Norman Lamb writes… A once-in-a-generation opportunity to fix our health and care system

In 1997 Tony Blair told the Labour Party conference “I don’t want [our children] brought up in a country where the only way pensioners can get long-term care is by selling their home.” And yet speaking to the Health Select Committee in 2010, in Labour’s final months in office, Andy Burnham said, “every member of the Cabinet believed social care to be an area that had not been properly reformed and was one of great unfairness”. In thirteen years of talk, and promises, Labour did nothing to fix our dysfunctional, and profoundly unfair, system of funding social care.

In 2010, the Coalition Agreement included an important commitment to establish a Commission on Funding for Care and Support, which was chaired by Andrew Dilnot and reported in July 2011. We recognized that putting an end to the situation where people had to sell their homes at a time of distress to fund their care was essential to building a fairer society. When I was appointed Care Minister last year, I was determined to ensure that we took action to implement the proposals, and with Nick Clegg’s support we secured agreement that the key proposals of the Dilnot Report would be implemented as part of the Care Bill, the first draft of which had already been prepared by my predecessor Paul Burstow, and which has its second reading in the House of Commons this week.

At the heart of the proposals is a cap on the contribution someone has to make towards their eligible care costs. Up until now, some people (especially those with conditions like dementia) could face crippling care costs over many years, creating further distress and anxiety for them and their family at what is already an impossibly difficult time. Our proposals will cap care costs at the equivalent of £61,000 in 2010-11 prices as compared with the upper limit of £50,000 proposed by Andrew Dilnot. (this amounts to £72,000.00 in 2016.) However, Dilnot has said himself that, “I recognise the public finances are in a pretty tricky state. It doesn’t seem to me that it is so different from what we wanted as to radically transform the basis of the system.”

At the same time, we are increasing the means testing threshold from £23,250.00 to £118,000.00 which will mean that far more people will get some help with their care costs. Additionally, no one will be forced to sell their home to pay their care costs, with a new right to defer payment during their lifetime. Taken collectively, the proposals are expected to directly help 100,000 by the mid 2020s who would receive nothing under the current system. The proposals have been described as a “once in a generation opportunity” to reform social care funding, and as Liberal Democrats we can be incredibly proud of this achievement.

But the Care Bill doesn’t just bring about the biggest change to social care funding for a generation. It is also central to delivering the Liberal Democrats’ “better care promise”. Over the past year, many of us have been shocked by the institutional failings in our health and care system that were shown up by the independent reviews into Winterbourne View and Stafford Hospital, and the Liverpool Care Pathway. We have a duty to ensure that every patient is treated with the dignity and respect that they deserve, and that when serious mistakes are made they will be admitted, investigated, and addressed.

Following on from the recommendations of the Francis Report, Part 2 of the Care Bill establishes new fundamental standards of care, and compulsory minimum training standards for health and care workers. It also appoints three Chief Inspectors of Social Care, Hospitals, and General Practice at the CQC, to ensure that these standards are met, highlighting both good practice and unacceptable practice.

As a constituency MP and Minister, I regularly encounter situations where people, after they or a relative has been let down by our health and care system, experience complete frustration as organisations refuse to admit that mistakes have been made. In our 2010 Manifesto, we made a commitment to force organisations to own up to mistakes, and the Care Bill introduces a new duty of candour on providers of health and care, with criminal sanctions when providers supply false or misleading information. These sanctions will also apply to directors and managers where unacceptable care has been provided.

The Care Bill has come a long way from the first draft published over a year ago, and I look forward to working with colleagues in Parliament, across the political divide, in the coming weeks. I am immensely grateful to Paul Burstow for his work as Care Minister in producing the original draft Bill, and for his support since. Lib Dem colleagues in the Lords have also made important improvements to the Bill. When it comes into law next year, the Care Bill will be the most valuable legacy in health and care reform for a generation, delivering a fairer society for some of our most vulnerable. And it is happening because of Liberal Democrats in government.

* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee

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  • Great article. If the Liberal Democrats gets crucified next election and don’t return to power for years, implementing this policy is worth it. I hope whoever’s in power next election build on the caring and fair principles of this system.

  • so you’re trying to justify a policy on care costs that will cost the elderly MORE than the under last government

  • What is being cut to pay for this? It is reality that pensioners are the most wealthy age demographic, while young people the least. It would be a shame if the latter had their services cut to pay for the former.

    Also, the dig at the LCP is shocking. This was an apolitical process for the final few hours of life that politicians, in response to tabloid scaremongering, sought to disrupt for electoral gain. Horrifically cynical and shameful and should it be changed, will almost certainly increase suffering, not reduce it.

  • I’m in favour of allowing people to defer payment, but is supporting people with £100k of assets really something that we should be aiming for?

    Good news on getting organisations to own their mistakes though, More transparency is always good.

  • jenny barnes 16th Dec '13 - 2:47pm

    It looks like a policy to benefit those inheriting housing. The logical way to pay for this is to include money earned from inheritance in income, and tax it, possibly allowing it to be spread over a number of years – ten, for example.

  • “Our proposals will cap care costs at the equivalent of £61,000 in 2010-11 prices as compared with the upper limit of £50,000 proposed by Andrew Dilnot.”

    Except that only around half the cost of being in a home will contribute towards the capped amount. So some people will still be paying well over £100,000 for residential care. But most people will die before they reach the cap anyway.

  • Graham Martin-Royle 16th Dec '13 - 4:13pm

    Please explain why I should be supporting someone about to inherit a shed load of money? That’s what all this amounts to, not helping pensioners at the end of their lives but those who inherit their wealth. Why should a house or any thing else for that matter be kept back solely to be given to the next of kin and the rest of us pay for that? That is what you are arguing for, that society subsidises the inheritors of wealth.

  • I have always felt that the cap should be a percentage of assets up to a maximum amount. For example, I am in a far more secure position financially than my Mother. Should I need help in the future I would expect to contribute more than she should. I see a straightforward cap as a way of protecting those with the most significant assets to bequeath.

    I would read the thread Joe refers you to. You will see that in his reply to myself and others, Norman does not go in for blanket criticism of the LCP but rightly criticizes it’s incorrect use. Used properly, it is a an approach that can alleviate suffering allowing people to die with dignity rather than continue treatment regimes which can in themselves be distressing, painful and ultimately pointless. My family had a positive example of the LCP but that does not mean there have not been institutional failings in its use and it is right that in his current position it is examined and where necessary revised.

  • Steve/Joe you are quite correct. Lamb does appear to be sensible and reasonable on the LPC. Nevertheless, as a general principle, politicians getting involved in evidence led healthcare procedures (rather than their availability, which is a political question) always worries me.

  • Eddie Sammon 16th Dec '13 - 5:51pm

    I agree with increasing the threshold for state support to £118,000, but I strongly disagree with giving more state money to wealthy pensioners.

  • Eddie Sammon 16th Dec '13 - 5:52pm

    Via the care cap.

  • Eddie Sammon 16th Dec '13 - 6:08pm

    “criminal sanctions when providers supply false or misleading information.” – one rule for the government and another for everybody else.

  • Norman Lamb 17th Dec '13 - 7:07pm

    Thanks for all your comments.

    I completely agree that our approach to funding care costs must be progressive and fair. This policy is being funded, in part, by cancelling a Tory planned increase in the Inheritance Tax threshold. The deferred payments will also be subject to interest, as they have been under previous proposals, so there is no revenue cost in providing the facility.

    At the same time, though, I hear again and again – including from people of fairly modest means – how upsetting it is for people to have to sell their home to pay for care. In particular, it often puts people off accepting care and support when they need it, resulting in decline and, all too often, emergency admission and a need for expensive NHS-funded support following a crisis.

    Best wishes, Norman

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