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9.14 pm
Mr. Alan Milburn (Darlington): For the benefit of the House, I should declare at the outset that I receive research assistance from Unison, although I am not representing its views in this debate.
The debate has been especially well informed and considered, and overwhelmingly consensual, with hon. Members often drawing on local experience and their interface with local disability organisations. We have had on display an array of national talent and expertise on issues affecting disabled people.
In some senses, it is slightly invidious to single out particular Members for attention, but I should like to pay tribute to the hon. Members for Brighton, Kemptown (Sir A. Bowden), for Bolton, North-East (Mr. Thurnham), and for Mid-Kent (Mr. Rowe), and to my hon. Friends the Members for Stratford-on-Avon (Mr. Howarth), for North-East Derbyshire (Mr. Barnes) and for Wakefield (Mr. Hinchliffe) for their long-standing commitment to disabled people's rights. We have had important speeches from those hon. Members, and from all who have spoken.
The Bill has been broadly welcomed by hon. Members on both sides of the House. It has been long desired both by disabled people and by the organisations that represent them. We have come a long way since the pioneering work of the early 1980s in Hampshire to encourage independent living among disabled people. That experiment has found an echo throughout the land.
By 1990, the Royal Association for Disability and Rehabilitation found that more than 60 per cent. of local authorities were operating some form of direct payments scheme--albeit through third-party agencies--despite the somewhat doubtful legal status both of their establishment and sometimes of their operation. The Bill legalises the direct payments approach, and at last gives official sanction to a new and highly popular form of community care.
The success of the independent living fund is but the most graphic illustration of how an approach that maximises user choice resonates with disabled people. When the ILF was established, it was estimated that only around 300 new awards a year would be made, but, by 1993, as my hon. Friend the Member for Bradford, South (Mr. Sutcliffe) reminded the House, 22,000 people were receiving payments. The Governments's decision to close the ILF in 1993 flew in the face not only of its popularity, but of its achievements.
A 1994 study for the Policy Studies Institute and for the British Council of Organisations of Disabled People summarised the benefits that flowed from the ILF. It said:
Tragically, the Government have a history of coming only belatedly to recognise the case of disabled people for improved rights. Organisations such as the Disablement Income Group, the Disability Alliance and the British Council of Organisations of Disabled People have long campaigned for such a Bill. They have received handsome support from organisations as diverse as the Association of Directors of Social Services, housing and local authority associations and many others, including the House of Commons Select Committee on Health.
There is almost universal agreement that direct payments are a positive and innovative development that secures better delivery of community care services. They make the disabled person the centre of the care system rather than its dependant. That point was amply made in a telling contribution by my hon. Friend the Member for Stratford-on-Avon.
The first choice of most elderly and disabled people is to live independently in their own homes, and to feel part of the community. For care in the community to succeed, it must enable all people to live with the same respect for their dignity and autonomy. Direct payments allow services to be suited to the needs of the individual, rather than the individual having to suit the needs of the services. In other words, direct payments empower service users by allowing the user to shape the service rather than be shaped by it.
It is not only disabled people who benefit from direct payments. The taxpayer can also be a net gainer. The right hon. Member for Chelsea (Sir N. Scott) told us that it is reckoned that direct payments result in average savings of between 30 and 40 per cent. on comparable service provision. When a disabled person is commissioning services it puts him or her in charge, gives real choice and provides cost-effective care.
The principles of the Bill are a matter of political consensus, which I welcome, but its fine print is a subject of real dispute, and the fine print has dominated our debate. In the first place, it is regrettable that the Bill was introduced in another place before the publication of the consultation document outlining in much more detail the Government's thinking on many of the specifics of the Bill.
It is also a matter for regret that the results of the consultation exercise, which finished last month, have still not been made available. Inevitably, the debate has sometimes felt a bit like a shot in the dark, with hon. Members on both sides of the House having to second-guess what is in the minds of Ministers about the final detail of the Bill.
My hon. Friend the Member for North-East Derbyshire rightly called the measure an enabling Bill, and was therefore cautious about it. Similar suspicions were voiced by my hon. Friend the Member for Falkirk, East(Mr. Connarty).
I believe that it is not beyond the wit of the Under-Secretary to arrange the consultation exercises and the debates on the Bill so that those who debate it both here
and in another place can fully consider the facts. I hope that he can at least give us an assurance tonight that the results of the consultation exercise will be published before the Bill goes into Committee. Otherwise, we shall continue to rehearse backwards and forwards all the arguments we have had over the past few hours, and still be taking a shot in the dark.
It is especially important that the principle of openness applies to the Bill, because, as we know, it is planned to make so many of its detailed provisions by regulation rather than by primary legislation. None the less, several concerns are already clear. They have been flagged up by the disability organisations, by my noble Friends in another place, and by hon. Members on both sides of the House tonight.
The major concern expressed by organisations such as the Law Society, the British Medical Association, the Royal National Institute for the Blind, the Carers National Association, MIND and the Disability Alliance relates to the artificial restrictions imposed on the categories of people who will be eligible to receive direct payments under the Bill. That concern was made clear by the hon. Members for Bolton, North-East, for Mid-Kent and for Brighton, Kemptown, my hon. Friends the Members for City of Durham (Mr. Steinberg), for Nottingham, East (Mr. Heppell) and for Ealing, Southall (Mr. Khabra), and my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris).
The whole point of the Bill is to put disabled people and their needs at the centre of the care system. It is about treating the individual as an individual, regardless of their disability. Instead, the Government seem to be determined to disempower individuals according to the category of disability that they have been placed in by the Secretary of State.
Surely it is entirely incompatible with the whole thrust of the Bill, and with what the Minister said earlier, to deny the choice of receiving direct payments simply because an individual is either too old or too young, or has the wrong sort of disability according to the Secretary of State's arbitrary diktat. We believe that anybody suffering from any disability may be suitable, and should be eligible, for direct payments rather than services. We have much sympathy with those who argue that direct payments should be available in every local authority area to ensure equal access to the benefits that flow from them.
Since direct payments will represent a departure for some authorities, however, we are willing to concede that there should be no mandatory obligation on councils to offer them, providing that two key concerns are met. First, the Minister should actively encourage local authorities to introduce direct payments, and secondly, all classes of disabled people should be allowed access to them.
If we are serious about treating individuals as individuals and about shaping services to meet individual needs, it surely follows that age or disability should form no barrier to qualification for a direct payment. After all, someone who is in their late 60s may be much better qualified to take advantage of a direct payment than someone in their early 30s. Similarly, someone with a moderate learning difficulty may have a greater capacity and willingness to deal with direct payments than someone with a severe physical disability, which leaves them frail, poorly and sometimes confused.
The tests for direct payments should be solely about whether the person is in need and has been assessed as requiring community care services and whether direct payments represent value for money for the authority and are in the best interests of the individual who is able and willing to take advantage of them. Those should be the tests--no more and no less.
Instead, the consultation document issued by the Department tries to make the Secretary of State's discretion predominant in determining who will gain access to what we all believe is an innovative and exciting means of putting disabled people at the centre of the care process. Frankly, such arrogance flies in the face of a needs-led approach to the care of disabled people. I hope that the Minister will carefully review the matter, not only in the light of the 300 responses to his consultation document, but because of what he has heard in the debate. A consensus has been established, and I hope that he will listen.
I should like to highlight two issues. First, given that community care services are available to people over the age of 65, an age limit seems especially unnecessary and unfair. More than one third of clients of the former ILF were aged over 60 in any case, and research into current local authority payment schemes shows that only two out of the eight authorities studied explicitly ruled out people over the age of 65.
Similarly, as the ILF has given 18 per cent. of its awards to people with learning disabilities, excluding them from direct payments is equally unfounded. It also contradicts, as my hon. Friend the Member for Stratford-on-Avon reminded us, the recent Law Commission recommendation that there should be a presumption against lack of capacity.
There remains a real worry--again, I hope the Minister will address this when he winds up--that unless the Government relent and broaden the eligibility criteria, some people will lose the direct payments that they are currently enjoying through third-party agencies. It is surely not the Government's intention to narrow or remove opportunities that disabled people currently enjoy. Yet the eligibility criteria as defined in the consultation document do precisely that.
The Opposition will not accept the undermining of the Bill's purpose by its proposed means of implementation; nor will we accept the denial of real choice entailed in the Government's restriction of direct payments to certain groups of selected people. That is why we will be tabling amendments to the Bill to ensure that real choice is available to as wide a range of disabled people as possible.
We shall also be seeking to broaden choice in other ways. These take several forms. To allow people to make informed decisions about whether they wish to receive direct payments for certain services, it is vital that advice and information is provided to them. Under the Bill, hundreds of disabled people could become employers for the first time. They will need support.
As my hon. Friends the Members for Wakefield and for Bradford, South pointed out, the lesson from the independent living fund is that the best-run schemes were on the basis of the advice and support available to the
disabled people who had access to the funds. The Bill must ensure that such services are available to disabled people--should they require them--to maximise choices about whether direct payments are an option for them.
Choice should be maximised by ensuring that the distinction that the Government rightly make between formal and informal care is not drawn so tightly that a disabled person is prevented from employing any family member on a paid basis. Of course we do not want informal care to be brought into a cash-for-care arrangement, but we recognise that disabled people will want to employ those they know and trust, particularly when it comes to the performance of intimate tasks for them. In some cases, they may have little choice in any case, because of where they live, their domestic arrangements or the nature of their disability. The consultation document's virtual blanket ban on employing any relative runs against the grain of the needs of those disabled people. We hope that the Minister will concede that the proposals are too prohibitive, and need to be reviewed.
It is vital that choice is not restricted by adverse charging policies. The Bill proposes to treat service users and cash users on an equal basis, so, just as an individual is charged for a service, he will also have to make a financial contribution towards the equivalent direct payment. There can be no argument about that, but we have a number of concerns. I hope that the Minister will be able to clarify that certain social security benefits received by disabled people should be disregarded in calculating the amount of direct payment or financial contribution that an individual is expected to make.
I also hope that the Minister will make it clear that direct payments are to be used for social care services only, and will not be used as a substitute for health service responsibilities. That distinction is vital, since otherwise direct payments received by disabled people will be means-tested even if they have to be used to purchase services that they should be receiving free of charge.
I also hope that, as my right hon. Friend the Member for Wythenshawe said, there will be a level playing field between community care services and direct payments in lieu of them, so that no means test is involved if direct payment is made where the equivalent service is provided free. That assurance would be extremely welcome.
Finally--and most fundamentally of all, in my view--the proposal to leave it up to individual local authorities to decide how to take into account service users' financial status when setting the level of direct payment is, frankly, a charter for confusion. The care that a person receives and the price he pays should not depend on where he lives.
Last year, a National Consumer Council report on local authority charging procedures found that charging systems for non-residential social services were structured differently in virtually every local authority area. The NCC found also that widely different criteria were used by local authorities to assess people's ability to pay.It would be tragic if the same situation developed for those receiving direct payments for care. Is it not now time for a national framework for charging policies for social care, to end what has become a lottery?
Disabled people living in Dorset should be entitled to the same financial assessment as disabled people living in Durham. After all, their needs will not differ even if the respective areas are different.
The Bill provides a golden opportunity for the Government to consider ending the restriction on choice that applies to so many community care users merely because there is such latitude in the ways in which local authorities are allowed to charge for services.
The Bill provides an opportunity for the Government to take further action. Although those receiving direct payments may decide to purchase care from a number of sources, the Bill will almost certainly lead to increased use of services provided by independent sector domiciliary care agencies. There should be no objections to that, provided that the services offered to disabled people are of the highest quality and standard.
There lies the nub of what might be a problem. When other care providers are subject to greater registration requirements and inspections, there is still no statutory framework governing the operation of domiciliary care providers, despite the fact that the services they provide are made available in an individual's home, and are therefore subject to much less scrutiny.
The clients of domiciliary care agencies are among the most vulnerable people in the population, yet the protection afforded to them in their own homes is negligible compared with that which is available to clients in residential care. That is why organisations such as the British Medical Association and the Association of Directors of Social Services, in responding to the Bill, have called for the regulation of providers of domiciliary care. Their calls have been echoed this evening by the hon. Member for Mid-Kent and by my hon. Friends the Members for Glasgow, Maryhill (Mrs. Fyfe) and for Wakefield. I hope that the Registration of Domiciliary Care Agencies Bill, introduced by my hon. Friend the Member for Wakefield, will be considered by the Minister in the light of the Bill before us.
The calls to which I have referred have been repeatedly echoed by Labour Members. I know that these calls have been taken up by many providers in the private sector. Domiciliary care agencies that have taken up these calls recognise that they are providing care for extremely vulnerable people, individuals who have few opportunities to raise concerns about services and who need protection from unscrupulous operators. It is in the interests of us all to drive the cowboys out of the industry. Everyone wants to see that happen.
The Bill brings to a head all the tensions about the lack of a regulatory framework for private domiciliary care. I know that the Minister will say that he has only recently finished consulting on a Government document designed to move things forward, and that it is too early to give any categorical views on what the Government have in store for the future registration and inspection system. However,I believe that it is incumbent upon him to give some assurances this evening that it is at least in his mind to provide a proper form of regulation for domiciliary care. We are dealing with extremely vulnerable people receiving services paid for from the public purse in their homes. Both public money and disabled people deserve proper protection.
The Bill is a great opportunity radically to improve services for disabled people. Our proposals for strengthening its provisions will make the individual's needs ever more the focus of services. It provides a model that can be built upon. All too often, disabled people,and other community care service users, are reduced to a state of artificial dependency by their contact with statutory agencies.
The whole thrust of community care is surely to reverse that process, and ensure that elderly and disabled people or those with mental health problems have their needs addressed in such a way that they are able to participate to the fullest extent possible in the community. It is time that users were given more power to shape their services.
"enabling disabled people to organise their own support arrangements offers considerably more choice, control and flexibility than direct service provision; consequently, direct payments are seen as greatly increasing disabled people's independence."
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