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"welcomes the Government's proposals to create the National Care Service, the first national, universal, entitlement-based system for care and support in England; notes that the proposals will deliver real benefits to people including wider provision of prevention services, a single needs assessment across England and information, guidance and advice for all; recognises that in 20 years' time, 1.5 million more people will have care and support needs, whilst the number of people aged over 85 will have doubled; further notes that around 400,000 people will benefit from enactment of the Personal Care at Home Bill, which contains no proposed changes to disability benefits; acknowledges that the Government is considering responses to the Big Care Debate consultation before any decisions are made between a range of options for the National Care Service; understands that changes to disability living allowance for under-65s as part of the introduction of a National Care Service have been ruled out; and welcomes the reassurance that, if disability benefits for older people were to be reformed as part of the National Care Service, those receiving the affected benefits at the time of reform would continue to receive an equivalent level of support."
Let me begin by saying that I welcome the debate, which deals with a subject that matters greatly to many people in this country. The hon. Member for South Cambridgeshire (Mr. Lansley) and the shadow Secretary of State for Work and Pensions should be thanked for securing the debate, but I cannot stand the simplistic, petty and partisan manner in which the hon. Gentleman introduced it. So far, the approach has been nothing more or less than crude electioneering. The nasty party-the shadow Work and Pensions Secretary knows all about that-is back in all its glory, and it is showing its unpleasant side in the Chamber this afternoon. The debate deserves a higher standard of comment than that which the hon. Gentleman has given today.
Andy Burnham: I am going to come to that point. Let me say to the hon. Gentleman right now that this debate raises difficult questions. If one seriously intends to embark on a reform of social care in England, one cannot, as the hon. Member for Northavon (Steve Webb) rightly said, reduce it to simple press releases that are designed for electioneering, in the crude, simplistic and crass way that the Conservative party seeks to do. The debate deserves better than that and is more complicated than that, and we would expect a better level of engagement from Her Majesty's Opposition than they are offering.
Justine Greening (Putney) (Con): I am listening to the right hon. Gentleman with interest, but I seem to remember that every time there is an election, we knock on pensioners' doors and they confront us saying, "The Labour party has told us that you're going to take away this benefit and that benefit." That is the Government's strategy in every election, so the right hon. Gentleman will forgive me for saying that this is a case of the pot calling the kettle black.
Andy Burnham: Is that the best the hon. Lady can offer? This is crude electioneering. She has just owned up to it in the House. She has said, "That is what we are doing; you do it, so why can't we do it?" She has let the cat out of the bag.
Let me set out the important context. Some 61 years ago, the House agreed to the establishment of the national health service to end the unfairness that the people with the greatest needs faced the highest costs and that the people who had the least were in danger of having their needs left unmet. Today, the same unfairness exists in social care. A person who happens to develop dementia in old age, rather than cancer or heart disease, is yet to find the freedom from fear that Nye Bevan promised as the goal of the NHS.
Mr. Chaytor: My right hon. Friend has brought us on to the very point that I was going to make. He referred to the difficult issues that the Green Paper raises. Is not one of them that so many elderly people on the standard level of attendance allowance cannot be persuaded to apply for the higher level, even though their needs would certainly make them eligible for it? Is not one of the other difficult issues that so many people with disabilities or incapacities of any kind do not get the care they currently need precisely because of the absence of a national care service? The analogy with the formation of the NHS is absolutely the right one.
Andy Burnham: My hon. Friend puts it very well. It is because the system has grown in a piecemeal way over the years that it has become confusing and in many ways a lottery. It varies very greatly around the country, according to the eligibility criteria operated by councils and a range of other things. That means that the system is a lottery, and the serious purpose that lies behind the Green Paper is to create a fairer care system for all, in which the people with the greatest needs have those needs met and society as a whole shares the risks and costs of providing that care. In creating such a system, we will provide a better standard and quality of care.
As I said, those who suffer the most face paying the most. It is an enduring unfairness that was not resolved in the post-war settlement, but it becomes more evident and urgent as people increasingly live longer. This House has failed to address the problem, but I do not believe that that can continue. In my view, all parties should commit to reforming social care in England in the next Parliament.
One in five people will need care that costs less than £1,000 during their retirement. One in five will need care that costs more than £50,000. In the worst cases, the sum can exceed £200,000. This cruel lottery leaves us with no way of predicting our risk and makes it hard to protect ourselves against it.
John Mason: The Secretary of State mentioned England for a second time just now. Does he accept that, if something happened to attendance allowances, that would also affect Scotland, Wales and, potentially, Northern Ireland? Has he decided how that would be dealt with?
Andy Burnham: The hon. Gentleman will know that social care is devolved, but he is right to point out that any change to attendance allowance, which is a UK benefit, would have implications for Scotland. Of course we would work with colleagues in Scotland, and with the First Secretary, on making progress with any changes.
The current care system is piecemeal and complicated. Many do not know that care is means-tested. People face a battle to access the care that they need. When they succeed, the care can be of a poor quality, but not always. Resources are not channelled to where they are needed the most and, as we all know, carers often do not get the support that they need to make life tolerable and to enable them to provide the care and support that they want to to their loved ones, while also balancing other aspects of their life, such as work.
This much we know, and we know that the problem will become more pressing as the population gets older. When the NHS was created, there were eight working adults for every retired person. Today there are four,
and by 2050 that figure will fall to just two. If the system is left unreformed, there are real questions about its sustainability in the long term.
Jim Sheridan (Paisley and Renfrewshire, North) (Lab): My right hon. Friend is absolutely right to identify the excellent work that carers do. Will he expand on exactly what the Government are doing to provide for carers, who in turn help elderly people to stay in their own homes?
Andy Burnham: My hon. Friend raises a very important point. In years to come, this will be as important as Sure Start is in helping young mothers with children to balance work and home. That is something that we have discussed in our debates about child care. We must give people looking after elderly relatives quality support that they can draw down when they need it, because that gives them the ability to work and to balance work with caring for their relatives. If we cannot provide that support, there will be an economic consequence for the country.
We have taken steps to support carers, and my Department has made funds available from our budget to support respite care. My hon. Friend is right to raise the issue. A crucial part of any national care service is to provide quality support for carers so that life becomes tolerable and they can carry on with their work and other responsibilities, knowing that there is good-quality support for their loved one when they are not with them. For all those reasons, we brought forward a Green Paper.
Mrs. Madeleine Moon (Bridgend) (Lab): Quality is really important to elderly people, and it takes two forms. It relates both to care workers-their training and their capacity to understand people's care needs-and to when care is provided. Care should be given at times convenient for the person receiving it-when they want it rather than when it is convenient for the care agency. Are the Government eager to address and rectify that issue?
My hon. Friend is quite right, and that is why direct payments and personal budgets will lie at the heart of any proposed national care service. We want that level of control at the heart of any reformed system. She is also right to raise the issue of quality. Although there are good examples around the country, and many councils are doing their best, the system is stretched and-if we are honest-it is not systematically providing quality to people across the country. Many people who work in social care earn at or close to the national minimum wage, so in some parts of the country it is difficult to recruit care staff to provide the services that are so desperately needed. For all those reasons, and to put quality at the heart of the work force, we need to pick up the work on strategy in social care being done by the Minister of State, my hon. Friend the Member for Corby (Phil Hope), who has responsibility for care services. If we can do what we did successfully for the NHS work force, we shall develop a clear career structure, putting money behind training and development to ensure we have a high-quality, motivated work force. For all those reasons, the debate
is important and complicated. It cannot be reduced to the level the Conservative party seeks-it is more complicated than that.
We have had a detailed debate on our Green Paper and the consultation has attracted a huge number of replies. Overwhelmingly, people support the principle that the system has to be reformed. The hon. Member for South Cambridgeshire did not say that, but it is what people are telling us. Of course there are difficult views about the nature and shape the reform should take, but people are agreed that worst of all would be to leave the system as it is, with more and more people's needs unmet as we go into a future with an ageing population.
Mrs. Joan Humble (Blackpool, North and Fleetwood) (Lab): Will my right hon. Friend comment on the key role of qualified social workers in that scenario? They will have the important responsibility of assessing the needs of elderly people and vulnerable disabled adults before considering the care package that is needed. As he knows, social workers do an excellent job but, sadly, they do not get praise for their excellent work.
Andy Burnham: My hon. Friend is absolutely right. That point came out strongly last week when the social work taskforce reported its conclusions. It pointed out the need to raise the status of social work as a profession and talk up the changes it makes in helping people to live better lives and give them more opportunities. The point was also well made by my hon. Friend, and we have to work hard to make it a reality. Everything in our Green Paper depends on those professional voices in social work. Helping people to unlock the benefits of personalisation and steering them through the system is crucially dependent on a motivated social work profession in adult services. Young people today want to make a difference. One of the biggest differences they can make is to go into social work, be it for children or adults. On both sides of the House, we need to work hard to communicate that message very strongly indeed.
Our Green Paper set out a vision of a national care service that is fairer, simpler and more affordable, underpinned by national rights and entitlements and personalised to individual needs. It set out a system with quality at its heart, whereby people get the care and support that they need. People would know exactly what to expect, what they were entitled to and what they needed to do to get it. The national care service is about helping people to live their lives the way that they want to. It is about putting the person's needs and wishes first, and helping them to keep up relationships with family and friends, to live in their own home for as long as they can and, where possible, to continue to work and contribute to their community.
Mrs. Anne McGuire (Stirling) (Lab): Does my right hon. Friend agree that there is absolutely no inconsistency in the reform of social care service and the Government's priority of independence, choice and control for disabled people and older people?
My right hon. Friend is absolutely right. The two systems are coming together. With the introduction of direct payments, we have seen council support beginning to replicate the benefits system, and the two systems have been slowly merging. Reform
would continue and deepen that process, placing individuals with the most need in control of their budget so that they can draw down the support and care that they need. My right hon. Friend is quite right to make that point.
Every citizen would stand to benefit under that new system. As well as helping people who need care, the national care service is about changing the lives of the friends and relations who support them. Many carers in this country have told us about the daily battle they face to get the support that they need, and we want to end that battle by providing a reliable, transparent and accessible system that makes it easier for them to manage their responsibilities. We intend to publish a White Paper in the new year, setting out our proposals for the future of care and support, based on the replies that we have received to our consultation.
I turn now to disability benefits. The current care and support system is provided through a combination of local and central Government funding, personal contributions and benefits. It is complicated, it is not clearly targeted at levels of greatest need and it is not sustainable. In each case, the amounts are increasing. Local government expenditure on adult social care has gone up by more than 50 per cent. since 1997; and the total fees paid by people who use the services have increased significantly over the same period. Today, there are more than 1.5 million recipients of attendance allowance, amounting to expenditure of more than £5 billion a year; and there are more than 790,000 disability living allowance recipients who are over 65 years old, totalling expenditure of some £4 billion a year.
By 2026, we can expect that 1.7 million more adults will need care and support than is the case today, and the cost of disability benefits for the elderly could rise by almost 50 per cent. in real terms. Demographic and financial pressures on that scale cannot easily be met within the current unreformed system, so we have to find a better way to provide support to older and disabled people, and there may be a case for bringing together some disability benefits within adult social care. That is the argument that we are putting forward.
The Opposition's motion refers to people who currently receive disability benefits but are not eligible for social care, and it is true that many people today do not get help from the state towards their care costs. However, that is precisely why this Government are showing leadership and looking at how we can best support care and reform services. As I said in my intervention, it is completely wrong to suggest that all those who currently receive disability benefits but do not receive support from social care services would lose out under a new system. The hon. Member for South Cambridgeshire made a big point of stating that he did not say that, but I am afraid that anybody who has picked up a Conservative party leaflet or a local newspaper recently will have been given a different impression from that which he has given the House this afternoon. He says one thing here and his party's parliamentary candidates say quite another in constituencies throughout the country. If he is serious about this debate, he must get his story straight now. He needs to say here-at that Dispatch Box-the same thing as his candidates say throughout the country. I am afraid that he has been found out today, and he was very helpfully smoked out by the hon. Member for Northavon (Steve Webb).
"And to top it off, unbelievably, they're cutting disability benefits for the oldest and most vulnerable members of our society."
Andy Burnham: I agree with my right hon. Friend: it is unbelievable. Conservative councils up and down the country are cutting day centres and nursing homes for older people-cutting social services budgets-and then the Conservatives make that kind of opportunistic statement that comes from a deliberate misreading of the situation in order to give fuel to their candidates in constituencies around the country. Whatever the hon. Member for South Cambridgeshire says today, the reality is what my right hon. Friend has just read out, and it is now on the record for all to see.
It is completely wrong to say that people will lose out under a new system. This is not about using benefits to support the existing system. We want to create a new care and support system that goes beyond that and is fit for the 21st century. We accept that that means we need to carry people with this reform. We also need to protect people in the interim. We have therefore categorically ruled out using disability living allowance for the under-65s. No other decisions about benefit reform have yet been taken. However, we have been absolutely clear that if disability benefits are reformed as part of delivering the national care service, those currently receiving benefit will not lose out financially. To put it simply, there would be no cash losers from this reform. That will remain the case for life. Existing benefits recipients will keep the cash and keep the control-it could not be clearer.
People like disability benefits because they provide a universal entitlement, they provide a cash budget that can be spent on the services that people want, and they support lower-level needs that help people to stay well for longer. Those three principles will all be important features of the new care and support system that we seek to introduce.
Bob Russell: May I seek clarification from the Secretary of State? Is he referring to people currently over the age of 65 who are in receipt of benefit or those over the age of 65, who will in due course require benefits? Will they have those benefits secured as well?
Andy Burnham: The hon. Gentleman is right-I am talking about existing benefit recipients. We are saying that, in future, we propose having a new system of support for people with care needs, but it is not correct to say that that means that support will be withdrawn, which is the argument that the Conservatives are advancing. Our whole aim in this reform is to give more help and support to the people who need it most. We believe that at the moment the money in the system is not properly targeted at those who need most support. That is the difference between our two positions.
Mr. Lansley: Will the Secretary of State clarify what he is saying? He seems to have changed the policy. The policy up to now, including in the Green Paper and as stated in the Government's amendment, has been:
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