Care minister Gillian Keegan: 'I don't think I will ever be in a meeting where somebody isn't asking for more money'
Care minister Gillian Keegan, who delivered the government's long awaited adult social care white paper this Wednesday, pictured at the 2019 General Election count in Chichester [Photo credit: Alamy]
Gillian Keegan believes that she will get dementia.
“Most people in my family live a long time and get dementia, so I am pretty sure that I will get dementia,” she says. “Therefore, I take a keen interest in it. Not just for me, selfishly, but you do find in certain families that you have a lot of people who get dementia. And more of us will get dementia in the future.”
As we sit in a meeting room in Portcullis House in Parliament, Keegan, 53, reflects back on a busy day. Four hours ago, she was on her feet delivering her first ever ministerial statement in the Commons announcing the government’s much awaited adult social care white paper, People at the heart of care.
She’s pretty pleased with how it went, but for Keegan, who has been in role as care minister only since September, it is a deeply personal plan. One of her first acts upon becoming MP for Chichester in 2017 was setting up the All-Party Parliamentary Group on Social Care with Labour’s Louise Haigh, informed by the experiences of her grandmother who they had to place in a care home.
“Most people don't understand today's system, unless you get you go into it. Then once you understand it, it really is a very, very unfair system,” Keegan says. “In my nan's case, she bought her council house in Liverpool where I grew up, under the Right to Buy scheme. She'd only ever worked in a biscuit factory all of her life, but she'd saved up, she was very cautious. Then everything went, apart from £14,250.”
Even before the pandemic put unprecedented pressure on the social care sector, it has been a policy area which makes headlines, and inflicted political pain on more than one prime minister.
The time is now. You could argue the time is actually previous to now, it would have been better if it was done already.
Keegan points to the political difficulties around New Labour’s proposals for a universal national care service paid for by a 10 per cent levy on top of inheritance tax – dubbed a “death tax” by George Osborne in Opposition – and Theresa May’s so called “dementia tax” in 2017.
“This has been attempted many, many times. It always gets knocked off track by lobbying in some way.” The consequences of this have been devastating, Keegan says. “That's why you really do need to take the brave step of reforming adult social care. The time is now. You could argue the time is actually previous to now, it would have been better if it was done already.”
Keegan repeatedly emphasises that the latest proposal is the start of the journey, a 10-year-vision shaped around three key principles: people have choice, control, and support to live independent lives; people can access outstanding quality and tailored care and support; and people find adult social care fair and accessible. This is being delivered by investment into supported housing, a cap on care costs for individuals, plans to make the system easier to navigate, and investment into development and progression for the workforce. In the Autumn spending review, the government committed £5.4bn over three years to care through the Health and Social Care Levy – £3.6bn to pay for changes in how individuals are charged for their care, and £1.7bn for wider system reform.
(L to R) Health Secretary Sajid Javid, Prime Minister Boris Johnson and Chancellor of the Exchequer Rishi Sunak, during a media briefing in Downing Street on the Health and Social Care Levy, Tuesday 7 September 2021
However, with no new money announced in the white paper, it falls far short of the £7bn extra a year that the Health and Social Care Select Committee has called for as a “starting point for social care funding” by the end of this Parliament. The committee’s chair and former health secretary Jeremy Hunt deemed the plan as a “disappointment” and “three steps forward and two steps back,” failing to address the immediate crises in the sector.
Keegan dismisses Hunt’s criticisms. “I don’t see that that's the case. The most important [response] really is the response of the care sector, which has been by and large quite positive.”
“You can't really put every aspiration [for care integration and improvement] on this reform white paper,” she says, adding that it should be seen as wider set of reforms along with the Integration white paper, the Health and Social Care Bill and reforms to the public health system.
However, while many in the sector praised the government’s vision in the white paper, there has also been widespread criticisism over the lack of funding and failure to address the care staffing crises. There is currently a turnover of up to 40 per cent a year and 105,000 vacancies in a workforce of more than 1.5 million.
These are dismissed by Keegan too: the white paper was never meant to be an immediate solution to the problems the care sector faces, and by introducing career development opportunities for a workforce with an exceptionally flat structure, it will help address some of the recruitment and retention issues, she says.
So, what is the government doing now to address the chronic-underfunding? “[Local government settlements] are in negotiation,” Keegan says, describing the settlement for social care agreed earlier this year as “quite good”; she “very much doubts” the local government settlement will reach the requested £7bn.
“I've been in business for 30 years before being an MP, [if] there's one thing I've now realised as a minister is that I don't think I will ever be in a meeting ever again where somebody isn't asking for more money. It's just the nature of the job.”
“What happens at the moment, if you don't have social care or access to GPs, everything goes to acute hospitals, and everything backs up. The whole point of the Health and Social Care Bill and the integration white paper, which we said will come out next year, is that we need to make those processes work a lot smarter together. Because the person is not out in the street, they’re either in the hospital or at home, and we're paying more money for them to be in hospitals than it would be if they were in social care,” she says.
Keegan won’t put a number on the amount that she thinks would be needed for the full reforms to the sector to be delivered, but she accepts that the £5.4bn is a “pump priming” amount, with more money needed down the line.
That manifesto pledge said nobody would have to sell their home, but really what we meant was nobody will have to sell their home during their lifetime
She is clearly frustrated at the self-inflicted political pain the government is facing over the issue of social care. Two weeks ago, the government saw its majority cut to 26 after 19 Conservative MPs rebelled and 70 abstained on plans for the means-tested support provided by local authorities to not count towards the newly introduced £86,000 lifetime cap on care costs (those with under £20,000 of assets will not pay anything). Critics, including red wall MPs, said that those with assets worth less would have to spend significantly more of their wealth on care costs before hitting the cap, and be more likely to be forced to sell their homes compared to those with higher assets, disadvantaging the less well-off and those in areas with lower house prices.
Keegan says such critics are over-simplifiying the issue, but it has led many to say that the Prime Minister has broken his 2019 manifesto pledge that no one would be forced to sell their home to pay for care. Does she regret that this pledge has been broken?
“That manifesto pledge said nobody would have to sell their home, but really what we meant was nobody will have to sell their home during their lifetime,” she says. “You couldn't basically guarantee that every house in the country, based on whatever cost, the government would say, ‘we will always act as a guarantor and back behind that’. That would be silly.”
Keegan continues: “What we say now is, they don't have to sell their home, they could rent their home out, get some income so people do not have to sell it, and they can get deferred payment. But they will have to pay up to £86,000.
“Some people at £86,000 may have enough in their other assets. And some people may have to use their house assets towards that, but they will never have to pay a penny more than £86,000. That is a huge comfort to people, because today, anybody could lose everything down to their last £14,250. As in my nan's case, this isn't wealthy people, this is everybody. Dementia doesn't look at your bank account.”
So did the Prime Minister make a rod for his own back by oversimplifying the issue in the 2019 manifesto?
Keegan dodges the question. “Everybody I spoke to face to face about it has said, ‘Is it absolutely true that we'll only have to pay £86,000?’ And I say ‘yeah, it is’, and the relief on their face is palpable.
“People are not comparing the right [things]. The difficulty with this has always been people don't really understand today's system, and how unfair it is.”
I was 49, when I got elected [as an MP]. It's a brilliant model that could be replicated for other people who have a career already outside politics
So, does Keegan think the system the government is introducing is fair? She says this is one of the first questions she asked upon taking the job, naming the same issues as her critics now; the short answer is that any other system is unworkable, with house values going up and down, and care costs differing vastly across the country. A second reason is that a fixed sum makes it easier for individuals to plan and navigate the system, and for insurers to develop social care insurance products, something she says there have been discussions about.
Despite facing some tough questions from the backbenches, many Conservatives speak admiringly of Keegan, who was formerly director of Women2Win – an organisation founded by Theresa May and Baroness Jenkin to help more women become Conservative MPs. While representation for women in Parliament is at an all-time high, at 34 per cent of MPs, for the Tories it is still less than one in four.
Keegan thinks one way to boost this number is to encourage more people to come into politics via different routes, at any age. “I was 49, when I got elected [as an MP]. It's a brilliant model that could be replicated for other people who have a career already outside politics, and then decide this could be a great second career, or second vocation, if you want to call it that.”
It also needs to be a more attractive proposition to women, she says – and that means tackling online abuse, and selling the role.
In recent weeks, there has been little public support from fellow Conservative MPs for former minister Caroline Nokes, who alleges Stanley Johnson sexually harassed her in 2003 (Johnson denies this), with Culture Secretary Nadine Dorries saying that she didn’t believe Nokes’ allegation. Does Keegan believe Nokes?
“I have no idea, it all happened way before my time,” Keegan says. “I think the key important thing is that there needs to be processes in place. The processes are very important. One of the first things that I understood when I was here first an MP is there weren't that many processes, either to protect staff or MPs to be able to make some of these claims, whether it was harassment or bullying, and of course, those processes have all been developed now. It’s really important that both the party and parliament have processes in place, and my understanding is processes are in place now. We have to let those processes be followed.”
She may have got through her first oral statement relatively unscathed, but with more health and social care legislation coming next year, Keegan’s battles to build a system better care aren’t over yet.
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