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Care Services: Older Adults and Disabled People

My Lords, the noble Baroness, Lady Fookes, spoke so eloquently about these important issues and I congratulate her on securing this debate. We know about the ageing of our population and we know that the huge numbers of older people will include many with acquired disabilities even if they did not have them earlier, so we are talking about very large numbers of people. Yet unfortunately age discrimination is still rife and those older people who need care and support often get much smaller packages than young people who have similar needs. I remember saying very often that if you are going to get a disability, make sure you get it before the age of 64 because your benefits and the help you get will not be the same if you are older. That is really unacceptable and it just goes on. We need a clear timetable for reform where it is so urgently needed. All the different payments and care sources need to be brought together so that people who are frail and vulnerable and often in a crisis situation—where they and their families may be in urgent need of advice—do not have to go from one place to another. If you are frail, old and tired, you cannot always do that. People just need a one-stop shop where they can get the advice and help that they need without charge and they know exactly what is going to be available to them. We also really need to have human rights embedded in the services that are provided. Human rights can do a great deal to ensure dignity and respect for people, and should be at the heart of commissioning as well as regulation. At the moment an awful lot of the help that is provided has become more and more task-oriented and time-limited. If a care assistant or a worker goes into somebody’s home they just have time to get them up or put them to bed. They do not have time to deliver the humane care and the kindness really needed by the sort of people we are talking about, who are very vulnerable, often very lonely and desperately in need of help. The personalisation agenda is very good. It can help enormously and, as the noble Baroness, Lady Fookes, has said it must be introduced with a high degree of sensitivity, recognising that a lot of people will need continuing help in managing the care package they will receive. That package and the resources allocated to it should be fair and transparent; it needs to be outcome-focused, as Age Concern and Help the Aged have stressed continually. Free advice is essential and funding remains an enormous issue. On dementia, which the noble Baroness, Lady Fookes, underlined, 75 per cent of people in care homes today suffer from some form of dementia, but two-thirds of all sufferers are actually still living in the community. This is a desperate situation, not just for them, but for their families and those who care for them. Unfortunately, we know that the early stages of dementia are often misdiagnosed and that dementia research is abysmally underfunded. It receives just 2.5 per cent of the Government’s medical research budget, but more people suffer from this than suffer from cancer or heart conditions. It is an urgent need. We must get more research done because we must find the answers to this huge problem. The national strategy is excellent, but there is no mention in it of research funding, which is a huge omission. An awful lot of people suffering from dementia are at the beginning of an appalling journey into the care system. Discrimination is even worse when we talk about dementia. Even calling it "social care" when other illnesses come under the NHS is one form of discrimination that should not continue. We have heard it eloquently said that a new, fair system of funding must be found for residential care. There are all sorts of proposals, some of which are excellent. The organisation with which I am connected, the ILC, has proposed a national care fund, which is an interesting idea. However, whichever system is used, whether it is that proposed by Wanless, the Rowntree Foundation or the King’s Fund, we must soon find an answer. We must also do something to protect the self-funders, who are often subjected to an illegal, unpublicised tax by having to pay extra to care home managers to fund their care because their local authority’s funding does not cover it. That is not the way in which taxes should be levied in this country. We must find a way of ensuring fairness and equality in the long-term reform. If we cannot get it from the Green Paper, we have to hope that the equality Bill will do something to ensure that it happens before very long. We know that preventive care has virtually disappeared in recent years, so the people we are talking about are left without the help that they need. I hope very much, as has been said, that the Green Paper is not lost as the forthcoming election draws closer. We need a single budget as the basis of assessment. The transformation agenda could do a great deal to make this a reality. One-third of men and a half of women over 65 will need some long-term care. There is a strong case for bringing the funding streams together and producing sound advice for every family facing these serious and difficult issues, which are not easy to face. We must have a service which puts the individual and their family first and which gains the confidence of all our population, both young and old.