Clause 72 - Five-yearly review by Secretary of State

Care Bill [Lords] – in a Public Bill Committee am ar 23 Ionawr 2014.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Question (this day) again proposed, That the clause stand part of the Bill.

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation, NATO Parliamentary Assembly (President) 2:00, 23 Ionawr 2014

I remind the Committee that with this we are also discussing the following:

New clause 13—Funding for new costs arising from Part 1

‘(1) The Secretary of State must provide local authorities with sufficient funding to enable them to meet new costs arising directly or indirectly to them by virtue of this Part.

(2) The costs mentioned in subsection (1) include (but are not limited to)—

(a) costs of introducing the new measures set out in this Part;

(b) on-going costs of implementing those measures (to be allocated through the annual spending review);

(c) costs identified by the Department of Health to be funded through the Better Care Fund.’.

New clause 14—Social care free at the point of use—

‘The Secretary of State must prepare a report on the costs and benefits of requiring, and providing funding for, local authorities to offer all social care free at the point of use. This report must be laid before each House of Parliament within 12 months of section 3 coming into force.’.

New clause 15—Joint Care and Support Reform Programme Board: assessment of funding—

‘(1) Before any provision of Part 1 is brought into force, the Joint Care and Support Reform Programme Board must have informed the Secretary of State whether sufficient funding is in place or will be put in place to ensure that the provision in question can be implemented satisfactorily.

(2) In subsection (1), the “Joint Care and Support Reform Programme Board” means the board of that name consisting of representatives including the Local Government Association, the Association of Directors of Adult Social Services and the Department of Health.’.

New clause 16—Ministerial advisory committee—

‘An independent ministerial advisory committee shall be set up to keep under review the workings of the set level as set out in section 15, and the means-testing arrangements set out in section 17.’.

New clause 17—Initial funding assessment—

The Secretary of State must ask the Office for Budget Responsibility to complete by the end of 2014 a review of the funding of adult social care that assesses—

(a) the adequacy of current public funding of these services;

(b) the proposals for funding the provisions in this Act;

(c) the implications of the Act and its funding for the NHS over the next five years; and

(d) in particular the short and long term costs of setting the eligibility criteria at the level set out in regulations.’.

New clause 18—Impact assessments of regulations—

‘(1) Before bringing into force sections 13, 17 and 35, the Secretary of State must lay before Parliament an impact assessment of the regulations set out in those sections.

(2) In relation to the regulations set out in subsection 13(6), the assessment must show how the provisions will affect the likely impact of the set level above which an adult starts receiving financial assistance with the costs of their care.’.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

I tabled new clause 14 after Second Reading when I spoke about social care that was free at the point of use. It seemed logical, if we have an NHS that is free at the point of use and we are trying to integrate health and social care, that at some point in the not too distant future we must consider the concept of social care that is free at the point of use. Our discussions in Committee and before about the difficulties with the cap highlight just why this is an important discussion.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I agree entirely with the hon. Gentleman that it is an important discussion. But when he explains why the new clause is merited, can he address himself to the question why on earth, for 13 years when there was resource, the previous Labour Government chose not to do anything about this?

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

Because my hon. Friend was not a Member then.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

My hon. Friend helpfully points out that I was not here. Perhaps if I had been we might have resolved it. As ever with these things, it is about where we are now and how we go forward. The growing demands of social care and the needs of an ageing population and the pressures on services increasingly bring this forward. It is unfortunate that the right hon. Gentleman asked the question in the way he did. An enormous amount of progress was made by the previous Government to address the issues and the challenges around social care.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

Like my hon. Friend, I was not a Member under the previous Government but I seem to remember that in 1997 people were waiting 18 months for hospital operations and dying on the hospital waiting list. At the time we thought that was an absolutely key priority for a Government caring about reforming the care system.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

My hon. Friend might have added that by the time we left office we had the best NHS in the world according to international comparisons. The Labour Government’s record on the NHS bears great scrutiny and we are extremely proud of it.

The new clause tries to look at the long-term implications of funding. We have debated the cap and, as we said, it is a cap that may not really be a cap. People are worried about losing their homes. The Under-Secretary claimed that they do not really lose their homes because they are dead before the homes are sold; they do not have to sell their houses. That was the point he was making. Whether people sell their houses before they die or they are sold after they die to pay for their care, they and their families still bear the cost. It is still the individual who bears the cost, either directly or indirectly, of their care.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

Is the hon. Gentleman aware that of all the different options, entirely free social care is the most regressive of all? It gives bucketloads of money to rich people. Is that what the hon. Gentleman is arguing for?

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

We could say that about the NHS. We could say that about any service.

We have an increasing demand. We have an increasing ageing population. The way that we pay for an integrated health and social care system is proving to be extremely problematic, as we have debated on a number of occasions. My amendment is a probing amendment asking for the issue to be studied properly. I am not aware of an in-depth study on how free social care might be achieved. That is what my amendment is asking for.

Is there a way of raising funding without the individual’s having to take responsibility at the time? I am assuming a moderate eligibility threshold. I am waiting for an intervention.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

My hon. Friend the Member for Truro and Falmouth and I were questioning what the hon. Gentleman was saying about there being no attempt to scrutinise and study these issues over the past 13 years. There was a royal commission; there was Derek Wanless doing work. Tonnes of files of paperwork have been generated. Shelves have been gathering dust with the reports that have been written on this subject. The difference between the Labour side of the Committee and this side is that this side has actually done something about it—published a White Paper, and now we are debating a Bill that will become an Act to make the changes. That was never delivered under the last Government.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

We have established already in this short debate the proud record of the last Government in addressing issues of health and social care.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

There was plenty of action on social care. The point is that we need Government to carry out that analysis and I do not think that has been achieved so far. I am not going to revisit the entire debate on the cap and where it is set and the concerns about costs that do not count towards the cap and the impact of the cap on different parts of the country. Those concerns are on the record and have been expressed many times.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

The hon. Gentleman expresses concern about the contributions that people may or may not have to pay towards their care. Generally speaking, that would be people who are better off. Would he accept—I think this point was made in the Dilnot report—that if the previous Government had done something about the cost of social care and providing better social care, these costs might be considerably less than they are now?

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

This is becoming a politicised debate, by choice of Members on the Government side of the Committee. It was not for want of trying on the part of  the last Labour Government that we failed to achieve a consensus across all parties. It was not the Labour party that had difficulty with the concept of all-party talks and trying to achieve agreement. Agreement across the parties is essential on this, because the issue is not just for one Parliament or one Government or one party. We were trying to achieve cross-party agreement and it is unfortunate that it did not happen.

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation, NATO Parliamentary Assembly (President)

Order. May I interrupt the hon. Member’s speech for a moment? I have been very tolerant. Members on the Government side have put on record their strongly held view that the previous Government did not do what they wish they had done, but we are here to debate a proposal from the current Government for new legislation and it is the new legislation, and not history, that we ought to be debating in this Committee.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

I appreciate your comments. The Minister in his earlier remarks made the point, which I accept, that one of his aims is to avoid an individual’s facing excessive costs. That is one of the things that the cap achieves at any level. It is debatable how high those costs might be in some parts of the country. Nevertheless, I accept the principle of what he says. I think we all accept the Dilnot principle on that. But they are still expensive costs. I am trying to remove the requirement to pay up front—for individuals themselves to pay for social care.

The issue of funding is identified in this group. My hon. Friend the Member for Sheffield, Heeley, in proposed new clause 13, addresses the need for adequate funding for local government. We need to grapple with how social care is funded in whatever system, both under the current arrangements ensuring local government has enough money, and longer term as pressures continue to grow. That is what my probing proposed new clause seeks.

We discussed free social care at the end of life and talked about the need to define end of life. If we agree that social care should be free at the end of life, at what point do we bring that forward? I made that point on Second Reading. The London School of Economics estimates £2.8 billion to set the threshold at moderate. If we accept a figure of £2.8 billion or thereabouts, the question is how to fund it. I am asking whether there are other ways of doing it through general taxation, presumably, rather than an individual’s making a contribution for their own care.

Given the many difficulties we have discussed, the nature of the debate, and the long-term challenges that have yet to be resolved, whether social care should be free at the point of use in order to fit in with the NHS merits further discussion. I think the Government should analyse that proposition. I hope they will address the point made in my proposed new clause and look at the costs and benefits, to see whether it is the answer to the challenges we have debated in Committee.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

It is really good to be back, Mr Bayley. I will start by saying how disappointed I was by the tone of the hon. Member for Sheffield, Heeley. I felt we were having a constructive debate. In previous sittings she had made some powerful points about the need to do things differently, to facilitate families, provide support  for loved ones and recognise the need to maintain sustainability in the system. Then we had an outpouring of the sort of political rhetoric that we have not had up until now in this Committee. I find that sort of sanctimony hard to take. When I asked to intervene to challenge what she was saying she refused, on the basis that, “We all want to go to lunch.” That is the new concept of strictly limited moral outrage.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

No, I will not. Let me make the point. She talked about “this dreadful Government”. The dreadful Government are now overseeing the fastest growth in the western world.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

If the shadow Minister would listen, I suspect she probably agrees with me. This Government are now overseeing the biggest cut in unemployment for very many years, something we are all incredibly proud of on the Government Benches. There seems to be a sense of complete denial in the Opposition about the need to get public finances back under control. When we took office the Government were spending every year £160 billion more than they were bringing in in taxes.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

Every single cut that we have tried to introduce has been opposed by the Opposition.

Photo of Andrew Griffiths Andrew Griffiths Ceidwadwyr, Burton

Does the Minister also agree with me that it is this terrible Government who have brought forward this legislation that will help the people who desperately need support when they get ill in old age? Despite 13 years of a Labour Government, they never brought forward this Bill to help these vulnerable people in the way that this Government have.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health 2:15, 23 Ionawr 2014

I am grateful to my hon. Friend for making that point. This Committee has heard a lot from the other side about how much they welcome what is in the Bill. Then they try to send out a message to their supporters in the country that it is a dreadful Government. Well, it is a dreadful Government—

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

No, I will not. I am making a point. It is a dreadful Government who are introducing really important reforming legislation which will make a massive difference to people’s lives. What frustrates me above all is the fact that this is empty rhetoric, because when we challenged Opposition Members about what they would do about it, the answer from the shadow Minister was: “No, we are not talking about new money; we are talking about using the money that is available in a better way”. That is exactly what this Government seek to do by integrating care in a more effective way.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

I am grateful to the Minister for giving way. I do not apologise for anything I said, but I want to put straight the point he made. I did not say that we all wanted to go to lunch. I said that lunchtime was coming up. As the Minister well knows, he gets to respond to every point in the debate, as he is doing now. That is the point I was making. That is why I wanted to finish what I had to say. I am perfectly happy to debate the issues with the Minister—that is what we are here for—but would he have the courtesy not to portray what I said in an incorrect way?

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I do not want to detain the Committee on this. I wrote down the hon. Lady’s precise words. That is all I am saying. The point of substance is, if you make a complaint about how tight public finances are, which we all accept on this side, and if you claim that it is all a disaster, then you have to come up with an alternative. We have heard no alternative from the other side. All we had was a Government leaving office in 2010, spending £160 billion more a year than it was raising in taxes—a completely unsustainable position. We all know, incidentally, that if you do not get public finances under control, it is always the most vulnerable in society who get hit the most. We should always remember that.

So let us get back to a more rational debate, discussing some incredibly important reforms, and discuss them in a way that we have previously done with the hon. Lady, looking at some really difficult challenges for society and how we try to make lives better for people. Let us not indulge in empty political rhetoric.

New clause 13 seeks to ensure that local authorities have the resources to implement the Care Bill and deliver lasting change for the millions of people in this country who give and receive care and support. I completely agree with this aim, but there are already sufficient safeguards in place and this new clause would duplicate those provisions. The new burdens doctrine states that the net additional cost of all new burdens placed on local authorities by central Government,

“must be properly assessed and fully funded”.

All Government Departments must honour this commitment and the Care Bill is no different. The Department of Health has fully assessed the cost of implementing the Bill and published a suite of impact assessments. In last year’s spending round we ensured that the costs will be met in full in 2015-16.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

Will the Minister now confirm on the record that all the costs for implementing this Bill that we listed come from existing budgets?

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I will absolutely confirm it. The Labour party seems to believe that there is some new money somewhere, as if money grew on trees. Where is this new money coming from? If the Labour party has a proposal to bring in new taxes to pay for something additional, will hon. Members please tell us? Yes, of course this is money, as we have made clear throughout, that comes  from the way in which the Government have already spent money. We want to spend it more effectively. The shadow Minister made an absolutely fair point in an earlier debate in this Committee that it is all about how we can spend the money more effectively by integrating the health and care system. That is precisely what the better care fund seeks to achieve.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

I will tell the Minister where the money could have come from: not wasting £3 billion on a top-down reorganisation that nobody wanted and nobody voted for, and not spending £225 million on delayed discharges from hospital. Instead of having one budget, where they could have put the money in the right place—

Photo of Andrew Griffiths Andrew Griffiths Ceidwadwyr, Burton

Put it in the manifesto.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

We are full of suggestions. I am simply asking the Minister to confirm on the record, so that councils will know, that the cost of setting up the new care accounts and the means test will be coming from existing budgets. Yes or no?

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I simply make the point that the reforms that the shadow Minister criticises are achieving substantial administrative savings every year. My hon. Friend the Member for Central Suffolk and North Ipswich tells me that it is £1.5 billion per year, and the number of managers and administrators employed by the NHS is significantly down and the number of clinicians significantly up. That is the right direction. In addition, we are working closely with the sector through the care and support reform programme board to keep costs under review. New clause 14 would require the Government to publish a report on the costs and benefits of providing social care free at the point of use.

The amendment is years too late. I apologise to the hon. Member for Sefton Central for that, but the issue has been debated for 15 or 20 years. When this Government came to power, we moved quickly to set up an independent commission led by Andrew Dilnot to explore the options for how people pay for their social care. The Dilnot commission looked at the costs and benefits of different approaches, including providing free social care funded from taxation, which was the hon. Gentleman’s suggestion. The commission recommended that the best way to provide a fair and sustainable system was to put a cap on care costs.

My point was that—counter-intuitively—introducing a new spending commitment for free social care is regressive in its impact, as the people who benefit most are the wealthiest. If Opposition Members want to do that with public money, fine, but they need to be clear on that. Dilnot stated:

“Experience in other countries, such as Germany and Japan, which have recently reformed their social care funding models, demonstrates the vulnerability of a free care system to a changing economic and political environment. In both of these countries, social care costs rose more quickly than had been predicted or governments were willing to sustain, and both governments adjusted their systems—by making them less generous—to control these costs. This then went some way to undermining the promise of free care as people were still exposed to significant costs.”

The conclusion was:

“Free care is not in our judgement a resilient proposal.”

I supported the extra investment in the health service undertaken by the previous Government, but in a period of 13 years the Labour Government did nothing to reform a broken system of social care. There was a royal commission in 1999, but nothing happened to implement its conclusions, or any alternative conclusions. We had manifesto commitments and wonderful statements from the former Prime Minister—who has so much support from Opposition Members—Tony Blair. He said he did not want to live in a country where people have to sell their home to pay for care. And yet 13 years later, tens of thousands of people had sold their homes during their lifetime to pay for care, and the Labour party did nothing.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

It is worse than that. Not only did it do nothing—

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation, NATO Parliamentary Assembly (President)

Order. This is not a partisan debate. We are here to debate the proposals in the Bill. The new clauses currently under debate relate to the financing of care. We can debate the financing of care, but we will not have party political speeches about somebody who was Prime Minister three terms ago.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I will take that guidance. May I simply draw the Minister’s attention to the work done by Derek Wanless? He looked at how we had financed the health care system and recommended that the then Government conduct a similar review of social care, but no such review was undertaken. What conclusions does the Minister draw from that?

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I draw the conclusion that the reform is long overdue and that it is brilliant. I am so proud of the fact that the Government are reforming a broken system. On the cost of what the hon. Member for Sefton Central proposes, the Dilnot commission estimated that at £4.75 billion in 2016-17, with that escalating over time owing to demographic change. If that is his proposal, that is fine, as that is a legitimate alternative, but he needs to say where the money will come from and I have not heard that so far.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

The point of the new clause is to ask the Government to come up with a study to look at the costs and benefits. For precisely that reason, it is a probing new clause.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

That is precisely what we did with Dilnot. We asked Andrew Dilnot and his commission, which included Lord Warner who is a Labour party member, to look at exactly these issues and the options available. I have read to the hon. Gentleman the conclusions that the commission reached on that proposal and we are acting on its recommended proposition to implement a cap from April 2016. That is a significant step forward that will end decades of uncertainty by providing a clear system that shares the cost fairly between the individual and the state. Now is not the time for another report to go over old ground; now is the time for action, and that is what the Government are producing.

New clause 15 would require the care and support reform programme board to inform the Secretary of State that sufficient funding is available before the Bill  can be implemented. The establishment of the board is a vital step in the process and reflects our continued commitment to collaboration.

Photo of Debbie Abrahams Debbie Abrahams Llafur, Oldham East and Saddleworth

Will the Minister say how that can be married with the cuts that my hon. Friend the Member for Sheffield, Heeley mentioned this morning of 45% by 2016-17? Oldham council has had cuts of more than £10 million from social care in the last three years, which is 15% of its budget, and that will only get worse.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

The hon. Lady expresses a legitimate concern. I have never sought to deny that councils are under financial pressure—I completely understand that. We sought, because of the settlement that local government experienced to try to get public finances back under control, to compensate local authorities by way of—I think—£7.2 billion in the Government’s first spending plan and, indeed, that has since been enhanced. It is also true that some local authorities have not committed all of those resources to social care, but used them to prop up other services.

Councils of all political persuasions are under an enormous burden of responsibility to re-engineer how they work, but there is great scope for that, such as cutting bureaucracy out of the system. The tri-borough experiment in London, where three councils merged their bureaucracies into one, released funds to be spent on the front line. That seems to be exactly the way in which councils ought to be behaving.

Photo of Paul Burstow Paul Burstow Democratiaid Rhyddfrydol, Sutton and Cheam

I agree with the Minister’s balanced approach in acknowledging that local authorities have pressures on them and that different authorities are making different hard choices about how to balance their books. Would he be interested to know that a report just yesterday from Community Care that looked at a King’s Fund survey found that 64% of the local authorities who responded expected either to underspend or break even on their social care budgets this year? Of course, that leaves a third that reported difficulties, but the picture that has been presented in the debate suggests that it is far worse. The report suggests something different.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health 2:30, 23 Ionawr 2014

I am grateful to my right hon. Friend for that intervention. One of the think-tanks—I believe it was Civitas—did the analysis. When one analyses the impact of spending on services, one finds that there is not a close correlation between the money spent and the quality of the service provision. The councils that provide great services are often those that radically change the way they do things by introducing personal budgets and direct payments, empowering communities to do things differently and giving voluntary organisations a greater role in the provision of local services. Those are the sorts of changes that need to be made.

If the Labour party returns to power at any stage, it will be confronted by exactly the same challenges and will have to think about how to do things differently. What worries me is that I do not see Labour Members thinking about how that can be done and how public services can be improved in a time of austerity.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

That is not correct. Even without austerity and the cuts, we would be looking at how better to meet people’s needs. The services that I have talked about in previous sittings, which are relatively cheap and easy to deliver, can deal with the greater need. My point was that the Bill would be more likely to be successful if we had up-front funding to put those services in place before the cuts. I speak with the experience of having done precisely that 20 years ago. It is not correct to say that we do not have ideas. That is what I am asking for.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

That is a very reasonable proposition, but we have provided for that. We have gone through a rigorous process to identify the cost of implementing the Bill. We have worked closely with representatives from local government. There may have been disagreements, but it has been a highly collaborative process, and we will keep it under review. Local authorities must, of course, be able to maintain the reforms we are talking about. That is why we are saying that it should be reviewed periodically when it is in place.

The hon. Lady’s earlier contributions were thoughtful and fully cognisant of the challenges we all face, but I was disappointed that she became aggressively party political. We will simply not take sanctimony when we are having to make incredibly difficult decisions to clear up the mess that the Labour party left.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

The mess was created by the worldwide crash.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

We had the largest deficit in the G20.

I assure Opposition Members that, given our approach, it would not be possible to get to the point of implementation without being informed of the opinion of our partners on all aspects of the reforms. It is neither necessary nor appropriate to elevate a particular board to legal status simply to give prominence to a view that we could not possibly ignore even if we wanted to. I therefore hope that, on reflection, Opposition Members do not press their new clauses to a Division.

New clause 16 would establish an independent ministerial advisory committee to keep the level of the cap under review. There needs to be ministerial oversight of the implementation of that critical set of reforms to ensure that they deliver both protection against catastrophic costs and peace of mind, with the most help going to those with the greatest need. The new clause would place ministerial oversight, an activity that is in the normal course of Government business, on the face of the Bill. One of the key drivers of the reforms is the need for greater certainty and clarity on the potential long-term costs of care. Creating an additional ministerial oversight committee would introduce uncertainty and give the impression that the system was subject to change at any moment. It would undermine the certainty and peace of mind that the cap will deliver, and make it more difficult for the financial services industry to develop products.

Again, I make this offer to the shadow Minister: it would be far better if we could agree that the framework of the funding reforms makes sense, and that the reforms provide greater certainty and protection against catastrophic loss. There can be a debate in the years ahead about the level of the cap, but let us, as a group of politicians  coming together, support the case for the reforms and then go out and raise awareness, and ensure that we give them the best chance of succeeding. The issue would be important for a Labour Government, too. Crucially, it is important for the people who rely on the social care system.

Photo of Sarah Newton Sarah Newton Ceidwadwyr, Truro and Falmouth

The Minister is making an essential point, as we are so close to the general election. Dilnot and all the thousands of people who have been involved in the debate over many years have said that, unless there is cross-party support, the reforms will not stand a chance of working. The financial products and all the other things that need to come into place simply will not do so. It is therefore essential that we hear an answer from the Opposition this close to an election. Otherwise, people who need the reforms simply will not benefit from them.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I agree. That was a helpful intervention. I just do not know where the Opposition stand—that is the problem—and I do not know when we will find out.

New clause 17 would require the Office for Budget Responsibility to complete by the end of 2014 a review of the funding of social care, and the cost and impact of the reforms. The Government have robust processes in place to ensure that policies are costed accurately. We have published full impact assessments for all the reforms and have worked closely with the sector and leading experts to ensure that the reforms are based on the best possible evidence.

In addition, when allocating funding for specific policies, the Government need to take a broad overview of activity across all public services and not look at individual policies in isolation, so they can make the best possible decisions. That is the purpose of the spending review, and why a spending review is the best place to take funding decisions.

It would not be productive to ask the OBR to repeat the analysis in 2014, as that would duplicate what has already been done, and it will have no further evidence on which to base its work. Nor would that be an appropriate role for the OBR, which is independent and has complete discretion to determine the content of its publications and its programme of research and analysis. Instead, we will conduct post-legislative scrutiny, which the Government have committed to do across the board for all new Acts.

New clause 18 would require the Government to lay before Parliament impact assessments for regulations on eligibility criteria, financial assessment and deferred payment agreements. They are three elements of the reformed care and support system, so I recognise the desire to ensure that proper consideration is given to their impact and that that is published. I hope I can reassure the Committee that it has always been and remains our intention to publish impact assessments for those regulations, and for all regulations associated with part 1.

We have already heard support in the Committee for the open and collaborative approach that has been taken to developing part 1. I have not been the only one to demonstrate support—other hon. Members have  done so. That collaborative approach does not end here. It will continue through the publication of draft regulations for part 1.

We will definitely publish impact assessments for regulations made under part 1, but it is unnecessary to place such a provision in the Bill. I trust that that provides sufficient reassurance for hon. Members not to press the new clauses to a Division.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

First, there was a worldwide financial crash affecting all western industrialised countries. Our former Prime Minister helped to pull the country back from a depression—[ Interruption. ] I am answering the points raised by the Minister, and it is only fair. We did not bring that up—he did—and I am going to respond. Unemployment was coming down. We were borrowing less than we had expected post the crash in 2010. For the record, it has taken this Government three years to get back to where we were before.

Secondly, I am proud of what we did on social care. We started the whole process of introducing rights for carers. We put in investment, carers’ breaks and training for carers. I have seen all of it. Before the general election, we had a big and bold proposal on funding social care—the Minister would have signed up to it if it would not have turned into a dreadful row with his Conservative partners. We have made positive proposals to improve the Bill and try to work together where can. Outside the Committee, we proposed big, bold plans for a fully joined-up health and social care system, which would have made better use of taxpayers’ money, but our job in Committee is to scrutinise the Bill. That is what we are doing and it is right that we are doing it. I hear what the Minister says about our new clauses. I am happy not to press them to a Division, but I am proud that we put the issues on the record.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

I am disappointed that the Minister was disappointed. I am also disappointed that he described the political rhetoric as “empty”. It might have been rhetoric, but it certainly was not empty. I will not talk about the coalition’s fantasy of how the economic crisis came about and Government Members’ failure to mention how well the Labour Government were doing, or the fact that the economy was growing and the coalition Government choked it off. I will not mention those things because they are not the subject of the debate. I entirely accept that the debate is complex and difficult, so coming to a position is not easy. We can say, “Your Government didn’t do this and your Government didn’t do that,” but it is a complex and difficult subject, so it would have been preferable to have proper agreement on everything.

The Opposition support the overall approach to well-being. I have already been critical of a number of aspects of it, but I see where I made my mistake: I was critical in an aggressive way. The Minister said I was aggressive, but I would have said I was assertive—women are used to being called aggressive when they are being assertive.

I genuinely feel angry. I spent a lot of my career in social work and as a local councillor having to make cuts, and it is tough—extraordinarily tough. When I raise the issue of funding, as I do with my new clause, I do it with genuine concern. It is heartbreaking to sit  with people in the NHS and the local authority who say, “We don’t know where we’re going to find the money.” I get angry because we all know and understand the differences of deprivation, and the greater reliance on the public sector, in certain parts of the country.

The Government’s choice to give a greater proportion—it is not a fair share, as the Minister has claimed—of the cuts to local government and services has devastated some of our councils. The choices councils have to make are on whether they close every library, sports centre and everything they do not absolutely have to provide so that they can provide care services and completely protect their child protection services. That is what my local authority has done. It had a 5% cut to its adult services, but has defended its child protection services.

It is easy for us. When I sit with councillors, I feel dreadfully sorry for them, because they have the weight of tremendously difficult decisions on them. The Minister and his hon. Friends are asking an awful lot if they think that we will sit here and not at times get angry and raise our voices. We are elected and sent here by our constituents. We have to do right by them. I do not think I would be doing right by them if I did not raise these issues, even if he does not like the way I raise them.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health 2:45, 23 Ionawr 2014

I made the point at the start that most of the hon. Lady’s contributions in Committee have been brilliant. They have been constructive and thoughtful and she obviously speaks with a lot of experience. I agree that things are tough. There are really difficult challenges out there and they will probably get worse because of the demographic change that we face. But does she not agree that it is incumbent on all of us, at whatever level of government we are, to find ways to make the money go further, to stretch that public resource to ensure that we safeguard and secure the services that are really important for some very vulnerable people? It requires innovation and change and a willingness to do things differently. Does she agree?

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

I do agree with that but top-slicing budgets that are already under pressure to produce the new innovative ways of providing the care will make it extraordinarily difficult. I worry. I went to see my director of adult services only a few weeks ago and I spoke to her in great depth. We agreed that some of the cuts they have had to make that withdraw services from people who are deemed not to be at a high level of need are likely to be the wrong thing in the long term. There are some innovative approaches going on. There is a great new scheme happening in the Lowedges, Batemoor and Jordanthorpe part of my constituency where funding is being found from some budgets to employ community support officers.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

Great place. They are coming up with innovative solutions to problems that elderly people and lonely people face. They are not just bringing in the public sector but the baker and the Co-op—a great thing too—to help support people. They are using local  services and local businesses to do that. That work is ongoing, but inevitably, all public sector organisations, whether it is the NHS, GPs or social workers, have things they absolutely have to do. If the money for the things they absolutely have to do keeps getting cut, finding that money to go into the services that will save money becomes nigh on impossible. They get so exhausted because they continue to give of their time and energy to undertake these tasks and they find there is no energy to provide these new innovative solutions.

Photo of Jamie Reed Jamie Reed Shadow Minister (Health)

Is my hon. Friend concerned that there might be a particularly disproportionate regional aspect to this? I am not talking just about the north of England but about peripheral economies, areas of market failure whether they are Conservative, Liberal Democrat or Labour areas, where precisely the kind of situation she describes will be most keenly felt.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

I am. One thing I wanted to mention in responding to the Minister is that the figures I quoted were from the County Councils Network, which is not massively Labour, and the Local Government Association, which is cross party. It was not party political rhetoric as such. It came from those people who will have to implement the measures. I know the Minister was disturbed that I would not take his intervention. I was genuinely concerned about the time and wanted to move that forward. He has been in the House longer than me but it has been my experience in Committee, and certainly when I was a Minister, that generally speaking, Ministers respond at the end rather than by intervening in colleagues’ speeches. That was why I did not take his intervention rather than being hungry or something. I hope that has reassured him on that matter.

The Minister rightly referred to the new burdens doctrine. That was the basis on which I tabled my proposed new clause. His officials have undertaken an impact study and come up with certain figures. I am afraid those are disputed by me, based on figures prepared by the Local Government Association’s County Council Network. There is a fear that this measure will not achieve what we want, due to a lack of proper funding.

I explained that this was a probing new clause and that I did not intend to press it to a vote. The Minister might be pleased to know—though I am not sure about my Front-Bench colleagues—that I do not support free care for everybody. I think there are a lot of pitfalls. I set out my position earlier: a system that levers in as much community, family and other carer’s support as possible by meeting whatever they need so that they can continue to perform the wide range of tasks that they do.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

May I express my delight that the hon. Lady is back on track and speaking sensibly again? That is so welcome.

Photo of Meg Munn Meg Munn Llafur, Sheffield, Heeley

I am not sure what they call that, Mr Bayley. However, as far as I was concerned, I was never off track. Some day the Minister may come to understand that the Member of Parliament who gets up and has a go because they are angry and concerned about their constituents is precisely the same person who has lots of experience of this area, has some good ideas about how  it should go forward as well as legitimate concerns about how the legislation is drafted and how it will be implemented. I hope he will come to see that in his calmer moments.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

The continual accusations about partisan politicking coming from Government Members are interesting given the way that they intervene. I will not repeat the responses to the partisan comments from Government Members. I am far more likely to listen to the advice of my hon. Friend Member for Leicester West than the Minister’s on my new clause on free social care. I am grateful to the Minister for going through the detail of the analysis of the Dilnot commission and the international comparisons, and I take the point. However, I do not think this issue is going to go away. I do not think it has been resolved by the process of the cap, which is the point I made earlier. I predict we will return again and again to how we pay for social care and whether it should be free at the point of use.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

I have received information, Mr Bayley, that the hon. Gentleman has tweeted that I have said that local authorities will have to pay for new responsibilities from existing budgets. That is simply not the case and I wanted to put the record straight.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

The Minister has not denied the point put to him by the shadow Minister. The logic of that point is that that is exactly what will happen. That is exactly what he said. I will give him the chance now to say on the record that new money will be provided to local authorities to pay for the new requirements under this legislation.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

The better care fund sensibly encompasses all the different elements of sums both for the implementation of the Bill and adaptations to people’s homes and money coming from the NHS. Of course, the whole point is that it is grouped together into one fund, because all this is related. However, these are clearly identified resources that will be used to implement this Bill and are additional to what councils would otherwise have had.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

There is a lot of double counting going on. I shall take interventions shortly from my own Front Bench, but I will just tell the Minister what my local authority said on this issue. It is very clear that it is not new money and that it is insufficient to cover the known additional demands—and that is before the Bill comes in. It also says that the money is to be found from hospitals, which will create pressures of its own and is a point that we made earlier in the discussion.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

Perhaps my hon. Friend would agree with me. I do not know why the Minister will not say that £335 million for setting up the early assessments, deferred payments and information campaign comes from council budgets, and that £130 million directly for adult safeguarding boards and assessments for carers comes from the better care fund. That is what councils say. In the spirit of honesty, for which the Lib Dems are well known, I would have thought the Minister would confirm that point.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

Once again: what I put on the tweet is very clear. I will give the Minister the opportunity now to say on the record that every penny of the new duties and responsibilities being given to local authorities as a result of this legislation will be provided.

Photo of Norman Lamb Norman Lamb The Minister of State, Department of Health

The reason that I objected is that it is untrue. Councils would not have had this resource had we not been introducing these reforms. There is a clearly identified sum of money, which has gone through a rigorous and robust process, being allocated to local government as part of the better care fund, which they would not have had but for these reforms. I would be most grateful if the hon. Member could withdraw what he has said in his tweet, because it is not true.

Photo of Bill Esterson Bill Esterson Llafur, Sefton Central

I am listening very carefully. I have given the Minister a number of opportunities to put on the record that local authorities will be given the funds to pay every penny of the new responsibilities and duties. He has just not said that, so I stand by what I have said. The expectations among service users and carers is another point made to me by my local authority. It says that central Government should provide funding for the initial peak in work that passing the Bill would generate. It makes the same point as the LGA: there is real concern that local authorities will have neither the money nor the facilities—by which they mean software and staff—to get up and running immediately when the Bill is passed. They request that the Government provide both funding and access to relevant data to each local authority to support the transition. That is the view of local authorities. I have heard nothing from the Minister to indicate that what the local authorities say is not true, so I stand by my comment.

As for my amendment, this issue will not go away. Mine is a probing amendment. I understand the analysis, but we have not anywhere near resolved this issue for the long term with the proposal the Government are bringing forward. Although I will not press the new clause, I fear that we will come back to this in the very near future.

Photo of Hugh Bayley Hugh Bayley NATO Parliamentary Assembly UK Delegation, NATO Parliamentary Assembly (President)

We have had a good debate on the new clauses that were grouped with a stand part debate on clause 72, which we have hardly mentioned. We have been told that each of the new clauses will not be pressed to a vote, but we have to dispose of the question that clause 72 stand part of the Bill.

Clause 72 ordered to stand part of the Bill.

Clause 73 ordered to stand part of the Bill.

Schedule 3 agreed to.