Social Care

Kelvin Hopkins Excerpts

Wednesday 25th April 2018 Commons Chamber

[Kelvin Hopkins (Luton North) (Ind)]

It is a pleasure to speak once again in a debate on this important subject. I applaud my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), the Labour Front-Bench spokesperson, who has made this speech before and been resolute in standing up for the care industry, and I support the Labour motion, which is very good. The hon. Member for Central Ayrshire (Dr Whitford), who spoke for the Scottish National party, also made some very important points.

I support what the royal commission on long-term care for the elderly said 19 years ago: long-term care should be free at the point of need and paid for out of general taxation. I want to go beyond what Labour is saying at the moment, however, which I applaud and support, and look to a world with free long-term care and a care service run on exactly the same basis as the national health service. We were moving in that direction just before we lost office in 2010. The then Secretary of State for Health suggested a national care service like the national health service. I intervened on him and said, “Yes, and paid for out of general taxation and free at the point of need,” but we did not get it. We did not get the support all those years ago, despite the support of many Members for the royal commission report, strong support in the country and a trade union-led campaign calling for free long-term care. It was all to no avail and so the issue has rumbled on ever since. The issue did not go away, however, and I raised it myself in the Chamber several times over those years.

Eventually, the Dilnot commission was set up, and in its 2012 report it recommended a compromise. Sir Andrew Dilnot, whom I know well, is a superb man, and he did a brilliant job. He came up with a compromise that he thought might be worn by the Treasury, proposing that self-funding should be capped at £35,000 for a lifetime. The Government dragged their feet and resisted, but eventually, after wriggling a lot, they agreed to a lifetime cap of £72,000—twice the amount that Sir Andrew had suggested. Even then, however, that was deferred until 2020, and now it seems to have been deferred indefinitely. We are well away from where we should be. Scotland, of course, has had free care, and I applaud Scotland for that. I do not know why we should not follow suit.

If self-funding affected only the wealthy, it would not be such a worry, but it actually affects millions of working-class families. The first generation who became owner-occupiers have been particularly badly hit. Successive Governments have wrung their hands about the difficulties experienced by young people in achieving owner-occupation, while at the same time cutting off one of the only possible routes to owner-occupation for many: the cascading of family equity down the generations, whereby the capital in Granny’s home passes down to grandchildren when she ends her days.

I hold resolutely to the view that long-term care should be free to all, and funded from progressive taxation at the point of need. I am not too concerned about how that taxation is raised—it could be national insurance, income tax or a hypothecated tax—but the money should come from general taxation.

[Scott Mann]

The hon. Gentleman is making a valid point about the funding of care, but I should be interested to know whether he considers the use of technology, which I mentioned and which was mentioned by a couple of my colleagues, is an option that might enable us to do things slightly better.

[Kelvin Hopkins]

I am always in favour of improving the way we do things, and technology is of course important.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the hon. Gentleman agree that, given that some funding decisions and challenges are very difficult, and given the amount of money that is needed, we should adopt a cross-party approach, looking at all the options, building consensus, explaining the position to the public and ensuring that this arrangement is delivered?

[Kelvin Hopkins]

In fact, the royal commission did cover funding. Over the last 20 years and more, I have spoken to many audiences, and have asked them, “What would you prefer—to have your house taken away from you, or Granny’s house taken away, or to pay slightly more tax?” The unanimous view was in favour of a slightly increased level of taxation to pay for long-term care. Everyone is going to get old. I am easily the oldest person in the Chamber. I am not planning to go into long-term care any time soon, but on the other hand I am closer to it than the other Members who are present. However, I will not speak about myself.

There is another factor in all this. In my constituency, there were three local authority care homes where the residents were happy, the staff were wonderful, and the healthcare professionals treasured them. All those homes were closed, and the land was sold off. Now we see the private care sector in constant difficulty. Given the collapse of Southern Cross and the ongoing threats to the future of many more homes, I believe that at some point the state will have to step in to ensure that care continues to be provided. Indeed, the Minister conceded that point: she said that we would have to step in and solve the problem. Why not set up a national care service now, and start to bring care homes back into the public sector as we did in 1948? I am not old enough to remember Nye Bevan’s speech in the House in which he proposed the establishment of the national health service, but I was inspired by him when I was at school, and my policies developed as a result.

Another scandal has been reported recently, namely the practice of effectively using self-funders to subsidise publicly funded residential care. Contracts with cash-strapped councils are squeezed, and charges for self-funders are increased to compensate. In one case, the charge for a care home resident who had been state-funded and then became self-funding was multiplied by several times. Most worryingly, there have been reports of inadequate care in homes across the country, which was mentioned by my hon. Friend the Member for Worsley and Eccles South. When care is provided by homes in the private sector that are squeezed for funding and have to make profits, it is inevitable that care standards will eventually be cut. It is clear that long-term care should not be in the profit-driven private sector, but should be a true public service, in the public sector. I commend today’s motion and all that has been said by many hon. Members on both sides of the House, but we have to move towards a national care service, based on exactly the same principles as the national health service.

[Andrew Selous (South West Bedfordshire) (Con)]

I would like to praise our social care workforce and those who provide care voluntarily. The Government are not in denial about the issues that we face. That is why the Green Paper is being worked on and will be with us within months.

In spite of the huge challenges in this area, the Select Committee on Health and Social Care learned only yesterday that there were 1,700 fewer delayed transfers of care this February compared with the previous February. That is a small bit of progress in the right direction. In evidence to our sustainability and transformation inquiry, the Committee learned about some of the other good things happening around the country, including the passport scheme for care home staff in Wakefield, which allows them to transfer easily around the sector with their qualifications and experience properly registered and recorded. That will lead to an extra 750 jobs in that area by 2025.

In addition, we learned that in the 12 months to quarter 2 in 2017-18, compared with the 12 months to quarter 2 in 2015-16, emergency admissions in enhanced healthcare homes fell by 1.4%, compared with care homes in the rest of England that were not in that scheme, where they rose by 6.7%. We learned that in Buckinghamshire, through joint working between the NHS and local councils responsible for social care, there was a 57% reduction in falls leading to harm. The last example is from Tameside and Glossop, where, we were told, nurse-led telemedicine to care homes reduced hospital admissions from 122 to 75 and resulted in 75 earlier discharges. Those are examples of good practice around the country, but as ever with health and social care the question is how we can mainstream them all over the country.

In my remaining few minutes, I want to discuss what we do about the situation. Germany has introduced a proper nationalised social care insurance scheme, whereby people pay contributions, with adjustments made every few years. It has been in place since 1995 and has settled down. It is not contentious, but has broad agreement, and Japan has a similar scheme. They have been doing it for 23 years, and for me that points to the direction that we need go in.

[Kelvin Hopkins]

Will the hon. Gentleman give way?

[Andrew Selous]

Very briefly.

[Kelvin Hopkins]

It seems to me that the hon. Gentleman, my constituency neighbour, is agreeing with what I was saying. We can debate how it is paid for, but we want a national care service, paid for by everybody.

[Andrew Selous]

I think Germany absolutely has something to teach us, and it has a private insurance scheme on top of that as well.

We need to see weekend discharges in hospitals, on Fridays, Saturdays and Sundays, with local authorities and social care being available over the weekend, so that we do not get a bulge on Monday morning, causing our hospitals huge problems. We need proper pay for care home staff. They have a choice, but there is no choice for us as a country about whether we look after our frail elderly people and those who need social care. We have to do it, but people do not have to choose social care as a profession. Therefore, we need some proper labour market analysis and parity between similar jobs in the NHS and social care. The lowest-paid workers in the NHS have just had a 29% pay rise. If we are to have true parity, we need to treat the social care workforce as well as we treat the NHS workforce. Independent living schemes, which my own local authority of Central Bedfordshire is pioneering, are showing the way, and the Housing, Communities and Local Government Committee was impressed when it went to see Priory View in Dunstable. I gather that in East Sussex there is data to show that this type of extra care scheme—