PARLIAMENTARY DEBATES - United Kingdom Parliament

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111 Debate on the Address 9 MAY 2012 Debate on the Address 112 [Chris Skidmore] maiden speech. I wanted to make it as soon as possible so that I could get into the cut and thrust of debate, so I put in and waited to make it on several occasions. I will never forget my first moment in <strong>Parliament</strong>. I was sitting in the corner of the Chamber and waiting, and new Members on both sides bobbed up and down to say how beautiful their constituencies were—it was funny how that theme kept coming up. I waited from half-past 2, without having a drink of water or going to the toilet, until half-past 10. I sat there for eight hours, so afterwards I went over to the Chairman of Ways and Means and explained that I had hoped to be called that day. “Oh no”, he replied, “You weren’t going to be called at all. You should have come and seen me and I could have told you that you were never going to make it today.” That was the first lesson I learnt here. Priti Patel: Welcome to <strong>Parliament</strong>. Chris Skidmore: Absolutely. There is a lot of waiting going on here, but we do not have to wait long for the contents of the Queen’s Speech, which I will come to shortly. To continue with my anecdote for a moment, I remember still wanting to make my maiden speech as soon as possible, and sitting in the Tea Room looking through the draft of what I hoped to say when a more senior Conservative Member came over and asked, “Oh boy, you’re looking to make your maiden speech, are you?” I replied that I was and explained that I had waited to be called for eight hours the day before. “Oh well, there’s only one piece of advice I can give you about making your maiden speech,” he said. I was a young newbie and so asked what it was. “Well, just don’t muck it up,” he said, before wandering off laughing. He actually used stronger language, but I will not use it in the Chamber— [Interruption.] Yes, indeed, it rhymes with muck. Stephen Pound: Don’t say it. Chris Skidmore: Oh dear; hopefully the Hansard reporters can delete that for me— Madam Deputy Speaker (Dawn Primarolo): Order. To help the hon. Gentleman, I think that his colleague was telling him, “Good luck in making your maiden speech.” Chris Skidmore: Indeed, and I wish the hon. Member for Ealing North (Stephen Pound) the best of luck in contributing to this excellent debate on the Queen’s Speech. The first line of the Queen’s Speech refers to the importance of growth in the economy, but one of the sectors in which we know there will certainly be growth is social care, because we have an ageing population. We used to say that there are two certainties in life: death and taxes. We now know that our population is getting ever older; by 2030 the number of 85-year-olds will double and 11% of the population living today will reach 100. Therefore, we have an enormous cost—not a burden—that society will face as a result of the population getting older, which is inevitably a good thing. The Queen’s Speech recognises this, importantly, by proposing a draft Bill that will seek to modernise adult social care and support, which I absolutely welcome, but it is worth reflecting on the word “modernise” and on what we need to do to modernise adult social care and support. The Government recognise that tackling social care is not just an issue of tackling the funding of social care, important though that is. The Health Committee, of which I am a member, has already produced a report on the Dilnot commission and recommended it to the Government, and I hope that the Government will look at it in the forthcoming White Paper and that we will have proposals on the table. I know that there is cross-party support for looking at the Dilnot commission proposals and that we had a Backbench Business debate on that in the previous Session. Members from across the House, regardless of their party colours, are passionate about tackling this issue and the impending crisis. Dr Coffey: My hon. Friend makes a really important point, but is he concerned that the Dilnot commission and the risk of open liabilities could make the process unaffordable, or are Members being misinformed on that? Chris Skidmore: The Dilnot issue, which is one of presentation, is that the Government commissioned a report that addressed the specific question, “How do we fund social care as it currently stands?” That is why I want to turn to the issue of modernisation, but we have to remember the important tenet that Dilnot does not cover all forms of social care. It does not cover domiciliary care or living costs, so it is not a panacea, and we as parliamentarians must ensure that we work together and at the same time—Dilnot was very strict on this—come up with a proper system by which we can inform not only elderly people now but the elderly people of tomorrow that they need to begin to save. Only by developing a savings culture and a culture of contribution, which I shall turn to also in my speech, will Dilnot work and will we ensure that the social care system works tomorrow as well as today—although today it is beginning to fail, as I shall explain. In modernising social care, we need to recognise that the current system is not working on several levels. Personally, I feel that local authorities are becoming not the best places in which to deliver social care. Last week I published a report on local authorities and their delivery of social care, demonstrating from a series of freedom of information requests to every local authority in the country that local authorities have already written off £400 million of debts owed to them by families—and are still owed more than £1 billion. Put simply, we have a system in which local authorities are not only struggling to provide care, but for financial reasons have lowered the bar and reduced their eligibility criteria. They have done so principally because they have to juggle social care with the services on which people really want to focus when they pay their council tax. For instance, people want their bins emptied or potholes filled, and that, for democratically elected local authorities, can take priority over those citizens who are most vulnerable but who, unfortunately for them, form a small minority. So roads and bins take precedence over social care. That should not be the case, but at the same time local authorities are deeply mired in debt because of their services, and we desperately need them to break out of that.
113 Debate on the Address 9 MAY 2012 Debate on the Address 114 The current system also does not work because the failure of social care ends up rebounding in only one place: the NHS. We need to make the point strongly that the NHS and social care are two sides of the same coin, and that if there is a crisis in social care there will soon be a crisis in the NHS. Even the IMF has produced figures on the NHS will look by 2050 if we do not manage our ageing population and work out ways of prevention. We must also look not only at how elderly people can be given the life and dignity that they deserve, but at early intervention. If any problems that they may have, such as diabetes or a disability, are dealt with soon enough, it costs the NHS less. The IMF predicts that the NHS will end up costing £230 billion by 2050, and that is completely unaffordable. It means that the NHS will go broke unless we solve the social care crisis now. Dr Coffey: Does my hon. Friend agree that cross-party consensus on the draft social care Bill is critical? That is why a draft Bill is appropriate. Does he agree also that, as long as somebody is in hospital the NHS pays for them, the draft Bill needs to tackle the key issue whereby local authorities sometimes delay a person’s exit from hospital so that they do not have to pick up the bill in the interim? Chris Skidmore: That is an interesting point. Obviously, one of the first moves that the Government made when they came into office was to create an output measure of 30 days’ discharge from hospital. Although that was created in August 2011, it is already controversial because we are seeing the scale of the problem. The problem is not new; it has always been there, but the Government are for the first time providing the figures on how many people are leaving hospital and rebounding back into hospital. We should have solved that problem sooner. My hon. Friend argued for a cross-party approach, and I entirely agree. We must achieve cross-party support on social care. We are talking about a settlement that must last decades, so it cannot be a patchwork solution or a plaster over a wound that might open up in several years’ time. We need to come up with a binding compact on social care. I hope that the draft Bill will aspire to that. I have talked about the relationship between the NHS and social care. The Government have recognised that the future of saving the NHS will come through a consideration of social care. We focus very much on the NHS, and the Health and Social Care Bill of the previous Session tried to address the matter. Funds were placed in the hands of GPs; for the first time, GPs are taking responsibility for patients. Rather than sending patients directly to hospital, GPs have to look at what preventive measures they must take to cure illness or disability. Over the past three years, the number of over-80-year-olds who have been admitted into A and E has risen by about 40%. We know that 65% of unplanned NHS bed admission stays involve the elderly. If we can solve that, we will solve a huge issue within the NHS. I am a member of the Health Committee, which recently wrote a report on social care. We visited Torbay, which was instructive. The authorities there have ensured complete integration between social care and health care services. They have done that by pooling budgets; when they have team meetings, there is no empire building in which people say, “This is my budget for the primary care trust, this is mine for the GPs and this is mine for the hospital.” People sit down and consider their overall budget. They have in mind an 85-year-old lady called Mrs Smith, and they ask what treatment pathway they could create to ensure that Mrs Smith gets the best possible care. The authorities in Torbay recognise that social and community care is the best way to prevent unplanned admissions to NHS hospitals. The result is that Torbay has the fastest-decreasing and lowest number of unplanned hospital bed day admissions in the country. The approach there clearly works, so the modernisation of social care must also be about proper, true integration between social care and health care. We also need to recognise that to modernise social care is not to speak of the elderly as some homogenous group. Above all, senior citizens are individuals with individual needs. Each will have their own particular pathway through the later years in life. As a Government, we must recognise that to ensure that the individual has the best possible life in old age, we must give them a chance to lead their life as they would like to. To do that, the Government have built on the work of the previous Government in introducing personalised services. Above all, we have seen the rise of personal budgets. In England, their uptake doubled, from April 2010 to March 2011, to almost 340,000 service users. That is still only about 35% of eligible users and carers. Although the increase in personal budgets is welcome, it has come in the form of local authority managed budgets, rather than individual direct payments, which make up only 26% of that 340,000—that is, 26% of the 35% of eligible users. Although there has been an increase in personalisation, there has not been a proper increase in individuals being given freedom in how they would like to use their budgets. In other words, councils are offering a menu to choose from but they are not offering a choice of restaurants. Key to the modernisation of social care will be the introduction of direct cash payments. At present, individual budgets cannot be paid to a spouse or partner to provide care, and that limits uptake and entrenches the difficulty that millions of people have in wanting to care for a loved one in their old age. If we look across to the continent, we see that places such as Germany have a far more liberalised social care system. In Germany, people are assessed as needing care at one of three levels, and they are then offered a choice between an individual budget cash payment with services in kind, including residential care, and a tailored combination of the two. Interestingly, the individual budget cash payment is of significantly lower value than the social care package. In 2007, people who needed considerable care, or care level 1, received ¤384 per month; those in need of intensive care, or level 2, received ¤921 per month; and those in need of highly intensive care, or level 3, received ¤1,432 per month. They were also offered the choice of claiming direct individual budget cash payments that were about two thirds lower than the payments in the social care package, which meant that people at care level 1 received ¤205 per month, those at care level 2 received ¤410 per month and those at care level 3 received ¤665 per month.
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