Chris Skidmore
Main Page: Chris Skidmore (Conservative - Kingswood)Department Debates - View all Chris Skidmore's debates with the Cabinet Office
(12 years ago)
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Chris Skidmore (Kingswood) (Con)
It is an honour, although a daunting one, to follow that excellent speech by my hon. Friend the Member for Witham (Priti Patel), who speaks with a wealth of expertise as both a parent of young children, a job she juggles very well with her other abilities, and an excellent parliamentarian. She spoke about businesses in Essex, again with a wealth of expertise as the daughter of shopkeepers, and gave a thorough going over of the Queen’s Speech.
It feels odd to speak on the first day of a parliamentary Session. It reminds me of when I turned up here in the previous Session hoping to make my maiden speech. I wanted to make it as soon as possible so that I could get into the cut and thrust of debate, so I put in and waited to make it on several occasions. I will never forget my first moment in Parliament. I was sitting in the corner of the Chamber and waiting, and new Members on both sides bobbed up and down to say how beautiful their constituencies were—it was funny how that theme kept coming up. I waited from half-past 2, without having a drink of water or going to the toilet, until half-past 10. I sat there for eight hours, so afterwards I went over to the Chairman of Ways and Means and explained that I had hoped to be called that day. “Oh no”, he replied, “You weren’t going to be called at all. You should have come and seen me and I could have told you that you were never going to make it today.” That was the first lesson I learnt here.
Chris Skidmore
Absolutely. There is a lot of waiting going on here, but we do not have to wait long for the contents of the Queen’s Speech, which I will come to shortly.
To continue with my anecdote for a moment, I remember still wanting to make my maiden speech as soon as possible, and sitting in the Tea Room looking through the draft of what I hoped to say when a more senior Conservative Member came over and asked, “Oh boy, you’re looking to make your maiden speech, are you?” I replied that I was and explained that I had waited to be called for eight hours the day before. “Oh well, there’s only one piece of advice I can give you about making your maiden speech,” he said. I was a young newbie and so asked what it was. “Well, just don’t muck it up,” he said, before wandering off laughing. He actually used stronger language, but I will not use it in the Chamber—[Interruption.] Yes, indeed, it rhymes with muck.
Madam Deputy Speaker (Dawn Primarolo)
Order. To help the hon. Gentleman, I think that his colleague was telling him, “Good luck in making your maiden speech.”
Chris Skidmore
Indeed, and I wish the hon. Member for Ealing North (Stephen Pound) the best of luck in contributing to this excellent debate on the Queen’s Speech.
The first line of the Queen’s Speech refers to the importance of growth in the economy, but one of the sectors in which we know there will certainly be growth is social care, because we have an ageing population. We used to say that there are two certainties in life: death and taxes. We now know that our population is getting ever older; by 2030 the number of 85-year-olds will double and 11% of the population living today will reach 100. Therefore, we have an enormous cost—not a burden—that society will face as a result of the population getting older, which is inevitably a good thing. The Queen’s Speech recognises this, importantly, by proposing a draft Bill that will seek to modernise adult social care and support, which I absolutely welcome, but it is worth reflecting on the word “modernise” and on what we need to do to modernise adult social care and support.
The Government recognise that tackling social care is not just an issue of tackling the funding of social care, important though that is. The Health Committee, of which I am a member, has already produced a report on the Dilnot commission and recommended it to the Government, and I hope that the Government will look at it in the forthcoming White Paper and that we will have proposals on the table. I know that there is cross-party support for looking at the Dilnot commission proposals and that we had a Backbench Business debate on that in the previous Session. Members from across the House, regardless of their party colours, are passionate about tackling this issue and the impending crisis.
Chris Skidmore
The Dilnot issue, which is one of presentation, is that the Government commissioned a report that addressed the specific question, “How do we fund social care as it currently stands?” That is why I want to turn to the issue of modernisation, but we have to remember the important tenet that Dilnot does not cover all forms of social care. It does not cover domiciliary care or living costs, so it is not a panacea, and we as parliamentarians must ensure that we work together and at the same time—Dilnot was very strict on this—come up with a proper system by which we can inform not only elderly people now but the elderly people of tomorrow that they need to begin to save. Only by developing a savings culture and a culture of contribution, which I shall turn to also in my speech, will Dilnot work and will we ensure that the social care system works tomorrow as well as today—although today it is beginning to fail, as I shall explain.
In modernising social care, we need to recognise that the current system is not working on several levels. Personally, I feel that local authorities are becoming not the best places in which to deliver social care. Last week I published a report on local authorities and their delivery of social care, demonstrating from a series of freedom of information requests to every local authority in the country that local authorities have already written off £400 million of debts owed to them by families—and are still owed more than £1 billion.
Put simply, we have a system in which local authorities are not only struggling to provide care, but for financial reasons have lowered the bar and reduced their eligibility criteria. They have done so principally because they have to juggle social care with the services on which people really want to focus when they pay their council tax. For instance, people want their bins emptied or potholes filled, and that, for democratically elected local authorities, can take priority over those citizens who are most vulnerable but who, unfortunately for them, form a small minority. So roads and bins take precedence over social care. That should not be the case, but at the same time local authorities are deeply mired in debt because of their services, and we desperately need them to break out of that.
The current system also does not work because the failure of social care ends up rebounding in only one place: the NHS. We need to make the point strongly that the NHS and social care are two sides of the same coin, and that if there is a crisis in social care there will soon be a crisis in the NHS. Even the IMF has produced figures on how the NHS will look by 2050 if we do not manage our ageing population and work out ways of prevention. We must also look not only at how elderly people can be given the life and dignity that they deserve, but at early intervention. If any problems that they may have, such as diabetes or a disability, are dealt with soon enough, it costs the NHS less. The IMF predicts that the NHS will end up costing £230 billion by 2050, and that is completely unaffordable. It means that the NHS will go broke unless we solve the social care crisis now.
Dr Coffey
Does my hon. Friend agree that cross-party consensus on the draft social care Bill is critical? That is why a draft Bill is appropriate. Does he agree also that, as long as somebody is in hospital the NHS pays for them, so the draft Bill needs to tackle the key issue whereby local authorities sometimes delay a person’s exit from hospital so that they do not have to pick up the bill in the interim?
Chris Skidmore
That is an interesting point. Obviously, one of the first moves that the Government made when they came into office was to create an output measure of 30 days’ discharge from hospital. Although that was created in August 2011, it is already controversial because we are seeing the scale of the problem. The problem is not new; it has always been there, but the Government are for the first time providing the figures on how many people are leaving hospital and rebounding back into hospital. We should have solved that problem sooner.
My hon. Friend argued for a cross-party approach, and I entirely agree. We must achieve cross-party support on social care. We are talking about a settlement that must last decades, so it cannot be a patchwork solution or a plaster over a wound that might open up in several years’ time. We need to come up with a binding compact on social care. I hope that the draft Bill will aspire to that.
I have talked about the relationship between the NHS and social care. The Government have recognised that the future of saving the NHS will come through a consideration of social care. We focus very much on the NHS, and the Health and Social Care Bill of the previous Session tried to address the matter. Funds were placed in the hands of GPs; for the first time, GPs are taking responsibility for patients. Rather than sending patients directly to hospital, GPs have to look at what preventive measures they must take to cure illness or disability. Over the past three years, the number of over-80-year-olds who have been admitted into A and E has risen by about 40%. We know that 65% of unplanned NHS bed admission stays involve the elderly. If we can solve that, we will solve a huge issue within the NHS.
I am a member of the Health Committee, which recently wrote a report on social care. We visited Torbay, which was instructive. The authorities there have ensured complete integration between social care and health care services. They have done that by pooling budgets; when they have team meetings, there is no empire building in which people say, “This is my budget for the primary care trust, this is mine for the GPs and this is mine for the hospital.” People sit down and consider their overall budget. They have in mind an 85-year-old lady called Mrs Smith, and they ask what treatment pathway they could create to ensure that Mrs Smith gets the best possible care.
The authorities in Torbay recognise that social and community care is the best way to prevent unplanned admissions to NHS hospitals. The result is that Torbay has the fastest-decreasing and lowest number of unplanned hospital bed day admissions in the country. The approach there clearly works, so the modernisation of social care must also be about proper, true integration between social care and health care.
We also need to recognise that to modernise social care is not to speak of the elderly as some homogenous group. Above all, senior citizens are individuals with individual needs. Each will have their own particular pathway through the later years in life. As a Government, we must recognise that to ensure that the individual has the best possible life in old age, we must give them a chance to lead their life as they would like to.
To do that, the Government have built on the work of the previous Government in introducing personalised services. Above all, we have seen the rise of personal budgets. In England, their uptake doubled, from April 2010 to March 2011, to almost 340,000 service users. That is still only about 35% of eligible users and carers. Although the increase in personal budgets is welcome, it has come in the form of local authority managed budgets, rather than individual direct payments, which make up only 26% of that 340,000—that is, 26% of the 35% of eligible users.
Although there has been an increase in personalisation, there has not been a proper increase in individuals being given freedom in how they would like to use their budgets. In other words, councils are offering a menu to choose from but they are not offering a choice of restaurants.
Key to the modernisation of social care will be the introduction of direct cash payments. At present, individual budgets cannot be paid to a spouse or partner to provide care, and that limits uptake and entrenches the difficulty that millions of people have in wanting to care for a loved one in their old age. If we look across to the continent, we see that places such as Germany have a far more liberalised social care system. In Germany, people are assessed as needing care at one of three levels, and they are then offered a choice between an individual budget cash payment with services in kind, including residential care, and a tailored combination of the two. Interestingly, the individual budget cash payment is of significantly lower value than the social care package. In 2007, people who needed considerable care, or care level 1, received €384 per month; those in need of intensive care, or level 2, received €921 per month; and those in need of highly intensive care, or level 3, received €1,432 per month. They were also offered the choice of claiming direct individual budget cash payments that were about two thirds lower than the payments in the social care package, which meant that people at care level 1 received €205 per month, those at care level 2 received €410 per month and those at care level 3 received €665 per month.
One might have expected the population to opt for the higher payment, given that the social care package seems to be more sophisticated and pays more in euros, but in fact 49% of Germans decided instead to opt for the direct cash payment, which gave them greater choice and freedom in how they spent the money, or spent it for their relative. That control is every bit as valuable to individuals as money. It gives them the opportunity to stay in their own home and receive informal care from relatives. They can purchase the service they need without an additional layer of bureaucracy getting in the way. We can learn from what Germany did in modernising social care. Local authorities have traditionally focused on a one-size-fits-all response, in effect acting as a single, inflexible state supplier that cannot hope to offer the choice that people approaching their old age nowadays—baby boomers who have lived their lives having choice—will want equally as they get older.
What would happen if we introduced such a system in this country? In 2009-10, local authorities spent £3.4 billion on residential elderly care. On that basis, if the same thing happened here as in Germany, with half this group opting instead for cash payments and staying at home, we would save £1.14 billion a year, with people receiving £566 million instead of £1.7 billion. We could free up £1.1 billion or £1.2 billion a year, which could go a significant way towards producing the money that might then implement Dilnot.
Above all, the way in which people contribute to their care must be something that they can control rather than something that is done to them. We need to ensure that in modernising social care we make the best possible services available. People will not put up with paying for the current levels of services if they do not think that they are good enough. If we are going to expect people to pay more for their social care in old age, knowing, as we do, that it has never been free of charge—it is a bit of a nasty shock for some people when they find out that it is not provided free—then they need to have the best possible services for their money, and that, essentially, means choice.
With choice comes competition. We must ensure that there is thriving competition between social care providers. We must not only introduce direct cash budget payments but ensure that agencies are available to guarantee a level playing field. The Good Care Guide website is a fantastic resource, but we should be looking to introduce a TripAdvisor-type service into social care so that people can analyse which are the best care homes and write about their own experiences of what they are like. We should trust the people to make those judgments.
I want to end by reflecting on this year. Many Members have spoken about it being the year of the diamond jubilee, but it is also 70 years since William Beveridge published the Beveridge report on 1 December 1942. On that day, there were queues at the shops to purchase the report, and in the first week 600,000 people did so. The report set out what the welfare state would look like for most of the 20th century.
In many ways, Beveridge still casts a shadow over us. The NHS and pensions were established, but when Beveridge wrote his report the average life expectancy was 69. When people received their pension at 65, their pensionable age was only meant to last an average of four years. Beveridge never gave any thought to how we should care for the elderly. It was assumed that families would look after their elderly loved ones. Somewhere along the line, we have gone wrong. I am not blaming any one political party, but why is it that in many countries it is a mark of honour for people to look after those who have brought them into this world? Why do we pay people child benefit in recognition of being parents but not focus on rewarding carers who look after their parents? There is an imbalance, and I hope that by focusing on social care, as all parties must in this Parliament, we can try to redress the balance.
I wish to end with a quote from Beveridge. The odd thing is, the Beveridge report cannot be found online, but I managed to dig out from the Library a copy of the original 1942 report. Everyone remembers the five giants—Idleness, Squalor, Want, Ignorance and Disease—but in the passage after that famous part Beveridge stated that
“social security must be achieved by co-operation between the State and the individual. The State should offer security for service and contribution. The State in organising security should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family.”
Beveridge understood 70 years ago that we needed a contributory principle in our public services. Somewhere along the line, that has been lost. Only through individuals making contributions towards their elderly care will we achieve the best social care services. I hope that as we consider how to modernise social care, the draft Bill that will be published as a result of the Queen’s Speech will focus on all the matters that I have mentioned.
Much of the media’s focus has been on the other place, which we might call a retirement home for rather successful eminent politicians, but what we actually need to focus on, and what our constituents want to focus on, is retirement homes for the elderly population as a whole and what is happening to them. We would do well to remember that. I recognise that I have spoken only about one specific point in the Queen’s Speech, but I believe it was possibly the most important one.
Ordered, That the debate be now adjourned.—(James Duddridge.)
Debate to be resumed tomorrow.