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Health and Social Care Bill

My Lords, we debated a similar amendment in Grand Committee. I said at that time that I have every sympathy with its intention, as the noble Baroness knows. I fully understand the reason for returning to this issue again today. I join other noble Lords in welcoming back the noble Baroness in good health to the Chamber. I commend her for the eloquence with which she and my noble friend Lady Wilkins spoke to the amendment. Noble Lords will be aware that, throughout the passage of the Bill, the Minister and I have sought on every occasion to listen to the experience and expertise in the various areas covered by the Bill. Together—that is, noble Lords and the Government—we have created a much improved Bill to send back to the other place. In the parts where it has not been possible or practical, for various reasons, to include provisions in the Bill, we have sought to engage in constructive discussion and provide reassurance and explanation. While it is with deep regret that I cannot support this amendment, as it is currently drafted—because it seeks to place a wholly new and rather fundamental provision in the Bill—I seek, in the spirit that has applied to the rest of the Bill, to discuss how we can take this issue further. I have spoken to the Minister responsible for this area of policy and I am able to give noble Lords more positive information about continuity of care than I could in Grand Committee. I hope to convince noble Lords that the Government are determined to resolve the issue. A Green Paper with white edges, as was mentioned by the noble Earl, is the right way to express that. First, I make it clear that the issue that lies beneath this amendment—whether care and support services should be the same no matter where a person lives, as opposed to local authorities being able to respond to local needs and provide different kinds of services—is a strong theme of the engagement activity that the Government are currently leading, in preparation for a Green Paper on the future system of care and support in this country. When looking at national standards versus local flexibility, the issue of transitional arrangements is fundamental. The Government accept that there are great challenges within the care system and have signalled their intention for radical reform with the announcement of the Green Paper. They have, for the first time, launched a public engagement process which specifically asks people whether care and support in the future should be based on the principle of devolved control and local flexibility, or on a more national basis where a person will be entitled to the same support no matter where they live. That is at the heart of this issue. This question is explicit in our published discussion document, is on our website and is part of our current programme of engagement events. I can also confirm that the issue of portability, which the amendment raises, is being addressed as part of the debate on the Green Paper. This is a fundamental component of the system that can be addressed only as part of a full review because of its implications for local and national accountability, democracy and control of budgets. The Green Paper will set out options for the future funding of care and support. I can confirm for the first time—I am happy to do so on the record—that these options will address the wider issue of local flexibility versus national standards, and the difficult problems that this presents to service users, as set out in the amendment. We will then hold a formal consultation on these options and decide, in the light of the responses, what the care and support system of the future will look like. I undertake to ensure that we pursue that with rigour and speed. Among other things, the Green Paper will be informed by the review of the eligibility criteria for fair access to care services that the Commission for Social Care Inspection is conducting for us. In January 2008, my honourable friend Ivan Lewis asked the commission, in the context of the Government’s vision for adult social care, Putting People First, to undertake a review of the eligibility criteria, their application by local authorities with social services responsibilities and their impact on people. This followed a report from the commission that highlighted major inconsistencies in the way eligibility criteria were applied in different local authorities. The commission has been asked to submit its review by 15 September. After Ministers have received it, we expect the commission to make the review public. We cannot say at this stage what the commission will recommend, but the aim is clear: to achieve greater consistency in eligibility criteria across local authorities. This is another activity related to the wider issue raised by the amendment, and further evidence of the Government’s willingness to tackle the issue as part of a coherent review of the whole system of eligibility for social care services. I turn briefly to the specific provisions of the amendment. It may be difficult to justify looking at these issues for people who recently moved out of a local authority without also considering those who have chosen to stay where they are. We should not tackle these far-reaching issues in a piecemeal fashion. Neither should we lightly dismiss the concerns expressed by local councils about this amendment. There is no question that this issue must be looked at as part of a wider review of care and support services. However, I hope that the noble Baroness and other noble Lords who support this amendment will accept my assurance that the Government are not walking away; the issue is simply too far-reaching to address through an amendment to the Bill. The principles of the amendment may indeed be the future direction of social care provision. However, if that is the case, it is right that this should emerge from a review of the whole system, rather than from this single debate. Detailed negotiation and discussion with local government, and certainly time, would be required before changes were introduced. I have one further announcement that may provide reassurance. On 11 June, the Law Commission announced that it was to draw up plans for the reform of adult social care law. This could result in the redrafting of current legislation. The aim would be to remove anomalies, contradictions and dated concepts. The review may also explore whether the current legal framework is in harmony with the Government’s policy direction. I am sure that noble Lords will be pleased to hear that my honourable friend Ivan Lewis wrote to the Law Commission on 23 June and asked it to include, within the scope of its review, consideration of whether the current legal framework contributes to the difficulties that people face when they move from one local authority to another and are unable to find out in advance what package of community care services will be made available to them in the new area. Through this action, we will bring to bear on the problem the highly respected and independent view of the Law Commission, to complement the work that is going on in preparation for the Green Paper. Noble Lords will recognise that Ministers have tried extremely hard, throughout the debates that we have had in your Lordships’ House, to respond to concerns with positive action. We have taken every concern seriously; we take this concern extremely seriously. I assure noble Lords that I have taken it back to the department for careful thought on several occasions in the past few weeks. We have also brought forward amendments and made commitments on the record. We have clarified the role of social care within the Care Quality Commission; we have made it clear that the Human Rights Act extends to those who receive publicly arranged care in a private setting; we have addressed the issue of ordinary residence; and I have announced new proposals today. Wherever possible, we have sought to listen and respond constructively. However, I am afraid that we are not able to support this amendment. I hope that, with the reassurances that I have given, the noble Baroness will feel able to withdraw her amendment.