Caring for the Elderly

During a Commons debate on caring for the elderly, Geoffrey Cox welcomes recognition that the country cannot sustain elderly and social care funded on the basis of taxation and suggests that the way forward should be some sort of insurance-based system.

Mr. Geoffrey Cox (Torridge and West Devon) (Con): I shall try to confine my remarks, to make them relatively short and, in the spirit of my right hon. Friend the Member for Charnwood (Mr. Dorrell), to avoid the partisan rhetoric in which it is too tempting to engage on the eve of a by-election. I was, if I may say so, struck by the sincerity and dignity with which the hon. Member for Colne Valley (Kali Mountford) addressed the House, and if I were tempted to engage in the debate in a partisan spirit, her presence here, listening to me, would shame me into not doing so.

This is a profoundly serious debate. As somebody with a 97-year-old grandmother, who lives near me, whom I am responsible for, who is in residential care, who has gone through the often bruising experience of losing a great many assets and who is now, I am afraid, afflicted by dementia, I must say that the problem is all too present and real to my family and to me. This debate is therefore not one in which I can engage with any light or bantering tone. Plainly, the situation that afflicts my grandmother as she descends into dementia afflicts tens of thousands of people throughout the country, and they look to this House not for party point-scoring, although hon. Members in all parts of the House have engaged in such activity in good humour today, but for solutions.

I have been struck by something in this debate: we seem to have made a breakthrough. In recent years, it has been particularly depressing to note that there has been an element of deception in how we have approached the foundation of public policy on this issue. Indeed, the more I have come to play a part in the system under which we now operate-on behalf of constituents and personally-the more apparent it has become that the system has become cruelly deceptive of those who operate in it. For example, carers are said to be entitled to an assessment and a carer's package. How often do we Members experience that as a reality as we carry out our constituency functions? In the rural part of the south-west that I have the honour to represent, it is more of a declaration than a reality.

In Devon, part of which I represent, it is not true to say that when a person has exhausted their assets they can choose a home or remain in the home in which they have been resident. If the county council will not pay the fee associated with such homes, more and more families end up digging into their own pockets to top up the amounts that the county council will pay. Alternatively, a benevolent fund or charity-whomever one can find-becomes involved.

The alternative with which the resident is presented is that of moving from a home in which he or she has become happy, or at least contented and used to. That is cruel. Having paid all they can and descended beneath the relevant threshold of assets, the resident comes to the system. In many parts of the country-particularly in Devon, which has the sixth worst social care grant in the country-they find that the reality is not what they were led to expect, which was that the state would provide for them in their straitened circumstances.

Far too many in residential care are affected by serious conditions such as dementia; the hon. Member for Colne Valley spoke a little about that, but did not go into detail. My grandmother is in a home, clearly suffering from moderate, and increasingly severe, dementia. That is not, we are told, a matter for the health service and it is extremely difficult for her to access the mental health services that might assist her. I suspect that thousands of elderly people in residential care are affected by dementia. I fear that the curious assessment system that decides who falls under the health category and who falls under the social care category is also, to a large extent, a deception. The system is variously interpreted in different parts of the country and one senses that the lower the Government social care grant for a local authority, the more people who should be paid for from the health budget are in the homes of that authority.

I make criticisms of that, but I understand its springs and origins; it comes down to a shortage of money. I said that we had made a breakthrough in this debate and the run-up to it: it is that I have yet to detect anybody who seriously contests the notion that all parties must make a frank and candid admission to the country. It is that we cannot conceivably fund these measures through taxation, and if both sides of the House start from that point, we will at least have the beginning of a consensus-the start of a foundation on which we can build a policy.

I have yet to detect that; indeed, the Liberal Democrats went to the country at the last general election with a policy based on precisely that position. That reminds me of Harold Macmillan-I am going to indulge in a little badinage, but I hope it is good-humoured-saying that the Liberals are full of original and practical ideas, but the problem is that the original ones are not practical and the practical ones are not original. One has to say that the policy with which the Liberal Democrats went to the country three or four years ago was not practical. I am delighted to hear that they are no longer wedded to it, given that even their own party members considered it to be based on a deception.

We cannot go on suggesting to the people of this country that we can sustain elderly and social care on the basis of taxation. I agree with my right hon. Friend the Member for Charnwood that there must be a balance. I am going to risk provoking the concern of my Front-Bench colleagues by saying that we need to use public funds more effectively. I say to the Minister that I am not speaking for my party, so let him not make too much of this. I participated in a Select Committee that looked into fuel poverty and asked, "Are we making enough of the public funds?" and "Are we directing them and making them more effective?" That Labour-dominated Committee decided in its report, which I commend to the Minister, that we were not making effective use of the public means at our disposal. In my judgment, winter fuel payments should not be paid to those on higher-rate tax bands. It makes no sense to do that, and we could save about £250 million by not doing so-a small amount, but it would be a start. We are not making effective use of the many different allowances that are-I fully accept this-designed and targeted to relieve the poverty of the aged, including fuel poverty. On top of that, we should, as my right hon. Friend the Member for Charnwood suggested, adopt an insurance system over and above a particular threshold.

Dr. Ladyman: If the insurance had to be paid while one was working, which seemed to be the suggestion of the right hon. Member for Charnwood (Mr. Dorrell), and if it were made compulsory, how would it differ from national insurance, which is effectively just another tax?

Mr. Cox: Plainly, the detail needs to be examined. I can think of solutions through the insurance system that would not necessarily mean that the money was lost if one did not subsequently have to call on the insurance fund, and other techniques could be used. The danger is that there would be no incentive to engage in it. However, it would be retrograde and unfortunate simply to have a tax on those who were elderly or a tax on their estates; we must look for alternatives to that.

The silver lining that I perceive in this debate, starting from a position of far less expertise than those who have participated in examining the problem in government, is that we have all been able candidly to accept-nobody has sought to argue otherwise-that we will need a system that is based at least partly on the private financing of those affected. If we can build on that as a starting point for this policy, we then have a responsibility to develop it. Twelve years ago, the former Prime Minister came into government promising that he would solve this problem. It is a bit late for the Labour Government to produce a policy now, but I am glad that they have, because at least we can all begin to talk about this an adult and sensible way and to say to the public that it can no longer be done on the basis of public means and direct taxation.

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GEOFFREY'S PREVIOUS INTERVENTION IN THE SAME DEBATE

Mr. Geoffrey Cox (Torridge and West Devon) (Con): I do not know whether the Minister has had a chance to read the report of the Select Committee, on which her party's representatives predominate. One of its criticisms of the winter fuel allowance is that it is extremely poorly targeted and goes to those who pay higher rates of tax. The Select Committee has made a recommendation that money could be saved by withdrawing the allowance from the rich. Does the Minister support such a policy?

Angela Eagle: The Government have no plans to do that, but I wonder whether the hon. and learned Gentleman's intervention gives a little glimpse into what the future might be were there to be such a tragic occurrence as a Conservative victory at the next election.

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