PARLIAMENTARY DEBATES - United Kingdom Parliament

59 Debate on the Address
9 MAY 2012
Debate on the Address
60
[Mr Dorrell]
I wish to focus on one specific policy—social care.
This is a more techy point than a political ideas point,
but it is an extremely important point from the perspective
of the people who rely on our health and social care
system. There was, of course, an expectation of legislation
on social care reform in this Session. What we now have
is a commitment in the Queen’s Speech to a draft Bill
reflecting a continuing thinking process within the
Government—I am pleased to see that the hon. Member
for Sutton and Cheam (Paul Burstow), the Minister
with responsibility for social care, is in his place. I shall
not seek his comments on what I am about to say, but
I am glad that he will hear it.
Tony Baldry: In the briefing that hon. Members were
sent before this debate by organisations including Carers
UK, they actually asked for a draft Bill so that it could
be properly considered before final legislation was eventually
brought forward.
Mr Dorrell: My hon. Friend leads me neatly to my
next point. It seems to me to be an odd argument to
suggest that if the Government have not yet clearly
made up their mind precisely how they propose to
deliver the important issue of social care reform, it then
becomes a source of criticism that there is not a Bill
with a commitment to legislate. I am old-fashioned
enough—as my hon. Friend suggests most of us interested
in this issue are—to think that the most important issue
is to deliver a clear policy and then to legislate. I do not
criticise the insistence that we have a clear policy before
we have a Bill and a commitment to legislate.
I welcome the fact that the process of clarification of
policy is continuing, provided that it takes us beyond
discussion about funding. While Dilnott made some
important points about the need for a fairer system of
distributing the cost burden among those who pay for
social care—some of those ideas will be part of the
eventual conclusion on health and social care—the
problem is that he was asked to answer the wrong
question, and that is becoming increasingly obvious as
the public discussion continues. The question put to
Dilnott was how to restructure the payment arrangements
for the existing structure of social care. But if we step
back from the question of funding and look at how care
is actually delivered in each locality—between the social
care system, the primary health care system and the
community health care system—the inescapable conclusion
is that the structure is no longer fit for purpose. It was
designed primarily to deliver health care to people who
had a burden of disease that was the pattern 30, 40 or
50 years ago, whereas today’s health and care system
needs to meet the needs of a very different group of
patients. It is a difficult thing to measure, but depending
on how one chooses to do so, between two thirds and
three quarters of the resources employed in the health
and care system are devoted to people with long-term,
complex needs. Their requirement is for joined-up care
that supports them and enables them to lead lives that
are as full as possible during the period of their longer
life expectancy.
Meg Hillier: As a former carer for two adults with
complex needs, I counted that at one point I was dealing
with 13 different agencies to provide their care. The
right hon. Gentleman seems to suggest that simplification
of the system is as important as proper funding. Funding
may be a big challenge, but simplification is vital if we
are to deliver the domiciliary aspect of care.
Mr Dorrell: I entirely agree with the hon. Lady’s view.
Reform of social care is not the same thing as reforming
the funding system. In my view, we cannot deliver a
good value, high quality health and care system just by
changing funding flows. What is required is something
more fundamental, which is changing the way in which
care is delivered in each locality, in order—as the hon.
Lady rightly says—to reduce the number of competing,
and often non-communicating, bureaucracies in the system.
If the time that the Government are taking will be
used to answer the question of how to deliver more
integrated, joined-up care, and then how to pay for it, it
will be time extremely well spent. If it is simply a delay
while we try to solve the problems of how to pay for the
existing system, we will continue to ask the wrong,
unanswerable question.
On social care, I have made a specific point, but on
the Queen’s Speech as a whole, I have made a more
important point with a broader political reach. The
Government have a clear purpose, both in our economic
policy and in our broader views about the type of
society that we are seeking to create. It is not a coincidence
that my right hon. Friend the Member for Haltemprice
and Howden spoke today about liberty and justice, or
that the right hon. Member for Bermondsey and Old
Southwark focused on the importance of individual
responsibility and rights as opposed to the collective
tradition that comes from parties on the political left. I
support the Queen’s Speech and this Conservative-led
coalition, because it already has achievements of which
both Conservatives and Liberal Democrats can be
proud. The Queen’s Speech makes clear the continuing
commitment on the part of the Government to build on
and follow through the achievements of our first two
years.
5.59 pm
Mr Elfyn Llwyd (Dwyfor Meirionnydd) (PC): It is a
great pleasure to follow the right hon. Member for
Charnwood (Mr Dorrell), who has once more shown
that he is a master of his brief. His remarks about care
were thoughtful. Over the coming weeks, we can develop
some of the thoughts he has expounded, and undoubtedly
he will make an important contribution to this debate, if
he has not done so already.
I am tempted into the arena of reform of the other
place. I will be honest: it is the least of my worries. As
we all know, it began in 1911, and for all I know, in the
next century we will still be talking about it—well, we
will not, but others will be. I recall the valiant efforts of
the late Robin Cook, for example, who was effectively
stitched up to fail by the Labour Whips. There are very
powerful forces at work within and without the usual
channels, so let us not get too excited about sudden
reform.
I am sure that Members will recognise, however, that
the other place needs reform. Clearly, any Chamber
with even a partly hereditary principle has got to be
wrong and due for reform, but how do we reform it?
Each suggestion seems to have consequences we have
not thought about. For example, would elected or appointed