Asked by Lord Warner To ask Her Majesty’s Government
when they expect to produce their proposals for a longer-term
solution to the funding of adult social care. The Parliamentary
Under-Secretary of State, Department of Health (Lord O'Shaughnessy)
(Con)...Request free trial
Asked by
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To ask Her Majesty’s Government when they expect to
produce their proposals for a longer-term solution to the
funding of adult social care.
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My Lords, in order to meet the demographic challenges
facing this country, the Government are committed to
establishing a fairer and more sustainable system for
funding adult social care. We will bring forward
proposals in a Green Paper later this year.
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I thank the Minister for that Answer, but can he confirm
that the review which is ongoing will examine the lessons
from Japan and Germany, where populations and politicians
have recognised that, as we live longer, we have to
prepare earlier for funding our long-term care? Can he
also assure the House that, in securing a new funding
system for social care, regard will be paid to the impact
of that on the long-term sustainability of the NHS?
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The noble Lord has done much work on the sustainability
of social care, including his work on the Dilnot
commission. He is quite right to point out that there are
lessons to be learned from other countries, and certainly
we will be learning them from Japan, German and
elsewhere. He will know that the measures announced in
the Budget are specifically designed not only to help
adult social care but also to help the interface between
the NHS and social care to provide exactly the kind of
sustainability he is talking about.
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My Lords, some of us in this House are veterans of social
care reviews that have led to very little change. Can the
Minister therefore tell the House whether he is confident
that the Green Paper will lead to urgent action? Will it
consider controversial issues such as helping families
prepare for care, savings products in the insurance
market and perhaps even care vouchers?
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The noble Baroness is quite right that this issue has not
been dealt with properly over a long time. The Green
Paper has a wide remit and therefore will look at all the
issues that she has brought to the attention of the
House.
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My Lords, in a recent answer to a supplementary question,
the Minister agreed with me that social care and health
would operate properly only when they were under the same
budget. Will the Green Paper go a little further and
consider bringing them under the same management?
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As I said to the noble Baroness, Lady Pitkeathley, the
Green Paper has a wide remit. It is trying to provide a
comprehensive solution to social care funding, which has
unfortunately eluded many Governments. In doing so, it
naturally needs to look particularly at the interaction
between health and social care. For many people now there
is no particular distinction between those as they follow
their journey, as it were, through the health and care
system. The important thing is that the care is joined up
and is of high quality.
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My Lords, is the Minister aware that he does not need to
go as far as Germany and Japan to find good examples of
this? Could he go up to Scotland, in particular to
Ayrshire, and talk to Ian Welsh, the chair of the NHS
health and social care partnership? That is a very good
example of two bodies working together under a joint
budget and joint administration. If the Minister were to
take a few days off and go up there, I think he would
find it very valuable.
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I will speak to the Chief Whip about taking a few days
off. I thank the noble Lord for bringing that point to my
attention. As he says, there are examples in the UK—in
Scotland, England and Wales, and of course Northern
Ireland has a joined-up system too—so clearly there are
lessons to be learned from home.
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My Lord, following the push by for this review that
the Government have been talking about and putting into
the long grass, the independent specialist group that he
convened gave its interim report this morning. It makes
it absolutely clear that we have to look at how the NHS
and social care are paid for. Can the Minister give an
assurance that the Green Paper will address those
Treasury issues, as well as the issues of care and the
relationship between the NHS and social care?
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As I have said to several noble Lords, the intention of
the review is to put the adult social care system on a
sustainable and long-term basis and to make sure that it
is fair and transparent and that it delivers high-quality
care. It will address all the issues required to do that.
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My Lords, will my noble friend acknowledge that he does
not start this process with anything like a blank sheet?
In particular, does he recognise that there is continuing
merit in the recommendations of the Dilnot commission? I
will not elaborate on that, save to say that they include
the fact that it was a manifesto commitment of the
Government at the last election.
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I thank my noble friend for bringing that to the House’s
attention—some might describe it as a hospital pass, if
noble Lords will excuse the pun. The Government remain
committed to implementing Dilnot from April 2020. My
noble friend is quite right that this is not a blank
sheet of paper. There have been some really important
reforms over the last seven years, including the better
care fund and the Care Act. In the Budget, we have more
funding for the short-term sustainability of the social
care system, as well as a commitment to the Green Paper.
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My Lords, I would like to ask a question about children’s
social care, where I notice there is also a problem. For
example, in the last year local authority support for
palliative care services for children was cut by
two-thirds, and it now provides only 1% of the
expenditure on children’s social care. First, does the
Minister acknowledge that there is a problem here as well
and, secondly, what are the Government going to do about
it?
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The issue of children’s palliative care came up in the
debate the other evening on palliative care. A review is
taking place with the charitable sector of the
distribution of funding, particularly for children’s
hospices, over the next year. In terms of children’s
social care—this may come as a surprise to some noble
Lords; it certainly did to me—the fastest-growing part of
the adult social care budget is for adults with learning
disabilities. Of course, that often comes in at the point
at which people leave the children’s social care system
and the school system and move into the adult social care
sector, so there is an important point about continuity
from one to the other.
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My Lords, does the noble Lord accept that the domiciliary
care of people in their homes is in deep crisis, with 400
care home businesses declared insolvent since 2010? Large
providers such as Mitie have recently been selling their
home care health business—it sold it off for just £2,
plus a £10 million pay-off to the new outsourcing firm
for business trading losses and other costs. What impact
do the Government assess that the £2 billion Budget cash
spread over three years will have on halting home
closures and reducing the risk of industry collapse? Will
the future Green Paper look at finding a new, more
sustainable model for providing and funding residential
and domiciliary care?
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The noble Baroness brings up the issue of care homes
closing. Inevitably, there is churn in the system. There
has been a stable number of residential care home and
nursing home beds, which is one metric. The other is the
fact that there are many more home care agencies, with a
lot more domiciliary care going on, and over 150,000 more
social care jobs, so I do not think that the picture is
quite as the noble Baroness described it. However, making
sure that we have a sustainable system is at the heart of
the Green Paper plans.
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