Oral Answers to Questions

Damian Green Excerpts

Tuesday 28th January 2020 Commons Chamber

[Ms Dorries]

We will introduce mandatory training for all health and social care practitioners. I hope that that will address the particular problem that the hon. Lady has brought up. It comes back to the substantial life expectancy issue, which is that regardless of the group, prevention is key.

[Damian Green (Ashford) (Con)]

In her initial response, the Minister rightly emphasised the importance of rising healthy life expectancy, as well as life expectancy more generally. Will she therefore join me in welcoming the forthcoming report from the all-party group on longevity—[Interruption.] If the Minister is listening, will she welcome the report, which will give the Government practical advice specifically on how to use prevention to raise the levels of healthy life expectancy?

[Ms Dorries]

I could not agree more with my right hon. Friend. We want everyone to have the same opportunity to have a long and healthy life, whoever they are, wherever they are and whatever their background. We will certainly look at that report.

Health and Social Care

Damian Green Excerpts

Thursday 16th January 2020 Commons Chamber

[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Blaydon (Liz Twist). As somebody who is in the early weeks of their seventh Parliament, I can say that I have therefore sat through many waves of maiden speeches over the years. The quality of the speeches that we have heard not just today—we have just heard from my hon. Friend the Member for Sevenoaks (Laura Trott) and from several Members from the Labour Benches—but throughout this debate over the past few days has been breathtakingly high. As somebody who has been round the block a few times, I can say that that is not only very welcome, but slightly alarming.

What I want to do is concentrate specifically on the social care element of today’s debate. It is a hugely important part of the wider health agenda and also obviously vital in its own right. I welcome a number of elements in the Government’s approach. The first is the recognition of the urgency of the need to solve the issue of social care, which has been left on the backburner for far too long. The second is the desire to work on a cross-party basis. I appreciate that that is going to be challenging for the Opposition Front Benchers over the next three months, because they will have other things on their mind, but for the past 18 months I have been working from the Back Benches with both Labour and Lib Dem Members. Although none of them is here at the moment, there are Lib Dem Members who are interested in this issue. I think that that cross-party approach is the best one. The third element is the Government’s recognition that the system today is incredibly fragile and needs extra money to tide it over. I am glad that the Government are helping local authorities with £1 billion in the coming year, but although it may be the world’s most expensive sticking plaster, it is still a sticking plaster, and we all know that we need a much more wholesale approach.

Many aspects of the problem need solving. There is the question of where the workforce are going to come from. Home adaptations will be needed so that more people can live in their own homes for longer. We will need the provision of extra places in care homes, where a shortage is developing. There are also problems when it comes to dementia patients. I think the Alzheimer’s Society has sent many Members a briefing for this debate, and everything it says is very sensible, but beneath all these questions is the issue of money. Where is the extra money going to come from? If there were a simple solution, a Government would have adopted it a long time ago.

I warn Ministers against reaching for the simplest and easiest solution, because the easy solution is to say, “We’ll make it free and we’ll fund it out of general taxation.” That is easy and seductive, because many people think social care is free anyway, but that would be wrong and unfair. It would be wrong not just because of the public spending implications, but for intergenerational fairness. If we fund the solution from the taxation paid by working-age people, we would be telling 20, 30 or 40-somethings not only that we are going to tax them to pay for their own social care if they need it in the future, which would be fair enough, but that we are also taxing them to pay for the social care of their parents’ generation, which would not be fair. That would be particularly unfair in this country, where there is a preponderance of wealth among the baby boomer generation. So much of the wealth in this country is tied up in housing, and that generation are far more likely to own their own homes than their children’s generation.

[James Cartlidge]

My right hon. Friend is making a brilliant speech, with great passion. Surely the definition of “sustainable” here is someone in their 20s who is entering the workforce and being asked to pay into a new system believing that the same quality of care will be available when they reach their 70s or 80s. That will not be the case if the model is unsustainable.

[Damian Green]

My hon. Friend is exactly right, and I wanted to talk briefly about the various ways in which we can achieve a sustainable system. We could have a compulsory social care payment that is made by everyone of working age and, indeed, beyond working age. That has been recommended by Select Committees of this House. Alternatively, I would suggest that we could have not a tax, but a hugely desirable saving, based on the model of the pension system, whereby the vast majority of people are encouraged to—and do—subscribe to auto enrolment pensions, but it is not compulsory.

In that pensions model, we would have the equivalent of a state pension—a universal care entitlement—which would have to be better than the current provision of care. On top of that, we would urge millions of people voluntarily to save for a care supplement, as they do for a private pension. That would guarantee them the quality of care that they would want in their old age. Of course, not everyone will be able to make those savings, and the system needs to be better for those who cannot contribute towards their own care if they need it in old age, but it is essential that we use this massive wealth, particularly among those who are 60 and above; a small sliver could help us to achieve these aims.

At the moment, the equity in housing of those over the age of 65 is £1.7 trillion. Just a small sliver of that would provide a much greater sum of money and therefore a much more sustainable system. The Prime Minister is absolutely right when he says that nobody should be forced to sell their own home to pay for care. People have worked for that, and will want to give some of it to future generations, but a small sliver saved into the sort of insurance system that I am suggesting would make a huge difference and would put the social care system on a sustainable level.

I have a final thought, which puts these ideas in the wider context of today’s debate. If we do not sort this issue out, the long-term plan for the NHS will not work. The 2020s need to be a decade of hope for the NHS, and every one nation Conservative will want that to happen, but to make that real we need to solve the social care crisis. I wish Ministers well in achieving this, and urge the House to reject the Opposition amendment.

NHS Long-Term Plan: Implementation

Damian Green Excerpts

Monday 1st July 2019 Commons Chamber

[Mr Speaker]

Ah, a veritable galaxy of parliamentary celebrities from whom to choose.

[Damian Green (Ashford) (Con)]

I felt that my right hon. Friend’s announcement deserved a more enthusiastic response than the uncharacteristically churlish one it received from the shadow Health Secretary. In terms of mental health, I particularly welcome the introduction of four-week waiting time targets for children and young people, because I know how much distress has been caused to many of my constituents by undue delays in the assessment and treatment of young people with mental health problems. Can he tell the House when he plans to implement those new waiting time targets and how he will keep pressure on CCGs, so that the benefits are seen on the ground as soon as possible?

Listeria: Contaminated Sandwiches

Damian Green Excerpts

Monday 17th June 2019 Commons Chamber

[Matt Hancock]

I entirely agree with and endorse what the hon. Lady has said. She is quite right to point out that a meal has to be appetising as well as nutritious. The best hospitals deliver that, and I would like that practice to be much more widespread.

I reassure the hon. Lady that the 2014 report by the Food Standards Agency was, as I understand it, looked into in great detail and assurances have been made that what it raised has, correctly, been followed through. Obviously, that was before my time as Health Secretary but I have taken advice on precisely the point she raises and I have been assured that what was necessary happened. I am open-minded, however, on what may have happened and what more needs to be done, and the review will absolutely look into that question.

Finally, the hon. Lady is absolutely right about the incubation period. We remain vigilant. Because listeria is a notifiable disease, Public Health England is told of every case and is able to analyse the links from every new case to existing cases. Notification of most cases takes place after the fact, given the nature of the disease, but we are then able to find genetic links, where they exist, and find out whether different cases have the same source.

[Damian Green (Ashford) (Con)]

As my right hon. Friend said in his opening remarks, one of the cases took place at the William Harvey Hospital in my constituency, and my constituent Tanya Marston, who is, happily, recovering from listeria, says that there should be a very urgent inquiry, so I welcome the announcement that my right hon. Friend has made today. On the specific safety aspect, however, rather than the wider inquiry on nutrition, what is the timescale for coming to some kind of conclusion so that people can be reassured that hospital food is safe?

[Matt Hancock]

I am grateful to my right hon. Friend and erstwhile campaign manager for his question. I am glad to hear that the patient who is his constituent is recovering. I am informed that all patients are either stable or have recovered, but for the five who tragically died. On the timescale, the urgent task at hand is to ensure that there are no further cases and that there is no more of the food that we know has the potential to cause problems in the food supply chain. That is what is going on right now. The timescale for the review will be a matter of months.

Eurotunnel: Payment

Damian Green Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

Of course, the medicines are going on these boats that we are procuring and that makes this a serious health matter. The hon. Lady is perfectly within her rights to ask these sorts of questions. The truth is that the £33 million is the maximum figure. It may not be as high as that, but we have been clear about the full exposure.

[Damian Green (Ashford) (Con)]

If we can essay a transport-related question, could my right hon. Friend give me some assurance that the extremely important cross-channel rail link will continue as it is now, under any circumstances, after 29 March? On the medical front, can he say what steps his Department has taken on radioactive isotopes and particularly important medicines? I have constituents who are very concerned about that.

[Matt Hancock]

Of course, we very much hope that the train will also continue to operate as now and we have received such assurances. When it comes to radioisotopes, we have also procured flights and aircraft capacity to ensure that those goods and those parts of the medical supply chain that need to be brought in faster and cannot be stockpiled can also be brought through.

Social Care Funding

Damian Green Excerpts

Wednesday 17th October 2018 Commons Chamber

[Matt Hancock]

There are more nurses on our wards than in 2010, but it is important that we have more in the future, and a whole run of work is going on to ensure that we can get more nurses right across the NHS and the social care system, including community nurses. As we put £20 billion extra into the NHS, we are going to need more nurses as a result. The nursing associate route is now available in social care, and there is a policy programme to try to ensure that we answer the exact question that the hon. Lady rightly identifies.

[Damian Green (Ashford) (Con)]

In the light of what my right hon. Friend just said about the long-term nature of the challenges, may I put to him the question that the Chair of the Health and Social Care Committee put to the Opposition spokeswoman? Does my right hon. Friend agree that the only way to get a decent long-term solution for all the people who will need social care is by doing so on a cross-party basis with a wide degree of consensus?

[Matt Hancock]

I pay tribute to my right hon. Friend’s work in this area. He is incredibly thoughtful and has been prepared to ask some of the difficult questions and give his answers to them. I agree that this is something that we should take forward on a cross-party basis wherever possible. I will come on to the long-term funding in a moment, but I just want to address directly the question of short-term funding.

I query the Labour party’s motion because 80% of local authority funding was reliant on the central Government grant in 2010, and that is no longer the case. Looking only at the central Government grant is an inaccurate way of assessing the question. For instance, we introduced the social care precept directly to address some of these costs. It would be far better if this debate took place in the context of the available budget for social care, which is increasing by 8% in real terms over the four years from 2015-16 to 2019-20. The debate should be based on facts rather than partial facts, and that is how I will seek to proceed.

Quality is important, too, and 83% of adult social care settings are now rated good or outstanding by the CQC. The figure has risen from 79% in just the last year, and it is the highest since measurement started in 2014, but I want to see it rise further still.

The links between the social care system and the NHS are important, too. No one should stay in hospital longer than necessary.

Social Care

Damian Green Excerpts

Wednesday 25th April 2018 Commons Chamber

[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I think the Opposition are quite right to want to debate this issue, and I also think strongly that the long-term solution to the problem of funding care—particularly for the frail elderly—will require cross-party agreement, so I hope that the debate can take place in a relatively non-partisan way.

I agree with the hon. Member for Worsley and Eccles South (Barbara Keeley) that radical change is needed, but I gently put it to her and her colleagues that in this long-term and complex area, indignation is not enough. Simply saying, “We must spend more money,” at the same time as saying, “But we must restrict the amount of money we take from other people,” which I understood to be the import of part of her speech, does not cut it.

[Norman Lamb]

Will the right hon. Gentleman give way?

[Damian Green]

I will certainly give way to the right hon. Gentleman in a moment, because I am about to mention him, but I am conscious of time.

There needs to be radical change, and the Green Paper needs to be radical and brave, because although in this debate, as in the wider debate on this issue, a lot of people talk about the fact that we live in an ageing society, we have not remotely adjusted as a society to what that means yet. Our population is projected to grow by around 10 million over the next 40 years. Almost all that growth comes from older people, and particularly those in the oldest age group. There are 5.3 million people over 75 in Britain today. That number will double to more than 10 million in 40 years. This is not just a looming problem; it is a problem today. There is a short-term and a long-term problem to solve. Frankly, in the spirit of non-partisanship, no party has a record unblemished by using social care as a political football. Phrases such as “death tax” or “dementia tax” make good copy and can affect the outcome of elections, but they do not help rational debate or, more importantly, help us improve the lot of the increasing millions of older people.

[Barbara Keeley]

I wonder whether the right hon. Gentleman is admonishing his own Chancellor, who used the expression “death tax” in the last Budget.

[Damian Green]

I think that the phrase “death tax” dates back to the previous Labour Government’s attempt to solve the problem in 2008, and I am sure that the hon. Lady used the phrase “dementia tax” during the last general election campaign. I hope that she will reciprocate my attempt to be non-partisan—so far it does not feel like it.

In the short term, the challenge for the Government is one of capacity and quality of care. Both problems will become more difficult in the long term. There is a range of things that we must do as a society before people need social care. For example, we need to keep people active for longer, we need to keep them in the workforce for longer, because that is good for their health, and we need to make changes to the planning system so that we can keep them in appropriate housing of their own for longer. In the end, however, the nub of the issue will be funding.

I want to address a point raised by the hon. Member for Central Ayrshire about joining the whole thing up with health funding. I agree with the broad thrust of the 10 principles proposed by the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Leicester West (Liz Kendall) and my hon. Friend the Member for Grantham and Stamford (Nick Boles) yesterday, particularly the idea of hypothecation, whose time is coming, but I think there is a problem with the idea of simply integrating all health funding and all social care funding.

It is a no-brainer that, organisationally, social care and healthcare need to be much better integrated, so that the individual is not trying to negotiate a very complex system, as the hon. Member for Central Ayrshire said. If we simply roll all the funding together into one pot, however—a sort of national health and social care fund—there are two serious dangers. The first is that social care takes over from mental health as the Cinderella of the health system, never quite at the top of the priority list when money is allocated. The second is that nobody feels that their contribution is related to their personal needs. The effect is that some of the sources of funding that could be made available—I agree with all those who say we need more funding—such as the £1.7 trillion of equity in residential property, of which more than two thirds is held by the over-65s, would be in danger of being permanently excluded, which I think would be a great mistake.

[Norman Lamb]

The right hon. Gentleman is making a thoughtful and reasonable contribution. He suggests that if there was a completely combined united funding stream for health and social care, social care would be relegated and disadvantaged. Of course, social care already loses out here and now—under Labour, the coalition and the Conservatives—compared with NHS funding. He complained about people just using indignation, and he made the case for cross-party working. Does he share my frustration that those of us who have tried to make the case for working together are constantly rebuffed by the Government? Will he join us in pressing the Prime Minister actually to engage in this, so that we can make it a reality?

[Damian Green]

I agree with the right hon. Gentleman that cross-party working is necessary. I gently point out that when I was a member of the Government, I met him and the hon. Member for Leicester West in a cross-party group to discuss precisely this—I was responsible for this policy area at the time—because I wanted to work with them. I thought that was the only way forward when I was in government, and I still do.

There is not time today to go into detailed funding proposals, but I think we have to accept that in the long term the funding of social care will need to be not only more generous than it has been in recent years, but fair, and seen to be fair, to every generation. I make the point, which is not often made in this context, that intergenerational fairness means being fair to older people as well as younger people. The view has taken hold in some circles that being over 60 means being over-privileged. I strongly challenge that view. The current generation of 50 and 60-somethings is the first in which people are often simultaneously trying to help their children with housing and their parents with care needs. This is not special pleading for a particular cohort. It is important to remember the obvious but salient point that young people themselves will grow old. Setting one generation against another is not only a bad basis for policy making but very short-sighted for the individuals most affected. Instead, we need to find a solution that will provide stability for decades to come.

I suspect that Members on both sides of the House would be united by the proposition that, however much better we get at using technology and housing design to keep people in their own homes for longer, the sheer growth in the number of people needing some kind of care will mean that we need to find more money. Precisely because that will be a problem for decades, not just for the rest of this Parliament, it is vital that the solution has cross-party support. Social care is a challenge for all parties.

The fundamental issue of whether social care should be a national or local service is often ignored. I am struck that 44% of Kent County Council’s budget goes on adult social care. That number will only rise. I am also struck that, in contrast with almost every other area of policy that involves local government, when I talk to local councillors about this issue they say, “Maybe this should be dealt with at a national rather than a local level.” They almost do not want it to be their responsibility any more. That is practically unique. I hope that Ministers will address that.

I urge Ministers to include staffing needs, the importance of which has been mentioned by Members on both sides of the House, in the Green Paper. Given what the wider situation will be post Brexit, we need to find ways of using technology, being much better at training care workers from the British population, and raising the status of care work. Labour Members mentioned that, and I agree. Looking at care purely as a business sector, it seems to me a classic case of somewhere that both technology and the human touch are vital. That combination is vital to providing high-quality care. To put it starkly, a robot may be able to do the lifting part of the work, but it cannot provide the equally necessary words of encouragement and comfort. I think social care will be an employment growth sector in the decades ahead.

Getting social care right is clearly one of this Government’s biggest challenges, as it will be for every Government for many decades to come. Over the next couple of years, we will have the chance to reset the debate so that it becomes calmer and more realistic. I know that my right hon. Friend the Secretary of State and the Minister for Care want to provide that calm and realism, and I hope that those of us contributing to this debate from the outside will live up to that, too. I very much look forward to the publication of the Green Paper.

Oral Answers to Questions

Damian Green Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

It is the hon. Gentleman’s party that should be ashamed of itself for leaving us with the financial crisis 10 years ago that has created such huge pressure in both the health and social care systems. Yes, in 2010 there were some cuts in the social care system, but that has changed now and over this Parliament the budget is going up, with £9.4 billion of additional resources, which is an 8.6% increase in real terms. We need to go further, however, which is why we have a Green Paper.

[Damian Green (Ashford) (Con)]

May I add my thanks to those of my hon. Friends for the fact that one of the new medical schools will be placed in east Kent, which is an extremely welcome development for the health economy? On social care, the Secretary of State will be aware that the funding issue is one of the big long-term questions that need to be answered. Can he assure the House that the Green Paper will not only address that, however, but will place equal emphasis on the need for rising quality in social care across the board, because in the short run that is what many families feel most anxious about?

[Mr Hunt]

I thank my right hon. Friend for doing some incredibly important work when he was responsible for this area; he laid some really important foundations. My right hon. Friend is absolutely right: earlier my hon. Friend the Minister for Care talked about the fact that 81% of adult social care providers are good or outstanding, but that means that one in five is not, which means too many people are not getting adequate social care provision. We must put quality at the heart of this, and of course that does link to funding.