Care Bill [Lords]

Paul Burstow Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.

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

Will the shadow Secretary of State confirm to the House that the use of notional costs, which he is describing, was not a Government proposal but one of the Dilnot commission’s recommendations?

[Andy Burnham]

I remember that the right hon. Gentleman showed a good deal of support for the Dilnot proposals, as did we, but they worked as a clever package. They were carefully constructed to ensure that the system would work, be progressive and provide support to everybody. They have now been pulled apart and different figures have been introduced.

[Paul Burstow]

indicated dissent.

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

I want to echo the remarks made by the right hon. Member for Salford and Eccles (Hazel Blears): we must keep the dignity and well-being of those who need care and, indeed, their carers at the forefront of our thinking in this debate and as we seek to implement the Bill.

Like the right hon. Lady, the hon. Member for Worsley and Eccles South (Barbara Keeley) made a very interesting speech. I thank her for her service on the Joint Committee that scrutinised the draft Bill. I had the pleasure to chair that Committee, which had a very strong team from both Houses. It made some recommendations to which I will return in a minute.

What struck me during the speech from the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), is that if so much in the Bill appears to be wrong, surely he should have the courage of his convictions and go through the Lobby to oppose it. There is apparently so much awful stuff in it—so much of it is inadequate, does not reach far enough or does not do enough, or if it does enough, there will not be enough money—that the Opposition should perhaps have the courage of their convictions.

At the same time, we have heard really interesting examples of where social care should be celebrated. Too many speeches have suggested that the picture of what is being done on the ground is uniformly bleak, but examples have been given of dementia-friendly communities, Unlimited Potential and the “garden needs” scheme in Salford. Those are just a few examples, and I am sure that every hon. Member could go back to their constituency and find such initiatives. Many of the initiatives do not require substantial resources because, as the hon. Member for Sheffield, Heeley (Meg Munn) just said, they can lever in additional resources by enabling communities to respond to need. That is an essential part of the Bill.

[Barbara Keeley]

Will the right hon. Gentleman give way?

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Paul Burstow]

I give way to the hon. Lady because she tried to intervene first.

[Barbara Keeley]

It is about a year since the right hon. Gentleman and I started four months’ work on the Joint Committee, and I was prepared to commit that time although I still find some aspects of the Bill disappointing. The reality of our situation in Salford now and over the next year is that—week in, week out—I, as a local MP, will find that people and their carers have lost care packages. I invite him to think about the situation of the very many MPs who now see the heart-breaking decisions that families face when they suddenly find themselves without care, respite care or support.

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[Paul Burstow]

I entirely understand that, and I see it in my constituency, where my local authority is grappling with those budget choices, but there is still scope for innovation. There are good, bad and ugly local authorities when it comes to grappling with the resource constraints that the deficit has led to, and I will come back to that in a moment.

I believe that the Bill deserves to be described as landmark legislation, because it will provide a new governing purpose for our social system—the idea of well-being, to which I will return—new rights for carers and, for the first time, parity of esteem between those who are cared for and family members who provide care and support. The new national eligibility threshold will end the postcode lottery for access. We can debate where the line is drawn, but for the first time that will become a national debate rather than simply a local one.

There will also be new obligations on local authorities on behalf of the whole population that they serve. There will be obligations to prevent and postpone the need for care, to ensure quality and choice of services and to ensure that there is good information and advice about the whole range of choices that people might need to make as they approach the point at which they need care. Importantly, the Bill is foundation legislation upon which a more co-ordinated and integrated system of health and social care can be built.

I could stop there, but the Bill will do more than that. It will simplify and clarify entitlements to state-funded support and put personal budgets into law for the first time. That is all before I have even mentioned the Dilnot reforms, about which it is important to give some context. Social care in this country today is not free. That is the nasty little secret that families discover when they are tipped into crisis and have to negotiate with their local authority over whether they will have access to any means-tested support. Most people do not know that, and it comes as a shock and creates anger and dismay in many families. While I was a Minister, Members from both sides of the House showed me letters of anguish from people who felt that the system was letting them down. To understand the value of Dilnot is to make a true comparison not with what people hope the system will be but with what it actually is today—a nasty, mean system that is means-tested. That is why the Government deserve to be commended for having the courage to start to put in place the principles that Dilnot proposed.

The right hon. Member for Leigh gave no direct quotation from Andrew Dilnot in opposition to what the Government are doing. I know why—it is because there is no direct quotation of that sort. Andrew Dilnot supports the changes and sees them as a much-needed step towards implementing all the principles that he recommended in his report.

Of course, it is important that we recognise that not everyone will ever need formal care. A minority of our population will need formal support, no matter where the threshold is drawn. Perhaps some will need it right at the end of their life. Those who do will want the Bill to give them peace of mind, and that is what Dilnot provides to everyone. Some people are confused by the idea of catastrophic costs based on all people needing care, but the reality is that most people will never reach the cap wherever it is drawn, because they will never need to draw down that much resource to pay for care costs. Moving the means test threshold from £23,250—the meanest of means tests in our welfare state—to £118,000 is a huge step forward.

For all those reasons, the Bill can be marked out as a comprehensive reform of our social care system, and it deserves the House’s wholehearted support today. There are other reasons why it deserves support, too. The draft Bill was consulted on extensively and has been subject to pre-legislative scrutiny, of which I am a great fan. As the Minister at the time, I actively sought permission for it to be subject to that approach. By a curious twist of fate, I then found myself chairing the very scrutiny Committee that I had advocated. I was lucky to have cross-party support from both Houses in doing that job, and it was a strong Committee. We made 107 recommendations, the vast majority of which the Government accepted before introducing the Bill. Many of the others have been persuaded upon them through their lordships’ scrutiny, and I am grateful to colleagues in the Lords for what they have done.

All of that will be worth nothing if the Bill is not well implemented. As the debate has demonstrated powerfully, there is a huge knowledge gap that leaves people struggling in a crisis. It means that people do not plan or prepare for care, financially or in other ways. We need not just local information and advice services but a multi-channel, multi-media campaign to inform and educate the public, hon. Members and the people who work in the system. We need to ensure that we manage changes well, such as deferred payments, about which I hope the Minister will say more later, not least because it is not a sufficient defence to say, “Because Labour did this when it was in government, we will do it as well”. I hope the Minister will have a better answer on that point.

I want to give one example of why the implementation challenge is big. There are 300,000 to 400,000 people in this country who already pay for their care. It would make no sense for them all to be told to line up on 1 April 2016 to get their care accounts sorted out. The change needs to be phased and planned so that we do not overwhelm local authorities in April 2016. I hope that the Minister will be able to reassure us about that.

The hon. Member for Sheffield, Heeley, said that the Bill was a look back to 20th-century models of care. I disagree, because at front and centre, in the Bill’s first clause, is the disruptive idea that we should promote individual well-being. It states that well-being is about quality of life, work, leisure, study, the right to be an active member of the community, being in control and maintaining and recovering physical and social function—all things that were anathema to many of the paternalistic models of 20th-century care.

We need only compare current care plans for older people with those for active and working-age people to see the stark difference. The plans for working-age people are about their being engaged with their communities, but for far too many years the plans for older people have too often been about “task and finish”, with tasks being burned down to just 15 minutes or less. That cannot be right, and it has to change. That is why I welcome the fact that the Secretary of State will also be subject to the well-being principle in discharging his obligations under the Act to regulate the system.

I would welcome some clarification of the term “beliefs” with regard to well-being. It would be helpful if the Minister said whether it applies to religious and spiritual beliefs, and whether that point will be covered in guidance.

On prevention, which has an important link to the well-being principle, can the Minister confirm that the duty set out at the beginning of the Bill will be outside the consideration of national eligibility, and that it will be a universal obligation that will not just apply to those who qualify for care? Will the local authority actively have to secure it?

[Norman Lamb]

I pay tribute to my right hon. Friend for his amazing work in launching the Bill and in its pre-legislative scrutiny. I can confirm that the prevention duty will be universal and have no relation to the criteria for eligibility.

[Paul Burstow]

That is very helpful, and I am grateful. The fact that the prevention duty will be outside the eligibility criteria gives the lie to the idea that it will be curtailed. That is important to understand. There has been some dispute about that, and the Association of Directors of Adult Social Services now suggests that the change in eligibility will be more generous than many people have thought.

Several Members have touched on the issue of carers. Progress has been made in the Children and Families Bill, and I hope that there will be progress on the identification of carers as well. One of my deep frustrations as a Minister was that, even when I had pulled all the levers available to me to try to get the NHS to do more on carers, it still did not get it. It did not do enough, and although there are beacons in the NHS, the whole thing has not been set afire so that the NHS really changes how it engages with carers. We need seriously to consider legislation on that, and I look forward to the Minister setting out how that might be achieved.

I want to touch on the role of the Care Quality Commission. It might be right to remove its duty to do periodic reviews, but it is important that it can exercise its power to conduct special reviews of commissioners without reference to Ministers. Where it finds that there a provider’s failure is attributable to commissioning failures, it should be able to inspect the local authority in question without having to seek Ministers’ permission. In that way, the special inspection powers could be used much more creatively.

A lot has been said about integration in this debate. I hope that we can make more progress on the matter to include it in all parts of the Bill during its passage through the House. I believe that the Bill deserves a Second Reading tonight, because it offers a transformative vision of how care is delivered in this country. By making well-being the central organising principle, we can deliver a much better quality of life for those who need care.

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[Nick Smith]

I welcome that but I am not sure it goes far enough. I think the issue needs to be teased out further in this debate and possibly in the Bill Committee.

[Paul Burstow]

I know that the hon. Gentleman is campaigning hard on these issues at the moment. Does he agree that we need a clear criminal offence of wilful neglect in respect of people who have capacity, so that they are not left behind, as in the current position? If the Government cannot be persuaded—although I hope we can persuade them—of the case for a power of entry or power to interview a suspected victim of coercive abuse, they should at least adopt some sort of regulatory powers so that they can introduce such a measure later when they are finally persuaded by the overwhelming evidence.

[Nick Smith]

I thank the right hon. Gentleman for his suggestion. That seems possibly a good idea and something we should pursue in the future.

I congratulate my Gwent colleague, Lord Touhig, who tabled an amendment to the Bill in the House of Lords to introduce the offence of corporate neglect. If we do not get what is needed this time, I would like to table an amendment on the same topic in this House. I hope that following the welcome consultation on strengthening corporate accountability in health and social care that the Minister mentioned, the Government will now make our law fit for purpose.

I support clause 48, which was inserted in the other place and provides equal protection to all users of regulated social care, regardless of where that care is provided and who pays for it. As Age UK says,

“for those at the sharp end of indifference and abuse, it is essential that both the provider and the regulator have clear legal duties to protect human rights.”

As we know, social care and health are devolved issues in Wales, and last week the Welsh Government published a draft “Declaration of the Rights of Older People” to be considered by our older people’s commissioner and an advisory group. I warmly welcome that initiative and think the Government would be well advised to follow the example of Wales and appoint an older people’s commissioner for England—again, I know that the right hon. Member for Sutton and Cheam agrees.

Last Friday I visited the Rookery care home in Blaenau Gwent, now run by Four Seasons after the collapse of Southern Cross Healthcare. I saw how the implementation of the “Pearl” model of care for those suffering from dementia has seen medication levels plummet from around half to just 17% of residents. The staff were dedicated and caring; residents were comfortable and respected. That is the great care that everyone should receive.

A growing, complex market and tightening finances means that effective regulation and oversight is necessary. If neglect or abuse is found, those responsible must be held to account for their failures because the vulnerable and the frail have the same right to justice as everyone else. Older people should feel safe and secure in the place they call home.

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

I had to leave the Chamber earlier, Madam Deputy Speaker, for an hour or so, but I assume we have been approached by similar groups and organisations that no doubt will have been quoted in previous speeches, so I might be able to curtail my remarks.

I begin by paying tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has been heavily involved in this issue from day one, with the inception of the White Paper. I thank him for coming to Bradford and talking to people there about local issues, and I welcome his contribution tonight. This is probably the most important Bill we will be considering this Parliament, because it deals with one of the most important areas of public policy that we have to face. There is no choice about it; it is something we have to face. It has been referred to over the years as a ticking time bomb. The good news, of course, is that people are living longer, but that will be accompanied by an enormous cost if we are to ensure that people are provided with the quality of care that they are entitled to and desperately need. It is hugely important.

Like the hon. Member for Gloucester (Richard Graham), I am confused by the reasoned amendment. I come from a place where people say what they mean and mean what they say, so I find it difficult to read a so-called reasoned amendment that is so scathing of a Bill and then listen to people say, “Well, actually, we’re not opposed to it and will not necessarily vote against it.” I do not understand that. Perhaps this is just a really strange place that I still need to spend more time in before I understand those things.

As I understand it, a Second Reading debate is about the principles, which is why I will avoid going into too many details. From my experience of working with many organisations and groups in the past few years, including very closely in the past 18 months or so, it seems to me that the principles in the Bill are pretty well applauded out there. There is a general acceptance that something needs to be done and that this is a pretty good attempt to lay down some basic principles. That was why the initial skirmishes and exchanges were disappointing.

[Paul Burstow]

My hon. Friend has taken a close interest in, and campaigned on, the Bill during its passage through the other place, and he said how widely welcomed it was outside the House. Would he be interested to know, therefore, that in almost every session of the scrutiny of the draft Bill—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Will the right hon. Gentleman face the rest of the Chamber and address the Chair, and while I am on my feet, I should remind him of two things: interventions should be brief, and handheld devices in the Chamber, before or after interventions, should be used with due decorum.

[Paul Burstow]

I apologise to you, Madam Deputy Speaker. I have been here long enough to know that I should speak through the Chair.

I simply wanted to say that during consideration of the draft Bill, when asked, many people told us they had nothing by way of criticism of the Bill, although they saw areas where it could be further improved.

[Mr Ward]

I thank my right hon. Friend.

Acceptance of the principles—certainly acceptance of them by myself—is there, but as the Minister knows only too well, as I have bent his ear on the subject so many times, I have some serious concerns, particularly about the FACS—free access to care services—criteria. He will probably not know—it is a recent decision by Bradford council—that the Labour council has decided to move from “moderate” to “substantial” in respect of the criteria. It has to go into a budget process; unfortunately, this will happen. We campaigned hard against that, with a 1,700 names on a petition opposing it, but it is going to go ahead.

What was unfortunate about earlier exchanges was a certain degree of dishonesty. This thing did not happen all of a sudden three years ago. Conservative, Labour and possibly some Liberal authorities—I do not know—up and down the country were from 2005 onwards moving away from “moderate” to “substantial” FACS criteria way before the change of Government and way before the vicious cuts took place as part of the austerity programme. Indeed, it was before the recession really bit, and I regret that. What seemed to be happening was a “follow my leader” approach—“Every other authority seems to be doing this, so why shouldn’t we?” It was seen as a way of reducing the budget. What I argued, continue to argue now and will continue to argue all the way through until this Bill becomes an Act, is that this is a false economy. I have made all those points to the Minister several times, including, in detail, in a Westminster Hall debate.

I believe that eligibility is the gateway to care, but I am not convinced by the proposed savings that are supposed to be made. We worked closely with various organisations, including Scope, which has done a fantastic job of looking at the issue of working age disablement, which accounts for one third of benefit recipients. People desperately need care to live a more fulfilled life, whether it be in education or work. This is just one example—there are many others—where savings can be accrued, but taxation can also be generated if people are given just a small amount of support to become economically active.

Other charities and organisations have raised serious issues. Principles are most important, but data collection is crucial. Charities that exist to help people with Parkinson’s and other neurological conditions identified the fact that they had no idea how many people with Parkinson’s actually received social care. How can that be the case? How can that happen? Something must be sadly going wrong with data collection. Macmillan Cancer Support pointed out that free social care at the end of life needs to be a crucial element of any changes we are looking to make and that, if we aim for true integration, we must have proper identification of carers within their health settings. We should not wait until people are turned out of hospital and go home before identifying who is going to look after the person and provide support. Leonard Cheshire Disability provided further useful information, and I ask the Minister to look further into some of the issues it raised.

Important principles are at issue here. On the national criteria, I may not like the level, but it is important to have standardisation. On the carers assessment, we should be applauding the fantastic proposal to make carers the centre of attention, as they are so often forgotten. How many times have carers ended up being the people who need care because of the lack of support they receive? A young person I know has come to my office on a regular basis to express serious concerns about the people he was caring for, but I have seen with my own eyes that person deteriorate over the last 12 months or so as a result of the lack of support that he has received. The Bill introduces a wonderful innovation, which we should all appreciate.

I have already mentioned the principle of integration. We have the framework: the health and wellbeing boards are still in their early days, but this way of bringing together the different parts of social care, public health and the national health service is so important. The links between health and social care are crucial. I cited a case in the Westminster Hall debate of a man in his 50s who had an accident at work when reversing his vehicle. He had no seatbelt on, as he was just backing into the car park, yet he became tetraplegic. He was in Pinderfields hospital for five months. He received superb support and everyday attention, but when he went home in the ambulance, he could not get into the house because there was no ramp. He had to go away again. Then the local authority provided the money for a ramp and the hospital brought him back again, but he could not get in because it was a wooden ramp and they did not dare take him on it because that would have broken it. That is madness in this day and age, and it needs to be dealt with.

On the cap on lifetime payments, we do of course need to discuss in detail what it should be and how it should be operated, but please let us not talk it down, because an incredibly important new public policy is being put forward here, which we should applaud.

Let us try to forget what happened earlier. It was unpleasant to see and I do not think it truly represents the true passion and commitment of people on both sides of the House to improving social care for the people of this country.