage directly with me. I thank him, but this is a big challenge not just for him but for the Chancellor and the Prime Minister. Will the Government accept that cross-party talks are required across Government? This is a once-in-a-generation chance, and the House and the public will need to hear from the Prime Minister himself to believe that his Government are determined, as we are, to build a better, fairer and lasting system of care in our country.

I am grateful to the right hon. Gentleman for the welcome that he gives to the report by Andrew Dilnot and his colleagues, and indeed to the report that Tom Hughes-Hallett and Alan Craft produced on palliative care. They are both immensely valuable.

The right hon. Gentleman rightly says that it is important for us to move beyond many of the suggestions that have been made in the past. One of the essential purposes of the Dilnot commission was to seek something that was affordable and sustainable, that met tests of choice, fairness, value for money and ease of understanding, and that would be sustainable for the longer term. Dilnot has responded immensely well to the issues that we put to him, but that is part of a broader process of reform. In that sense we have not waited for Dilnot, because we have made progress on the wider aspects of reform. Now we have to ensure that we bring them together in a way that is coherent and works to deliver long-term, sustainable reform across the whole social care sphere.

The right hon. Gentleman rightly points to the fact that we inherited a fragile system in which there had already been a substantial tightening of eligibility and loss of care and support, with increasing levels of unmet need. That was precisely why, in an interim report last year, Andrew Dilnot and his colleagues asked us to make additional resources available in the spending review. I set out in my statement precisely how we have done so.

The concerns in relation to Southern Cross are particular to that company, and the Minister of State, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), has made clear to the House how we are interacting with those who are involved with the company. We are making it very clear to the public—I reiterate it today—that we are prepared to act to secure the interests of individuals if there were any threat to their position in care homes. We are working with the Association of Directors of Adult Social Services and local authorities to ensure that those contingencies are in place. What I said today in the statement, and which people have not previously recognised, is that as early as last year we set out in the Health and Social Care Bill that we were prepared for regulatory powers to be available to ensure the future viability of social care providers, as we intend to do in relation to health care providers.

Let me may make one final point. I believe that my statement makes it absolutely clear that we will engage on the basis of the Commission on Funding of Care and Support, and that we will do so on a timetable that will work and that gives stakeholders and the public, and indeed the Government and the Opposition, an opportunity to come forward with a consensus. I discussed that timetable with Andrew Dilnot, and he is clear that he supports it. It will lead to a White Paper in the spring and an associated progress report on funding reform. I am clear that that assures stakeholders that we will take this forward as a priority.

I very much welcome the report and the Secretary of State’s statement. It was the previous Government who kicked the fixing of our broken care system into the political long grass. Will my right hon. Friend reassure me that we will work with all parties in both Houses to find a lasting solution?

Yes, I agree with my hon. Friend. That is indeed what we will set out to do. There have been many false starts, and not just under the previous Government. It is important for us to make progress, and for us to do so on a basis that is sustainable for the longer term.

The Secretary of State will be aware that all sorts of new and innovative ways of caring for elderly and disabled people are developing. The terms “domiciliary care” and “residential care” will become obsolete as services are provided in different ways. Will he ensure that whatever funding mechanism is being developed does not limit the type of services that can be provided, because providing for elderly people to be cared for in their own homes and in settings where they can live in a more normal way will be enormously important in future?

The hon. Lady very well illustrates one reason why Andrew Dilnot’s commission is, among its recommendations, looking to eliminate discrimination between residential and domiciliary care services. We should not have a system that tends to provide perverse incentives to go into residential care, or indeed one that prevents that from happening when it is the right thing. However, part of the reason why the Dilnot commission should be seen in its wider context is that we are looking towards innovative and more effective means of supporting people’s independence at home. The Department is now looking towards the evaluation of the telehealth whole system demonstrator pilots, the world’s largest randomised controlled trial of telehealth, which should come in a matter of weeks.

Will the Secretary of State acknowledge that it will be easier to get agreement on the principles underlying the proposals than on the mathematics and the cost? Does he agree that only a renewed NHS focus on the chronic diseases of old age will ultimately make the latter bearable?

My hon. Friend is absolutely right. Although we are looking to ensure that we have a sustainable system of social care and support both for social care and the NHS, the linked priority of our Department and our Government is to improve and increase the effectiveness of our public health services. That is why I was this morning with the Faculty of Public Health to discuss precisely how we can improve health planning at local level, not least with local government, to try to reduce the prospective burden of disease in future.

As a vice-president of the Alzheimer’s Society, and like many hon. Members, I am aware that it is dementia awareness week. The most enormous resource is needed to help both individuals and their carers, particularly with residential support. Is not my hon. Friend the Member for Sheffield, Heeley (Meg Munn) entirely right to draw attention to the fact that even within Andrew Dilnot’s acknowledgement of the perverse incentives, there is still an emphasis on the care market and the drive to encourage people to take up, or to consider the option of, residential care? Do we not need to put the glue back by supporting families and neighbourliness, so that we can keep people independent in their own homes as long as is humanly possible?

I understand the point that the right hon. Gentleman makes and in the past some of the criticisms of previous proposals have been made because they would have led to a situation in which informal care and family care would not have been properly supported—indeed, there would have been perverse incentives for people not to have family carers. We need to support family carers rather than bypass them.

I am glad that the right hon. Gentleman raises the issue of dementia. It is tremendously important that we understand it is one of the principal reasons for such a rising burden of disability and requirement for care and support. It is why we are looking to the longer term, not least to improve research into dementia. I am grateful to the Minister of State, my hon. Friend the Member for Sutton and Cheam, who has chaired the work on research into dementia, and he was able to announce substantial additional funding to support dementia research just the week before last.

I declare an interest as I have an elderly step-mother who is in a home and this will be very important news for her family and my family. Have there been discussions with the Treasury, and does it recognise that this is one of the key issues? How far have those discussions reached, or if they have not started, when will they do so?

My hon. Friend will be pleased to know that the statement I have made is the product of collective discussion, which of course fully involved the Treasury.

Does the Secretary of State agree that it would be a big mistake to miss this opportunity for root-and-branch change of the present system? Would it not be handy if local authorities played a bigger role than the billionaires who run Southern Cross, Winterbourne and the rest? Would it not also be nice for him to acknowledge that when he blurted out about the death tax he got it all wrong?

On the hon. Gentleman’s point about local government, he should remember that the overwhelming majority of the residents in Southern Cross care homes are funded by local authorities, and that is precisely why we are working with local authorities to ensure that those residents’ interests will be protected. I recognise the problems that we have seen with Southern Cross, although I do not know of any other companies in a similar position. None the less, it is one of the reasons why we seek the powers in the Health and Social Care Bill to regulate social care provision in the same way as health care provision.

If we are to see elderly and disabled people needing more carers, my right hon. Friend will need to work with the Secretary of State for Education to enhance the status of those who work in the care industry, because we will need far more people willing to work in it and with the skills, qualifications and commitment needed to give the enhanced care that people would like to receive.

I am grateful to my hon. Friend. During the engagement that we are undertaking, one of the areas that we should certainly pursue is the work force development strategy in relation to care and support—and we will do that.

Can the Secretary of State tell us why one part of the UK gets care free and the other has to pay? Is it because the other part—Scotland—pays more taxes?

I welcome the fact that the Secretary of State has gone wider than the Dilnot report today. It was at least two years ago that the Commission for Social Care Inspection, the regulator, called for wider powers to deal with financial regulation, and it is very welcome that that is to happen. Does my right hon. Friend agree that the level at which the cap is set under the Dilnot regime will be important in deciding whether an insurance market can develop? If it is set too low, the risk that is being shared will not be great enough, and if it is set too high, it will be too expensive.

I am grateful to my hon. Friend. That is precisely why we drafted the Health and Social Care Bill in the way we did. I hope that people will bear that in mind when debating the need for, and appropriateness of, this further regulatory measure. He made a perfectly valid point, and it is one reason we need to ensure engagement. It is not only a matter of whether the insurance and financial services industry would respond: along with stakeholders and the public, we need to understand what the public’s attitude would be were they to have greater clarity about potential care costs and if they were willing to engage with financial services products in meeting those care costs. If they were, significant benefits would be derived, not least through bringing additional resources to bear and through creating organisations with a direct incentive to undertake more prevention.

Dilnot offers a new dawn but not for three years, and in the meantime the fabric of social care is coming apart at the seams because the Government have imposed a 28% cut on local government, leading to such councils as Birmingham cutting care all over England. Will the Secretary of State act now to ensure that in the meantime the elderly and the disabled get the support that they deserve and which any civilised society should provide?

The hon. Gentleman should be aware that the maximum reduction in local authorities’ spending power this year compared with last year is 8.8%. We removed the ring fence from Department of Health social care grants but we did not reduce the scale of those grants. In addition, he must remember that, as is not always recognised, the NHS is making specific provision to support social care. This financial year, £150 million will go to support reablement, and £648 million will be transferred, as I said, to support social care, which will also have health benefits. That will be spending power in the hands of local authorities to support adult social care.

I welcome the Dilnot proposals, but does my right hon. Friend agree that he should resist the demands from the shadow Health Secretary to rush into a White Paper this side of Christmas? It is more important to get it right, and there may well be ways to improve on the Dilnot proposals, particularly with regard to the cap and by making provision more affordable and fairer.

My hon. Friend makes a fair point. It was clear that had we sought to publish a White Paper before Christmas, the net effect would have been that we did not give the public, stakeholders or the official Opposition the time needed to discuss the issue and to do the job properly .

It is clear that there are two issues: not just the future funding of social care but the current funding—the crisis referred to by my hon. Friend the Member for Birmingham, Erdington (Jack Dromey). Only 15% of councils are now meeting moderate need, but that figure used to be 50%. The Secretary of State cannot say that there is no crisis. It seems to me that building a future funding solution rests on not letting current provision deteriorate much further—but it is deteriorating rapidly. What, then, will Ministers do beyond the excellent cross-party work that probably will go forward to do something about the resources that are leaking away and the current crisis in provision?

I do not believe I did say that there was no crisis. The hon. Lady and the House must recognise, however, that last year the Dilnot commission, in an interim report, sought additional support specifically for social care and that we provided it through the local government grant and a transfer of resources from the NHS. She says that few authorities now provide social care for those with moderate needs, but that has been the product of years of change—it has been happening for many years. That creates a risk, but we are addressing that risk through the transfer of NHS resources and by helping people with lower levels of need through home adaptations, community equipment and reablement if they leave hospital, in order to make certain that we avoid the risk that we are running: of large numbers of people with moderate need falling rapidly into severe need.

I understand the need for the timetable to allow for adequate consultation, but Andrew Dilnot’s excellent report draws attention to several areas including a lack of transparency, a lack of information available to families making decisions about care homes and, in particular, a lack of portability, which results in many patients being trapped and unable to move closer to loved ones. Does the Secretary of State feel that he could expedite any of the report’s recommendations to allow such proposals to receive more detailed consideration?

I entirely understand my hon. Friend’s point. In the course of the engagement during the latter part of this year, some of those issues will certainly come to the fore. My colleagues and I felt that it was better for us not to cherry-pick Andrew Dilnot’s report now, but rather for us to give people an opportunity to comment on the recommendations in full. That will, however, take place over the space of weeks rather than many months.

I should remind Government Members that this issue has already been delayed because the Conservatives broke ranks before the election in order to score political points. However, there is now cross-party support for the recommendations, so why has the Secretary of State let the timetable slip from the autumn to next spring? Can he reassure the House and the country that there will be no further slippage in the timetable?

I am afraid that I do not accept the hon. Lady’s premise. I am not going to revisit the past, but the truth is that, since I became directly involved, I initiated cross-party discussions before the election on the reform of social care, and I did not leave those discussions. It was her former Prime Minister who effectively broke them down.

I think everyone knows where we want to get to on palliative care. We want to provide those people who want it with a much better opportunity to die at home or to die in a hospice while being properly cared for and supported. How does my right hon. Friend see us getting from here to there? What process will be involved, and who is going to drive that process to improve palliative care?

I am grateful to my hon. Friend for his question. This is very much about ensuring that, at the same time as engaging on the palliative care report, we build pilots that will enable us to see how the proposals would work in a number of places across the country. I know that some areas of the country are ready and willing to do that. The essence of what we are doing is to be increasingly clear about what quality services for those at the end of their lives look like, and to be sure that we can integrate those services by developing a system of per-patient funding. That would enable the providers to work together within the funding framework, without the current constraints and demarcations, and without the silo system that currently divides palliative care and end-of-life care services in a way that makes the system immensely confusing and difficult for people at the end of their lives. This is a real opportunity that has been fashioned by Tom Hughes-Hallett and Alan Craft’s report.

Funding for care is clearly a hugely important issue, but so is the quality of the care that older people receive. The parliamentary ombudsman and even the Financial Times have reported the need for greater respect and dignity for those receiving care. When will the Secretary of State return to the House and inform us in detail of the standards of care that older people can expect?

The hon. Lady will know that we are continuously seeking to improve the standards of care that older people receive, and, in so doing, we sometimes have to tackle what are clearly serious abuses. In the wake of the Winterbourne View events, for example, we will bring forward a report to Parliament on standards and the means by which they are to be met. With regard to hospital care, it was I who asked the Care Quality Commission to undertake specific unannounced nurse-led inspections to look at dignity and nutrition. We will work continuously to ensure that we deliver the standards of care that people have a right to expect.

My right hon. Friend might be aware that more than 100,000 people a year are not receiving the palliative care that they need. Can he assure the House that that will be a key priority, following the issue of this report?

My hon. Friend is right. I very much welcomed and encouraged the dialogue that took place between Andrew Dilnot’s team and Tom Hughes- Hallett’s team, and they have made complementary recommendations. My hon. Friend is absolutely right to say that, as far as end-of-life care is concerned, there is widespread unmet need. The disparity in the quality of care and the services provided in different parts of the country is staggering. Just as the Dilnot commission deals with care and support, we certainly aim to deliver greater consistency in eligibility and in the quality of care provided.

I am sure that the Secretary of State is aware that there are concerns nationally—and locally in Coventry—about Southern Cross. Can he be more positive, because so far the answers we have received from the Government have been very vague? Equally, there is concern about the regulator being undermanned, so how does he intend to improve that and improve the quality of care?

I am sorry if the hon. Gentleman feels that the Government have been anything other than absolutely clear about what we are setting out to do. This is a problem that derived from the commercial decisions that the company made and it should be resolved by further commercial discussions between the company, its landlords and its lenders. We are constantly in touch with all of those, but it is not the Government’s responsibility to step in and take those decisions. What is the Government’s responsibility, which we are clear about and ready to take action as necessary, is to ensure that individuals in those care homes and their families are not abandoned and do not fall through the gaps or find themselves without access to the care and support they need. I hope that, in the midst of the perfectly legitimate concerns being expressed, people do not stray into causing people to be more fearful than they need be.

Will my right hon. Friend confirm that the Government are taking the action necessary to ensure that residents in Southern Cross care homes, such as Harmony house in my constituency, will not be left without the care that they need?

My hon. Friend is absolutely right. I have a Southern Cross care home in my constituency and I am sure that most Members do. We cannot know precisely how the commercial discussions will turn out, but what we can be sure about is that we have put together with the directors of social services in local authorities clear contingency plans to protect the residents if need be.

The Secretary of State will be aware that many people both inside and outside the House believe that this matter is going to be kicked into the long grass by the Government. Can the Secretary of State set out the time scales for the consultation process and for the introduction of the legislation that will be needed?

Many people would therefore be wrong in that respect, because we are clear about taking this report forward as the basis for engagement in the autumn, publishing a response and carrying out other related work on palliative care in the spring, publishing a White Paper and a progress report on funding reform and legislating at the first available opportunity thereafter.

Through the broad principles of the Dilnot report and the work already carried out by the Government, we at last have a framework that we can work towards to bring security, dignity and fairness back to elderly care, which I believe is really important. Will my right hon. Friend assure us, however, that we have a sensible and workable time frame within which to deliver?

My hon. Friend is absolutely right. At the heart of this, we know that additional resources have to be brought to bear and that given the financial circumstances we face, we also know that this will have to be a partnership between taxpayers, families and individuals—it cannot simply be handing costs over to the state. Although Andrew Dilnot makes no specific recommendations about how to pay for his proposals, he is very clear that even if it were to be through a tax mechanism, he believes it should come from an existing tax and should bear particularly on the same groups of older people rather than be a further intergenerational transfer from working age adults. What that immediately points to is the necessity of engaging fully with some of the stakeholder groups such as Age UK and others and of engaging properly with the public so that before we embark on this major reform, they can feel confident that they understand those trade-offs and precisely how these costs are to be met.

The increased availability of care at home is to be welcomed, but it also poses increased challenges for safeguarding vulnerable adults. Given that personal budgets can be spent on unregistered and therefore unregulated care providers, what steps will the Secretary of State take to ensure that taxpayers money can be spent only on good quality and safe care provision where the rights of care workers are also fully respected?

The hon. Lady makes a number of important points. As the Minister of State, my hon. Friend the Member for Sutton and Cheam, made clear recently, one purpose of legislation in due course will be to put the safeguarding on a statutory basis, which is important. Working with the CQC, we must ensure that in domiciliary care as well as in residential care homes, mechanisms are in place that enable us to assess the quality of care and get feedback from residents. The social care outcomes framework must be developed in a way that captures an understanding of the experience of care users, their families and supporters.

I thank the Secretary of State for his statement and I welcome the Dilnot review. As other Members have said, however, hundreds of thousands of families across the country are already worrying about how they will pay for care bills for their relatives, including the Strachan family in my constituency, who said publicly this morning that they have only two months’ money left to pay care home bills and are not sure what they will do after that. When my right hon. Friend launches the consultation, may I urge him not to forget the needs of those already in the care system who are worrying about paying bills, as well as being rightly concerned about those facing future care bills?

My hon. Friend’s point relates to the degree of uncertainty and insecurity that the current system tends to engender. It is important that we deal with that, and that people understand the circumstances in which the state pays and will continue to pay. We should not give people who have no assets the sense that they will be required to pay when they have no means of doing so. The state will be there to support them. There will be a safety net, and the commission makes recommendations about how further to develop it in future. Beyond that, we must arrive at a place where people are able to understand better the nature of the care costs that they might meet, and where there are good, affordable, secure mechanisms through which they can prepare for those costs, so that they do not have the gross insecurity that exists at the moment.

Does my right hon. Friend agree that improved palliative care will be enormously helpful to those of us who wish to resist the calls for the legalisation of euthanasia, and that a reduction in the number of deaths in hospital could save tens of millions of pounds each year for reinvestment in patient care?

I share with my hon. Friend the feeling that if we can improve the quality of end-of-life care and give people an understanding of the recent great developments in symptom control at the end of life, people’s perception of the decisions that they might have to make about end-of-life care might change, and that might give them greater confidence that they can have what most people would regard as a good death.

I welcome the Dilnot report’s many practical suggestions, which will be very important in Devon because it has the highest level of retired people—22%. With regard to the need for any new funding proposal to cover a range of different provision, given the change in relation to when people need to go into residential care, the contracting will need to be looked at carefully. Does the Secretary of State agree that if we are to have contracts, they need to be standardised? For example, the contracts that councils enter into with care homes are not standard, so although in theory they offer the same quality of care—

Order. I am extremely grateful to the hon. Lady, but I think that that is an excellent subject for her to pursue in an Adjournment debate, and I feel sure that she will.

There is the nub of a very good question there. If we develop greater national consistency in eligibility and in assessment, we might also start to engender greater consistency in quality, including the contracting that supports it.

My local borough, Bromley, tries very hard to use its resources for social care as efficiently as possible. Might boroughs such as Bromley and others throughout the country be given more resources to help them to ring-fence funds for social care, particularly palliative care?

As my hon. Friend will know, local authorities were keen for many of the grants that we provided not to be ring-fenced in future, including the social care, public health and learning disability grants. We aim to give local government more flexibility, but, through the NHS, we are providing additional resources—in Bromley and elsewhere—to support preventive interventions that benefit both social care and the NHS, and I think that that will make a big difference in Bromley. As we know, however, all local authorities are, of necessity, having to seek greater efficiencies, and we are working with local government to identify where they can be delivered. There is still a dramatic variation between the costs of care services provided in different parts of the country.

As we know, going into a home is long on cost but short on life expectancy. I particularly welcomed my right hon. Friend’s comments about greater prevention. What more can be done to promote access to—and promote in general—day care and respite care?

We have made specific additional provision to support respite care. I hope that people will be given more independence and support at home not only as a result of NHS support—the £648 million that will be provided this year is a great deal of money, which will substantially increase access to such facilities as community equipment, home adaptations, reablement and rehabilitation —but through, for instance, telehealth, which I mentioned in response to an earlier question. I think that we can transform the quality of care and health services provided at home.

Because Haunton Hall nursing home in Tamworth is owned by Southern Cross, its fate is of grave concern to residents and their families. Will my right hon. Friend confirm that any advice he receives from the regulator about companies such as Southern Cross, which the Labour party unfortunately ignored, will not go unheeded by him?

In the past, Governments received advice from the regulator about the desirability of their being able to undertake proper scrutiny of the financial circumstances—the financial viability and sustainability—of organisations. No powers in that regard have been taken in the past, but we are seeking such powers in the Health and Social Care Bill, and one of the debates that we will need to have concerns the extent to which it will be right for us to use them in the future.

How will the Secretary of State ensure that the very best examples of the hospice movement, such as Cransley hospice in Kettering, can become involved in the establishment of the new framework for palliative care, so that best practice is extended throughout the country?

As my hon. Friend will know, Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care—who is leading the palliative care review—has engaged fully with Help the Hospices and the hospice movement. I understand from my conversations with hospice representatives over a number of years that they do not want their funding to be subject to the vagaries of public expenditure. Individual block grants that vary from year to year give them no confidence about the services that they provide. They do not want additional resources as much as clarity about what resources will be provided for the individuals who seek their care. They particularly hope that there will be a corresponding transfer of resources to hospices which provide services that replace the NHS and support people at home, as many are increasingly doing.

I have four Southern Cross homes in my constituency. Does my right hon. Friend agree that the Southern Cross situation highlights the need for a dedicated financial regulator for social care services?

As I said earlier, this is one of the issues on which I hope we will have further discussion as part of the debate on wider social care reform leading to the White Paper.

End-of-life care is massively enhanced by Kirkwood hospice in my part of west Yorkshire, and the construction of a new children’s hospice has just begun on the outskirts of Huddersfield, funded by the West Yorkshire Forget Me Not Trust. Does my right hon. Friend agree that when considering the hospice movement in our country, we must always remember the children’s hospice movement?

My hon. Friend is absolutely right. The children’s hospice movement has done immensely good work over the years. I am aware of that in my own constituency through the work of East Anglia’s Children’s Hospices, and I am sure many Members also completely understand. That movement’s work has been done in circumstances in which a very small proportion of the resources for children’s hospices comes from state sources. The palliative care funding review addresses both adult’s and children’s end-of-life care and palliative care and identifies per-patient funding for children as well as adults, and it therefore offers children’s hospices precisely the same kind of security in the future as adult hospices.

Does my right hon. Friend agree that the Dilnot report goes some way to addressing the long-standing issue that for many years the current system has been punitive to those who have been prudent and frugal in planning for their old age?

Yes I do, and one of the essential reasons why the Dilnot commission was rightly established is that there are many people who have worked hard, saved and accumulated assets and expected to be able to enjoy them in their older age or to pass them on to their families, but who instead found that all those assets were destroyed as a result of the sheer chance event of, for example, long-term disability or dementia. That is a tragic situation, and as Andrew Dilnot well puts it, if people have a health care need and are seriously ill the NHS will look after them, and if their house burns down or they have a car crash there is insurance for that, but here we have a potential catastrophe in people’s lives for which the state will not provide and nobody else is willing or able to offer them that similar kind of protection. It is therefore vital that we take forward the Dilnot recommendations in the way we are proposing.

I welcome the statement, and it is particularly welcome in Cheshire east where we anticipate a 120% increase in the number of people living beyond 85 in 10 years’ time. The Dilnot report stresses the importance of the awareness campaign. Does my right hon. Friend envisage an active role for third sector organisations such as Age UK and Citizens Advice not only in delivering the awareness campaign, but in helping to shape it, and is there also a wider role for such organisations within the Dilnot framework?

My hon. Friend makes a very good point, and I hope we will be able to take up and develop that during the coming weeks.

Does my right hon. Friend agree that in a modern, responsive and caring social care system, we need more transparent and effective decision making and improved integration with the NHS, so that the person in need of care can navigate their way around the system?

I agree with my hon. Friend, and in his county the early implementation of health and wellbeing boards, which are to be legislated for under the Health and Social Care Bill, will provide precisely that opportunity for the integration of health and social care services.

A constituent of mine who is 61 years old is the full-time carer for both her disabled husband, who lives with her, and her elderly mother, who does not. Since she drew her state pension, she has not been allowed any kind of carer’s allowance. Will my right hon. Friend join me in praising all retired people who do such work, which saves the taxpayer a fortune, and will he look into what we can do to provide more support for such people?

I am grateful to my hon. Friend for asking that question, and I will, indeed, join her—and, I am sure, the whole House—in expressing our support for those who care for their relatives. It is absolutely vital work, and we should understand and support it. As my hon. Friend will know, my right hon. Friend the Secretary of State for Work and Pensions is currently reforming welfare, and he has made it clear that although carer’s allowance does not form part of universal credit, it is important for us to continue to understand how it should in future meet its aim of supporting carers.