|Previous Section||Index||Home Page|
The most accurate assessment of the issue was provided by the Wanless report, which said that merely to stand still-merely to deliver the same quality of care to elderly people as now-would require the proportion of
gross domestic product committed to this area of care to rise from 1.1 per cent. to 1.5 per cent. over the next 15 years, and that that would represent an increase in the cash cost of providing that care of £14 billion. That is how much it would cost merely to stand still. A parallel report by the Commission for Social Care Inspection pointed out that to stand still is not to deliver on our aspirations. The background to our debate is, therefore the fact that for 12 years we have failed to address the question of how we as a society will fund our aspirations for elderly care.
Twelve years on, the Government produced a Green Paper this summer, which is the immediate background to the debate, because it tabled the suggestion that attendance allowance and disability living allowance should be put into the pot to square the circle of paying for this area of care. It also tabled the suggestion that "a National Care Service"-capital N, C and S-should be developed, but it set out almost no details of what such a service should look like, beyond saying that disablement benefits should be part of the funding solution for paying for reshaped care for elderly people.
Since that Green Paper was published, two fundamental conflicts have developed at the heart of policy in this area. They have now started to bubble to the surface, and I want to address those two conflicts this afternoon. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has already discussed the first of them: should we develop a policy that is based on a preference for the payment of cash benefits, or one that allows greater flexibility for commissioners of service to provide a package of care that is, in their opinion, tailored to meet the needs of elderly people, but that does not necessarily reflect the wishes of the elderly people themselves?
John Mason: Does the right hon. Gentleman agree that that option could turn out to be more expensive as well? Often, a friend or family member will visit to care for a few hours and they will incur only the cost of the taxi fare, but if such visits were replaced by the local authority providing paid care for a few hours, that would be much more expensive.
Mr. Dorrell: The hon. Gentleman is absolutely right, and what he says is relevant to the point made by my hon. Friend the Member for South Cambridgeshire about the way in which a local authority-commissioned service relates to carers. A local authority-commissioned service runs the risk of being less accurate in meeting what elderly people want and demand of such services, and therefore of being not merely more expensive, but less good value for money. There are therefore many reasons for choosing to have a policy that prefers, accentuates and develops direct payments, rather than officially commissioned services. That is why we passed the direct payments legislation before 1997, and it is why we have supported the development of that concept since. I believe that any move to put disablement benefits into the pot to pay for the national care service would be a big step in the wrong direction.
The Ministers say, "Don't worry about it. Local authorities will still have the same encouragement to pay direct cash payments." Who do they think they are kidding? They are clearly not kidding the next generation of elderly people. I accept entirely that there will be no
cash losers in the current generation of benefit recipients, but we are concerned here about the development of policy for the future. I simply do not believe that if we take a system that provides an entitlement to a cash benefit and give that cash to a local authority commissioning body, we will have entrenched or developed the policy of preferring cash payments to commissioned services. It flies in the face of common sense, and particularly so when we all know that we are going into a decade in which there will be severe resource pressure.
Of course, it is true that, against that background-even if the Department of Health does not prefer such an approach-the Treasury is encouraging this policy direction to create more flexibility to free up resources that, in its mind, are now being devoted to a demand-led programme so that it can put those resources at the disposal of a priority-led programme that will be subject to a cash limit in the way that the disablement benefit programme is not. All those reasons should, I believe, commit us to opposing a development of policy that takes an existing demand-led cash payments programme and puts it into a local authority cash-limited priority-led programme. That simply will not deliver the core policy objective that has been consistently developed since before 1997 and, to give them credit, by this Government since 1997 to build up a preference for cash payments over commissioned services. That is one fundamental conflict that I believe to be at the heart of the development of the policy for a national care service.
The other conflict that is equally at the heart of this policy has not yet been raised this afternoon. It is the unresolved conflict caused by the question of whether we are seeking to develop greater local flexibility, local choice and local management of these services or a single national blueprint, rolled out across the country. The Department of Health talks about putting the disablement benefits at the disposal of the national care service in order to fund and develop its vision of a national care service with national assessment, a national entitlement programme and the development, therefore, of a policy that moves social care for the elderly from being a local authority service to a national service on the model of the national health service. The Secretary of State made it entirely explicit that that was the agenda of the Department of Health.
At the same time, in this Chamber, only a few weeks ago, we were debating with the Department for Communities and Local Government the development of the Total Place programme, which embraces the idea that disablement allowances should be put into that programme in order to take funds that are currently determined by a national programme with a national entitlement prescription and to put them at the discretion of local authorities so that they can create a more flexible local model of service delivery that reflects more accurately the local circumstances of individual local authorities.
Which approach are the Government supporting? Are we putting attendance allowances and disablement allowances into the local pot in order to develop a national care service? There is something tautological about taking a national programme and putting it into local authorities in order to develop a national care service. That is a bit like listening to a Frenchman
explaining the game of cricket. Are we developing the programme in order to develop a national care service or are we taking these benefits and putting them at the discretion of the local authority in order to develop local flexibility and Total Place? Again, this comes back to a point that I made earlier. Is this about putting those moneys into a cash-limited programme to create greater discretion, as would be the Treasury's agenda, or is it about the national payment of cash benefits according to a national entitlement programme, which would be my preference?
My central point is that, against the background of the Government having failed for 12 years to address the resource challenges in the care of the elderly, they published a Green Paper this summer that said that the solution was the development of a national care service-three words with no policy behind them. That was a good headline, but behind it is an unresolved muddle of unresolved conflicts. All that is unresolved after 12 years of failing to rise to the challenge that was clearly there 12 years ago. Hon. Members need not take my word for that: in 1997, Tony Blair said that it would be a disgrace if this matter were not addressed. Those were his words, not mine.
Roger Berry (Kingswood) (Lab): It is a pleasure to follow the right hon. Member for Charnwood (Mr. Dorrell), who has raised two fundamental issues. I hope that the Government and others, in their response to the consultation exercise, will consider those issues carefully.
Roger Berry: The hon. Gentleman may say that, but I have voted against the Government on rare occasions when I felt that there was no alternative and I have not precluded entirely the possibility of my ever doing that again, but I hope that I do not have to. We have had a consultation exercise and the Government's amendment makes it clear that they are considering the responses to that consultation. It is quite wrong for members of the Opposition to say that the Government have decided to stop disability benefits. That is untrue and misleading, and it scares vulnerable people. That is another reason why I shall not vote for the Opposition's motion. We have heard some of the responses to the consultation, and most of us can guess what many of the responses from various organisations have been. Those responses should be treated seriously, and I am sure that they will be, but no decisions have yet been made.
Alistair Burt: The hon. Gentleman has been around this course several times. He knows this subject exceptionally well and he has a strong reputation in the House on this issue, so is he puzzled that, in dealing with some of the earlier responses to the consultation, the Minister and others have left hanging much of what has raised concerns outside? It appears that attempts are being made to deal with part of that today. If they had been as clear as he suggests, there would not have been the scares that currently involve certain organisations. Could Ministers have not done rather better?
Roger Berry: I can answer that in one sentence. People are anxious because others have generated scares outside. Let me speak for myself. I agree with the Government that disability benefits should be seen in the context of a national care service. I, as much as anyone, want a national care service that is similar to the national health service. That is long overdue. As the Government say in their amendment, the national care service is about having a
"national, universal, entitlement-based system for care and support".
The only part of the system that is currently national, universal and entitlement-based is the benefit system-attendance allowance, disability living allowance and other related benefits. My point of departure is this: if our purpose is to create a national care service, I find it strange that the part of the package that we should start considering is the one part of the service that is national, universal and entitlement-based. It would be much more logical, in summary, for attendance allowance, DLA and related national entitlements to be the basis on which we build a national care service.
I welcome the publication of the Green Paper. It addresses a number of the shortcomings of the social care system that deny disabled and older people the right to decent care and support. That is why virtually every disability organisation-Age UK, Age Concern, Help the Aged and many others-has also welcomed it.
It is interesting that, within a few days, the same organisations expressed specific concerns about the future of disability benefits, so I think that we should regard their submissions as pretty sophisticated: they passionately want a national care system, but they have concerns about removing the national entitlements that currently exist through the benefits system.
We all know why things need to be done. As Members of Parliament, we all know that needs are being met insufficiently. Our constituents frequently have unmet needs, and perhaps the same is true for members of our families. At present, local authorities are addressing only the most serious needs, and there are charges. For instance, a constituent wrote to me this week claiming that her charging regime was unfair and unreasonable, and I think that she is correct. In addition, the 6 million carers in our country do not get the kind of support that they should get, and all that is despite the fact that the Government are putting more money than ever into the social care system. I do not think that the Government can be criticised for not providing extra resources. They have done that, but the system itself is not functioning as it should.
As the right hon. Member for Charnwood said, provision varies from local authority to local authority. People who get an assessment for care and support in one local authority but who have the temerity to want to work, or visit relatives, in the next-door local authority have to go through the process all over again. When will that cease? Entitlements are not portable. When are we going to get portable entitlements? A national care system, if it is national, will at least address that problem.
Finally, disabled people are twice as likely to live in poverty as non-disabled people. In such circumstances, therefore, we should be very cautious indeed about considering changes to benefits in a downward direction. Let us not forget that people who receive attendance allowance and DLA are, sadly, some of the poorest in our society.
As I have said, I support the vision of a national care system and national entitlements. I welcome the emphasis in the Green Paper on preventive interventions and on promoting choice and control. As other hon. Members have said, it is the national entitlements that give choice and control at the moment, because people can choose how to spend that money.
I think that resources could be saved if we moved to a national care system, and away from multiple assessments of non-portable entitlements between local authorities. The existing bureaucracy could be reduced in size, and some resources could be saved that should be spent on front-line care and support. Nevertheless, we all know that that is not going to be enough to provide the resources that the social care system needs at present. It will certainly not be enough, given the well-known demographic changes, to ensure the resources that the social care system of the future will need, but I repeat that I do not think that it makes sense to fund the social care system by undermining that part of the benefits system that works most successfully at present.
As the hon. Member for Northavon (Steve Webb) has pointed out, many people who receive attendance allowance do not receive any social care support at all. Why should we consider any change to that entitlement, given the possible consequences for those people?
It must also be stated that, as we all know, many people's experiences of local authority social services are not good. I am a former local councillor and I am passionate about local government, but we all know that there are local authorities, for faults that either are not their own-perhaps insufficient resources-or are their own that do not provide the quality service that is needed. When disabled people say to me, "For goodness sake, we must retain AA and DLA", it is often because they cannot bear the possibility that the money would somehow end up under the control of local authorities with their current management of the social care system.
That is not a criticism of individuals who work for local authorities. Many struggle in very difficult circumstances indeed. Many local authorities are quite small, so there is often a real question about how they can provide a comprehensive social care service. I am not criticising individuals-I am simply relaying what we all know: many of our constituents who use local authority social care services are less than enthusiastic about their quality and are, therefore, all the more keen to hang on to national entitlements via the benefits system.
Attendance allowance and DLA are paid directly to individuals regardless of their personal circumstances, such as where they live, which makes the allowances an obviously desirable entitlement. As we have all said, recipients can spend the money as they wish. Those allowances have all the advantages of the individual budget-they are about empowerment, choice and control. The allowances have the important characteristics that we are saying the national care system should have in the future, so we should tamper with them only after we have come up with a very good reason for so doing. At the moment, it does not make much sense to move the part of the system that arguably works most successfully, given what disabled and older people expect from it, and that is why disability organisations, Age Concern and Help the Aged have expressed concerns.
"DLA and AA were intended to help with the higher costs of living disabled people and their families experience, and to help tackle the link between disability and poverty. We believe placing either or both of these funds in the pool for Local Authority distribution could cut support and restrict choice and control for many disabled people."
"If the idea to stop AA is taken forward, it will mean that many older people will be worse off than they are now."
Finally, we all recognise that the Institute for Social and Economic Research is an organisation that has no political agenda; it produces reports and analyses by experts in the field. Its response was:
"Since the need for 'care'...is the main criterion governing eligibility for the benefits, it is sometimes assumed that the money is intended to pay for care. On the other hand, the past governments that introduced these benefits made it clear they were intended to contribute to the general extra cost of living faced over the long haul by disabled people and their families-extra heating, special diets, the incidental costs of hospital visits and so on-not necessarily on caring services."
"Standard of living indicators suggest that the current benefits do little more than compensate disabled people and their families for the extra costs associated with disability. A reduction in their cash incomes is likely to lead to an increase in deprivation."
The significant additional resources needed for the national care system should come from general taxation. I do not believe that one group of disabled people should be required to pay disproportionately for care and support for another group of disabled people. It is a responsibility that all citizens should share. My concerns, therefore, are that we might end up damaging the most successful part of the current system, which is the national entitlements via the benefit system, and that the proposal may not be fair.
The truth is that we will not know the detail that might be in the White Paper until we see the White Paper. Indeed, a number of questions have been raised, not least by the right hon. Member for Charnwood, to which I suspect we will not get clear answers this afternoon, and I hope that that is for a good reason. I hope that it is because the Government are considering carefully the submissions that were made to the Green Paper as part of the consultation exercise.
Yes, I signed early-day motion 1, and I did so for the simple reason that I agree with it. However, I am afraid that I shall not support the Opposition motion before us, and I shall not do so for two reasons. Sixteen Opposition Members signed the motion, and a number of them did so yesterday. I have great respect for the views of many Opposition Members, and I make no personal comments, but it is not good enough for a
political party to use the early-day motion as a bandwagon on which to jump and bash others when three handfuls of its Members actually put their names to the relevant motion. When they also go around making statements, as they have explicitly done, saying that the Government are taking away disability benefits, despite no such decisions having been made, I think that that is outrageous. That was not in the statement of my right hon. Friend the Secretary of State, who was here earlier this afternoon, and I have it in front of me.
So, I shall not support an Opposition motion that has been presented in that way. The Government's amendment explicitly states that no decisions have been made, and I welcome that. It states also that they will take into account the consultation exercise and the submissions that have been made. The Government are not setting out to frighten people, and for that reason I shall support their amendment. That is no guarantee, however, that they can always rely-on every conceivable occasion-on such unqualified support.
|Next Section||Index||Home Page|