Care Bill [Lords]

Hazel Blears Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

I want to make some progress.

At Committee stage, we intend to table amendments to enable the creation of a £3.8 billion better care fund in 2015-16. That represents the first significant step any Government have ever taken to integrate the health and social care systems.

[Hazel Blears (Salford and Eccles) (Lab)]

rose—

[Barbara Keeley]

rose—

[Mr Hunt]

I will give way in a moment, but let me make some progress first.

I commend the right hon. Member for Leigh (Andy Burnham) for championing integration, although he chose not to do anything about it when he was in office. How, then, when a Government take steps to do that for the first time, can he possibly justify not supporting it?

[Hazel Blears]

At a time of austerity, when there is very little public money around, the need for innovation and creativity is much greater. On reflection, does the Secretary of State regret not being more ambitious in the Bill about the full integration of health and social care in order to maximise the impact for those who need care and support—unlike my right hon. Friend the shadow Secretary of State for Health, who has talked about whole person care and full integration?

[Mr Hunt]

With the greatest of respect to the right hon. Lady, who, I know, played a good role in the G8 dementia summit last week, the Bill is extraordinarily ambitious. Nearly £4 billion is going into a merger of the health and social care systems. The previous Government had 13 years to do something about this and they did nothing. We are delivering. I hope, if she believes in this, that she might at least support the Bill in the Lobby tonight and not decline to support it, as her party’s amendment suggests.

The fund will ensure joint commissioning and the seamless provision of services, preventing the nightmare of people being pushed from pillar to post with no one taking responsibility. It has led to the unprecedented step of the NHS and local authorities working together in all 152 local authority areas to plan joined-up services.

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[Hazel Blears (Salford and Eccles) (Lab)]

I should like to begin by quoting one of the Alzheimer’s Society’s ambassadors, Arlene Phillips. Talking about her father, who had Alzheimer’s, she said:

“I did everything I could to care for my dad when we discovered he had dementia. Unfortunately, the efforts of one person—or even a family—aren’t always enough. It soon became clear to me that while I could keep Dad safe when I was by his side, I couldn’t be there every minute of every day.”

The words of Arlene, and thousands like her, should provide all of us in the House, irrespective of party, with the greatest incentive to act to support those people who are suffering and need care and, crucially, their carers and families, who are the backbone of the social care system in this country.

A society should always be judged by the way in which it looks after the most vulnerable people in its communities, and it is safe to say that, over the years, we have all failed that responsibility. Today is an opportunity for us to acknowledge that, and to point out that, even today, in a modern 21st century developed industrial nation, we are still failing the people who ought to get a great deal more support and care from us than we are currently in a position to give.

The Bill is a small step forward, rather than the giant leap for mankind that I would have liked. One of the central issues is a lack of ambition. We face the biggest social challenge that any of us could possibly see, yet the Bill’s provisions, some of which are well meaning, do not, when taken together, add up to a whole system’s series of changes that result in a basic reconfiguration. The right hon. Member for Charnwood (Mr Dorrell) spoke about that, and I pay tribute to his championing of integration, change, re-engineering and being ambitious. I do not see that in this Bill.

Instead, I see some perverse incentives. If we are talking about the well-being duty and the duty to prevent, reduce and delay somebody’s need for care, how can we say that we are going to support only people with substantial and critical needs? How are we going to engage the system further up the chain, with people who are beginning to suffer, perhaps beginning to have memory problems and beginning to need social care? How are we going to incentivise the system to invest in the new commissioning in clause 5, which talks about diversity and shaping the market? How are we going to get the system to focus on that if all the focus, after £2.85 billion-worth of cuts in social care, is on how we might manage to look after the people with substantial and critical needs? We should be focusing far more upstream in the system.

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

As my right hon. Friend has said, the backbone of care in this society is provided by friends and family. Should we not be moving towards a system that incentivises the people currently giving care to continue to do so for as long as possible by supporting them at the lowest level, not at the highest level?

[Hazel Blears]

My hon. Friend makes an extremely powerful point. I am pleased that the Bill strengthens support for carers. I draw the House’s attention to the Bill introduced by the other Member for Salford, my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), which seeks to make sure that carers have the right to stay in work and the support to be able to do that. We must consider the cost to our economy of people having to give up work in order to care. We have talked a lot today about perverse incentives and false economies, and that has absolutely been a false economy for a long time.

I wish to say a word about diversity of provision and commissioning new models of care that can help with prevention. In my city we have been working on that for a long time, and I look forward to showing the Minister some of our examples when he visits. Social adVentures is a social enterprise that helps people with mental health problems, and one of its projects is “garden needs”. It has taken control of a garden centre, and people with dementia and people with mental health problems are now attending. The way it is keeping people active in the community and able to do many more things than they would if they were isolated and at home is amazing. Unlimited Potential is another fabulous social enterprise, which stands on its own two feet, is not grant-dependent and is able to invest more money back into the community. Last week, I had the pleasure of launching a website called Really Useful Stuff, which is just what it says on the tin—it is a website where people can get aids, adaptations and kinds of social care that are modern, innovative and creative. Those are just a few examples of what is already happening in the community.

I say to the Minister that at a time when money is tight, and will be, no matter which Government are in power, the imperative to innovate and be more creative with the funds we have has never been greater. Therefore, investing, in particular, in the social enterprise sector, which often has these great ideas, and in enabling those ideas to get to scale so that provision can be made across the country, is really important. Another company in my constituency, 2ergo, has recently developed an app for the iPhone where people can see what provision is available in Salford for care, respite care and activity, and how to book it. They can book it over their iPhone—families can do that; they can help the people they are caring for. So this use of new technology is now developing apace, and, again, we have to take advantage.

I commend the Government for organising the G8 summit last week in London—an amazing event where we gathered support from countries across the world. I hope that next year we will be able to expand that to a global event examining dementia, not just one involving the G8 developed countries. Part of that G8 meeting was about how we get more research. I would like to see far more research on the quality of care. There is a lot, but not enough, research on the bioscience, but hardly any research on the interventions we do, particularly for people with dementia. We all know that “singing for the brain” has a great reputation. It helps cognitive development, as do art, drama and reminiscence work. There is no evidence base behind that, so if we are to have a better system of social care, we need better research into therapeutic interventions that work. That will enable commissioners to commission packages of care that they know will make a difference. If money is tight, we need to spend it on things that we know will be effective, and I ask the Minister to support that.

The Alzheimer’s Society has also done a lot of work on dementia-friendly communities. That is not expensive. It is a matter of mobilising the good will of local people, shops and arts centres. In Salford, a taxi firm has trained 400 drivers to look after people with dementia. Such care does not cost a lot of money if we can mobilise ordinary people in their communities. In Japan, 4.5 million people are signed up to be dementia friends. Our ambition is to have 1 million such friends. Again, I push the Government to be more ambitious to see what more we can do.

Clause 5 is about not just diversity and shaping the market, but quality, and that is an area about which we all feel passionate. How can we in this country tolerate a situation in which those who do the most difficult job in caring for our friends and family are actually some of the least regarded workers? It is utterly unacceptable to have zero-hours contracts in the social care sector. The carers who care for my dad come in for 15 minutes. They will do more if they can. They have to ring up to be assessed when they have done 12 minutes. They get no payment for travelling and no expenses for their petrol. They came out one Sunday. They started at 8 o’clock in the morning and went home at 9 o’clock at night, but because they only had five hours of 20-minute slots, they got paid only for five hours. Members should try being out on a Sunday for 13 hours and going home with five hours of minimum wage payment. It is an absolute disgrace and a scandal that we tolerate that in this country. I hope the Minister will assist in bringing such practice to an end.

I want to say something about my own local authority. My hon. Friend the Member for Worsley and Eccles South mentioned the fact that Salford has recently had to change its eligibility criteria from moderate to substantial and critical. We were the last authority in Greater Manchester to have to make that decision, and it was heartbreaking. Our social services have always merited four stars. When I was a councillor 30 years ago, cuts were bad, but we always prioritised social care and nursery care for children. The decision to change the criteria was not made lightly, and the cuts have been absolutely horrendous.

Let me again say to the Minister that we need creativity and imagination to deal with this matter. I want to draw the House’s attention to my unpaid interest in social finance, which appears in the Register of Members’ Financial Interests. We have a real opportunity to draw extra funds into the social care system. If we could have a social investment bond that aimed to keep people with dementia in their own homes for longer, we would save the NHS a fortune. People with dementia are admitted to hospital more often. They stay longer in hospital and many more of them die there. If we could mobilise social investment to offer a reward for keeping people in their own homes, funded by the savings to the NHS, we could bring in some new money, not just what we are getting from local authorities.

[Norman Lamb]

I am very interested in the right hon. Lady’s proposition, and would be happy to talk further with her about it.

[Hazel Blears]

I am grateful to the Minister for that. In these difficult times, we all have a responsibility to look at creative and innovative ways of funding and to try to carry them through. The whole area is becoming very exciting. It was the legacy that the UK agreed to take on from the G8 meeting last week. We are global leaders. We have 14 bonds in this country; America only has one. For once, we are well ahead of the United States, and I am delighted that the Minister wants to discuss that issue.

All of us could talk for at least 20 or 30 minutes on that issue. As I come to the end of my contribution, I will just say that the Bill is a step in the right direction. I am disappointed—I say this to the Minister in the kindest way I can—that we have not been more ambitious. If we want to move towards whole-person care, we will have to be much bolder than we have been. I remember when we said, “We are at our best when we are at our boldest,” and that applies in this case. Nevertheless, over the next few weeks and months, I shall keep holding the Government to account, holding their feet to the fire and pushing them on to see what more we can do. We all feel a personal, deep and emotional responsibility for the most vulnerable people in this country who look to us to care for and support them at a difficult time in their lives.

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[Norman Lamb]

I will just finish this point.

There is also a focus on protecting everyone from catastrophic care costs, ensuring that people will no longer have to sell their homes during their lifetimes to pay for care. The Bill reforms a fundamentally unfair system, drives up standards in GP surgeries, hospitals and care homes through the new chief inspectors, adds a new statutory duty of candour so that hospitals, care homes and other care providers are open with patients when mistakes are made, and introduces valuable new rights to carers. Of enormous significance is that it signals the first ever big step, as the Chair of the Select Committee said, towards joining up our health and care systems through the better care fund, which is worth £3.8 billion.

The best description of the Bill was in a letter forwarded to me by a Labour MP, which said that the Bill is a groundbreaking piece of legislation that has the potential to make a big difference for older people. Despite that, the Labour party is declining to give it its support.

[Hazel Blears]

rose—

[Barbara Keeley]

rose—

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[Hazel Blears]

The debate this evening has been fabulous and has engaged people from across the House on one of the biggest challenges we face. Earlier in the debate I asked the Secretary of State whether, on reflection, he thought that he could have been more ambitious about the integration of health and social care. The costs to our system are now unsustainable, and this was an opportunity to seize the moment. The Minister has tinkered around the edges of integration, so may I press him to be more ambitious, to think bigger and to be more committed to greater integration that will benefit us all?

[Norman Lamb]

I note the challenge, but I have been passionate about integrating care for many years. I made the case for it on many occasions when I was my party’s spokesman in opposition, and I remember not getting much of a response from the right hon. Lady’s party when it was in government. The Bill is really ambitious and marks the potential for a fundamental change in how our system works.

The right hon. Member for Stirling (Mrs McGuire) welcomed the principles of the Bill and rightly said that it is the duty of the Opposition to challenge and to probe. However, to use her expression, I think that many Opposition Members have been “churlish” in their response, with a few honourable exceptions, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke). I say that because in 13 years, Labour had two manifesto commitments, one royal commission, another promised commission, a Select Committee report, a White Paper, a Green Paper and numerous independent reviews on the issue, and what was the net result of all that talk? Absolutely nothing. In 1997, Tony Blair told the Labour party conference:

“I don’t want our children brought up in a country where the only way pensioners can get long-term care is by selling their home.”

That is exactly what happened throughout Labour’s time in government. In contrast, the coalition Government are getting on with reform.

Even now, we have no idea what the Opposition’s policy is. The shadow Health Secretary has hinted that he prefers an all-in approach—everything free, paid for by new taxes on death and by cutting hospital beds—but he has clearly failed to persuade his own colleagues about the plan or to set out how he would pay for it. Opposition Members’ criticisms can only be of any real value if they can answer the question about how they would pay for anything that costs more. So it was good to hear the right hon. Member for Salford and Eccles, who seemed to be about the only Opposition Member who recognised the scale of the challenge that we face, whoever is in power, and the fact that we need to think afresh about where money can come from. Her ideas about innovation using social investment bonds are welcome, and I would like to talk further to her about them.

We want to reshape care and support so that it is focused on enabling people to live more independent lives and giving them a good life. The Bill provides a new framework that places people’s well-being right at the centre and empowers them to take control of their care and support. It consolidates 60 years of legislation and pulls a dozen Acts together into a single legal framework, and it has been roundly welcomed. The King’s Fund has said:

“The government’s proposals for funding reform are an important achievement against the odds in a daunting fiscal and economic climate.”

Baroness Pitkeathley of Carers UK has described the Bill as the “most significant development” in the history of the carers movement.