Below is the text of a speech Sir George made on the future of personal care.
Sir George Young (North-West Hampshire) (Con): It is a pleasure to follow the hon. Member for South Thanet (Dr. Ladyman). He was the architect of some of the reforms that we have debated this afternoon and has made a plausible bid to get his job back by sharing with us his vision of social services in the future. I hope that he will excuse me if I do not follow him down the same path.
The only point that I want to pick up from previous speakers is that which the hon. Member for Kingswood (Roger Berry) made, quite rightly, about the lack of portability of social care packages. It is not just local authorities that do not provide portability; it is the national health service. We can move from one GP to another and find a totally different prescribing philosophy or find that a new primary care trust has a totally different approach to IVF, for example. The hon. Gentleman put his finger on the problem, but it is much broader than he described.
I want to focus on one aspect of social care, namely the move to self-directed support in social services, which is the most radical and exciting change currently taking place in social policy. Before I talk about that, however, I want to say a word about two carers organisations in my constituency.
My hon. Friend the Member for Eddisbury (Mr. O'Brien), in a powerful speech, mentioned young carers. Growing up nowadays is difficult enough, but it is even more difficult if, at the same time, a young person has to care for a parent or sibling. I pay tribute to the work of the Andover young carers project, which cares for about 150 children between the ages of eight and 17 by providing somewhere to meet, homework clubs, support groups in school, short trips and holidays. The project is a lifeline for vulnerable families and enables them to function effectively. The other organisation is the Princess Royal Trust for Carers. I am sure that other hon. Members have branches in their constituencies and that, like me, they will be launching carers week in their constituencies next week.
We have made enormous progress in enabling people who work to care at the same time, by developing flexible working. We now need to make similar progress in enabling people who care also to work, in order to achieve their goals and raise their incomes. Both the organisations that I have mentioned survive on a shoestring, and I am sure that that is the same for many voluntary organisations in other constituencies.
I want to talk about personal directed support—the move from an inflexible, institutionalised response to personal care needs, individual budgets and personalised care or self-directed support. Personal directed support is a much more user-friendly response to social care, which, as the Minister said, means that people will have a life, rather than a set of services, which often entrench further dependency on the local authority.
Hampshire county council, which is a progressive authority led by Ken Thornber, with Nick Georgiou as director of adult services, has set up a commission to take the policy forward. Serving on that commission is this year’s president of the Association of Directors of Social Services, a local authority chief executive, leading academics and representatives of the voluntary sector. I sit on the commission as a humble observer.
I want to make three points about the change to personal directed support. First—the Minister touched on this—there is a parallel between the debate about personal directed support and a similar debate that took place 30 years ago, when I was the doing the job that the Minister is now doing. At that time, we had large numbers of elderly people in long-stay geriatric wards in hospitals and even more people in mental hospitals with learning difficulties, or mental handicap as it was then called. Most of them did not need to be there and did not want to be there. They were disfranchised and institutionalised; they were not in charge and they could not choose what to do. So, we moved to a new policy—care in the community—that enabled people to become de-institutionalised and to lead as normal a life as possible in the community. We hear the same kind of language today about the need to move away from today’s institutions—adult training centres and residential care, for example—to other forms of personal support.
At this point, I need to mention the Treasury. The Minister was briefly a Treasury Minister. When the debate on care in the community was going on, the Treasury’s interest was aroused. It saw enormous savings; pound signs flashed before its eyes as the mental hospitals were closed, the land was sold off, and the public sector employees in hospitals and mental hospitals were dispensed with; informal and “cheaper” care in the community was just round the corner.
The policy was never going to save any money. The reason for introducing it was not to save money; it was done because it was the right thing to do. Moving away from large-scale institutional provision to more tailor-made individual provision is likely to cost more. In the short term, it will certainly cost more, because of the need to keep two systems going in parallel. We had to develop the services in the community before we could close the mental hospitals. I think that the same will be true of the move to personal directed services. It will not save money if it is done properly.
I think that it was the university of Lancaster that carried out some research on this subject, which showed that less can be spent on individual budgets than on local authority-provided services. However, part of the reason for moving over to a new regime is to intervene earlier and to help all those people who are not being helped at the moment. I think that my hon. Friend the Member for Eddisbury mentioned CSCI—other hon. Members certainly have—which has criticised the tightening of the eligibility criteria. Many people with substantial needs—let alone those with low levels of need—do not get any help at all at the moment. This is before we even start to consider introducing the Wanless model, in which everyone gets something for nothing, and which must cost more. The lesson of history is that these types of social reform will not save public money and that, if we are to achieve the goals and unlock the potential, they will actually cost more.
My second point might help to solve the first one. Other potential sources of funds could go into individual budgets besides what is being spent by adult services. The primary care trusts, for example, might be able to put some money into the kitty. As the hon. Member for Sutton and Cheam (Mr. Burstow) said, the trusts have had much more generous settlements over recent years than social services. Other local authority departments, such as adult education, could chip in. The potential pool to be spent is therefore bigger than the one currently being spent by adult services. Indeed, one could argue that disability benefits should also go into the pot. If the aim of a disability benefit is to enable someone to overcome their disability, should it not form part of the pot of personally directed support?
My final point on personalisation, or self-directed support—
Dr. Ladyman: Will the right hon. Gentleman give way?
Sir George Young: Very briefly.
Dr. Ladyman: The right hon. Gentleman is making an excellent speech, and I am enjoying it very much. I agree with an awful lot of what he is saying. May I encourage him to look at a 10 Downing street strategy document that was produced about two years ago, which covered personalised budgets? It included the recommendation that we should indeed investigate taking money from all those sources and putting it into people’s personal budgets.
Sir George Young: Indeed. The point that I was about to make was even broader: personalisation need not be confined to social services. We could apply it to education, and to higher education. Indeed, once the personalisation genie has been let out of the bottle, where do we stop? We almost reach the point of education vouchers if we go down the path of personal budgets or individual budgets for personal care.
Finally, I want briefly to touch on the implications of the new policy. There are obviously going to be implications for social services departments. At the moment, they are the funder, the advocate and the supplier. They provide all three functions. Once we move to personally directed support, they will be the funder, but they will not be the advocate and they will probably not be the supplier. This will have enormous implications for the structure of the departments, and they will have to make absolutely certain that independent advocacy services are available. It is not true to say that older people do not want choice, but it is true that most of them do not want the hassle of navigating the care system without easily accessible advice and support. At the moment, sadly, information and advice services are exactly those that are being cut back, and that needs to be addressed if the roll-out of self-directed support is to be feasible.
The supply side of personal social services must respond. There will be a whole new market as individual buyers try to invest in particular packages of care to meet their needs and a whole new infrastructure will have to be created to respond to the change in the market as resources are shifted from institutional provision to more individualised provision. There will be fewer block contracts, much more transparency on costs and, crucially, a need for more trained providers who can provide the individual packages that people want. That has implications for those working in the adult training centres and in residential care. All the pilot studies of those local authorities that have gone down that path show that there is reduced demand for that type of provision. On the commission that Hampshire has set up, which I mentioned, we have already heard the concerns of those who work in social service departments, thinking that their jobs are threatened or are at best going to change.
Related to that is the viability of the traditional services as some people opt out and it becomes uneconomic to keep the adult training centres going. That has happened in, I think, Oldham, which makes the case for a gradual phasing in of the new regime and retraining those whose jobs may go. Then there are some people who may choose not to choose—people who prefer to stay in a comfortable institutional setting—and we need to look after them.
There is the issue of risk. How do we reconcile the right of the individual to determine how he or she spends his individual budget with the obligation of a local authority to ensure that public money is wisely spent and to discharge its responsibility to look after vulnerable people. Risks were taken with care in the community. Some of them were unacceptable, and people were discharged who should not have been. The risks with personal directed support are different—that the resources will be misapplied or inappropriate services might be bought. Safeguards exist—the local authority will have to validate the plan before it can be implemented—but the fact that there is an element of risk is not a reason for holding back. What I find unacceptable is what is done at the moment in the name of risk avoidance—the curtailment of activity, particularly by elderly people in residential care, some of whom are sent to bed under sedation because of inadequate supervision in the communal lounge.
Any new system must be simple and easy to access. One reason why so few people have accepted direct payments—I think only 5.4 per cent. of those eligible have accepted them—is because of the paperwork. We have to make it absolutely clear that local authorities or the advocate can handle the paperwork once the individual has decided on the package.
A point made by other hon. Members is that the new regime must reach out to everybody who needs help, not just current users. One of the problems of the current regime is that the self-funders are left struggling while those who are eligible get a decent service.
Some real issues arise for carers. Can the funds in the budget be used to pay for what the carer does at the moment for nothing? Can they be used to help them remain in work and carry out other responsibilities? Can they be extended to help them and pay them beyond retirement age?
My final point is about resources. The issue of calibration is crucial: how much money do we allocate to individual budgets? There is a risk of getting the whole policy wrong if we make unrealistic provision for it and for the budgets, with people then finding that they get less support. At the moment, we can send someone to an adult training centre for three days. There is no transparency on costs and the cost is irrelevant to the individual. With personal directed support, the costs are of enormous importance and are very transparent. The experience with direct payments is that in some cases the sum allocated has been wholly inadequate to purchase the care that was needed, perhaps explaining why take-up is low. The policy will have to be adequately resourced, not least if we are to help more people and intervene earlier.
I make the point, which I have made to the Minister in other debates, that we need a step change in how social services are funded. I have expressed disappointment in earlier debates at the recent three-year settlement, which has left social service departments severely squeezed. The Treasury has got to be at the table if the policy is to fly. The new policy provides real, challenging opportunities. The challenge is to find the necessary resources, but we have an opportunity to make a real difference to the social care system—to come up with a system that is fairer, is seen to be fair, is more accessible, and makes a difference to everyone’s life. I hope that all Members can rally behind that objective.