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Personal Care at Home Bill

My Lords, I thank the noble Baroness, Lady Thornton, for introducing the Bill. Everyone who heard the "Today" programme this morning will have recognised that she will not have an easy task. If it is any consolation to her, summing up on behalf of the Opposition when the noble Lords, Lord Lipsey and Lord Warner, are in the vanguard is not exactly a picnic either. ""The present situation cannot go on much longer. People are entitled to security and dignity in their old age and so we must ""find a way in which to fund long-term care which is fair and affordable, both for the individual and for the taxpayer".—[Official Report, Commons, 4/12/97; col. 489.]." Those are not my words; they were said by Frank Dobson MP when he announced the setting up of the royal commission. Since the royal commission the Government have not stood still. They have brought forth a raft of research reports, policy papers and legislation. I pick out highlights, as noble Lords have done already, such as Sir Derek Wanless’s report in 2006, the Government’s Green Paper in July 2009, the dementia strategy and the Community Care (Delayed Discharges etc.) Act 2003. Along the way we have had rafts of research and policy papers, the National Service Framework for Older People and the falls prevention strategy. However, today we are no clearer and no nearer to answering the question the royal commission was set up to answer. The most dispiriting thing about the Bill is that it takes us back to talking about a narrow, focused part of social care. The great tragedy is that the Bill’s production has meant that work on the costing models for the Green Paper had to stop. When we discussed this matter in the Queen’s Speech debate there was general consensus that, whatever one thought of the detail in the Green Paper, the financial modelling was crucial. The Bill has delayed that. Why is that so important? It is important because, as the right reverend Prelate the Bishop of Norwich said, this is a political issue of some importance. I congratulate the charities and the groups that have worked so hard to make this a key issue for the election. In truth, all parties are struggling with the issue of the funding of long-term care and this important debate could not come at a worse time. We all know how bad the outlook is for the public services and public service finance. Had we had this debate 10 years ago, the atmosphere would have been different. The Conservatives have brought forward their pledge for the election—a voluntary insurance scheme which would enable people to pay £8,000 in order to meet some of the costs of going into residential care. There has been a great deal of talk about perverse incentives and there is a great deal of concern that such a policy would encourage relatives to put people into residential care before they should be. As the noble Lord, Lord Warner, said, the Liberal Democrats have put on hold our commitment to free personal care—a decision we did not take lightly. At the same time, we also put on hold our long-held policy of funding free nursery education for all three year-olds. Passionately committed as we are to enhancing the life chances of children, I hope noble Lords will understand that the need to defer both policy commitments has come about because we are in such a difficult financial situation. I echo the speeches of the noble Baroness, Lady Murphy, and the noble Lord, Lord Sutherland. Debates on long-term care are always a mix of high principle and devilish detail. We will support the Bill going forward, not because we think that it has general overall merit in the greater scheme of things for putting us onto a sustainable future for long-term care but because in the draft regulations and guidance we go one step forward towards something which has been lacking throughout all the debates on personal care—a definition of what it is. The noble Lord, Lord Sutherland, is right: we have known for more than 12 years that we need a definition of what constitutes social care and what will be the state entitlement that is sufficiently clear to enable individuals, by whatever means, including insurance, then to bring in their own resources to top that up. That is why there is a value in this. The noble Baroness, Lady Campbell, referred to the question of assessment and whether we will have a critical plus band for services and, if we do, how people will be assessed. The noble Baroness loves talking about assessments—so do I. Last week I addressed the AGM of Counsel and Care, where one of my fellow speakers on the panel was Imelda Redmond, the chief executive of Carers UK. She reported that at the moment, in some local authorities, if a person turns up with the person for whom they care to an assessment meeting, the person being cared for can have their eligibility assessed as 50 per cent less than someone with similar care needs solely on the basis that they have a carer, and without that being mentioned to the carer at any point during the interview. Does the noble Baroness agree that that is wrong; that if it is happening it must stop and stop now and does not have to wait for this legislation? I should like assurances that the assessment of need will not include a carer’s contribution but that carers can be taken into account in working out a care plan. Other noble Lords referred to the activities of daily living, but I shall not go into them because that is a matter for the Committee stage. However, I will ask the Minister for clarification about what needing significant help with those activities will mean because it is on such small details that the daily fate of hundreds of thousands of people rests. The noble Baroness, Lady Murphy, made an eloquent case for saying that we have come to a time when we have to acknowledge that assessment of people who have dementia is different and, therefore, we have to have parallel assessment criteria for them. What somebody who has capacity can manage is not the same for somebody who lacks capacity. It is helpful to have the list of qualifying services set out in the guidance. In her introduction, the noble Baroness, Lady Thornton, talked about the criteria for NHS care. In her reply, can she say how the criteria for this policy will work with the criteria for continuing NHS care? It is not that long since local authorities and the health service were playing games with one another to see who would pick up the tab for individual people. That stopped when there was an increase in funding. It will reoccur the moment the pinch begins to fall on the public purse. A propos a point made by my honourable friend Norman Lamb in another place, reablement is a good thing and we are all in favour of it, but does the Minister agree that people who need palliative care should not be put through an assessment for reablement? That is simply a bureaucratic nightmare for people and their families when there is no need for it. On the issue of budget allocation, the right reverend Prelate the Bishop of Norwich talked about local authorities trying to implement this policy and having to cut services for other groups of people. I think it will be different and that social services departments will sit down and look at cutting other services for older people, who are by far one of their biggest client groups. That is the tragedy of having to debate such a small and narrow-focused element of social care. Were I in the unenviable position of being a chair of social services faced with this Bill, I would have to look at the work of my department and say, "Am I going to cut the wardens in sheltered housing? Am I going to cut the transport? Am I going to cut the lunch clubs and the shopping services?" These are all services which help thousands of older people and their families to get by. Given the lack of clarity about the number of self-funders and the capacity of councils to meet the obligations which this Bill places on them, does the Minister agree that this policy needs to be reviewed earlier than the 12 to 18 months proposed, so that we can see very quickly the extent to which it is, or is not, meeting its aims? I share the curiosity of the noble Baroness, Lady Masham, as to which Department of Health budget will be cut in order to fund this Bill. Finally, there is the proposal of the noble Lords, Lord Lipsey and Lord Warner. I have immense respect for the noble Lord, Lord Lipsey. Over the past 10 years we have done battle on this subject many times. He has consistently taken the approach that he does out of a passion for ensuring that the quality of services for older people in this country improves. I admire him for that. I am afraid we will not be supporting him on these Benches tonight. I have advised my colleagues to abstain for two reasons. The first is a technical one. We on these Benches do not intend to vote either at Second Reading or in Committee unless a matter is of exceptional importance, and I do not believe that this Bill falls into that category. The second reason is this. The Government have raised a whole raft of questions on a pretty thin evidence base. I have never read an impact assessment like it where the word "unknown" appears time after time. But having raised the debate just before a general election, the Government’s proposals deserve greater scrutiny than they received in the House of Common—although, having read Hansard, I would say that one clause got far more scrutiny than usual down another end. However, it needs to be taken much further apart. We can all argue about the principle and wonder about the economic climate and what we would do if we had the money, but when it comes to a national care service, we are not talking about reordering providers or establishing branding and all that which goes with the NHS, but about entitlement and funding. This Bill does not address funding but it begins, in a very small way, to address entitlement. I believe noble Lords have a right and a duty to examine that in very great detail, so I wish to go forward to Committee stage in order to do that.