Social Care

Debate between Jackie Doyle-Price and Alex Cunningham

Tuesday 25th February 2020 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

I feel like I am in groundhog day. It is approximately two years since I responded to a very similar debate secured by the hon. Member for Worsley and Eccles South (Barbara Keeley). It is disappointing that we are still debating the very same issues that we were then. Of course, there has been much water under the bridge since then in our broader politics in that time, but in respect of social care, to coin a phrase, nothing has changed. The questions we need to settle are exactly the same as they were then. I say very gently that with Brexit done and with a majority Government, there is no excuse for continuing to kick this can down the road. It is time that we genuinely took action.

At the heart of this question, we need to establish to what extent the cost of care should be met by the individual and by taxpayers. We need to establish a consensus on the balance between those two. From my perspective, it is not fair that at the moment that cost is met almost entirely by individuals. Equally, it would be unfair for it all to be met by taxpayers when people have some assets. We therefore need to settle that question properly. I would also gently say that our politics has not been entirely honest about that. It is worth reminding the House that at the moment only £14,250 of capital is protected. As the hon. Member for Worsley and Eccles South mentioned, that means those with very long-term care costs, particularly those who suffer from dementia, can face catastrophically high bills. There are, therefore, very strong arguments for a cap.

There are other reasons why we have to grip this issue now. As the hon. Lady mentioned, local authorities cannot plan their long-term finances. That also brings a real threat to financial stability within local councils. It is fair to acknowledge the challenges within the care sector, too. Many providers are finding the marketplace challenging, not least because of workforce challenges, but also because local authorities are insisting on paying low rates for residential care. That brings with it an additional injustice—people who are deemed able to pay for their care find themselves paying higher rates for the same product than local authorities do for those who do not pay for their care. I think that is a major injustice in the system.

[Alex Cunningham]

Would the hon. Lady support the Government funding local authorities so that they can pay the proper living wage to careworkers?

[Jackie Doyle-Price]

The issue is that local authorities are commissioning care from local care providers and paying the rate that the individual resident is incurring. It is about what they are prepared to pay for that bill and not the local authorities paying living wages directly to employees. However, that is pushing the risk on to care providers, and we need to acknowledge that there will be workforce challenges for those providers. They will be competing more and more for people. While there is that downward pressure from local authorities on what they are prepared to pay and the upward pressure on wages, the risk is being borne by providers.

Part of the solution is also not just about who pays. We need to be a lot more imaginative about this. We all know that we will live longer—beyond 70—and that we will have more years in life in retirement. Just as we make plans for our pensions, we need to make provision for our homes and how we are going to live in old age. The simple fact is that our housing requirements when we are in our 40s and are raising a family are rather different from what we might require in our 90s. We know that falls are one of the biggest burdens on the NHS, so the fact that we are not encouraging people to make sensible lifestyle decisions about their homes is causing additional cost to the NHS, as well as, potentially, the need for more long-term residential care. One reason why we have that issue is that we have allowed, collectively over decades, so much wealth to be stored in our housing stock that we have encouraged people to behave in a way that makes them want to cling to it. I would like us to look more imaginatively at incentives through the tax system to encourage people to downsize and look at different ways of living. We want to use the planning system to encourage the development of retirement villages where people can purchase extra care.

[Jackie Doyle-Price]

I completely agree. That is exactly the kind of incentive that we should encourage. The longer that we can encourage people to live independently, the better their quality of life and the better it is for the taxpayer, because there will not be those ongoing bills. The point is exactly that as we live longer, we will spend many years in a condition of frailty, and that needs to be properly managed through the system.

Every parent, with the best will in the world, will wish to hand on as much of their assets to their offspring as possible, but that could also encourage behaviours that are bad for their health. I want my parents to realise the value of their assets rather than protect their inheritance for me. I am sure that most people would think that about their parents, but there is a lot we can do on the tax system and incentives to encourage families to manage those issues collectively and in a way that is good for people’s welfare as they become elderly and enables them to do more for their children.

It is high time that we tackled this issue. We should also not look at this entirely in isolation from the issues regarding working-age adults, which are also a major challenge for local authorities as they manage their finances in this area. We must look at the issue of people with learning disabilities and autism being increasingly placed in areas of long-term care. The issue is that, although we have been broadly successful in moving out people with learning disabilities through the transforming care programme, sadly the pipeline afforded by those people moving out has been filled by people with autism. The Government have to give a much clearer challenge to commissioners. When faced with people with complex needs, the first instinct should not be to put them in residential care. Too often we have seen how those kinds of placements do harm. We need to challenge local CCGs and NHS England to put much better care upstream by providing early diagnoses for people with autism and giving them the tools to protect themselves.

[Alex Cunningham]

On the workforce issues, surely the answer to the dilemma the hon. Member is describing is to have a professional, well-paid, well-trained workforce that can deal with people with the most complex needs in their homes and allow them to remain there as long as possible.

[Jackie Doyle-Price]

The key words the hon. Member just used were “in their home”. There is no public policy challenge that does not come back to having the right kind of housing solutions. Many of these issues arise from our not investing in the right kind of supported housing environments that would enable more people to live independently. That has to be part of the solution. Local authorities and the local NHS need to come together to commission the right kind of service.

As we are short of time, Mr Deputy Speaker, I will end there, but it is high time we gripped this once and for all.