Department of Health and Social Care and Ministry of Housing, Communities and Local Government — House of Commons, 2018-07-02
Topic: Social Welfare
Clive James Charles Betts (Labour, Centre-left): It is a pleasure to follow the hon. Member for Yeovil (Mr Fysh). I concur at least with his points about local government funding and the pressures on councils in general with regard to their social care responsibilities. I want to address the points made in the joint Select Committee report. I thank the hon. Member for Totnes (Dr Wollaston) —she is my hon. Friend on this occasion—for her contribution to the report. Everyone worked together on it I do not think there is any doubt at all that funding is needed for social care. We cannot carry on trying to get this sorted out on an as-and-when basis every year. We need a long-term solution that people, and particularly the local councils that have to deliver the services, can rely on. Politicians are often good at identifying what needs to be done, but not very good at saying how it should be done. A great strength of the report is that I think it actually does say how this should be done. We say that we cannot carry on providing care in the same way and to the same level as has been the case over the past few years. We are say that, yes, there is a gap here and now, as identified by the Local Government Association, the King’s Fund and the Nuffield Trust. There are clearly demographic issues that are pushing costs upwards with regard to not merely the elderly, but people of working age with disabilities—there are demographics in both. We also have to accept that if we broaden the scope of people who get care, including people who have moderate needs, that will mean prevention and taking people out of the national health service. That is one way in which we can join up the two services very effectively We then have to look at quality. We all know of examples of quality failing at present. We know that the workforce are often on zero-hours contracts and the minimum wage—the same wage someone working on a supermarket checkout can get. We need to look at the long-term stability of the workforce, as well as their pay and conditions. We need to consider the viability of care providers, which are often giving contracts back or going out of business. All those issues require money. That is why, in the end, I have to say that although I very much support the long-term principle of care that is free at the point of delivery, according to need—that is one way in which we can join up health and social care in the long term—all the issues that I listed immediately need extra funding. It will therefore perhaps be some time before we can move to that free care system, but we can deal with clinical needs much earlier We can ensure that any money that is raised, whether through the national insurance funding model or the German model, is earmarked so that people can see that if they have paid extra, it goes towards social care. That came out very strongly from the citizens’ assembly. It is also about fairness and pooling risk, so that if everyone who can afford it pays a bit of inheritance tax, no one needs to find that the vast majority of their assets, including their home, has to go towards paying for their care. That really upsets people—it is the lottery of life, is it not? If someone has dementia and ends up in care for a long period of time, their home simply goes to pay for that. Most people feel that is really unfair, so if everybody pays a bit when they can afford it, no one would risk losing everything in the way that they do under the current system One of the strengths of our report that we have perhaps not made enough of is the fact that this is doable. It is practical and can be delivered in a reasonable period of time. As we have said, if business rates—75% of which are going to be retained by local councils in 2020—were kept in the local government system, that could address the local government problems to which the hon. Member for Yeovil referred. That can be done. We know that there can be a simple switch from the current intention of replacing public health grants and other things. If we consider the basis of a social care premium, either through national insurance or the German model, the structure is there to collect the money and would be relatively simple to adapt. As for the change to inheritance tax, again the system and framework are in place. They would be relatively easy to adapt and it could be done in a fairly short time Integration is a really important issue. We have not started from scratch and called for a whole new national health and care system, which could take years to bring about. We have said that, yes, health and social care need integrating and bringing together, as do housing services—most people who get social care do so in their home—and the link with public health, but that can be done within existing frameworks locally. The integrated care plans have been mentioned as one basis and there are the health and wellbeing boards. We have also heard about the Manchester model. All those models already operate and we can use them to bring about this practical integration at the point at which people need the service. This is not about a new bureaucratic framework, but about delivering services better for the individual Yesterday I was pleased to go on a 10-mile walk, raising funds for the Sheffield Hospitals Charity—that perhaps says something in itself. I went with my excellent consultants, Professor John Snowden and Dr Andy Chantry, together with their team from the haematology department at the Royal Hallamshire Hospital in Sheffield, who have given me such excellent care and treatment over the last year. I thank them all very much for that. There is a little secret that I have to let out though: John Snowden and Andy Chantry did a 50-mile walk over two days, and I just came on the last 10 miles of it. The commitment that they showed with members of their team demonstrates and is symptomatic of the approach that so many of our NHS staff have to the job they have to do—a job that we rely on them so much for.