Oral answer (Lords) on Personal Social Care: Funding - Oct 16

To ask Her Majesty’s Government what assessment they have made of the report by Independent Age, A Taxing Question: How to fund free personal social care, published in September.

My Lords, the Government welcome and recognise the contribution of Independent Age and other stakeholders to the important debate around social care reform. The Green Paper that is to be published later in the year will set out proposals for a sustainable social care system that strikes a fair balance between what the state and individuals pay. Reforms must be affordable and fair across the generations, including to working-age taxpayers.

I thank the Minister for his response. The report sums it up when it says that,

“today … accessing such support has become a game of chance: based on where you live, your social class, and your ability to pay”,

all of which was echoed in last week’s CQC state of care report, which also made it clear that any future extra funding for the NHS will just be wasted and swallowed up treating people in hospital unless there is a similar major cash injection for social care. Will the Minister confirm that all the options set out for future social care funding in the Independent Age report, particularly the strong case made for free personal social care and support for older people, are under active consideration in the social care Green Paper? How are the proposed 10-year NHS plan and the Green Paper joined together to deal with the integration lottery and fragmented care that the CQC’s local systems reviews have highlighted?

I thank the noble Baroness for raising this important issue. She is quite right that extra funding is needed, which is why we have pledged £20 billion extra for the NHS and want to get this long-term funding settlement for social care. There are many proposals in the Independent Page document—nine, I think—and we are looking at a range of different options. As I said, there needs to be a fair balance between those who are working today and those who need care today, an issue that has evaded a number of Governments and which we sincerely hope to solve. On how the two plans will work together, the intention is that the long-term plan and the Green Paper will be published together around the same time and will therefore be complementary in trying to achieve the goal of integrated health and care.

May I press the Minister further on his Answer to my noble friend about the consideration of free personal care? Those of us who were at the memorial for Lord Sutherland earlier today remember that he chaired a Royal Commission that came up with a proposal for free personal care. Sadly it was not implemented then, nor has it been implemented by any of the endless reports we have had on this issue in the ensuing 20 years. We need to consider free personal care as one of the options. I ask the Minister again: will it be considered?

I shall have to disappoint the noble Baroness: the proposals will be set out in the Green Paper and I will not give a sneak preview today.

My Lords, Scotland has been giving over-65s free personal care for years now and is now running a feasibility study on extending it to under-65s. This is not the action of a Government who are unconvinced of the benefits. Will the Government consider running a trial in a defined English health community—say, the Manchester community or perhaps even Cornwall—to determine whether the benefits can be replicated south of the border; and, if not, why not?

I am not sure that a trial is required; what is needed is a systematic change in the way we do things for everybody. I am interested to hear what the noble Baroness says about the under-65s. One thing I can tell the House is that the Green Paper we will publish this year will deal with adults of not only retirement age but working age. Those were two separate streams that were working in parallel, but they will be contained within the same Green Paper.

With respect, the Minister has not answered the question he was just asked. Free personal care has been implemented to a large extent in Scotland. How is it possible to do it there but not here?

It is the Scottish Government’s decision to do that. Of course, they receive higher public funding per citizen than we do in England, and we make different decisions, just as we have on higher education funding and so on. As I said to the noble Baroness, the details of the proposal will be set out in the Green Paper during the year, and I am afraid that the noble Lord will have to wait.

Will my noble friend resist the temptation to do what has been done in Scotland, which is to announce free personal care, only for people to find that the resources are not there and the care is not available to them because of rationing? We need a properly funded system which will give everyone the quality of care that they need.

I completely agree with my noble friend. It is right that we have a sustainable system that delivers what it says it will.

Do the Government have any plans to reintroduce a proper meals-on-wheels service? When I worked for the City of London, it came to light that only five boroughs were left providing a rudimentary service, yet malnutrition and dehydration are among the main reasons why old people go into hospital. So we save 15 quid a day maximum and end up with a £700-a-day bed from which you cannot go home. The simple provision of a meal would be both humane and healthy.

The noble Baroness makes an excellent point. I do not know about the distribution of such services, but she is absolutely right that what everybody wants—the cared-for person and those looking after them—is to stay in their homes and remain independent for as long as possible, which is why so much more care must be delivered in the home. I will write to her on the specifics of meals-on-wheels services.

My Lords, the noble Lord talked about taking a firm policy decision. I have yet to understand why the Government commissioned the Dilnot commission, accepted the principles of its recommendation, legislated to introduce it but then failed to implement it. Why?

The noble Lord is right: the Dilnot commission proposed risk pooling, which we legislated for, and it was decided that it was not the right time to proceed with those proposals. However, I can tell the noble Lord that Sir Andrew Dilnot continues to be involved in the policy-making process, as does Dame Kate Barker, who chaired another review. We want to ensure that we can draw on their expertise as we put our ideas forward.

Will my noble friend correct my noble friend Lord Forsyth: there is no such thing as free social care, it is just a question of who pays for it?

My noble friend is absolutely right, which is why there must be a balance between what is paid by individuals and by the taxpayer through the state.

My Lords, are my ears deceiving me, or did the Minister talk about a sustainable social care system in England? If so, he ought to talk to some people who are seeking social care at the moment, because they and their families think the current system is not sustainable.

What I said was that we need a sustainable system, and that will be the goal of the Green Paper.

My Lords, am I the only Member of your Lordships’ House who is not just frustrated but deeply angry that the Government, with all their warm words, consultations, Green Papers and the rest, will not grasp the nettle and recognise that we have to pay for proper elderly care? That will require taxation and taxpayers’ money to be invested in providing respite and a decent future for people who are living in miserable conditions with families stressed beyond belief. The Government ought to get on with it.

I agree with the noble Lord that we need to get on with it and to decide what is the fair burden of “who pays?”. I remind the noble Lord that for many years he served a Government who had umpteen reviews, Green Papers and royal commissions, and did not act. We are trying to grasp the nettle that his Government avoided.