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Care and Support

Volume 548: debated on Wednesday 11 July 2012

With permission, Mr Deputy Speaker, I would like to make a statement on the future of care and support for adults in England.

The coalition programme said that reform is needed urgently. We inherited a system that too often let people down and was unfair; a system that was complex and confusing, and which responded to a crisis, but too rarely prevented it. For many years, people have called for a system fitted around the needs of care users, not the preferences of the service; one that puts people at the heart of the service and delivers high-quality care with dignity and respect.

We knew two years ago that we had to offer urgent support to social care. In the spending review 2010, we provided an additional £7.2 billion for social care over the course of this Parliament, including nearly £3 billion from the NHS to deliver more integrated care. This gives the current system resource backing, but not reform. We need also to build a better service for the long term.

The White Paper I am publishing today represents the greatest transformation of the system since 1948. The practical effect will be to give service users, their carers and their families more peace of mind. Services will be organised around each individual's care and support needs, their goals and aspirations. Intervention will be earlier, promoting independence and well-being.

The White Paper will support people to remain active in their own communities, connected to their families, friends and support networks. We will invest an additional £200 million over five years in the development of specialised housing for older and disabled people, so that people can stay independent in their own homes for as long as possible. The role of carers is critical, so we will transform how the system views and treats carers. We will extend rights for carers to have an assessment and for the first time provide a clear entitlement to the support they need to maintain their own health and well-being.

The measures in the White Paper will make it easier for people to understand how care and support services work, and what their entitlements and responsibilities are. To give people greater consistency of access, we will introduce a national minimum eligibility threshold, as the Dilnot commission suggested. We will require councils to start supporting people as soon as they move into a new area, so that it is easier for people to choose to move home, to be nearer, for example, to their relatives. Local authorities will be under a duty to ensure continuity of care, and that care users are able to take their assessments with them if they move area.

We will establish a single website to provide clear and reliable information about all care and support services for self-funders and local authority supported users and carers. As well as these improvements to national information, we will invest £32.5 million to ensure that there is better local information about the range of local care and support services available in each area.

We want people to be confident that the care and support they receive is delivered by a compassionate and caring work force. We will place dignity and respect for care users at the heart of a new code of conduct and minimum training standards for care workers. Alongside the new minimum standards, we will train more care workers, with 50,000 more apprenticeships by 2017.

A key requirement is for people to be confident that they will be treated with dignity and respect, and that providers deliver high-quality care at all times. We will rule out the crude practice known as “contracting by the minute” that can so undermine people’s dignity and choice. We should contract for quality and service, not by the clock. We will call on local HealthWatch organisations to make active use of their new power of entry, allowing them to visit care services in their local area, and to make recommendations to the providers and to local authority commissioners.

People should also be entitled to expect that services will be maintained if a provider fails. Working with local government and the care sector, we successfully handled the consequences of the Southern Cross crisis, but we also learned lessons, so we will consult on how we can anticipate and act to ensure continuity of care if a provider goes out of business. Care itself, not the provider of care, is the most important factor.

A key theme of the White Paper is that those receiving care and support know what is best for them. It is right that they must be in control of their care and support. We will make sure everyone is entitled to a personal budget, so they can be in control of their own care. We will offer all who want it a personal budget, and by 2015 support that with a legal right to request this as a direct payment. To make it easier for people to get the care they want, we will ensure that they have better access to independent advice. We will make it easier for people to see whether a care provider is good or not so that they can make real choices through an online “quality profile” for each provider. We will work with a range of organisations to develop comparison websites so that people can give feedback and compare the quality of care for themselves.

Integrated care is important for everyone, regardless of age or the reason they need care and support, but getting integration right is particularly important for those moving from one service to another. That is why we will transfer an additional £100 million in 2013-14 and £200 million in 2014-15, beyond previous plans, from the NHS to support social care services that benefit people’s health and well-being and promote better integrated care.

The White Paper will help people get better joined-up care at key points in their lives. We will legislate to give adult social care services a power to assess young people under the age of 18, and we will ensure protection so that no young person goes without care while waiting for adult support to start. We want people to receive the best possible care at the end of their lives, including a choice over where they die. The palliative care funding review recommended that all health and social care should be funded by the state once someone reaches the end of life and is entered on the end-of-life care locality register. We think that there is much merit in this and will be using the eight palliative care funding pilot sites to collect the data and experience we need to assess the proposal.

Alongside the White Paper, I am today publishing the draft Care and Support Bill. Many of the White Paper reforms need new legislation to make them work, but the draft Bill is also a major reform in its own right. The law for adult social care is complex and outdated. All those involved know how it has made the system harder to work in. The draft Bill sets out a single, modern statute for adult care and support. It brings together and simplifies provisions from at least a dozen Acts of Parliament, reflecting the recommendations of the Law Commission. It builds the law around people’s well-being and needs and outcomes—clear principles, clearly set out in law.

I am also today publishing a progress report on funding reform. In July 2010 I asked Andrew Dilnot to review the funding of the system of care and support in England. I can confirm today the Government’s support for the principles of the Dilnot commission’s report as the right basis for any new funding model: financial protection through capped costs and an extended means test. As Andrew Dilnot himself has said, that would enable people to plan and prepare so that they are not so vulnerable to the arbitrary impact of catastrophic care costs.

The progress report sets out a detailed analysis of the funding model, giving us a better basis for making decisions on how these changes can be funded. Of course, any proposal that includes extra public spending needs to be considered alongside other spending priorities, including the demographic pressures on social care services. The right and necessary time to do that is at the next spending review. Our talks with the Labour party were constructive, but no plan for funding Dilnot was agreed or, indeed, proposed by either side. A decision at the next spending review will allow time for continuing discussions with stakeholders and between the parties, and we can undertake open engagement on detailed implementation issues and options. These discussions will include the level of the cap, whether a voluntary or opt-in approach is a viable option in addition to the universal options and whether legislative provision is required.

However, as the report makes clear, we are also taking definitive steps now by accepting a number of the Dilnot commission’s recommendations. Most notably, we will introduce a universal deferred payments scheme. This will mean that no one will be forced to sell their home in their lifetime to pay for care. Provisions for this are included in the draft Bill.

The White Paper, the draft Care and Support Bill and the progress report on funding together set out our commitment to a modern system of care and support, one designed around the needs of individual people, one with dignity and respect at its heart, and one that brings care and support into the 21st century. These reforms are also the product of immensely helpful reviews by the Law Commission and the Dilnot commission and a positive and wide-ranging engagement with the care sector and the public, which is helping us to design the kind of care services and support that we would all like to see for ourselves and our families. We are determined to secure these reforms to achieve in this Parliament that which our predecessors failed to achieve in over 13 years. I intend to continue and develop an open and co-operative approach in developing these reforms. I commend this statement to the House.

I thank the Secretary of State for his statement—and, indeed, for the constructive cross-party discussions that we have held on these crucial matters.

First, let me say that we welcome many of the ideas in the White Paper that the right hon. Gentleman is publishing today. A universal deferred payment scheme would help to spare vulnerable people the agony of watching savings and assets being washed away. National standards on eligibility could help to bring some consistency to a care system in England that is today the ultimate postcode lottery. Stronger legal rights for carers are overdue, as are improvements to end-of-life care.

The proposals are important steps forward; they were also in my own White Paper, “Building the National Care Service”, which was published before the last election. I take the right hon. Gentleman’s decision to carry the proposals forward into his White Paper as a positive sign of the developing consensus between the parties, but there is one crucial difference between his White Paper and ours. Despite the obvious political risks of doing so, we faced up to the difficult issue of how to pay for care and support in the century of the ageing society. The Government have failed to do that.

With no answers on money, the White Paper fails the credibility test; it is half a plan. The proposals that the right hon. Gentleman has set out are in danger of appearing meaningless and may raise false hope among older people, their carers and families. The proposals have no answers to the immediate funding crisis that is engulfing councils and resulting in thousands of older people seeing support taken away or facing huge increases in charges for day care and meals on wheels—stealth taxes on the most vulnerable in our society. Furthermore, there are no answers on how we pay for a fairer care system in the long term. Let me take each of the two issues in turn. I shall start with council funding.

Today we have a promise of new standards, new services and new rights for councils to deliver. I fear that that will be greeted with sheer disbelief in town halls up and down England. Councils are already facing a major funding shortfall, estimated to be at least £1 billion. They cannot cope with what they already have to do, never mind their being burdened with additional unfunded pressures. What is the Government’s assessment of the extra costs that will fall to local authorities in England from the proposals in the White Paper? Will the Secretary of State tell us how and when he plans to pay for those costs, as well as make up the existing shortfall in council budgets?

There is simply no point in promising new ideas if they come on top of the crumbling foundations of inadequate care budgets. Councils need emergency support. The right hon. Gentleman has allocated just £100 million and £200 million today, but last week it was confirmed that the Treasury had clawed back £1.4 billion from the Department of Health budget. Surely it would have made sense to have reallocated at least half that clawback—£700 million—to council budgets, to relieve pressure on care. Does he not accept that such a move is needed if his plans are to have any credibility in local government circles?

Let me turn to the flagship proposal—the new duty on all councils to provide loans to older people so that people can pay care costs after they die. Before we judge that, we need more detail. Can the Secretary of State tell us what the upfront set-up costs will be to local authorities? Currently, there is a deferred payment scheme based on no interest, but we read that, when his scheme is up and running, councils will be able to charge interest so as not to lose money.

Will the Secretary of State confirm that that means that councils will have to charge close to commercial rates of interest? Does he not accept that, if that is the case, taking on such large amounts of debt might be very frightening for older people? Was it not for that very reason that the proposal really made sense only if it came as part of a package alongside a cap, as promised by the Dilnot commission? This is the problem with the Government’s White Paper: they are adopting a pick-and-mix approach to the Dilnot package, which was conceived as a coherent and complementary whole.

That brings me to my second issue. I hear talk only of a vague commitment in the progress report to the main principle of Dilnot, so are the Government not in danger of sliding back on their own independent commission, which had produced the best hope for years of a consensus between us? I know, perhaps more than anyone, how politically charged these issues are, but I also know that progress will never be achieved if politicians cannot put difficult options on the table for fear of being accused of political point scoring. That is why my right hon. Friend the Leader of the Opposition made a genuine offer of cross-party talks to give the coalition the political space to look at those difficult options. I thank the Secretary of State for the way in which he conducted those talks—indeed, I thank the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), too—and I have welcomed his idea of producing a joint progress report on funding.

I do not doubt the Secretary of State’s personal commitment to making progress, but I suspect that he was thwarted by the Treasury and a Chancellor who is making one wrong judgment call after another. The Government’s decision to change course at the eleventh hour and produce their own progress report, without input from Labour Members, reflects a Treasury decision to try to close these issues down—a mistake and a missed opportunity. Let me say this to the Government: if they offer a genuine, two-way discussion on the funding of care, with honesty about existing pressures and the difficult options, we will play our part, but they cannot expect us to provide political cover for a failure to face up to the scale and urgency of the care crisis in England. To do so would be to fail the millions of older people, their carers and families who have already waited long enough for politicians to get their act together.

The truth is that the Government are ducking one of the biggest issues of our time, with a White Paper that has today been branded a “massive failure” by the Alzheimer’s Society. Today’s announcements are designed to create a false sense of momentum and to disguise a Government decision to kick the funding of care into the political long grass. They have made their choice—they have placed Lords reform at the top of the agenda and shunted the care of older people into “Any Other Business”. That is the clearest sign yet of a Government who are losing their way and have their priorities completely wrong.

I am grateful to the right hon. Gentleman for welcoming the announcements about access to universal deferred payments, national eligibility criteria, and the work that we are undertaking on promoting free care at end of life. I am surprised, however, that his final remarks seemed to be completely contrary to what he said at the outset. Let me be very clear: the White Paper is the product of the priorities of the people with whom we have engaged throughout the “Caring for our future” process. It directly reflects the priorities of the care and support sector, and I would therefore be surprised if anybody in the sector failed to recognise that and to support it. It is focused on delivering quality and promoting the work force. For the first time, it gives access to legal rights for carers in terms of support. It is very clear about the issue of personal budgets, where there has been a dramatic expansion over the past two years.

Let me deal with the right hon. Gentleman’s specific questions. Since we came into office, we have continually recognised the need for support for social care and for the funding of local authorities for this purpose. That is why we made provision for £7.2 billion of additional support, £3 billion of which comes from within the NHS. As he will see from page 64 of the White Paper, the £300 million of additional resources that it announces more than meets the cost of the White Paper to local government. We are continuing to support social care within the NHS. The latest figures from the Association of Directors of Adult Social Services suggest that only about 13% of total savings took the form of reductions in any service for care users, with the rest relating to efficiency savings redirected into the service that is being provided.

It is simply not the case that we are adopting a pick-and-mix approach to the commission of Andrew Dilnot and his colleagues. We are proceeding with some of its recommendations—for example, on eligibility criteria and deferred payments—and supporting the principles for a new funding model based on the capped cost and extension of the means test. The right hon. Gentleman said that we have to be able to pay for it; yes, indeed we do. That is why we will continue to engage with him and his colleagues and with the wider sector. It is very important that we take people with us on this.

It cuts no ice for the right hon. Gentleman to say that after 13 years of a Labour Government he published a White Paper days before the announcement of the last general election. If he wants to go back to the proposal that he made at that time, which was to impose a tax in order to pay for this and to means-test access to disability benefits, then let him say so, but that is not the basis on which we are proceeding. Andrew Dilnot considered those proposals and did not recommend them. We need a proposal that garners wider consensus and support than was evident for the right hon. Gentleman’s White Paper. I am determined to try to secure that, and we will continue to engage with the sector to make it happen.

Order. Lots of Members want to get in and there is pressure on time. Brevity is in good order and I hope that we should then get everybody in. I call the Chair of the Select Committee on Health.

I welcome the package of measures that my right hon. Friend has announced, which represent important progress towards the delivery of many objectives that are, as we have heard, shared across the House. May I ask him two specific questions? First, he has published a welcome draft Bill showing that many of these aspirations can be brought into effect. Do the Government expect to be able to provide time to make that draft Bill law in the next Session of Parliament? Secondly, in the context of that Bill, does he hope that the continuing cross-party talks may yet provide the basis for answering the funding question that has bedevilled those talks for so long?

I am grateful to my right hon. Friend. It was neglectful of me not to mention that the White Paper and the announcement that I have made also drew on the recommendations and work of the Health Committee, and I am pleased to have been able to respond to its report as well.

First, matters relating to the legislative programme for the next Session will be announced in the normal way in the Gracious Speech. Secondly, I am determined that we will not only, I hope, have continuing cross-party talks but that they will be conducted, as I think that the shadow Secretary of State himself would wish, with the sector in a more open, public debate. If we were able to arrive at a position whereby, notwithstanding the fact that funding decisions might be made in the spending review, there was scope to put in place legislative provisions that allowed that to happen and could be agreed in time for the introduction of the draft Care and Support Bill, then we would look to make that happen. However, that is conditional at this stage.

The Secretary of State seems to forget two things. First, his Government did not implement the Personal Care at Home Act 2010, which would have made a difference to people. Secondly, they did not ask Dilnot to consider where the money was coming from, so he can hardly be blamed for not putting forward suggestions. The Secretary of State has committed to a few of Dilnot’s principles but ignored the fact that he advised the closure of the current funding gap in social care. Will he back Labour’s call for the Treasury to use £700 million of this year’s health underspend to close that funding gap, which is the cause of the crisis in social care?

First, it is ironic that the shadow Secretary of State said that local authorities would be aghast if they were asked to do extra things without resources given that we are providing those resources and that the Personal Care at Home Act was completely unfunded, which is why local government was desperate for us not to proceed with it. Andrew Dilnot and his colleagues are very clear, as are we, that there are, as I said in my statement, baseline funding pressures on local authorities in relation to social care. That will be addressed in the next spending review, as it was necessarily addressed in the previous spending review in direct response to recommendations that Andrew Dilnot gave us in 2010.

I welcome the statement, which contains many good things, but without financial clarity we risk offering an unsustainable solution to an unsustainable problem. What can coalition Back Benchers do to get the Treasury to go further and faster?

The statement I have made is a Government statement. We are working closely with our colleagues across Government to secure these proposals. I know that my hon. Friend understands these things very well. He will know that if there are significant public expenditure implications beyond the current spending review period, they must be dealt with in the context of a spending review. All Government Members are committed to deficit reduction. Understanding where, within those constraints, our priorities lie is the essence of a spending review.

This is a much more important issue than Lords reform. It is important to millions of people in this country and I am happy to have the opportunity to discuss it. There is clearly a huge shortfall and a crisis of funding in social care. The Secretary of State is not hoodwinking anybody by suggesting anything other than that. What has changed since he walked away from the cross-party talks led by my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown)? The Secretary of State dressed up the proposal made before the general election as a “death tax”, yet he has come back with a proposal that is broadly similar.

I am not attempting to hoodwink anybody. I have made the point very clearly that in this financial year the Association of Directors of Adult Social Services is making total savings of £891 million, of which only 13%, some £113 million, is being achieved through reductions in services. We are investing in and supporting such services. In 2012-13, £930 million of extra funding will go to local authorities through formula grant to support social care. The NHS is transferring £622 million and we are doubling last year’s figure so that £300 million will be available through the NHS for re-ablement. Those are major additions to the support for care.

On the other point that the hon. Gentleman made, even the right hon. Member for Leigh did not try to return to the debate that we had before the election, and rightly so. The right hon. Gentleman eschewed party political point scoring; the hon. Member for Easington (Grahame M. Morris) did not. I think he should have done.

I warmly welcome the statement. There is clear commitment in a number of good areas, including improving the portability of services, providing greater support for carers, improving respite care and having more joined-up working between the NHS and adult social services, which will save social services and the NHS money, and improve the care that is delivered to patients. Does the Secretary of State agree that when local government commissions services, it should do so with a view to improving the quality of care and moving away from the care-by-the-minute mentality to which many local care providers seem to adhere?

My hon. Friend is absolutely right in all respects. I know that local government will welcome the philosophy of commissioning for quality, rather than commissioning simply on the basis of watching the clock. That will also be welcomed by older people who are in receipt of care.

It is clear that the Secretary of State is moving on from causing chaos in the NHS to causing it in the care service. Given the crisis in the budgets of social services, will he set up an independent body to look at how much money local authorities require to provide high-quality social care?

I am sorry, but the hon. Gentleman simply demonstrates his ignorance of what is in the White Paper. Those who work in social care, those who represent care users, care recipients and carers want the changes in legislation and in support to focus on looking after people. That is absolutely our agenda. We know that there are funding needs. That is why, in the spending review, we have provided the sums that I have set out. That will enable local authorities to maintain their eligibility to care. This year, only six authorities have reduced their level of eligibility to care from moderate to substantial.

My right hon. Friend’s statement will be widely welcomed, especially the loans aspect and the emphasis on personal care budgets. Will he confirm that his Department’s trials are showing that personal care budgets are very effective in empowering patients, reducing costs and bringing in a wider range of services and greater patient choice?

My hon. Friend is absolutely right. A study published in the latter part of last year demonstrated exactly what he has set out. There has been a major increase in access to personal budgets. When we came to office, about 168,000 people had access to a personal budget. The latest figures show that we have reached 432,000 people. We are aiming for everyone who wants it to have access to a personal budget by April 2013. The draft Bill that we have published today would give legal backing to that and to access to direct payments.

On 5 December last year, the Minister with responsibility for disabled people said in a written ministerial statement that a consultation on the independent living fund would be published in conjunction with a White Paper on social care this year. Will the Secretary of State say how a consultation on a review of the independent living fund will be meshed with the proposals in the White Paper? Will he assure me that there will be a coherent approach in Government to deal with the ILF in the context of the proposals that he is announcing today?

I am grateful to the hon. Lady, because she gives me the opportunity to say that my colleagues at the Department for Work and Pensions will publish a document shortly. That will enable her and other hon. Members to see the relationship between the two documents.

I welcome my right hon. Friend’s statement, and in particular the recognition of the role of housing in helping people to live independently in their own homes. Will he elaborate further on how the £200 million extra may be spent by local councils? Does he support the recommendation of the Health Committee that we have a single commissioner for health, social care and housing?

The £200 million over a period of five years that I have announced today will be able to be leveraged, with the involvement of private sector investment and social landlords, to provide an opportunity for several thousand additional places in specialist housing for older people and those with disabilities. We are talking about the kind of extra-care homes that give people the sense that they are moving into their own home, but with care available. That will be available in people’s own communities to a greater extent if we can increase the supply.

The Secretary of State says that he can give no commitments past the spending review in 2015. However, he said that by 2017—two years after that—we will have 50,000 more care workers. There is a big question over how that money will be found. He makes a big point of saying he has given local authorities all these extra resources to deal with the extra tasks that they will have. In the discussions on that, have local authorities said they are satisfied that he is providing enough money for them to carry out those extra tasks?

I know that the hon. Gentleman will not have had a chance to look in detail at the White Paper, but it makes it clear that the costs in the spending review period are more than adequately met by the additional resources. [Interruption.] The hon. Gentleman and his colleagues are confusing two different things. The White Paper looks at specific additional tasks—for example, in the provision of independent information and advice, including local information about access to care services. That is more than fully funded. The figure he mentioned referred not to the number of care workers but to the number of care apprenticeships that are being developed with the sector.

As co-chair of the all-party parliamentary group on carers, I welcome the new rights for carers that are proposed in the White Paper. However, a couple of things follow from that. First, GPs, social workers and others have a responsibility to do everything possible to identify carers, because unless people identify themselves as carers, they will not be able to access those rights. Secondly, we should support carers by developing training programmes for them, so that those who find themselves in that position are empowered to undertake their caring role.

I am grateful for the work of my hon. Friend and the all-party group. This is an important moment. If the House approves the draft Bill, the rights and entitlements of carers to assessment and support will be set out in law for the first time, in the same way as we have done for those for whom they care. He makes an important point. The draft mandate for the NHS that I published last week gives specific attention to the need to identify and support carers. I hope that these proposals will also enable the NHS and social care to join together in support of carers.

May I return to the point that my hon. Friend the Member for Halton (Derek Twigg) made? Have local authorities confirmed that they are satisfied that the funding that has been made available will cover the new duties they have to undertake?

We have consulted not only the Local Government Association but my colleagues at the Department for Communities and Local Government, and I can assure the hon. Lady that that is indeed the case.

There is much to be welcomed in today’s announcement. After so many years, people all over the country will be pleased that so much progress has been made, particularly for carers and in improving the quality of care and professional standing of paid-for carers. Will the Secretary of State confirm what I think I heard him say—that if the Opposition were to redouble their efforts and the whole country were to engage in the debate that today’s announcement will trigger, the mechanisms to solve the bigger problem of how the funding can be provided could be included in the forthcoming Bill within the next 12 months?

Yes, and I am grateful to my hon. Friend. I will not reiterate what I said in response to the Chair of the Health Committee, but I hope that as we make progress we will be able to see what legislative provisions are required and make them available at the earliest opportunity. She makes an important point, because we must not lose sight of the opportunity to improve quality. There are certain things that require resources, such as access to quality profiles of care providers so that people can make proper assessments of the quality of service that they will receive, increasingly using their personal budgets or direct payments. There is dramatic potential in that. Starting today, quality profiles of 12,000 care providers will be made available.

A delayed solution to the growing crisis in social care is no solution. In Birmingham, there are none more noble than those who care and none who deserve our support more than those in need of care. Does the Secretary of State not recognise that in failing to act now he is both surrendering a historic opportunity for a new settlement based on Dilnot and letting down the most vulnerable in our country?

I know it is difficult for hon. Members when documents are published alongside a statement and they have not had an opportunity to read them, but when the hon. Gentleman does so he will know that what he has just said was utter nonsense.

I, too, greatly welcome today’s statement and congratulate my right hon. Friend on taking forward this important policy. Health and social care is devolved to the Welsh Government, but it is inevitable that statements, decisions and policy changes in England have a major effect on Wales as well, because some of the services provided to people in Wales are over the border in England. As well as cross-party talks, may we have cross-border talks to ensure that the system works well in Wales?

My hon. Friend makes an important point. We want people who move from England to Wales or from Wales to England to have continuity of care, so I will make it clear to my counterpart in Wales that I am entirely open to discussions about that. Given that it is a devolved matter, it is better in a sense if the initiative for those discussions comes from Wales, because I do not want to be interpreted as trying to impose any solution on Wales, but if the Welsh Government look for such discussions I will be open to them.

In response to the White Paper, the NHS Confederation has said that people are

“staying in hospital longer…because the right services are not in place to allow them to go home when they are medically fit to do so.”

Given that it is estimated that delayed discharges from our hospitals cost some £18 million a month, what action are the Government taking to get rid of that waste of public money?

The total number of delayed discharges is broadly the same as it was last year and, I believe, from memory, the year before—I will correct the record if not. Some 29% of the delays in discharge from hospital are due to the inability to access social care. Most of them arise because people are awaiting further assessment or treatment in the NHS. We have all the details of delayed discharges and are working actively to reduce them.

I very much welcome many of the measures that my right hon. Friend has announced, particularly on the improvement that he wishes to see in the dignity and respect accorded to those in our care homes and NHS hospitals, especially older people. Will he say a little more about the minimum standards for staff working in the care sector, and about the qualifications that people who apply for care apprenticeships might require to provide the right quality of care?

Yes, I am glad to do so. Through the work that we are doing with Skills for Health and Skills for Care, we will set out more clearly the training requirements for those undertaking care work and care assistance in the NHS. In addition, we set out in the White Paper that there should be a code of conduct, and I hope that across the service the philosophy of commissioning for quality, not simply commissioning or contracting by the minute, will help push us towards improvements in the dignity and respect with which care users are treated.

There are 800,000 people in this country with dementia, a devastating condition for themselves and their families. Many of them rely on the support of community-based services, which means that they are not admitted to residential care and may have a crisis that results in hospital admission. It is a false economy not to support community services. If the Secretary of State were really in touch, he would know that there are massive cuts across the country in exactly those services. Will he go back to the Chancellor now and say, “We need some money now to deal with the crisis”? Otherwise, the integration that he talks about in the White Paper will not happen and the crisis in local authority care will continue.

I am sorry that the right hon. Lady does not seem to recognise that in addition to what I have announced today, about three months ago the Prime Minister launched the dementia challenge. It provides resources in the NHS, through the commissioning for quality incentive, for the identification of patients with dementia and for follow-up assessments and support. It is doubling research into dementia and supporting a programme for the creation of dementia-friendly communities. As part of that dementia challenge, local authorities and the health service will work actively together to make communities far more dementia-friendly and more effective in treating dementia.

Like carers and many vulnerable people across the country, I warmly welcome the White Paper and the progress that is being made. People are keen to see a continued political consensus, which existed, and on which the Opposition were to be congratulated, until about half an hour ago. May I urge the Secretary of State to do everything he can to ensure that that consensus continues? Will he also set out a bit more about what the national minimum eligibility threshold will mean, so that people across the country know what they are entitled to?

On the latter point, my hon. Friend will be aware that the national eligibility threshold that we are legislating for will come into effect in 2015. We will of course make it clear before that at what level it will be set. I cannot provide that information at the moment, not least because we have reservations about the overall effectiveness of the classification of need under the fair access to care services system in the intervening period. If we can improve the eligibility framework, we will set out to do so.

I say to the right hon. Member for Leigh and his colleagues that I am very happy to continue to talk. I know that he did not want us to proceed on a unilateral basis from the progress report, but in truth what we published did not represent our making decisions unilaterally but instead reflected the point that we had reached. I am happy for further talks to take us beyond that point.

If we are to offer people the dignity and respect that the Secretary of State has talked about and prevent the type of abuse that both shocks the nation and frightens care users and their families, although training is very important, so is monitoring. Will he guarantee that the money necessary for monitoring will be available to HealthWatch, the Care Quality Commission and similar agencies? At the moment, people do not believe that those agencies are requested to monitor them properly.

The hon. Gentleman will know that we are making resources available for HealthWatch. It also has additional powers and a remit that extends in a way that the remit of LINks never did. There is therefore a patient and care users’ voice, and a much more effective power to enter, view and report. The link of HealthWatch England to the Care Quality Commission is important. We have increased the resources of the latter. I am sure that when he sees its annual report, he will appreciate the steps it is taking to extend its inspection more reliably on an unannounced basis, including into domiciliary care provision.

I have a great deal of respect for the Secretary of State, but I agree with the chief executive of the Alzheimer’s Society, who has said:

“Every day without a funding decision is another day where people…with dementia…face huge costs for…substandard care.”

Will the Secretary of State therefore take this opportunity to assure the House that any new system of funding will end the current dementia tax, under which those with dementia are penalised as a result of their condition with some of the highest social care costs?

In this instance, I completely understand where the Alzheimer’s Society is coming from. We all want to achieve what Andrew Dilnot made very clear in presenting his report. Any of us or any members of our families could be subject to catastrophic care costs as a consequence of a diagnosis of dementia and several years’ need for care. We want people to be able to plan and prepare, and to protect themselves against that. From the Government’s point of view, and as I have said today, the Dilnot commission’s report is the basis for a funding model for that, but it must be paid for. As with anything else, we are not going to start promising things that we do not know we can pay for. We therefore have a job of work to do, and I am determined that we will do it as speedily as we can.

The Secretary of State referred to deferred payments. In the time before the individual dies, who will pay for that care? Is there any estimate of how much the care will cost? It seems to be an extremely bad deal for the individual if they must also carry the interest rates of that loan. Will it be administered by local authorities? Who will fund that local authority?

From the care user’s point of view, it will be funded by local authorities. Central Government will back that up.

The residents of Thanet will be reassured by the paper, particular when it comes to caring by the minute, which shows so little respect and dignity for the elderly. However, I urge the Secretary of State to look at the culture of social care, in which funds go more to crisis management than to prevention. I urge him to understand that we could introduce many new measures that will keep people healthy as they get older rather than ambulance-chase after a crisis.

I agree with my hon. Friend. That is why we want the focus to be on maintaining well-being and independence. More specialist housing will help with that. The doubling this year compared with last year of resources from the NHS to support re-ablement—when people are discharged from hospital after, for example, a fall and a hip fracture—will directly enable people to be more independent. A lot of the resources that the NHS is putting in with social care is directed towards that kind of preventive work rather than to crisis response. I hope we can do more of that in future.

Without underestimating the inherent challenges, may I welcome the statement and commend the approach of the shadow Secretary of State? The draft care and support Bill makes provision in respect of the portability of care packages between local authorities in England, but it does not yet provide for the “passportability” of care packages to Northern Ireland and Scotland. Historical migration factors mean that many Irish people are lonely and in remote care settings in England who would much rather be in a care setting in which they can enjoy the support and contact of their families—their families want them there too. When will that finally be addressed?

As I told my hon. Friend the Member for Montgomeryshire (Glyn Davies), I completely understand the problem. I will be entirely open to representations from, and discussions with, the Wales and Northern Ireland Administrations on the scope for achieving continuity of care for those who move between different parts of the UK. There are differing systems, but we can at least try to ensure that we build continuity of care around the needs of the individual care user rather than constantly being obsessed with the characteristics of our own systems.

As the Member of Parliament who represents the area with the highest elderly population in the north-west of England per head, I welcome the statement and the importance that the Government place on care and support, which is the most challenging issue authorities such as Cheshire East council will face over the next few years. The Secretary of State is right to talk about working with local authorities, but how will this work on greater support for carers include greater support for, and, importantly, dialogue with, community and voluntary organisations, such as Crossroads Care Cheshire East, which does excellent work and provides real added value? It tells me that it could do so much more if it was given such support.

I am grateful to my hon. Friend. I know how important the work of Crossroads Care is in my constituency and others. The “Caring for our future” engagement over a number of months was a major contributory process to the White Paper. I believe we have accurately reflected in the White Paper the priorities set out then. This is not the end of the process. We have important and positive messages to take forward, and further work to do, not least on funding. I hope we can do that equally in close co-operation with the Care and Support Alliance and its members.

Given the scale of the care crisis in Wirral, I have listened to my constituents at a number of public meetings. They tell me that their priority is for loved ones to live at home with dignity, but local authority cuts make that harder, and—I am sorry—the NHS reorganisation is just a distraction. Contracting by the minute, which the Secretary of State mentioned, is far from the only problem. How will he tackle other problems in the care industry, such as older people being disrespectfully told what time to go to bed and get up?

As I said in the statement, we absolutely intend for care services to be responsive to the needs of patients, and to their goals, aspirations and wishes. That is not only a cultural shift, but a financial one—the availability of personal budgets and direct payments for everybody in the social care system will give patients the financial levers to make that cultural shift happen. However, the situation in the Wirral she describes is not how it was described to me when I was there in April. I was told that the health and wellbeing board brings together social care, public health and the NHS so that they are far more effective in the delivery of services locally.

I thank my right hon. Friend for making progress on this problem, which is a worry for so many of my constituents. They will welcome the proposals, but does he agree that the proposals for paying for care fees by way of a one-off insurance premium, which are contained in the Conservative party manifesto, would have been far better in promoting personal responsibility?

My hon. Friend will see in the progress report that we need to discuss both the universal options for paying for the Dilnot model of care and voluntary, opt-in systems. The latter could have a character not dissimilar to that he describes.

I welcome many measures in the paper, including on the transition from being a child needing care to becoming an adult needing care, and on allowing people to choose where they want to end their life in palliative care. I represent a coastal constituency. Many people retire to the coast to enjoy the benefits of the sea air. Will he assure me that Suffolk county council will not be penalised by the fact that, in bringing families together, they will not take on extra care burdens for which they had not planned?

I completely understand my hon. Friend’s point. We very much reflect the need for care and health care in the allocation of resources to local authorities through the formula grant, and the allocation of resources to the NHS through the NHS resource allocation.

Councils have faced a £1 billion cut in their funding for care of the disabled and elderly since the right hon. Gentleman’s Government came to power. Without the cash, the White Paper will be meaningless. How confident can he and everybody else in the country be that the Treasury will cough up, given the track record so far of a £1 billion cut to councils?

I am sorry, but I simply do not recognise the figures that the hon. Gentleman is using. The Association of Directors of Adult Social Services has suggested—these are not my figures—that this year the service reduction in adult social care budgets on a monetary basis was £113 million and last year it was £226 million. The great majority of the figures he is quoting are actually not cuts at all; rather, they are service efficiencies, which are being reinvested for the benefit of maintaining eligibility.

My constituent who has been campaigning on portability of care packages outwith England will be extremely disappointed, because he was given to understand in correspondence from the Secretary of State that this would be covered in the White Paper and it clearly has not been. While we are thinking about Scotland, does the Secretary of State accept that the problem will not be solved even by shifting some of the costs of care from the individual to the state? We have had free personal care in Scotland for some years, but it has not resolved the problems because no additional money was put into the system.

I will not attempt—not least because of time—to give an analysis of the difficulties that have been experienced in Scotland. From my point of view, I had understood that what we have set out to do in the White Paper is very much to ensure continuity of care, so that when people move—certainly in England, for which I am responsible—local authorities have a duty to ensure continuity of support. If we can make it so that this happens across the United Kingdom, I am absolutely open to having the discussions necessary to do so.

The Health Secretary has spoken about the catastrophic costs that face some older adults suffering from dementia. My nan was one of those people. She had to sell her home and spent more than £100,000 on her care costs. Under the loan scheme proposed by the Government today, would somebody like my nan not just end up paying more for the costs of their care? Can the Health Secretary also clarify whether the interest payments would eat into the small amount of money that people like my nan can pass on to their families?

We are very clear—I hope I have been clear—that the adoption of a universal deferred payment scheme gives people an opportunity. We are not talking about something that people are required to do; rather, they can choose to do it. One of the things that has most distressed some of those who go into residential care settings is that, as a consequence, they are required to sell their homes—they are forced to do it. What we have announced gives people an opportunity for that not to happen, but as the White Paper and the progress report make clear, we would like to proceed on the basis of a funding model, based on the Dilnot commission, that enables people also to have a cap on their care costs. If we can do that, the combination of the two will be an effective solution.

Without a cap on costs, which is what the Dilnot commission proposed for universal deferred schemes, will this measure not potentially leave some families with massive debts to pay when their loved ones die, far in excess of the £35,000 cap that the commission proposed?

I am sorry that the hon. Gentleman has read out the Whips’ question, but he did not listen to the last answer. We are both implementing the universal deferred payment scheme and proposing in the draft Bill that we should legislate for that. We are, as I have made clear, supporting the principle of Dilnot that we should implement a capped-cost model with an extended means test, but we have to demonstrate, as we know, that it needs to be paid for, and if those decisions involve public expenditure, they must necessarily be held for the spending review.