Health and Social Care

Paul Burstow Excerpts

Monday 13th May 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.

The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.

Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong. It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.

The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

[Andy Burnham]

I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

[Paul Burstow]

I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill, which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

[Mrs Madeleine Moon (Bridgend) (Lab)]

In a previous life I was a contracting officer for a local authority, and I contracted and commissioned care from the private sector. We always faced the same problem: the local authority tried to get more care for less money. That meant that contractors were paid less for their care workers, who were constantly not paid for travel time. How do we break this vicious cycle if we do not accept that we have to fund local authorities properly to make possible the provision of quality care?

[Paul Burstow]

I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

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

I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

[Paul Burstow]

I welcome that comment from the Minister and look forward to seeing more detail.

My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

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

Can I tempt my right hon. Friend to comment on his proposals on the use of universal benefits for wealthy pensioners? I know that he has produced a pamphlet.

[Paul Burstow]

I will try to do that in the one minute and 14 seconds left to me.

The ADASS survey paints a quite disturbing picture of the next two years. More providers will face financial difficulties and there will be increasing pressures on the NHS as social services shunt people into health care services.

The spending review that is under way is for just 12 months. It needs to fund the successful implementation of this legislation, and not least the introduction of the Dilnot proposals. More than 450,000 people will need assessments to get into the new system. The spending review also needs to sustain the transfers of money from the NHS to social care. Beyond that, the spade work needs to be done now to make the case for the critical interdependencies between social care and health that will sustain our social care system and make our health system deliverable and affordable.

The Queen’s Speech, with its specific commitment to this legislation, contains a landmark reform that will do a great deal to improve the quality of life of our constituents.

--- Later in debate ---

[Barbara Keeley]

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

[Paul Burstow]

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

--- Later in debate ---

[Mr Barron]

No, I have given way twice and I am not going to give way any more.

What is not in the Queen’s Speech? Public health has been mentioned by several people. I served on the Bill Committee for what became the Health and Social Care Act 2012. I will leave the reorganisation of the NHS for another day, but at the time the Bill was going through, the defence given by Ministers was, “What we will start doing is putting real measures down, and for the first time ever we will put in statute a responsibility to reduce health inequalities in this country.”

Two policies that most people involved in and concerned about public health thought would be in the Queen’s Speech are absent. One is the minimum pricing of alcohol, which was talked up by the Prime Minister over many months. There is evidence that it will stop some people drinking excessively. I served on the Health Committee in the previous Parliament, and just before the general election we published a report on alcohol. People ought to read it to see exactly what is happening. One of the worst statistics was on the people who are likely to die from alcohol-related diseases—certainly cirrhosis of the liver. Thirty years ago, they were people like me—men in their 60s—but now, men and women in their 20s are dying of that disease. This House has a responsibility to do something about that.

The other area that I wish to discuss briefly is the absence of legislation to bring in standardised packaging of cigarettes. That has also been talked up, not only by the Prime Minister but by others. The consultation on standardised packaging started on 16 April last year and ended on 20 August; now, nine months later, nothing is going to happen. I am deeply concerned, and I will tell Members why, although there can be no surprises about me and tobacco, because I have been on an anti-tobacco crusade in the House for nearly two decades. In my borough—I represent a third of it—there are still some 48,000 smokers, and although the number is declining, it is likely that more than 950 young people between the ages of 11 and 15 will take up smoking this year, and half of them will die a premature death. This year, more than 100,000 of our fellow citizens will die a premature death from using tobacco as instructed to by the tobacco companies. If half that many people were dying of anything else in this country, this House would be up in arms about such a massive number of deaths. In the past few months, what we have had is Ministers talking up the idea of legislation further to protect young children from starting smoking, but none of that has come about.

[Paul Burstow]

When the right hon. Gentleman chaired the Health Committee, it published the report that led to the banning of smoking in enclosed public places. That ban was only secured by a free vote in this House. Does he agree that, if we cannot get the Government to act, we need a free vote so that we can make the change in that way?

[Mr Barron]

I shall be putting my name in the ballot for a private Member’s Bill in a few days. If I am successful as I was in 1993, the right hon. Gentleman will have a Bill on standardised packaging on which to vote.

The Government have ducked the issue. There has been some influence—many people say that Lynton Crosby, who has come along to advise the Government, has had that influence, but I will not make that accusation. I wrote to the Prime Minister last week to ask several questions about whether Lynton Crosby has been involved in giving any advice in political circles in this country. Lynton Crosby is advising the Conservative party about re-election, but I want to know whether he has been involved in this area, given his record both politically with the party that he ran, and with his company’s work with and the money it has taken from tobacco companies.

The right hon. Member for Sutton and Cheam (Paul Burstow) is quite right to say that in 2006, when this House took a decision on smoking in public places, Members of this House had a free vote. I was effectively the architect of that free vote, because I tabled an amendment signed by 10 members of the Health Committee and I negotiated a free vote with my own party, as one was being offered by the then Opposition. On that major public health measure, this House was trusted to take the decision itself. Yes, we were lobbied by our constituents. There is nothing wrong with that—after all, it is what we are here for, although we cannot represent them all, as some people seem to think we can. The House was trusted to make that decision and the then Government, to their credit—they should have been awarded that credit—allowed it to do so. Many people were against that, including the Prime Minister, who has said since that he thinks it is the best piece of legislation that ever went through this House.

I say to Ministers that, whether it is because of strings being pulled by people close to the tobacco lobby or because of anything else, we cannot tolerate their not taking further action against tobacco when it is killing 100,000 of our fellow citizens each year. It is about time that someone showed some courage, stood up for ordinary people and for good public health measures—not nonsense measures—and did something to stop the dreadful premature deaths in this country.