Sir Jeremy Wright
MP for Kenilworth and Southam · Conservative · United Kingdom
“I applaud my right hon. Friend’s passion and clarity on this issue. On the subject of democratic accountability, he knows that if, as the hon.”
“I welcome the intent that the Secretary of State has set out this afternoon, and the urgency with which she will require the relevant companies to act.”
“The Electoral Commission has made no formal assessment of this. It would be a matter for Parliament to introduce such legal protections. It is prescribed in law that poll cards and ballot papers must be provided in English or Welsh, but there are no other prescribed language requirements relating to election materials.”
“We can all cynically speculate about the reasons why this sudden about-turn has taken place this week, but, as my hon. Friend the Member for West Suffolk (Nick Timothy), who spoke from the Front Bench, said earlier, it is our job to scrutinise this legislation and to ensure that whatever we put in place does justice to the determination o…”
“In today’s version of the amendment paper, for the first time, that amendment has disappeared and been replaced not with the detailed compromise that Intelligence and Security Committee members, who have been engaged with this process, have been working towards, along with many others, but with Government amendment 157.”
“As the House would expect, we engaged with that process as diligently as we could, with no partisan politics, in an effort to make good law in the pursuit of greater state transparency while preserving our national security equities. As the hon.”
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“I am grateful to the hon. Gentleman for giving way again. I wonder whether he agrees that the likelihood is that the treatment that he is talking about will not be deployed through the network that he is describing unless we spend more money on research. Would he like to comment on that?”
“The danger is that the Government have set up tremendous expectations by rightly isolating dementia as a huge challenge that we must confront. If a Government priority is nothing more than a soundbite, and if a national dementia strategy is nothing more than a title, we run the risk of not only disappointing the hundreds of thousands of people with dementia now, their carers and the people who love them, but disappointing millions more in future and failing to face up to the challenge that we must face up to in the next few years. If the Government, who are running out of time, are unwilling to take on the challenge and take the necessary action, I fear that it will fall to the next Government to do so.”
“There is no ring-fencing, and there is no reporting requirement for PCTs to tell the Government whether, in fact, they have spent the £150 million allocated over two years across the country on dementia care. We must ask, in all common sense, how confident we can be that cash-strapped primary care trusts facing an array of different Government targets are necessarily going to spend all that money on dementia care. We have to wait for the Government’s audit to find out, but I am not immensely optimistic. If the Government priority does not mean urgent action, if it does not mean substantially changing the systems, and if it does not mean substantially increasing the resources allocated specifically to the problem, what on earth does it mean?”
“The existing qualities and outcomes framework has only two criteria relating to dementia, and they are about maintaining a register and having 15-monthly reviews. I accept that those criteria are important, but they are not as fundamental as perhaps they should be. That is a good Government priority, and it is a substantial issue that should be addressed, but there is not much evidence of their doing so in the control mechanisms that they have put in place for the NHS. There is no evidence of a speedy response or of significant changes in the systems that deliver care. What about the money? Have the Government given substantial extra resources to those who deliver care and said that those resources must be spent on the new priority of dementia care? Again, the answer is no.”
“Dementia is not mentioned specifically or substantively in any of those tiers. Worse still, the 2009-10 framework published in December 2008—before the strategy was published, but after the substantive work that there must have been to enable the Government to know what they were seeking to achieve—stated that there would be no new national targets in the NHS until the next spending review. We are, of course, still waiting for that review. Even in the 2010-11 version of the framework that was published in 2009, there is only a brief reference to dementia, and that was about the improved outcomes and efficiencies to be gained by early diagnosis of the condition. It is not true either that GPs, as part of the NHS, are being asked to do a great deal of specific work on dementia.”
“If the Government believe that that is how the health service and social services should operate—with a great degree of central control exerted by means of the levers attributed to Whitehall—then they cannot simultaneously refuse to pull those levers and make something happen, saying that doing so is not their department. Reference has been made to the NHS operating framework, the mechanism by which the Government communicate their priorities for the NHS. Due to the delays that I have described in bringing the dementia strategy forward in the first place, the Government missed the boat entirely in the operating frameworks for 2008-09 and 2009-10. As we have discussed, those frameworks set out three tiers of priorities for the NHS—the things that all PCTs must do, national priorities for local delivery and priorities to be set locally.”
“I have said that the review of anti-psychotic drugs is welcome and important, but it was originally promised a long time before the strategy. The review was finally published on 12 November of last year, some seven months after the strategy was published and some two years after it was originally promised. Those delays do not have the hallmark of action that is a Government priority. Secondly, has making dementia a Government priority initiated radical change in how this country’s health and social services are run? The context is important here. This is a Government who set considerable store by central control. They set targets that they consider important, and which those delivering services must meet. Earlier, the Secretary of State said that the Opposition cannot have it both ways, but neither can he.”
“Does a Government priority on dementia mean that the Government will take action more quickly, or that they will radically change the operation of the relevant systems in the fields of health and social care? Does it mean that the Government will spend substantial amounts of new money specifically on this priority? I regret to say that I do not think that the evidence suggests that making dementia a Government priority means any of those three things, as I shall briefly explain. First, have the Government been quick to set our their response to the challenge? Although I welcome the national dementia strategy, it was promised repeatedly—from August 2007 right up to its publication in February 2009. An implementation plan with any significant detail came only later still.”
“The Secretary of State was right to say that we should not expect everything to be done by now, less than a year into a five-year strategy. I accept that it will take time to complete, and the Government have been right to say repeatedly that dementia is a priority for them. It is a national and a Government priority, but in this debate we should ask what that means. For example, does that mean that more money will be made available for researching a condition that has become a Government priority? As others have said, it is not apparent that that is what it means. The level of research has not increased at all, let alone dramatically. Greater priority should be given to dementia research; if it is not, we will not be able to address that widespread problem in a fundamental way or start to reduce the costs to the Exchequer that it incurs.”
“I shall not dwell on it now—I do not have time—but I simply repeat a request that I have made to him in the past, which is that he should keep it very much at the forefront of his mind, that we should set up substantive mechanisms to ensure that qualifications are available for those in the caring profession, that career paths should be set out in specialist dementia care and that everybody who has contact with those with dementia, which includes a large number of people across a variety of fields, has some understanding of the condition that is being dealt with. I concede that training features as part of the national dementia strategy. I repeat my welcome for the strategy, as it is a very positive move forward and contains a great deal that needs to be done.”
“That is a positive move forward, and I hope that the Minister will confirm that one of that clinical director’s first priorities in office will be to address this serious issue. One suggestion from Professor Banerjee to deal with the trouble caused by the over-prescription of anti-psychotics is to address the fundamental issue of training. The Minister knows, not least from the other report produced by my all-party group, how strongly I feel about that subject and how central it is to the issues of dementia care in general.”
“To know, as we stated in the all-party group’s report on this subject some time back, that there is a substantial degree of over-prescription of anti-psychotics among people with dementia is one thing, but to hear from Professor Banerjee that he thinks that some 140,000 people are wrongly on those drugs—the deleterious effects of which have already been discussed in the debate—and that, worse yet, an additional 1,800 deaths a year result from that excessive prescription, as do 1,600 or so strokes and the like, truly, in my view, puts this scandal into its proper context and underlines the need for action. I, like others, welcome the appointment of a national clinical director in dementia.”
“Hundreds of thousands are affected now, millions will be affected in the future and billions are being spent on the treatment and management of dementia at the moment; it is possible to become immune to those numbers and to forget the scale of the challenge that we face. However, some numbers still have the capacity to shock. The review of anti-psychotic medication undertaken by Professor Sube Banerjee recently reported to the Government and is, I think, one document that contains such figures.”
“I begin by joining the tributes that have been paid to Neil Hunt, the departing chief executive of the Alzheimer’s Society. He has done a great deal, as most people involved in this issue know, to drive the subject up the political agenda to where it rightly deserves to be. I also regret the absence from this debate of David Taylor. I know that he would have been here to contribute, as he always did on these issues. He was a well-respected and assiduous member of the all-party group that I chair, and he will be missed in this debate, as he will be in many others. The numbers that we discuss whenever we talk about dementia are staggering.”
“May I ask the Leader of the House to return to the subject of the national dementia strategy? She said earlier that it was on track, and I hope that she is right. She will know, however, that the National Audit Office this morning suggests that it is not so sure. The Government were right to make dementia care a priority last year, and to produce the dementia strategy. Given what has been said this morning, however, may we have a proper debate—the first in Government time—about the strategy, to ensure that this important priority is being effectively implemented?”
“I am grateful to the hon. Lady for her generosity in giving way so often. She will know that the pension trustee is taking IBM to court over that. Would it not be more sensible for the company to hold back on the changes until the legal challenge has been determined?”
“Does my hon. Friend agree that another consequence of the Bill taking effect and disappointing people is that it, in its production, it will inevitably raise expectations considerably among vulnerable people? If they find that those expectations are not met, will they look with favour on further discussions—cross-party or otherwise—about the future of social care?”
“Aside from raising hopes unduly, it would be tragic if we were to miss the opportunity to discuss more substantially, even at the end of this Parliament, the big issues surrounding social care. Another problem with the Bill is the fact that it does not answer with authority questions about whom exactly it would help, how it would help them and how much it would cost to do so. It does not even try to answer the bigger questions that are thrown up by the social care debate for us all to address. That is a shame, and we could and should do better.”
“That is why it is regrettable that we are dealing with these issues piecemeal and we do not have the opportunity to consider what is being provided on domiciliary care, as well as who should pay for it. This issue is, as others have said, too important to deal with in a piecemeal fashion. We should not have had to wait for 12 years, from when one Labour Prime Minister said in a conference speech that it was very important to deal with social care and that it would be a disgrace if we did not. Now, suddenly, because another Labour Prime Minister wanted an eye-catching initiative to fill a passage in a speech, we have to legislate in haste to make things happen. A potential problem with the Bill is the fact that it has a big title but not much content beneath it.”
“We must consider not only how we pay for this, but, alongside that, what we are paying for. We must ask ourselves whether commissioners are commissioning the right things and whether they should, as they do all too often now, be commissioning for blocks of time—such as commissioning 15 minutes for a particular task—or whether there is a better way of commissioning good quality care. We have to ask whether it is acceptable for a different agency care worker to arrive on someone’s doorstep every day of the week, when the advantages of having someone they know and trust and for whom they can leave the door open while they take the dog for a walk are considerable. Those are substantial issues that are as fundamental as the question of who pays for the care that is delivered.”
“Members have, that Carers UK, in its response to the Bill, which I accept broadly welcomed it, also expressed concern about the situation of those families where family members are prepared to offer care in the home but would value assistance with other things such as gardening, shopping, transport and so on. We have to ask whether the provisions will enable such families sufficient flexibility to have what they need rather than what the Government wish to give them. We come back to the question of how committed the Government are to their personalisation agenda, to which I fully subscribe. There are broader issues, too, about what we pay for. The Minister has heard me talk before about what is commissioned. That point applies to residential care but, in this context, it applies particularly to domiciliary care.”
“There will be a big step between those who are assessed as having substantial care needs and those assessed as having critical care needs, in much the same way as we experience with NHS continuing health care. Let us be charitable, however, and assume that we can establish whom we will be paying under this scheme and how we will pay for it. We still have to answer the question of what we will be paying for. I do not want to revisit the debate that we had last week on attendance allowance and disability living allowance, but the freedom to spend the money that one receives in the way that one chooses was crucial to that debate and, I suggest, it is important in this one, too. The Minister will have seen, as I am sure many other hon.”
“We all know that assessment takes a long time—we all deal with constituency cases weekly that involve long-running processes of assessment, assuming that there are enough people to carry out the assessments in the first place, as my hon. Friend said. We also have to assume that we are capable of withstanding the extra pressure on the system that will inevitably be caused by the extra demand for the extra social care provision. That will include many people who have substantial care needs, but not quite the critical care needs required for the free social care, who will ask and expect to be given a reassessment. A great deal more assessment will suddenly need to be done, and if that assessment and extra demand on the assessment system are going to cause further delay, that is a concern.”
“Lait) on the elegance, or lack thereof, of that term—is a crucial point. It is vital that we get people back into being able to deal with their own daily lifestyle needs to the extent that we can and to the extent that they can. However, I am concerned about the practical implication of that. It seems to me to be inconceivable that in order to move to a process of helping someone with reablement, there should not first be some form of assessment to ensure that they will benefit from the process. That means that there will be one assessment to ensure that somebody is suitable for reablement, a process of reablement and then another assessment, assuming that that is appropriate, to decide whether they are entitled to free social care under the criteria.”
“If we do not spend a great deal more, it is very unlikely that we will find the cure that we hope for or, failing that, effective treatments, which will reduce the demand on our social care system in the first place. If there is a gap in funding—it is at the very least foreseeable that there might be, given the uncertainty, as we have heard, about the figures—who will pay for that gap? Will it be local or national Government? I rather agree with my hon. Friends who suspect that the answer is likely to be local government, once again. We must be sure, if that is the case, that it will be given adequate support to enable it to carry that burden. Let me say a word or two about the detail of the Bill. I agree with many who have spoken that reablement—although I am with my hon. Friend the Member for Beckenham (Mrs.”
“We have heard that the estimate of the cost for the first year is £670 million, £250 million of which is expected to come from local government efficiency savings—one can only imagine the joy with which that news was greeted in town halls up and down the land. The remaining £420 million is expected to come from the Department of Health’s research and development, marketing and consultancy budgets. I refuse to believe that the Government spend anything like £420 million on the Department of Health’s marketing and consultancy budgets, so a substantial amount of the sum must be expected to come from the research and development budget. I hope that the Minister will be able to reassure me, and the House, that that will not affect the crucial work that goes on, not least in the field of dementia, where we already spend too little on research.”
“That is why the uncertainty over the potential demand for free social care—the Government have not set out the terms of that in the Bill, but I hope that they will do so in the regulations that will follow it—is so important. This is about the unknown impacts on those currently funding social care themselves who may subsequently approach the state for free social care, of those who will not subsequently choose residential care as otherwise they might have done, and perhaps even of those in residential care who may choose to leave that care and return home to be cared for there—as we know, many prefer such an option. As my hon. Friend said, if we do not know what the demand will be, we do not know what the cost will be.”
“The Wanless report, which asked a number of important questions about social care, was followed a considerable number of years later by a Green Paper that asked all those questions again, and now we have before us a Bill that proposes to answer part of one of them. If the Bill is even to do that, it needs to deliver on its promises, and that is where I am in entire agreement with my hon. Friend the Member for Norwich, North and with others who have made this point. If the Bill is incapable of meeting the expectations that it has raised, not least by its title, it will be a cruel deception for those who are most reliant on social care and who will hope for most as a result of what the Government are proposing to do.”
“It is a pleasure to follow my hon. Friend the Member for Norwich, North (Chloe Smith), because I agreed with a great deal of what she said. May I apologise to you, Mr. Deputy Speaker, and to the House for missing part of this evening’s debate? I was chairing a meeting of the all-party group on dementia. As the Secretary of State said, many people with dementia will be directly affected by what the Government propose. I wish to start my contribution, as many have done, by applauding the Government’s intention—it is right that we should do so. There are few more important issues than social care and it is right to make a start on this, but we cannot accuse the Government, over most of their term of office, of legislating with breakneck speed on it.”
“I accept that we can do both, but there needs to be sufficient flexibility in the system to allow people to have what they want rather than simply to be given what they are expected to take. That is the concern.”
“I am grateful. May I bring the Minister back to the wording of the Bill? Surely the difficulty here is not that we are asking for new law that would make sexual infidelity of itself and solely a qualifying trigger in this context; rather, the problem is that the Bill provides that a thing done or said that constitutes sexual infidelity is to be disregarded. The Minister would be right if the Bill set this out as solely sufficient for a qualifying trigger, but it does not; surely what is unrealistic is, as my hon. and learned Friend the Member for Beaconsfield (Mr. Grieve) said, that the jury is being invited to take no notice at all of something that must count as relevant circumstances.”
“Does my hon. Friend agree that this issue is part and parcel of the problem with the Government’s overall approach to constitutional reform, whereby they start down a road with no clear idea of their destination? The later provisions of the Bill will show that the same thing is happening to the House of Lords as happened to judicial appointments.”
“In the context that my hon. Friend is correctly describing, is it not all the more important to ensure that money already being spent within the legal system is being spent wisely, which is why we are interested in the specific workings of the JAC?”
“Given that the Government’s intention in setting up the JAC was to encourage those who would not otherwise come forward to seek judicial office, does my hon. Friend share my view that any obstacle to those potential applicants is to be regretted? Is it not at least possible that the written test is one of those obstacles?”
“Is not the central thesis of the argument put forward by my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) that if it ain’t broke, don’t fix it? The problem here is that the Government have embarked on a programme of constitutional reform with regard to the judiciary that they did not need to start and that they have no idea how to finish. The Minister cannot possibly argue that the independence of the judiciary was weak before these reforms and is stronger now. The judiciary challenged Executives of both political colours in a robust way well before the Judicial Appointments Commission was thought of.”
“May I ask the Minister to add something else to the list— schools? He is rightly focusing on dealing with young people and giving them the right messages about the consequences of their antisocial behaviour. However, must it not also be the case that bad behaviour must have consequences in schools and that young people should understand that clearly? Is it not important to look at exclusions and ensure that head teachers have the authority to exclude without appeals panels putting children straight back into schools, thereby undermining the head teacher’s authority and teaching young people that they can get away with bad behaviour, which is why, I would suggest, the rates at which antisocial behaviour orders are broken are so high, as my hon. Friend the Member for Woking (Mr. Malins) mentioned?”
“May I take the Minister back to a point he made earlier in reference to what we are discussing now? Is it not the case that often people will go to an organised display, but will also have fireworks displays in their back gardens? The problem is that the fireworks season now extends to about a quarter of the year. We need to start saying to people that it might be nicer if they were considerate to their neighbours and did not set off quite so many fireworks quite so often.”
“Does my hon. Friend agree that one of the difficulties for animal owners is the unexpected use of fireworks? If we have an organised display on 5 November, everyone knows that they have to prepare their pets and horses for the event, but when they do not know that the fireworks are coming, they cannot do the necessary preparation and look after their animals properly.”
“My hon. Friend is making a very good case. Does he agree that one of the other problems in this country is the closeness in time between Halloween and 5 November? There has been an increase in trick or treating, and fireworks are being used in that activity. That is particularly distressing, especially for the elderly who are coming to fear this time of year for all the wrong reasons.”
“I understand, of course, that a large part of this debate will be about how we pay for care. However, does the Secretary of State agree that it is equally important to talk about what we are paying for? I welcome entirely what the Green Paper says about standardised assessments. Multiple assessments are not only wasteful financially but extremely distressing. Will he also address commissioning in his speech, and whether or not we are commissioning the right things at the moment? It seems to me—he might agree—that there is far too much commissioning for tasks and far too little for good quality care overall. Does that not need to be a large part of this consultation?”
“Gentleman will include it in the Government’s thinking on the improvement of social care more generally.”
“The right hon. Gentleman mentioned that the issue will effectively be a problem for the next Parliament. Regrettably, it has come before this Parliament at its end rather than its beginning, but we are where we are. He mentioned dementia, and he knows that that is growing as fast as, if not faster than, the other problems that he has described. He knows, too, that people with dementia are among those who are particularly affected by the mismatch between the quality of the services they receive and the amount of money they pay to receive them. One reason is the lack of training for those who provide dementia care. May I commend to him the report of the all-party dementia group, which I know his colleague, the Minister of State, the hon. Member for Corby (Phil Hope), has seen? I hope that the right hon.”
“I am grateful to my hon. Friend for giving way. Does he agree that there may well be some merit in the Government’s argument that the subject cannot be rushed? It involves the need for cross-party consensus. However, does he also agree that the real question is what has happened in Government between the publication of the Wanless review in 2006 and the publication this week of a series of options for further discussion? What have the Government done between those two dates?”
“As part of the review, could we reflect what is one of my frustrations and, perhaps, one of the Minister’s? In such debates, we always refer to older people as a drain on the nation’s resources, not as contributors to them. May we please reflect the fact that older people make a huge contribution to the child care needs of a variety of families and to the charitable sector, and recognise at all times that they are net contributors as well as drawers on the nation’s resources?”
“The Secretary of State referred to the wish to see a system that “ends the cruel lottery of older people facing financial hardship” because they happen to get dementia rather than cancer, for example. I applaud that sentiment, but he must know that one of the main reasons for that distinction is that those who have dementia are considered to have social care needs, not health care needs. In all the possible options that he has set out, extra finance will be required from a person who needs dementia care. Will he look again at that distinction?”
“In support of my hon. Friend’s case, does he think that part of the problem is the dissonance between what the Government say about the importance of carers and the fact that carers’ interests tend to slip so regularly off the Government’s priority agenda?”
“Does the hon. Gentleman agree that we cannot afford not to do something about this issue? If carers decided—I am sure that very few of them would wish to do so—that they could no longer shoulder such burdens, and the state was asked instead to do the work that they do unpaid, we would end up with a very much greater liability on the taxpayer.”
“I am sure that the right hon. Lady was as encouraged as I was to hear the Minister talk earlier about the training of those professionals and helping them understand more about the role that carers play. I am sure that she hopes, as I do, that that training will involve an understanding of how to respect the experience and understanding that carers develop about the people they care for, so that what she has just described happens rather less often.”
“I am grateful to the right hon. Lady for giving way again. She said that carer’s allowance was regarded from its inception as some sort of expression of the gratitude of the nation to carers. Is not part of the problem the cliff edge that emerges at retirement for carers who reach retirement age and are no longer entitled to carer’s allowance? It is now regarded as an income replacement measure, so people who retire are not allowed to continue to receive carer’s allowance, and that causes difficulty in trying to replace it with something else, which carers may not be as confident about claiming. Does she have any reflections on that subject?”
“We need to persuade those carers to identify themselves as such before we can offer them the sort of assistance the Minister set out and to which others have referred. The offers of help and support, the information exercises and so forth are linked with the opportunity that we should take to recognise carers and encourage those who do not yet recognise themselves as such to do so in order to access all those streams of support.”