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Social Care Green Paper

I agree with the hon. Gentleman that that is one way through this. We could use empowerment, by giving more of a say—more of the budget—to the individual herself or himself. Another way through would be to be more radical about trying to pool budgets across agencies. Some such pooling goes on in health and social care. I think that the Cabinet Secretary, Sir Gus O'Donnell has recently spoken about that happening at a more macro-level, and it is an interesting idea. In other words, instead of public spending simply relating to the Whitehall furniture or the local furniture of Departments and so on, we say, "Here is a larger sum of money than we provide at the moment to crack this problem." We need to experiment with that in the future as we enter difficult times with public expenditure in a range of areas. I want the Minister to comment on this. The issue about joined-up working, which an earlier Labour Government called the joint approach to social policy—everyone has had a go at trying to make it work—is that achieving it is like finding the holy grail. It is very difficult but well worth the effort. My third point is about carers. We have all acknowledged their importance. There are nearly 5 million to 6 million of them, some caring, I am almost tempted to say, too much. Some are caring almost around the clock—and some for more than 50 hours—until sometimes they drop because the fatigue and stress are too much. I want gently to say to the Ministers that I think the provisions in the Green Paper on the treatment of carers are a bit feeble. It looks to me a bit like they have been added on—when I was a civil servant in the Home Office many years ago, somebody referred to it as "joining up with a staple," although I think that there are now electronic ways of joining up a document. I was disappointed that carers were not more central to the analysis. I know that the Government have done a great deal on carers—more than any other Government—and that there has been a recent statement on the issue, but I would like to have seen the subject more central to the analysis, because the choices about how to provide care and the difficult decisions about residential care are ones that the carer and the wider family have to take as well as the cared-for person. I am not sure whether the Green Paper mentioned carer's assessments at all—if it did, forgive me, but they certainly were not central to it. I speak with a vested interest as the promoter under a Conservative Government of a private Member's Bill that became the Carers (Recognition and Services) Act 1995—the first Act, with all-party support, to enable the carer to have her or his own needs assessed. That is important and we should have heard something about it in the Green Paper. On carers, may I also pick up another important issue that is mentioned? Perhaps increasingly—and certainly numerically—lots of carers are workers and employees. We have heard how they might also be parents or grandparents. That all adds to the busyness of the life of the British carer. The Government have done a lot in terms of what some people might call the work-life balance—or the employment-care balance—and I urge the Department of Health to push at that door. There will always be at least one other Department, which I know quite well, that will resist that, urged on by certain business interests, but we need to recognise that a modern economy and a modern society has to allow for the fact that people have a dual role as workers or parents of young children while also caring for elderly parents. Some 3 million people combine work and care and I am advised by the statisticians that that is some 12 per cent. of our work force. It is no mean issue. Finally, I want to talk about the most difficult issue, which is the financing of long-term care. I have referred to it, not terribly originally—others have called it this—as the obvious unfinished business of the modern welfare state. We had a royal commission some 10 years ago, and a minority report was produced. It was an interesting document, but, to be blunt, the Government then parked it in the "too difficult" box. I am pleased that these Ministers are returning to it—[Hon. Members: "Or going."] I see that the Secretary of State is leaving—it is not that difficult an issue. However, I know that Secretaries of State have many things in their crowded diaries. Government and Parliament may have found the issue too difficult, but avoiding it actually left the people needing care and the carers themselves facing difficulties. Some of that care is difficult, and some of the issues that those people face are difficult, but, unlike Parliaments and Governments, they have not been able to avoid them for 10 years. On the Green Paper's analysis of financing long-term care, my assessment is, two cheers for the Green Paper. It advances the debate, and one option could see us through into the future. However, I must echo what one or two colleagues from all parts of the House have said. As a Daily Mail columnist might ask, "Why, oh why have you rejected what you call the taxation option?" I simply do not understand. Although I would not advocate a taxation option, I would look seriously at the pros and, no doubt, cons of a social insurance option—or what we now call a national insurance option. To dangle that option before the public, while talking about its advantages and how many people rather like it, but then to reject it, was, to be honest, slightly strange. On page 116, however, the Green Paper states:""During the engagement process, many people told us that they thought an NHS-style system, where the full costs of care and support were met through taxation…would be the fairest option."" It goes on:""This would require a significant increase in the tax… For this reason we have ruled out this option."" Then, unless I have misunderstood the sequence of the Green Paper, it states:""The advantage of this system is that it would be universal, and would probably be the simplest and most easily understandable way of funding care and support."" It is almost as if two hands wrote that section of the Green Paper, and I am bound to say that I see the cold, grey hand of the Treasury all over it. That option should not necessarily be the way ahead, but it requires serious study. The Secretary of State talked about Beveridge, but I thought that, for my colleagues who are students of Beveridge, he was getting into trouble. After all, when Beveridge studied the risks and needs facing society then, and the likely risks and needs in the future, he thought that they were essentially insurable. One had a real risk—if I can use the world "risk"—of becoming old, so one needed a retirement pension. There was always the risk of unemployment, sickness and death, so a social insurance system was the fairest way ahead. I look at those on the Liberal Benches and wonder, "May I refer to Beveridge as the last great Liberal?" [Interruption.] I am glad that they are still awake. He was certainly a great Liberal, and my guess is that, if back then the demography was going to mean that huge numbers of people faced frailty, he would have wrapped up care in his social insurance system. I do not really understand Ministers' argument that to do so now would be a burden on employees. Yes, it would, and I understand the immediate argument that many constituents feel they pay too much tax, and that there are burdens. We would therefore have to be careful, but, before we say that employees should not have to carry that burden, we should note that they do so with pensions. Otherwise, the argument would amount to an attack on our pension arrangements. I suppose that national insurance is really how we pay for our national health service, too. I therefore urge the Government to reopen that idea, as an option, because it is a serious one. After all, the Secretary of State talked about the current economic difficulties, but we are presumably trying to fashion a system that is fit for purpose for 30, 40 or 50 years. Beveridge, in 1942, and those who became the Labour Government in 1945 had the vision and the courage to go for a, no doubt, expensive welfare state based around social insurance—and that was in 1942, when we had some economic difficulties and, if I remember my history, some difficulties with our European partners at that time. So are we really saying that, at the beginning of the 21st century, that idea is too difficult even to consider as a proper option?