Mr. Dave Anderson (Blaydon): I just want to pick up on the point made by my hon. Friend the Member for Luton, North (Kelvin Hopkins). Can we be clear that the Secretary of State is not ruling out discussions on the type of model that has been proposed by my hon. Friend - a model that should be fully funded by tax or national insurance? Although that is not one of the options in the Green Paper, will the Secretary of State, as he said, be listening and not ruling it out? If he wants to rule it out, I will go home now and get the 2 o'clock train.
The Secretary of State for Health (Andy Burnham):Far be it from me to prevent my hon. Friend from getting home this evening. In the Green Paper, we have put forward three options that we believe are the fairest way of funding care in the future. I was going to give some statistics on how the nature of our society will change in terms of the number of working age people in comparison with the number of people in retirement. Those statistics need to be borne in mind by my hon. Friend - I know that he will do so - in considering the fairest way to proceed. Obviously we have a system today whereby people are paying out large amounts to fund their care. They are already making a substantial personal contribution to the cost of their care. In my view, it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation. We have ruled out that option, and my hon. Friend has good time to get up to King's Cross.
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Mr. Dave Anderson: I share my right hon. Friend's unhappiness that the shadow Secretary of State is not here. Does my right hon. Friend have any idea how much of the £8,000 that was proposed to be put forward as a donation by anyone going into residential care would be kept by the private insurance company?
Andy Burnham: That is why it is disappointing that the shadow Secretary of State is not here. We cannot see how a system that requires an £8,000 contribution to care can possibly be workable, on any basis. Indeed, on the eve of the Conservative party conference the Daily Mail had a front-page headline saying "£8,000 to save your home". Two days later, a spokesman for the shadow Health Secretary was saying that "top-ups might be required". The £8,000 figure lasted all of two or three days, yet during the big care debates people have been using it as though it would be the extent of the contribution that would have to be made. We cannot conduct the debate in those terms. People have to be open and honest about the scale of the costs, not put out misleading figures for political purposes that then fall to bits in their hands, and think that they are adding to the debate.
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Mr. Dave Anderson: Does the hon. Gentleman accept that the debate has been going on for much more than a decade? For the two decades before this party came into power, his party dismantled social care, promoted private care and cut billions of pounds from the care budget.
Mr. O'Brien: Rather than getting into a ding-dong dispute about that, I shall just say that I do not accept the hon. Gentleman's underlying point that there were cuts to the budget. However, I accept that there was a shift in approach. Many people were moved out of institutionalised care, particularly elderly people. Often, inappropriate presumptions about mental health problems were made and mental health problems were not properly diagnosed, and there was a move towards care in the community.
There are many arguments on that and it is fair to say, in the light of experience, that to some degree the pendulum went too far, and we are now trying to find a new balance. There is a difference between wanting to preserve people's independence and dignity and their ability to remain in their own homes with a certain quality of life, and wanting to preserve and maintain the dignity and appropriate care of those who on proper criteria need long-term residential care, particularly as they move towards the end of their lives.
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Mr. Dave Anderson: Surely that is what happens now. People are assessed for need by the local authority, but when they need to go in to a care home they refuse to, because they do not want to. When the scheme is introduced, there will be an incentive for people to go in to care because they will keep their homes, so if they are assessed for need, they will go in.
Mr. O'Brien: The hon. Gentleman seems to misunderstand that we all agree across the House that, above all other things, older people want to maintain their independence, dignity and so forth as best they can. There are no people sitting out there thinking, "I must rush into a residential care home." It is only when the need requires it that it happens, although the local authority might have no incentive to meet that need because of capacity issues.
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Mr. Dave Anderson: Does the hon. Gentleman agree that the very fact that the Conservatives call their scheme a "home protection scheme" shows where their minds are? Their policy is about protecting the home, not about delivering quality care for the elderly people of this country. [Interruption.]
Madam Deputy Speaker (Sylvia Heal): Order. If the hon. Member for Eddisbury (Mr. O'Brien) wishes to make a comment, he knows the way to do so.
Greg Mulholland: The hon. Member for Blaydon (Mr. Anderson) is right. I have heard a lot from the hon. Member for Eddisbury in debates in this House and outside, and it is extraordinary for him seriously to suggest that his policy will do anything on the wider, important issue of keeping people in their homes. I found it extraordinary that when he was challenged on the Conservative policy for the millions of people who need but are currently not getting care, he wandered off and started talking about public health. I do not imagine that I was the only one in the House who was a little confused by that. The Conservatives might think that announcing that they will have a Minister for public health is exciting, but it has no relevance to today's debate.
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Mr. Dave Anderson: The hon. Gentleman has laid out a plan with which I fully concur. Will he give me an idea of his party's position on how much such a system will cost the public purse?
Greg Mulholland: As the hon. Gentleman knows, we have committed to a form of the Wanless partnership model, and we are very clear that we believe that that is the right approach for moving forward to a system in which everyone receives an entitlement that they can know and understand. The hon. Member for Luton, North will not agree, but my party believes that both the state and individuals have to contribute. The question for the debate and consultation is by how much. That does not rule out considering increasing taxation; I echo comments that people taking part in the consultation should be allowed to consider that.
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Mr. Dave Anderson: May I suggest to my hon. Friend that one of the dangers of the personalisation of social care is that people will choose to employ those who have not been properly trained and do not have the experience or knowledge to look after people properly?
Laura Moffatt: I thank my hon. Friend for his intervention. There was indeed a sense of concern about that. Although people were keen to have their own care sorted and to feel that they were in the driving seat, there was also a great sense that we need the Government and the NHS to be involved to ensure standards and quality. In that respect, I utterly agree with my hon. Friend.
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Mr. Dave Anderson (Blaydon) (Lab): As Parliamentary Private Secretary to the Minister of State, Ministry of Defence, my hon. Friend the Member for Harlow (Bill Rammell), I have had quite a tough week. I have sat through Adjournment debates, statements, an Opposition day debate yesterday afternoon and a Westminster Hall debate. If I stand back from the issues being discussed, I can see that what was really important and what made it a huge experience for me was listening to people across all this House who had true, real-life experience of what we were talking about. They were people who had served in the forces. Today's Opposition Whip, the hon. Member for Ludlow (Mr. Dunne), spoke yesterday about his experience in the reserves - I believe in the naval reserve. Those people knew the real world that they had come from.
I want to speak from my experience as someone who worked as a care worker; 20 years ago this month, I fell into care work by mistake. I had been made redundant as a coal miner, which I had been for 20 years, and I was looking for something to fill my time in the short break before I picked up something else. I went for a 13-week part-time contract at Newcastle city council as a care services driver and 16 years later I left to come and work in this place. But the importance of the story is not why I went there and stayed there. I was fortunate that I went to work in a place that was built by two visionaries: Jeremy Beecham, the leader of Newcastle city council; and a gentleman who is no longer with us, Brian Roycroft, who was the director of social services and, in fact, the leader of social services directors across the country. In the mid-80s, they purpose-built a building in Newcastle called the Minories project, which was constructed to deliver real care in the community. The place was expensive, but it was quality. It included sheltered housing, and the people who lived there had access, as and when they needed it, to staff who worked in another part of the building. It had a respite centre with 16 beds, which meant that over a 10-week period 160 people could stay, giving their families some relief while we looked after them and saw to their needs.
The building had a restaurant that was open to the public, and people over 65-years-old right across Newcastle could go there and meet their old friends. It was a real place that really worked. It had a day centre that was second to none, and we even had our own bus - a 1970s Mercedes bus, which I loved driving. If I live until I am 90, I shall never, ever forget the pleasure that I used to get from driving that bus and seeing a particular old lady called Florrie, who used to look out of the window, with the sunshine in her eyes. The only thing was that she could not see, because she was totally blind, but the look of pleasure on that lady's face will stay with me as long as I live. Memories like that represent the real experience of people who work in care.
I went from being a man working the coalface in March 1989 to being a man standing with a doctor in March 1990, helping to put a prolapsed womb back into a 91-year-old lady. It was totally different, but that is the real work that carers have to do, day-in, day-out, 365 days a year. I want to put on the record my appreciation of the work that they do, whether they are professional carers or carers who help their family or friends. The real joy of that job was the total appreciation that we got from people after doing something as simple as cutting up their food, fastening their laces or helping them go to the toilet - things that we all take for granted, but things that, sadly, they were no longer able to do. But we had to do that work, and it was a privilege to do it.
The great thing that made that building work was that it had a good number of staff. It was a very staff-intensive unit, but because of that it worked. Sadly, however, because it was the early 1990s, we also had to face the reality of the budget constraints that our authority was working under. It was being told that it had to put a price - not a value - on care, and the price of the care that we delivered was, sadly, not in line with the price that the private sector delivered. That is hardly unusual, when we consider that legislation at the time said that there was a £50 disincentive on each bed in a public home as opposed to in a private home. We started off with that loss. If we then consider that staffing and training levels were lower in the private sector, and that their terms and conditions were much lower, we see that it was obvious that the public sector, on a purely comparative basis, could not compete.
We, as an authority, tried to set up an employee share option plan, which would have taken the homes out of direct public ownership and into an arm's-length body that the staff would run. I was unhappy with the plan ideologically, but practically we tried to pursue it. Despite that, the plug was pulled by the then Secretary of State for Social Security. He did not believe that the plan went far enough into the private sector, and the reality was that 25 homes closed in Newcastle and we were left with a rump of four. Home care workers had to pick up the pieces, but at the same time there were too many people to look after. The circle was squared by a change in the criteria for accessibility to care. The criteria for vulnerability and frailty were increased, as was the age level, and people could not access care. Those choices were enforced; they made people such as Brian Roycroft and Jeremy Beecham despair; and they made the staff and the families we took care of despair. So the truth is that, with the piece of work that we are all talking about today, we have the chance to rectify some of those mistakes.
As I said to the Conservative spokesman, the position we reached in the mid-1990s was the result of a programme of 16 years before, from 1979 onwards, when the people of this country made a choice that they wanted tax cuts. The Conservative party delivered those tax cuts, but one cannot give tax cuts and keep on giving quality services - it does not work. If the money is not there, the service cannot be delivered in the way that the people of this country deserve. There was less money to spend, so there was less money to be given out for care services, as well as for other areas.
The policy was also, clearly, ideologically driven. It was not a mistake that care homes were closed - it was direct destruction of the public sector. In the same way, it was not a mistake that public transport was taken away from council ownership and put into the private sector, or that council housing was taken out of the remit of councils. We had two choices back then, and now we have a chance to move forward and make choices in the other direction.
Since 1997, we have seen some improvements. For example, there have been huge improvements in how we look after people at work. The national minimum wage has been a huge positive for people working in the care sector. We now give people guaranteed holidays, people have better maternity rights and paternity rights, and to some extent we have levelled the playing field between private and public sector provision. We have increased resources and support to local authorities and the national health service, and we have supported and developed independent providers. There have been positive changes to training, skills and the registration of staff, so that caring is seen as a professional job.
All that has been important, but it has not been enough. The sad reality is that underneath it all, as the hon. Member for Leeds, North-West (Greg Mulholland) said, we are under-resourced. That is the nettle that we have to grasp, whether we like it or not. My hon. Friend the Member for Crawley (Laura Moffatt) said that care cannot be done on the cheap. In fact, low-cost, nasty, inefficient, unsafe and dangerous care can be done on the cheap, but quality care cannot be done on the cheap. We need to realise that.
I am sad that the hon. Member for Glasgow, East (John Mason) has left the Chamber, because I thought that he would engage in a debate about what has been done in Scotland, where the introduction of free care has been accepted. I believe that there have been problems and that there is debate between the Scottish Executive and local authorities about who picks up the tab. The royal commission came up with some positive views. If we, as the United Kingdom Parliament, had taken up the challenge back then, the problems that have arisen in Scotland would not have been an issue. We could have said, "We'll provide for this need across the whole United Kingdom, and we'll do it in a way that avoids these potential problems." It is a shame that that did not happen.
We have a national health service that ensures that someone who is out walking and gets run over by a bus will be taken to a hospital and looked after. But if someone cannot look after themselves, not because they have been run over by a bus but because they cannot go to the toilet on their own, fasten their shoelaces or feed themselves, they are told, "Sorry, you need to sell your house and give us everything you've got except £16,000." I cannot for the life of me see why that is; it is not fair.
This Government, to their credit, went to the people of this country with a 1 per cent. increase in national insurance contributions, directly to support improvements to the health service. I do not recall anyone - perhaps the Conservatives; I am not sure as I was not here at the time - opposing that. The public never complained about it: they said it was a good thing to do, and that was proven. I believe that we should be looking at doing that again. It is nearly a year since we had a 2.5 per cent. VAT cut, which apparently amounts to £12.5 million. Just think - if we put 0.5 per cent. on VAT, that would create £2.5 billion. Perhaps my sums are wrong; if so, someone brighter than me can put me right. That is the sort of mental attitude that this House must have in saying that there are ways to square the circle but they will have a cost.
I want to focus a little on the Tory proposals. I am sceptical, but genuinely interested, and I want to try to work out what the Tories have brought forward. The £8,000 proposal is worth looking at, if taken as a purely mathematical argument. I understand that they said at their conference that if five people pay £8,000, one person gets two years of care out of that £40,000, and the other four will not need it. How many people will have to pay before it becomes effective? Will it be five, 50, 5,000 or 50,000? If people do not buy into the scheme, it will not get off the ground, and what will we be able to do in the meantime? There have also been rafts of reports that the costs are being underestimated as they will be not £20,000 but £26,000 a year, and that the average stay will be three and a half years rather than two. If that is the case, the figures will obviously be inflated.
As I said to the hon. Member for Eddisbury (Mr. O'Brien), I believe that people will go into care earlier in future. When people are assessed now and told, "You should be in care", they say, "I am not going into care". They go into care at the last moment because of the pernicious impact of losing their home and not being able to leave it to their children, which is understandable. In future, if they realise they need care, they will say, "Yes, I will go in early, because my home is now safe". However we square the circle, people will go into care earlier and stay in longer. They will get the care they need at the front end rather than have to go in when they are on their last legs. The average period in care will be much longer.
Angela Browning: If those people were self-funding, would they not be subject to assessment to see whether they needed to go into care? They could not just go in voluntarily without a full medical need to be admitted.
Mr. Anderson: I agree absolutely. They would need medical, social and financial assessments, but my point is that that happens now and people are told, "The best place for you is in care". They say, "I know that, but I am not going in." In future, they will say, "I will go in, because my family is going to keep my home." There will be an incentive, whereas there is a disincentive at the moment because they want to protect the assets that they want to leave to their children. To a certain extent that is why we are having this debate, and the Opposition should bear that in mind and address it. The hon. Member for Leeds, North-West spoke about consensus, and if we are having a genuine debate a consensus has to be hammered out. We need much more data to show whether the £8,000 proposal is a runner.
The proposal is a private insurance scheme. I do not know whether private insurers will be full of the milk of human kindness all of a sudden and say, "We will run the scheme free". It hardly seems likely of a company such as Aviva, which has just announced almost £3 billion of profits. It might say, "We can afford to absorb this; we will do it for nothing", but I doubt it very much.
The crux of the matter is that some people will not be able to find £8,000, some people will choose not to pay it and some will not have a pension lump sum. Why say to someone, "On the day you retire, give us £8,000"? Why not say, "Give us £3 a week for 50 years while you are at work"? That is how we fund the national health service and most of the public services in this country. It is how we should have been funding care for the past three decades and how we should fund it going forward - it is called collectivism.
We have good quality caring staff who put a lot of trust in us to find a way forward for them. That is the whole team - ancillary workers, home care workers, domestics working in homes, social workers and people classed as backroom staff who do the paperwork and ensure that things are right and proper. They need to know that they are in a service worth working in. They are professionals and we need to treat them as such. We need to respect them and reward them in a way that clearly has not been the case in the past.
The royal commission reported that we should pursue various things. Ministers said that the report did not get consensus, but I can inform them that when it came out, I was the chair of the policy committee for the trade union, Unison. We set up the right to care group, which involved campaign groups including one of the main ones, led by Claire Rayner, user groups, carers and workers. The group was clear that the best way to address the problem was for the service to be directly funded by tax. If we had done that then, it would have been embedded in the culture of this country by now and we would not have been having this debate. If we had bitten the bullet at the beginning of this century, the Opposition would have seen the system work and been converted in the same way as on the minimum wage and the other positive things that we have done. We should go for the fully funded option and, if we cannot do that, we must ensure that it plays a huge part in future.
We have been here before and we did not make the right choices. We must now make the right choices - it is the mark of a civilised society. The shadow Chancellor said in his speech at conference, "We're all in this together." The Conservative party's programmes are not about us all being in this together, but about us all being individuals. I believe that we are in this together because none of us knows where we will end up if we are fortunate enough to live into old age. We should provide collectively.
In the past three decades, we have failed to provide for the people of this country. It was interesting to hear the hon. Member for Eddisbury describe how he is trying realise Tony Blair's promises. I lived about 10 miles from Tony Blair for 25 years, though politically we are probably a million miles apart. However, I agreed with him when he said that we are best when we are bold. I say to my hon. Friend on the Front Bench, "Be bold, comrade."
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The Minister of State, Department of Health (Phil Hope): We have had an important - indeed, I would say crucial - debate on the Government's proposal to create a national care service for older and disabled people. Members have spoken with great passion and considerable knowledge. We have heard from former Ministers, and from Members with personal and constituency experiences. I shall take each of the contributions as a submission to the Green Paper consultation, which will boost the numbers.
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Another key issue is the anger that I have heard expressed up and down the country at the unfairness of the means test, which forces people to use their savings or sell their homes to pay for their own care. That was mentioned by my hon. Friend the Member for Blaydon (Mr. Anderson). People are also worried about the quality of care services. I think that every Member referred to that. People are worried not only about whether they will be cared for well, but about whether the standard of care will vary according to where they live. Many are worried about the postcode lottery. Adults with disabilities are particularly worried about a variation between care assessments in different parts of the country. They do not feel confident that their care needs would be met if they moved to another area.
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Mr. Dave Anderson: The Minister has obviously made the assumption that the only way to pay for this is out of income tax. However, people carry on paying tax long after they have retired; everybody pays VAT every day of the week. I made the point in my contribution that one possible approach would be to have a 0.5 per cent. rise in VAT, which would put £2.5 billion directly into the care budget.
Phil Hope: All I can say to my hon. Friend is that we are listening hard to what everybody has to say about the way forward. I have tried to explain why the models that we have proposed are sustainable in the longer term - over decades of an ageing society - but we welcome any thoughts that people have and any contributions that they wish to make.
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