---

Care Services: Older Adults and Disabled People

My Lords, I congratulate the noble Baroness, Lady Fookes, on her choice of subject and on the absolutely outstanding way in which she introduced it. There can be few issues more important or wide-ranging than the care of older and disabled people. Today, the noble Baroness has provided an opportunity for this House to debate the crucial questions of how we care for and support some of the most vulnerable members of our society. I shall not be able to take advantage of the full time allocated to me because I wish to give the noble Baroness, Lady Fookes, time to respond to this wide-ranging debate. Therefore, if I do not reach any specific questions that noble Lords have put to me, I promise to write to them. Demographic change is, of course, one of the biggest challenges that this country faces, as was pointed out by the noble Baroness, Lady Fookes, and others. We live in an ageing society but it is important to remind ourselves that older people are healthier, more active and more aspiring than before and that life expectancy has improved. Today’s 65 year-old man can expect to live until he is 81 and a woman can expect to live to 84. Older people want to enjoy good health and remain independent for as long as possible. As people get older, remaining independent often depends on health and social care being effective enough to support them. In many aspects of care for older people, the NHS and social care in this country lead the world, thanks to the expertise and dedication of the staff. I thank the noble Lord, Lord Kirkwood, for branding me as something like the Mary Poppins of the Government, but I take issue with him on one point. We are very much aware that these are enormous challenges which have to be resolved over a period of time. There is no silver bullet here. However, I think it is fair to say that the current health and social care system has changed substantially from the one that the Government inherited in 1997. I hope that we now have a system that is more responsive, more flexible, more expansive and more empathetic. Concerns about the care of older people are not new. This Government introduced the first National Service Framework for Older People, the first ever strategy aimed at ensuring high-quality, integrated health and social care services. Since the national service framework was published, there has been steady progress in eliminating age discrimination and improving community health. We have also taken action to extend, for example, access to preventive services, such as flu vaccinations, blood pressure control and breast cancer screening. Older people, in particular, are reaping the rewards of this extra investment. The next-stage review of the NHS by my noble friend Lord Darzi, published in June 2008, presents a vision of the NHS that consistently delivers the highest quality of care to patients and empowers staff to offer care that is personal, effective and safe. High Quality Care for All, the final report of the next-stage review, sets out the national framework that will enable and support the delivery of the ambitious visions for health and social care published by strategic health authorities last year. We are also facing unprecedented challenges within social care. An ageing population, higher expectations about what services should be delivered and technological changes mean that a radical rethink is required of the care and support system to meet long-term pressures. That is why, later in the spring, the Government will publish a Green Paper, referred to by many noble Lords, on the reform of the care and support system. This will look at options for developing a sustainable care and support system and at whether it will be possible to develop a new system for all adults and not only for people over 65. The noble Earl correctly outlined the challenges with his usual eloquence. I take on board his reading recommendations, together with those of other noble Lords. Noble Lords should be, and I believe are, aware that a great deal of work has gone into developing the Green Paper. The public engagement process that ran throughout 2008 enabled many thousands of individuals, as well as organisations, to inform its development. They included the NHS Confederation, the Local Government Association, the TUC, Carers UK, In Control, Age Concern, Help the Aged, Mencap, the Disability Alliance, the Learning Disability Coalition, the National Centre for Independent Living, the Royal College of Nursing, the Allied Health Professions Federation, Crossroads, the Equality and Human Rights Commission, CSCI and so on. Therefore, a great deal of thought has gone into the preparation of the Green Paper. Noble Lords are correct that the Green Paper will not offer a definitive answer to the challenges that we face, but it will give staff, stakeholders and the public the chance to shape the solutions that we take forward. Again, the noble Earl was correct in saying that this is a very serious challenge. Although the Green Paper will be a major step forward, it is only part of the journey that we are undertaking in transforming care and support. My noble friend Lord Lipsey, with his long-standing expertise, outlined many of the challenges in, as he put it, the landscape of reality that we all face. I also agree with my noble friend and the noble Baroness, Lady Thomas, about the importance of good-quality, accurate and independent advice and information for those facing the challenges of old age. Noble Lords will be aware that the Government launched the national dementia strategy last month, as was mentioned by the noble Baronesses, Lady Greengross and Lady Gardner. We hope that this landmark document will set out initiatives to increase awareness of dementia, ensure early diagnosis and treatment, and radically improve the quality of care that people with the condition receive. We are also investing in research into dementia and related neurological conditions. I hope that, as a Government, we are taking steps to deliver better services for older people. In May 2008, my colleague in another place announced that a prevention package for older people would be developed to address the challenge of providing more and better preventive care. Therefore, we are taking forward core prevention services, such as sight tests, and making the case for commissioners to improve services for foot care, falls and fractures, together with all the important preventive measures that can make such a difference to the lives of the elderly. Through the carers strategy, we have put a deserved spotlight on the unsung heroes in our society, movingly explained to us by the noble Baronesses, Lady Gardner and Lady Fookes, and others. I refer to the 6 million carers who make an enormous contribution to their local communities and who should get all the support they need to continue this important work. We launched the carers strategy in June 2008. The aim of its key components is to ensure that carers have increased choice and control, and we are investing £255 million to ensure that the new strategy is implemented. That includes £150 million over two years for people to take breaks from caring—a point rightly highlighted by the noble Baroness, Lady Fookes. Before moving on, I shall refer quickly to a few other points that were raised concerning older people. The noble Baroness, Lady Thomas, made a very interesting contribution about the Hampshire commission’s report, which I should like to read. It seems to take a very practical look at the challenges that people face, and it sounds like a document that deserves wider appreciation. The noble Baronesses, Lady Fookes and Lady Thomas, and the noble Earl, Lord Howe, raised the issue of people selling their homes. In 2001, we ended the unfair system whereby people in care homes paid for their nursing costs by selling their home, and introduced deferred payments to help people to avoid having to sell against their wishes. However, charging for care is not new; people have always had to pay for their social care, but there is obviously a continuing debate about that. The noble Baroness, Lady Fookes, raised the issue of personalisation and giving people choice and control over their social care needs. Putting People First, when it was launched over a year ago, earmarked £520 million in total to develop personalised social care, £85 million of which has already gone into the system and £195 million is coming on stream in the next year. It is central to the transformation of giving individuals a personal budget and understanding how it should be met, but I agree that it has to be a supported choice. So far I have focused on the needs of older people but we should not forget the challenges we face concerning all adults and disabled people who have the right to expect quality of citizenship, independence and a full life, as mentioned by the noble Lord, Lord Rix, the noble Baroness, Lady Emerton and the noble Earl, Lord Howe. Last year the Government launched the independent living strategy which aims to give disabled people greater choice and control over the support that they need to go about their daily lives and how it is provided. We are making progress in delivering this strategy and we are committed to measuring it and reporting on it annually. The principles of control, choice and, particularly, empowerment are fundamental to Putting People First. This concordat sets out a cross-sector commitment to personalising public services and the need for the state to empower citizens to shape their own lives and the services they receive. It supports the commitment to independent living for all adults and is unique in establishing a collaborative approach between central and local government, the sector’s professional leadership, providers and the regulator. User-led organisations which are controlled by disabled people have a key role to play in delivering personalisation and independent living. Indeed, following this debate I am going to a workshop about exactly that. We are investing more than £1.6 million over the next two years to support the development of up to 25 learning sites around the country to develop best practice and share experience. We will announce very shortly the sites that will receive the funding. The new equality Bill will also benefit the most vulnerable among us and create a more equal society. The Bill will streamline the law, distilling nine pieces of legislation into a single Act. I am not aware of any delay on its production at the moment. I was at an equality Bill meeting yesterday. The existing disability duty puts a responsibility on public authorities to, among other things, eliminate discrimination and harassment, promote equality of opportunity, promote positive attitudes and encourage participation of disabled people in public life. We plan to retain all those principles for disabled people in the new duty, and extend them to other strands. We have some good existing legislation that protects against discrimination with regard to race, religion, sexual orientation while at work, but there are other areas where this protection is missing. Through the equality Bill we have the chance to build on that legislation. The noble Baroness, Lady Greengross, spoke movingly about the importance of tailored care packages and the need for humanity and kindness to be at the heart of all our work. She is absolutely correct about that. I shall now respond to some of the comments made on the issues. I promised the noble Lord, Lord Rix, that I would try to answer his points about the campus and care for learning-disabled people. The responses to the Valuing People consultation published in December 2007 showed a common theme from respondents across the stakeholder groups that what was needed was choice in housing options. For some people that meant choice over where a person lived and for others it meant retaining the kind of residential service options alongside tenancies and home ownerships. Experience shows that a number of plans might indicate a preference for congregate living and we need to recognise that. I believe that it is a transitional problem. To support the programme to close NHS campus-style services, a £96 million revenue grant has been made available over the next three years, increasing to £175 million in the coming period. I am afraid that I cannot address all the questions that were raised, but I want to end on an optimistic note. The noble Baroness, Lady Gardner, reminded us that we should be optimistic, especially when she talked about the research and the hope for medical advances in these areas. She was absolutely right. The noble Baroness, Lady Emerton, reminded us of the importance of leadership and nursing practice in the care of elderly and disabled people. My noble friend Lady Morris reminded us through her explanation about First Taste that this is not just about caring for bodies but also about caring for people’s souls. The noble Viscount, Lord Tenby, also reminded us that we need to move forward optimistically. We might anticipate that a debate led by the noble Baroness, Lady Fookes, and with the participation of distinguished colleagues from around the House, would be of the highest quality, and indeed it was. I thank noble Lords once again for their excellent contributions today.