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Care Services: Older Adults and Disabled People

My Lords, this has been a fascinating debate. We have heard 10 excellent speeches. I, too, congratulate the noble Baroness, Lady Fookes, on initiating the debate. Its timing is absolutely perfect. In those 10 speeches, we have heard about families who have been very significantly affected by physical or mental impairment. The noble Baroness, Lady Gardner of Parkes, made an emotional and powerful speech which demonstrated that no matter how strong a family is, the fickle finger of fate can strike unexpectedly. This is not an argument just about people who are in financial adversity; it can hit anyone. If you are looking for another example, look at what the author Terry Pratchett has been able to do in demonstrating his courage. He is so successful and established, and his bravery in confronting his condition is an example and a signal for many that there are planning and practical things that can and should be done. I hope that this debate will encourage people to think about these kinds of things. More than anything else, I add my voice to those who say that the delay that the Government are now engaged in is completely unconscionable. The noble Lord, Lord Sutherland, used the word "scandalous". Many of us studied the valuable piece of work that the noble Lords, Lord Lipsey and Lord Sutherland, did 10 years ago. For me, it was the appendices and the volume of evidence that the Royal Commission put into the public domain that convinced me beyond peradventure 10 years ago that this was an unanswerable case and something had to be done. There were high expectations that something would be done, and those expectations have been dashed. That is not a cost-free problem. In those 10 years, if people had had a signal about the direction of travel that the Government were going in, they could have made practical dispositions and taken steps to try to configure their lives during their working life by saving contributions, taking out insurance policies during their working life and building up circumstances to protect themselves for longevity and long-term care. No one has been able to make any sensible dispositions, because we do not know what the circumstances are going to be. It is absolutely imperative. It is not the Minister’s fault, because she is perfect in every way as a Minister. The Government have got a case to answer given the lack of any real direction of travel. Reports have been published not just by the Royal Commission but by the King’s Fund, the Wanless commission and the Joseph Rowntree Foundation. There is no shortage of things that can and should be done. The noble Lord, Lord Lipsey, is right to say that the resources that we are looking for will be harder and harder to find. That is not a reason for doing nothing. I do not think that he was saying that; I think that he was saying that we have to be practical and realistic. Everyone is prepared to be practical and realistic, but as a nation we have to understand that the total wealth devoted to this subject will have to increase, because we are all living longer. One in four people born in the United Kingdom today will live to be 100. Even if we do nothing, it is going to cost us more. Of course, the funds have to be found from somewhere, and we cannot look to the Government to do everything, because taxation has a part to play. No one is saying that this all must be paid for out of general taxation. People are looking for individuals to be encouraged to make working-age contributions, and they even are looking for families who can to make positive contributions, either out of personal pensions, state pensions, liquid assets or heritable assets. No one thinks that this is going to be easy, and everyone wants to contribute to sharing some of the costs. The point made by the noble Lord, Lord Sutherland, about sharing risks is nearly as important as the costs; it is an essential part of this deal. If you can share the risks across the generations, across age groups and across households, you get a much better deal for everyone. These things are obvious, and they are staring the Government directly in the face. It is puzzling why it has taken so long to get a Green Paper, for heaven’s sake. The point was made by the noble Baroness, Lady Fookes, at the beginning of the debate. That suggests to me that there is no prospect of legislation this side of an election. We may have a new Government after the next election, for all I know. You never know what might happen. That Government might say that they need a Royal Commission to start again. The situation is urgent. People may say that long-term care is a long-term policy, and it is, but we are running out of time to enable people to make proper dispositions for themselves and their families and in the future to protect themselves against some of these devastating things that can hit families. The demographic trends are known and have been mentioned. I wonder whether people understand just how dire some of the resource problems and care problems will begin to look. Looking at the demographics, by 2050 there will be twice as many people over the age of 85. That has really compelling policy implications, not just in health, care and transport but other things. We need to understand the extent of the problem. I was very encouraged by the speech made by the noble Baroness, Lady Morris of Yardley. We are far too unambitious about what we can do with people who are reaching the end of their natural life. As someone who spends quite a lot of time in the House of Commons gymnasium, I can tell you that its locker room is an interesting place to be; you learn all sorts of things in strange circumstances there. I learnt from the professional assistants there that every one of us can be a relatively fitter 70 year-old than we were at 60. You can target improvements in VO2, health and that kind of thing even at the end of your natural life. We need to introduce arts, photography and music and to involve the community instead of doing this care thing in isolation as we seem to be doing. We are heading towards personalisation. I can understand the value of that, but I am fearful that that just means that people are thinking that everyone can do it for themselves. There is a much wider community interest in this subject. We must not lose that in the pursuit of personalisation of care, which is worth having for itself. We also have to consider that the context in which this debate is taking place has changed from 10 years ago. The noble Baroness, Lady Greengross, who made an excellent speech, with all of which I concur, made the point about human rights now, rightly, being a much bigger part of the equation. Look at what the Government are doing with the Equality Bill, which is being delayed. It looks as if the age discrimination legislation, which the Government are right to advance, is also going to be delayed. Both of these things are intrinsically important to get the dignity and respect agenda properly implemented and enforced. Human rights and dignity, to which we all aspire, are something that the Government need to look to in making their Green Paper proposals. Noble Lords mentioned quality, which is very important I can hand on to the Minister for her Easter reading the book by JM Coetzee Slow Man. Coetzee is a very dark author, but he is a wonderful writer, and he describes the circumstances faced by someone who loses a leg in old age, whom he describes as eventually being "unstrung" by the experience. It is a very interesting book, because what he describes more than anything else is the value of the quality of the care rather than the clinical aspect of the package. Some colleagues mentioned that earlier. Sympathy and companionship are nearly as important as the clinical standards that are produced in the package. In the book, he is really saying that you need to care as well as to promote care when you are trying to help people in these dire circumstances.