Social Care (Bradford East)

David Ward Excerpts

Tuesday 5th March 2013 Westminster Hall

[Mr David Ward (Bradford East) (LD)]

Thank you very much, Mr Caton, for calling me to speak. It is good to appear before you today and to have my hon. Friend and colleague, the Minister of State, Department of Health, responding to this debate.

The Secretary of State for Health said in his statement to the House of Commons on this issue that

“these reforms herald an historic change in the way in which care and support are funded.”—[Official Report, 11 February 2013; Vol. 558, c. 594.]

Indeed they do, and the Minister is not only obliged to see these measures through—he has a duty to do so—but is actually quite privileged to be part of what I believe will be seen in the future as incredibly important legislation. As the Secretary of State said, the reforms that we are planning are “historic”. I think that the Minister like me, would want to thank on the record his predecessor as Minister, our right hon. Friend the Member for Sutton and Cheam (Paul Burstow), for the work that he did in introducing the Health and Social Care Act 2012 and for his commitment over a long period of time to this crucial area.

I believe that how we deal with social care, and how we fund it, is one of the biggest challenges that the Government face. To provide a local context, Bradford has 79,000 people over the age of 65, and that number will increase during the next 10 years to 85,000. The cost of caring for people over 65 in Bradford will increase by £30 million by 2025, on demographics alone; that does not take into account the increasing level and scale of need that people over 65 will have. Across the Bradford district, it is estimated that 5,500 people have dementia, but only 52% of those people are currently diagnosed.

We felt that this issue was so important that we could not ignore it. We not only needed to find out what the local perspective was but beyond that we needed to give an opportunity to people across Bradford, and not just to people within my constituency, to contribute to legislation. We carried out a survey; 35,000 survey forms were distributed. We also carried out interviews with carers, users and stakeholders, and we held a summit in January, which was attended by Baroness Barker, to report back on our findings. I want to put on record my thanks to Bradford council, Bradford Alliance on Community Care, Age UK Bradford and District, Alzheimer’s Society Bradford, Ideal Care Homes, the Bradford and District Disabled People’s Forum, the Consortia of Ethnic Minority Organisations and the Carers’ Resource, whose help and support were received during the production of the report; indeed, without their support we could not have compiled the report, which we have already submitted to the Minister. We have also received research and case studies from Scope, and we thank it for that.

I must say that, although I may refer to one particular case study today, reading the case studies that were submitted to us and that we collected was the most disturbing aspect of the work we carried out. We can look at statistics, figures, trends and analysis, but when we look at how the care system treats individuals—I have to say that very often such care is not very good—the importance of this issue really comes home to us.

We made a range of findings. Of course, funding is a crucial issue. We can look at the background. Yes, we can say that it is for local authorities to make priority decisions within their own areas, but that is happening against a background of a reduction in funding to local authorities. Many of the remedies that we came across required local solutions, but the context is that there has been a 16% reduction in spending on social care in Bradford in the past two years, and there is a proposed further reduction of £7 million for 2013-14.

We found that enormous contributions are made by family, and often also by friends, towards paying for the costs of care. In Bradford, 65% of the residential homes charge top-up fees, and 21% of the contributions to pay for those fees come from family and friends. I must say that the Dilnot proposals and principles received widespread support from the people we contacted. In particular, it was interesting to note that when we talked about the funding of social care, although the average age of respondents was over 65, many of them regarded the funding of social care from universal benefits to wealthier older people as being their favoured way forward in order to address the funding gap. The average house price in Bradford is £94,000, so people can immediately see the benefit to a place such as Bradford of having a £123,000 threshold by 2017. However, we worry about a national cap because it represents a greater share of wealth in a place such as Bradford, where there is much deprivation and lower incomes than elsewhere, but the general principles are applauded.

We have some problems in Bradford with self-funders, who pay more than local authority-funded care users. I think that there are provisions in the Health and Social Care Act 2012 to look at finding a greater role for the local authority in brokering services on behalf of self-funders, which people welcomed.

There was an issue that cropped up time and time again, and not only in our research; when I was a councillor, I held a hearing to try to get the views of the elderly across the constituency and it cropped up then. It is the issue of isolation and loneliness for the elderly, and it has become an issue of the utmost importance. Age UK believes that 10% of over-65s are either lonely or very lonely. Of course, there is not only the impact of loneliness on how a particular person feels there and then but the impact on their long-term health. Indeed, there are indications that isolation and loneliness may, in certain cases, lead to premature death. In our survey, 95% of respondents believed that the loneliness and isolation that I have referred to would have long-term health repercussions for those affected.

To provide more local context, some cultural barriers to ethnic minority communities’ acceptance of residential care were identified. We believe that that issue needs to reviewed on a national basis, to see whether any generalisation can be made from the particular experience of Bradford.

The issue of access to information was considered very important by respondents to our survey, and people’s increased dependence on online access to information was not accepted as being the best way forward. There is still a desperate need for face-to-face contact, so that information can be transmitted to those who are often in a vulnerable position and who are entering a world they have not been in before. For many people it will be a completely different world, either as a receiver or user of care. It will involve jargon, including technical terms, with which they are simply not familiar and which requires a personal input.

The issue of fair access to care services—FACS—threshold is crucial in Bradford. The idea of setting a national minimum standard, as contained in the 2012 Act, is good, but the fear expressed by many of our respondents was that that national minimum standard would result in a levelling-down, not a levelling-up, of provision. That is because the Lib Dem group in Bradford has fought hard to ensure that “moderate” levels of need are supported, as opposed to “substantial” levels. Scope has told us that in 2005 50% of local authorities were operating on the basis of a “moderate” threshold, but by 2012 84% of local authorities had transferred to using a “substantial” criteria threshold.

The effect of that change in Bradford would mean that 800 18 to 64-year-olds and 1,300 over-65s would lose the support they receive. It may not sound like a serious loss of support, because after all we are talking about “moderate” levels of need. However, it pays for the cooking, the cleaning and the support for learning opportunities. Such opportunities encourage engagement and reduce isolation, and therefore the loneliness that often accompanies old age. The long-term impact of reducing loneliness means that it is a false economy in the long run to save on things such as adaptations, which I will come on to in a moment, and preventive support, which is how we regard the support for people in “moderate” levels of need. It is a false economy given the later costs that will be incurred by individuals, and indeed by the state, in supporting those we have not dealt with at an earlier stage of need.

The issue of adaptations came through time and again. There were some distressing case studies of people requiring special attention who were let down by the system. I will mention one, although the report contains more. I recently visited a gentleman who had had an occupational injury. He was tetraplegic and after receiving fantastic intensive support in Pinderfields, including occupational therapy, he was returned to his own home, to another world. He received some support—four times a day he was visited to help him get out of bed with a hoist—but the rest was left up to him. He had no idea. His wife was in despair, unsure about what financial support would be available in future and how long the support they were receiving would last. In addition, a ramp—a simple thing, some might have thought—was taking months to arrive. The disparity between the first-rate service in the NHS and the level of support received once the gentleman returned home was stark and depressing.

Approval for the ramp was given, but its delivery and implementation was simply dumped on the man’s wife, for her to sort out herself. A temporary ramp was installed that the ambulance service refused, for health and safety reasons, to use. That was the only ramp that she could use to get him out of the door, and she had to do that on her own because none of the services, for health and safety reasons, would use it. That is not care; it is careless.

The final part of the statement by the Secretary of State was about the ultimate aim: where we would like to get to by the end. We want a good place to grow old in, but that will not be achieved on the cheap. It is to the credit of the Government that they have not waited until better times but have identified the burning need to address the issue of the funding and quality of social care. However, we must address the problem of how this is funded. The measures have been proposed, and we will see how the legislation proceeds.

We also need to understand the additional contribution that is being made day in, day out, voluntarily, by people who do not have the training or the background, and often do not have the financial resources available, to supplement an inadequate level of funding.

Mine is unashamedly a Bradford perspective, but as with all research the key is to look at the generalisations that stem from it. I hope that my hon. Friend the Minister will take on board some areas that we have identified in considering the national situation and carry out further research on regional caps, adaptations, the FACS threshold, the contribution that changing the threshold will have on isolation and loneliness, and the subsequent increased costs to individuals or the state of the failure to deal with what should be preventive measures. I hope that my hon. Friend the Minister will respond to those points either today or later.

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship for the first time, Mr Caton. I congratulate my hon. Friend the Member for Bradford East (Mr Ward) on securing the debate and on a brilliant piece of work—not just the report, which is fantastic, but the degree of discussion, debate and engagement with ordinary people and all the organisations that he listed, to get an understanding of what is going on in his community. That is immensely impressive. He has gone further than anyone else in understanding what is going on, on the ground. I thank him for his work. He is right to say that although the report looks in depth at a particular community and its needs, wider lessons can be learned from it. The report makes a useful contribution.

Like my hon. Friend, the coalition Government know how important it is to reform the current system of care and support. The voices of the people of Bradford reflect what we have heard from care users, their carers and voluntary organisations across the country, regardless of who they are or where they come from. They say that care and support needs to change. We have to move from an old-fashioned paternalistic system, where the council or the NHS knows best, to a personal system where we give real power to individuals to determine what their priorities are, what works for them and what makes them happy and contented in later life, despite sometimes having acute care needs.

My hon. Friend rightly highlights the significant demographic challenge facing us in years to come. About 14%—more than 71,000 people—of Bradford’s total population is aged 65 and over. Bradford’s local joint strategic needs assessment for 2012 predicts that by 2033 the number of local people over 90 will triple from 2,800 to 8,700. We should celebrate that. It is great that people are living to be older and often enjoying great quality of life for more years, but also many people live for years with more than one acute condition, which presents a challenge for them, but also a cost to society. Such a demographic shift will always be an immense challenge. Only if the care and support system changes and adapts can it meet the new demands and expectations of an ageing population in modern Britain.

The organisations that my hon. Friend mentioned are vital partners. This is not something that Government or local government can do on their own. The care and support White Paper, published in July last year, is an important step towards addressing these challenges. Our reforms will focus more attention on people’s well-being and independence throughout their lives, instead of waiting for them to reach a crisis point. They will also put people in control, giving them a far bigger say in their own care and support, and ensure that services are designed around their needs, rather than the needs of an institution.

The White Paper, together with the draft Care and Support Bill, will shape the care sector for years to come. The draft Bill, which my hon. Friend knows has been subject to pre-legislative scrutiny, sets out how we will put the plans into law. For the first time, we will create a single, modern statute, bringing everything together for adult care and support. It is good that that is written in plain English—English that people can actually understand without being a lawyer—which is quite useful. That statute will be clearer, fairer, and built around people, not processes, and around individuals, not institutions. It will empower people in Bradford and across the country to take control.

My hon. Friend highlighted the importance of the reforms to funding recommended by Andrew Dilnot. Last month, the Secretary of State for Health announced groundbreaking proposals to cap the costs of long-term care. That issue has been in the long grass for far too long. Successive Governments have put it in the “too hard to solve” category and just left it. As a result, ever more people have suffered catastrophic loss, losing everything that they have worked for. There is an acute unfairness in how the system almost penalises people for having been prudent and careful throughout their working life.

Individuals currently have little or no protection against the cost of care in older age. In Bradford, for example, some 5,000 people a year turn 65, and around 500 of those people each year could face significant care costs under the current system. Our reforms will ensure that everyone gets the care they need. We are ending the unfairness of, and fear caused by, unlimited care costs, while making sure that most support goes to those in greatest need. People will be protected from having to sell their home during their lifetime to pay for care.

The Government have committed to a £75,000 cap on care costs across England in 2017. I note my hon. Friend’s concerns about the cap’s geographical impact, and he proposes a regional cap as an alternative. The cap provides the same financial protection for people of equivalent wealth from different regions, and everyone will benefit from more peace of mind. However, I would say to my hon. Friend that, in some parts of the country, the costs of care are higher, so people reach the cap more quickly because they have to spend more of their own money. In a way, it is swings and roundabouts.

The other thing I would stress—my hon. Friend was right to point this out—is the significant increase in the range of means-tested support. At the moment, if people have more than £23,250, they get no help at all; they are on their own. That limit will be extended to £123,000. My hon. Friend said the average house price in Bradford is £94,000, so a substantial number of people there will get contributions towards their care costs.

In the spending review, we made clear our strong and ongoing commitment to adult social care by prioritising an additional £7.2 billion over four years—my hon. Friend raised concerns about tight social care budgets. Independent research by the King’s Fund supported our view that that should be enough for councils to maintain services, provided they make sure those services are delivered efficiently. Since that announcement of £7.2 billion, we have added another £500 million. In the context of a challenging local government settlement, that means that local authorities should be able to protect access to care. Ultimately, however, it is for local people and local authorities to determine their care spending priorities.

We cannot improve care and support simply by shovelling ever more money into the system. My hon. Friend was right to say that we must do things differently and work more efficiently to achieve better outcomes. Critically, that will be about a partnership between statutory authorities and the voluntary sector, including the organisations he spoke warmly of, which can really make a difference.

People have told us that the process of determining who is eligible for care and support is confusing and unfair. Decisions are not transparent, and they vary across the country. The result is that people are left without the support they need. The draft Bill provides for the national threshold my hon. Friend talked about. I understand his concern to protect the moderate threshold that Bradford has managed to maintain, and I applaud it for doing that. However, even if the threshold is set at a higher level—it has not been determined yet—Bradford will still be able to maintain a more generous system, if that is what it chooses.

My hon. Friend rightly focused on prevention as one of the key themes running through our reforms. We want a care and support system that is proactive and preventive, rather than reactive—repairing things when they have gone wrong. Such a system helps people to stay healthy and independent in the first place. We need to help people to maintain their health throughout their lives so that they do not, we hope, have to go into acute hospitals when everything goes wrong.

My hon. Friend might be aware that I recently announced a £300 million fund for specialist housing. Bradford already has seven extra care housing schemes, and it has submitted a bid to the specialist housing fund to develop further schemes. I applaud it on the work it has done locally to secure those schemes.

At the end of last year, the Government made available an additional £40 million across the country for aids and adaptations, and my hon. Friend referred to that. Bradford council will receive an extra £336,000. In total, £785 million will be provided over the four years to 2015. That will enable people to remain independent for longer.

My hon. Friend talked movingly about the problems of loneliness and isolation, and it is critical that we challenge them. If people are on their own, with no human contact, their mental and physical health will deteriorate. That is dreadful for them, but it is also costly for the system. We need to be much more effective at maintaining contact and using the voluntary sector—good neighbour schemes and so forth—to maintain human contact and friendship.

I want to say a word about integration. The White Paper sets out our ambition for health, care and support to be organised around the individual’s needs, rather than focusing on organisations and services. My hon. Friend mentioned the case study involving the ridiculously long wait for a ramp, which demonstrates how dysfunctional the system can be. It is crazy that someone returning home needs that little adaptation to maintain their independence, but it does not arrive for so long. That puts them at risk of a fall, which would result in their returning to hospital. That is a dysfunctional system. The Government’s absolute focus on encouraging and incentivising areas to integrate services across health and social care, and mental and physical health, is critical to providing better care and support for individuals.

[Mr Ward]

The absurd thing about this tragic case is that the gentleman was in Pinderfields for five months, and people knew throughout that time that he would go back to his own home. Yet, when he arrived, it was as if they thought, “What a surprise. He’ll need a ramp.” As I said, the gentleman is tetraplegic.

[Norman Lamb]

That is unbelievably stupid. All the preparation could have been done before he returned home so that everything was ready for him when he came back.

The draft Bill will significantly benefit those with caring responsibilities. It will simplify the process of assessments and, for the first time, place a duty on councils to meet a carer’s eligible needs for support. There will be a new resource of £175 million to ensure that that is implemented.

The Government’s independent advisory body—the standing commission on carers—visited Bradford in 2011 as part of a series of fact-finding visits. It had the opportunity to see first hand some of the valuable initiatives, including the carers information service and the emergency planning service, that have been commissioned by Bradford council from the carers resource.

Let me say a word about personal care. One of the best ways we can improve the quality of care is by getting people to exercise choice and control over how their needs are met. The draft Care and Support Bill will place personal budgets on a legislative footing for the first time. Local authorities should be working to meet the objective set out in the vision for adult social care and provide personal budgets for everyone eligible for ongoing social care. Preferably, that should take the form of a direct payment to individuals, so that they can determine exactly how they want the money to be spent. That should apply from April 2013.

My hon. Friend mentioned the importance of information and knowledge. He said that online information is not always accessible to all. IT and providing information online can be transformational in getting vastly more information out to people who need it, but we must always recognise that some people cannot access it in that way, and we must ensure that it is available in other ways.

Let me reiterate the fact that the White Paper, the draft Care and Support Bill and the Government’s decision to reform the funding of care and support represent a radical transformation of the way we meet the needs of individuals, families and communities. That transformation will require close collaboration and genuine cultural change, involving the Government, local authorities, the NHS, care providers, voluntary organisations, care workers, care users and their families, and communities.

I am therefore really encouraged by the brilliant work that has been undertaken in Bradford and by the local engagement and insight clearly evidenced in my hon. Friend’s report. Again, I congratulate him on the dedication and commitment he and his team have shown on one of the most important issues we face as a country. As our society ages, we face enormous challenges, but there is a message of hope, because these reforms will start to prepare us for the challenges of an ageing society.