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Care Services: Older Adults and Disabled People

My Lords, in moving this Motion, I am reminded of a conversation that I once had with the late Enoch Powell, who explained that he never made an important point during the first two or three minutes of his speech so that those who were rushing in to hear him would get its full effect. When I pointed out that it might be the reverse in my case, with people rushing out—we see the proof of it now—he replied, with impeccable logic, "The principle remains the same". None the less, I feel constrained to move swiftly to this very important subject. The statistics are quite frightening. We now have about 11 million people of pensionable age, and that figure is likely to rise considerably in the next 20 years, with those over the age of 80 becoming even more prominent. We have about 2 million blind or partially sighted people to care for. Some 7,000 people—I mean 700,000; would that it were 7,000—are suffering from various forms of dementia. Again, we are told that in the absence of any medical cure, that number may well rise to 1 million within the next 20 years. The amount spent is very great. On present arrangements, it is about £13 million, but that of course leaves aside payments made through the benefits system and the incalculable amount provided by carers, described formally as the "informal carers", which means in practice that they are paid nothing for the work that they do. I would be interested if the Minister could give an indication of the monetary effect if all the informal carers suddenly disappeared. I think that it would be a frightening figure. All is not well in the system as it stands, caused partly by what I call a crucial and essential fault line in it—the division between health and social care and the payment of benefits. We are always being told that the NHS is free at the point of delivery while social care, delivered by the local authorities through their social services departments, is means tested. So the system is complex and unfair, and people do not know where they are with it. The most notorious effect is on those who have to go into a care home. It is a traumatic experience on its own, and one of the most crucial and terrible decisions someone has to make. It is made infinitely worse if they know that the value of their house has to be taken into account in deciding what level of care they receive. It is also extraordinary that many of the people now entering care homes are suffering from Alzheimer’s or similar conditions which I understand—the medics will correct me if I am wrong—is a medical condition and a fault in the brain. Patients become confused, are liable to wander, suffer memory loss, and it then becomes social care for which they then have to pay. What is more, the regulations are not easy for people going into such care to understand. In the course of my researches I found a very interesting paper prepared by the House of Commons Library for MPs with constituents with these problems. It explained that the system and rules were complex and lengthy, and that it could give only a brief guide. That brief guide consists of 17 pages of close print. It is no wonder that people do not understand what it is. Let us look at the eligibility criteria, which vary from local authority to local authority. Although some attempts have been made to standardise them, they can still be difficult for people, especially if they move from one local authority to another. We had a terrible example of that during the debate on the Bill introduced by the noble Lord, Lord Ashley, last week. Someone moved to another authority and not only did they not receive the same package, they received no package at all until it had been worked out anew what it should be. With the monetary problems that all councils now face, it is tempting to tighten up the criteria. If someone is no longer eligible, the authority can save money. We have evidence that this is happening, and it is effectively rationing by the back door, so all is not well. We expected the Government by this time to give some clear guidance on the way forward for the system of care for older people and those with long-term disadvantages. They seemed to start brightly enough with the new Prime Minister saying that it was wrong for people to have to sell their homes to pay for care, and setting up a royal commission which reported some 10 years ago, but very little has happened since. There has been a bit of tinkering here and there and we were promised a Green Paper in spring 2009. Spring has arrived, so where is the Green Paper? Maybe the Minister can tell us when we may expect it. But, let us face it, even if she were to announce its contents this afternoon, a Green Paper is by its nature a discussion document, and one can expect some months of discussion before a legislative programme is put forward. However, as we are nearly at the end of this Parliament—it cannot go more than about 14 months at the most—in practice we will see nothing by way of a new deal this side of the general election. In the absence of clear guidance from the Government, various organisations have put forward their own schemes, notably the King’s Fund, in the shape of the Wanless report which came out with some very interesting proposals, particularly on the financing of care. It very sensibly said that one cannot expect the state to do everything, but that we need a clear division of responsibility so that everyone knows where they stand. It put forward about four options, one of which Sir Derek Wanless particularly liked and called co-payments. I prefer another one, which he called limited liability, which is very similar to an option put forward by the Conservative Party, whereby the person concerned is means-tested for the first two, or perhaps three, years, and thereafter the state picks up the tab, so at least one knows that there is an end in sight in what can otherwise be a very alarming situation for the person concerned. We need to look far more carefully at empowering people to help with their own way of caring. In the past, a person has been on the receiving end rather than being a partner. It is part of the "Does he take sugar?" syndrome. Noble Lords may remember the Radio 4 programme of that name about the needs of disabled people and the tendency for people to ask, "Does he take sugar?" when the person is sitting there and can quite well say, "Yes, I do," or "No, I don’t". That is something we need to build firmly into any new system. That is why I favour the idea of direct payments where, instead of the social services department deciding what should be done, the person or, more likely, the informal carer, will be given the possibility of deciding exactly what form the care should take. However, there are pitfalls, and where it has been tried out, it is plain that people need to be assisted with the administrative side. It is no good expecting them to take on responsibilities for payroll, national insurance and all that goes with them. It seems to work well where there is a third party to whom people can turn to carry that out for them. That is something I would like to see universally adopted. Even more radical—but it comes up against my fault line, as I have described it— is the idea of bringing together all the various streams of funding into one package so that there is even greater freedom. However, that cannot happen while we have this divided responsibility. Local authorities which have tried to work this have seen that there is an absolute bar on carrying it out properly. What of the carers who play such a crucial role? I feel very sorry for some of them, for many of them in fact, because they have often given up their own careers or have made them much less successful than they otherwise would have been. They have been tied night and day, and they have constant worries about what might happen if they are not able to carry out those responsibilities. Some of them must feel like an old banger of a car made to work day after day, doing unending mileage with minimal maintenance and certainly no servicing, until they end up as a virtual wreck. Before we do anything else, we need to look to helping carers. I believe that one of the things that would most help them would be respite care universally provided if they want it. It is very much easier to go on if you know that you can stop for a while. The other point is that unexpected emergencies will sometimes occur and put the carer in a very difficult position. Carers would like to know that there is an emergency aid post, as it were, to which they could go if unexpected circumstances make it impossible for them to care. Those two items alone would do much to improve the lot of those on whom we rely tremendously. One further point comes from the idea of people being partners in their own care. We need to go beyond the minimal package to make sure that people can eat, dress and all the rest of it; we need to make sure that they can live fuller, more interesting lives. The noble Lord, Lord Rix, will remember that when we were considering the Mental Capacity Bill in Joint Committee, one of the most moving sights was that of people with a learning disability coming to give evidence before us themselves—not people speaking on behalf of them, but them speaking for themselves. One of the points that they made was how much simple things such as choosing their own breakfast or wearing their own clothes meant to them. I give that as a simple illustration, but it can be extended way beyond that to people with all kinds of disability. For example, people who move into a care home may miss terribly the pet which they have had for years. We could do far more in care homes if we allowed pets where people wanted them. That is a simple thing, it need not cost a great deal, but it would make all the difference in the world to the quality of lives. Recently, I went to a dance performance at the Queen Elizabeth Hall—other noble Lords may also have attended—to watch the Candoco Dance Company, which mixes disabled and able-bodied dancers in one troupe. It was an amazing performance and it was very difficult to tell the difference between those with disabilities and those without until it was made clear to us. Who would have dreamed of that happening years ago? That is an indication of what could be done. Years ago, I remember my mother, who was a very keen bowler of county standard, being delighted to help with bowls matches for those who were blind or very partially sighted. I never quite knew how that was managed, but I know from what she told me that it gave great pleasure all round. We need to be far more imaginative than we have been hitherto. I pay tribute to those organisations which provide activities for people. I think in particular of the place where I was an MP, in Plymouth, where Plymouth Age Concern had done a magnificent job in making all manner of provisions for their people and had immensely improved their lifestyles and happiness—and probably their health as well. There is a great deal to be done. I can only touch the surface of it in this opening speech, but I look forward to the contributions which will be made hereafter in the debate. If we wanted a single example of the contribution that older and disabled people can make, we need look no further than this House itself, where the average age is 69. I rest my case.