Social Care Reform (Disabled People)

Liz Kendall Excerpts

Thursday 11th July 2013 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Clark. I thank the Backbench Business Committee for giving us time to debate this very important issue, and I congratulate the hon. Members for Bradford East (Mr Ward) and for South Derbyshire (Heather Wheeler) for sponsoring the debate. It is a great pleasure—this is the first time that it has happened to me—to follow my right hon. Friend the Member for Stirling (Mrs McGuire), who made a very powerful speech.

This subject is hugely important. One in five adults in Britain has a disability of some kind, and that figure is rising due to medical advances and better survival rates. As my right hon. Friend says, it could happen to any of us, so this is not a side topic but an essential issue. Britain will not be a fair country if disabled people are denied the opportunities that many of us take for granted, and we will not be a successful country if we miss out on the talents and contribution of disabled people, not only in economic terms, but in our communities and wider cultural and social life.

Good social care is essential to enable disabled people to be full citizens and live full and fulfilling lives. As hon. Members have said, that is about not only the basics of life—help getting up and getting washed, dressed and fed. It is about what I call the very stuff of life—ensuring that disabled people can spend time with their family and friends; learn and get new skills; find a job; contribute to their local community; take part in sport, art, culture and music; and have fun. In other words, it enables disabled people to have the same aspirations as every other citizen. That is why today’s debate, the joint report from the all-party groups on local government and on disability and “The other care crisis” report are important.

This is not about a particular public service, but about what kind of society and country Britain should be in the 21st century. Despite all the economic challenges, we are one of the richest countries in the world. What kind of country and society do we want, to ensure that we have genuine fairness and opportunity for people of all kinds? The debate is therefore about not only social care, but wider life, which is why it is so important.

As hon. Members have said, there is a growing crisis in social care for working-age adults with disabilities, and services have now reached breaking point. That is eloquently spelled out in the joint report of the all-party groups and “The other care crisis”, the report by Scope, Mencap, Leonard Cheshire Disability, Sense and the National Autistic Society. It rightly says that social care does not only affect older people: one in three people who use social care are working-age people with disabilities. It also says that local authority budgets for adult social care have been under pressure for many years, but have now reached breaking point, as councils have lost a staggering 28% of their budgets so far under this Government, with even greater reductions announced in the latest spending review. As a result, councils are reducing the number of disabled people eligible for free care and support.

The report says that 40% of disabled people are failing to have their basic needs met. They are unable get the help that they need to eat, wash, dress or get out of the house, and their mental health suffers. There are some terrible, upsetting and distressing quotes from people with disabilities. Disabled people’s families also suffer huge stress and strains.

[Norman Lamb]

I agree with the points the shadow Minister makes, but she mentions cuts to local government budgets and I hope that we can all be realistic and honest about the situation that we face. Is she saying that a future Labour Government would substantially increase funding for local government? Alternatively, does she recognise that, collectively, we must all think about different ways to make the money go further?

[Liz Kendall]

I believe that we must fundamentally rethink how our care and support system works. The Minister knows that my right hon. Friend the Member for Leigh (Andy Burnham) and I have called for a far bigger and bolder response, by fully integrating the NHS and social care. I shall come to the Government’s proposals for the £3.8 billion of pooled resources. With the greatest respect, I think that the Government should be bigger and bolder in their response, with full and true integration that goes beyond the NHS and social care. If we really join up local services and support and bring together support from the Department for Work and Pensions, there is huge potential to do much more to give better care, better outcomes and better value for money. I will say more on that in a moment.

In “The other care crisis”, organisations raised concerns about the number of people—105,000 in total—who will lose out if the Care Bill goes ahead as it stands, given where the eligibility criteria will be set. The report warns that the huge strides made over recent years in promoting independence and personalising care and support will go backwards, as councils and other providers revert to more traditional service models—salami slicing services separately—thus restricting peoples’ independence. That specific crisis in social care for adults with disabilities will lead to a far bigger crisis: a crisis in opportunities for disabled people to live the life they want, which other citizens have; a crisis for taxpayers, because failing to invest in up-front preventive social care services will lead to more expensive NHS and social security bills; and a crisis for our country as whole, as Britain misses out on the talents and contribution of disabled people and we all end up paying more as the price of failure.

What should happen instead? The Care Bill could and should be a profound opportunity to establish a framework for social care that could be truly transformational for disabled people. The Bill is the result of the Law Commission review of adult social care legislation, initiated by the previous Government.

[Norman Lamb]

Give us some credit for it.

[Liz Kendall]

I give much credit to the Minister, but the Bill is the continuation of a process that Labour established when we were in government—I want that on the record. [Interruption.] I fully and readily acknowledge that local council budgets have been under pressure for many years. He knows better than anyone that towards the end of Labour’s time in Government we tried to reach an agreement on a social care funding system, which I will come back to in a moment. [Interruption.]

[Katy Clark (in the Chair)]

Order. I ask the Minister to intervene formally if he wishes to say anything, for no other reason than it would assist the Hansard writer.

[Katy Clark (in the Chair)]

No problem at all.

[Liz Kendall]

I never mind interventions in debates; I warmly welcome them.

I shall make five specific suggestions to the Minister about how the Care Bill could be developed. First, the definition of well-being in the Bill is important. I welcome how broad it is. It covers mental, physical, social and economic well-being; personal relationships; and a person’s ability to contribute to society. The definition also includes ensuring that individuals have control over their day-to-day living, but I question whether the definition is as strong as it could be. The joint report from the all-party groups asks why it could not specifically include promoting independence, to strengthen the definition further.

An issue raised by my right hon. Friend the Member for Stirling relates to my point about definitions. The duty to co-operate in the Bill says that local councils will need to work with a range of partners. I understand that Ministers usually do not want to specify lots of organisation types, but I am concerned that although local councils would, we hope, know that they had to co-operate with the NHS, there is a real issue about the DWP. There is not that link-up locally, and if people’s ability to get training and to participate in the work force is so important, will the Minister consider whether, either in the Bill or in guidance, there needs to be more detail about who local councils should co-operate with? I am concerned that that local relationship might not be there.

Secondly, the eligibility criteria are, as the hon. Member for Bradford East said, the most crucial aspect of the social care system because they determine who is and is not eligible for social care support. We absolutely welcome the commitment to clear national eligibility thresholds, but the Minister knows that disabled people, organisations that represent older people and many of the groups involved are hugely disappointed that the draft regulations have set the thresholds at substantial rather than moderate. I am fully aware of the cost pressures on the system, but has the Department done a true cost-benefit analysis, to consider the potential saving? The hon. Member for South Derbyshire made a point about how investing up front can save money further down the line. Has the Minister discussed with his Treasury colleagues whether, if a longer time frame were used for assessing the costs, we would end up saving money for taxpayers if the moderate level was set?

My third point relates to the so-called capped care costs model—aka Dilnot. The Minister knows that I am concerned that the so-called cap on care costs is not really a cap. I am concerned not only because it does not cover hotel accommodation, but because it covers only what someone’s local authority would pay rather than the amount they might actually pay in residential care and because no one will benefit from the cap until 2020.

[Norman Lamb]

Does the hon. Lady accept that if the cap were to cover all someone’s care costs, however much they chose to pay, wealthy people who chose to live in much more expensive care homes would be at a substantial advantage?

[Liz Kendall]

The Minister will know that my point is that I warn Ministers, including the Prime Minister and the Deputy Prime Minister, that going around the country strongly saying that it is a cap on care costs will create confusion—that is the best word I can use.

I do not want to focus on older people; I want to come to the point that the APPGs raised. The joint report states that the majority of working-age people with disabilities will not benefit from the so-called capped social care costs model, because they will not have had the chance to acquire assets. How many disabled people will benefit from the model? Why does the Minister believe that it is more important to put in excess of £1 billion into implementing the Dilnot model rather than into the current system, which is being increasingly squeezed?

My fourth point is about personalisation. I am a huge champion of personal budgets. I have seen them transform many of my constituents’ lives, not just because they promote genuine independence by giving people a say in how they live their lives rather than the system telling them how they should, but because they are essential to integration. The people themselves know best about how to join up their needs and support, because they do not see the two things as separate. However, I have heard the concern expressed in many different places across the country that personal budgets are getting a bad name. People feel that they are increasingly not based on their needs and that less money is being given than is needed, because of how the resource allocation system works.

Another important recommendation in the joint APPG report is about considering whether the resource allocation system should go on to a statutory footing, supported by new duties on councils to be transparent about decisions. I do not want personal budgets to get a bad name, with people feeling that they are a cover for cuts, rather than being based on what people need.

My final point is on the absolutely essential issue of prevention and integration. The Government announced in the spending review that there will be pooled budgets across health and social care totalling £3.8 billion, including £2 billion transferred from the NHS. The joint APPG report states that much of the previous transfer of money from the NHS to social care never reached the front line, and there is a concern that just continually transferring money in that way is not sustainable. How will the Minister ensure that the money gets to the front line? Will it be available, as I think the hon. Member for South Derbyshire said, for working-age adults with disabilities, rather than just for older people? Finally, will the Minister acknowledge that if this keeps happening year after year, it would be far better to have much fuller integration, such as the whole-person care approach proposed by Opposition Members?

--- Later in debate ---

[Norman Lamb]

I will come on to the work that we intend to do on a more sophisticated way of assessing eligibility and responding to assessments. I absolutely accept the current danger that the system in effect says, “Go away, become more ill or more disabled, and when there is a real crisis, we might help you.” I want us to be more sophisticated and to intervene in ways that will help to build capacity and resilience and to stop the deterioration of health. I genuinely believe that the Care Bill will give us the foundations for a much more rational approach.

[Liz Kendall]

May I take the Minister back to the £3.8 billion pooled budget? He said that it was absolutely available for care and support for working-age people with disabilities. Will he explain, when the money goes down to clinical commissioning groups and local councils, first, where it will go to, and secondly, how he will ensure that it actually goes to working-age people with disabilities? I know how the NHS works, and all the focus is on the frail elderly because they are in hospital. The NHS wants to get them out of hospital—that is its prime focus—so unless there is something specific in what the Minister sets up, the money will not go to working-age people with disabilities.

[Norman Lamb]

We will publish further details about how the system will work. To deal with the hon. Lady’s challenge to our approach, we could go for another massive re-organisation, which in a sense is what she is advocating—

[Liz Kendall]

indicated dissent.

[Norman Lamb]

Well, it is. To bring health care and social care together structurally would be a massive re-organisation, and there is no way of avoiding that. The smart way is to focus on the care that an individual receives. The issue is not just about bringing health and social care together and integrating those two systems but about the health service itself and the fact that, institutionally, we have separated mental health from physical health and primary care from secondary care, which is crazy. The whole thing is fragmented, but we should shape services around the needs of patients. The Government’s approach, based on the duties to integrate in the Health and Social Care Act, is the smart, fast way of achieving much more joined-up care for the patient, whether individuals are elderly or of working age. I want to make some progress with my speech.

The Government are committed to improving the lives of disabled people and to supporting them in their independent lives. In very difficult financial circumstances, we have done much to achieve that through the disability strategy, welfare reform—it is incredibly controversial, but any Government would have to pay attention to the extraordinary growth in welfare spending—and a whole raft of condition-specific initiatives.

One outstanding issue still needs to be addressed—social care reform. The importance of care and support for disabled adults cannot be understated: it is the enabler of independent living. We hear much about the ageing population as the driver for care reform, but a third of all health and care users are working-age disabled people, so it is vital that the social care reforms address their needs. The fact that my hon. Friend the Member for Bradford East and his colleagues have secured this debate is valuable because it ensures that we focus on the needs of working-age disabled people. I repeat that there is a risk of their being forgotten, which must not happen.

Earlier this year, I read with interest the “Promoting Independence, Preventing Crisis” report into making social care reform work for disabled adults. It was a joint inquiry by the all-party groups on local government and on disability. I congratulate them on an important piece of work, and I will attempt to address some of the points raised in a moment. I first want to talk about some of the things we have done.

We know that disabled people face a number of challenges. They are far less likely to be in employment than non-disabled people. In fact, shockingly, only 46% of disabled people are in employment compared with 76% of their non-disabled counterparts. Some 19% of individuals living in a family with a disabled member are in income poverty, although I am pleased to say that that has been falling over time. Progress is being made, but much more needs to be done.

The first thing to say about all the Government’s reforms is that we are committed to the UN convention on the rights of disabled people, which includes the right of disabled people to independent living. The Department of Health has been working closely with the Office for Disability Issues on the new cross-Government disability strategy, “Fulfilling Potential”, which was published last September. It is about making the UN convention a living reality for disabled people in Britain. It describes the rights that disabled people—just like anyone else—have in all areas of life, and the duty on Government to ensure that those rights are met.

The shadow Minister made a point about co-ordination with the DWP. There is scope for much more joined-up working at a local level to bring disparate public services together and to achieve far more bang for our buck than we presently manage.