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Mr. Alfred Morris (Manchester, Wythenshawe): I want briefly to discuss amendments Nos. 1 and 3 and new clause 6 in this group. I am happy to do so, more especially after that impressive speech by my hon. Friend the Member for Darlington (Mr. Milburn).
Amendment No. 1 would make means tests for direct payments identical to those for services, while new clause 6 seeks to make all means tests that are imposed more or
less consistent throughout the country. To allow different means tests to be applied would enable local authorities to sway the decision of an entitled disabled person, either towards its services or towards a direct payment, depending on their own preferences or political proclivities. That would be wrong and unfair.
I believe that fairness will be achieved only if, in addition to the section 7 guidance that the Government have promised, the wording in the Bill covering the assessment of the contribution in the case of a direct payment is identical to the wording used in the assessment of a contribution towards local authority services in section 17 of the Health and Social Services and Social Security Adjudications Act 1983
Such assurances are heartening, but they fall a little short of requiring the same means tests for services as for direct payments. To achieve a truly level playing field, the two means tests have to be at least similar, if not identical. The amendment uses the words "reasonably practicable" in describing the assessment of needs for direct payments. Those are the identical words used in section 17 of the Health and Social Services and Social Security Adjudications Act in relation to services. I can see no valid objection to using the same words for the two means tests.
The changes now proposed to the Bill seem to me to be a reasonably practicable way of achieving what everyone--including the Government--professes to want.
Amendment No. 3 would ensure that the full costs of securing a service are taken into account by local authorities in calculating direct payments. Leaving aside the question of the contribution from the recipient, the payment should cover the real full cost of securing the agreed service. In the case of an agency providing the service, it should allow the agency's staff to enjoy terms of employment similar to those offered to local authority staff. If it is used by the recipient directly to employ a helper, the payment should allow the recipient to fulfil all her or his duties as a good employer.
In assessing how much a service provided by a local authority costs, the authority should ensure that the real total cost of providing the service is calculated. That should include all overheads and supervisory and administrative staff costs. The comparison between direct payments and in-house costs relating to individual clients must not allow a local authority to introduce direct payments as a means of reducing the quality and cheapening the cost of providing essential services.
Mr. John Heppell (Nottingham, East):
I congratulate my hon. Friend the Member for Darlington (Mr. Milburn) on providing such a full explanation about new clauses 6, 7, and 1 and Government clause 16. However, that also presents a problem. Because he gave such an excellent and comprehensive explanation, there is very little left to say. Moreover, the points that he missed were picked up by my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris). So I am somewhat left at a loss, and, no doubt, Conservative Members would like me to sit down. But I should like to say a couple of things.
It is important that we have the necessary framework in place to ensure that people are not discriminated against on a geographical basis and that there is equity. New clause 6 is important in that respect. As for the review, I should have thought that Conservative Members would always think that it is sensible to review progress, to report back and to fine tune. That seems to be sensible to me.
I suspect that, later today, we will debate the Government's concerns about eligibility. I think that they, wrongly, have a vision of opening the floodgates and people rushing in to take up direct payments. I believe that the opposite will be true and that, in some areas, the services will have to be promoted if people are to take advantage of them.
One thing that can affect eligibility--I do not think that the Minister has taken it into account--is charging. If charging is excessive, people will not take up direct payments. If we get the charging wrong, we will put restrictions on disabled people who wish to take up this new, excellent facility offered by the Government.
The "Disabled in Britain" survey, which was conducted by Scope in 1994, quite correctly made the point that72 per cent. of disabled people want more independence and that 59 per cent. of disabled people would like more control over their everyday lives. So the issues are choice, independence and control. However, those goals do not seem to accord with what people have said about what they might have to put up with because of the charging policy and its effect on direct payments. One person said:
Another person said:
Another person said:
I now turn to a survey on charging for community care services which was reported in a briefing to the all-party disablement group on 27 February. It is important that we recognise what disabled people think about present charging policies. The study was called, "The Cost of Care--the impact of charging policy on the lives of disabled people." It was commissioned by Disability Alliance and Social and Community Planning Research, and it was funded by the Joseph Rowntree Foundation. The disabled people interviewed had a high level of dependency on care provided and most had little scope to reduce or withdraw from services. People are captives in terms of the amount of care they have to have, so we must be careful that we do not overcharge them. Market forces do not apply.
One of those interviewed said:
There was strong evidence that people were receiving fewer services than they needed and were reluctant to ask for more. One reason was that they thought that the local authority did not have enough resources and the second was that they were worried about charges. We need to ensure that we get the charges right so that we do not put people in that position in future.
("reasonably practicable for him to pay".)
In Committee in another place, the Minister gave assurances that neither service users nor direct payment recipients would be treated more favourably than the other on the question of the financial contribution that each is expected to make towards the cost of their care. She spoke, as did my hon. Friend the Member for Darlington, of a level playing field and of no perverse financial incentives. She then went on to refer to section 7 guidance on this important issue. That is in House of Lords Hansard, 15 January 1996, at columns 402 and 403.
"Relying on other people is the most frustrating part of my life, not being able to do what I want, when I want".
That frustration would end with a proper direct payment scheme.
"Once I was left in bed for over 40 hours, and on two occasions they should have got me up at 9 am but came at noon."
That could end with a proper direct payments scheme.
"Home helps and night sitters who get me out of bed suddenly, without notice, don't turn up, and I have to ring people and get them out of bed to help. Social Services 'out of hours' emergency phones are not manned."
We have all heard the horror stories about people who, sometimes through no fault of the local authority, are told, "Well, you may want to get up at 7 o'clock or 8 o'clock
in the morning, but you cannot get up till 10 o'clock in the morning because that is the earliest that we can send someone to get you up. You may want to go to bed at9 o'clock or 10 o'clock at night, but unfortunately you have to go to bed at 5 o'clock or 6 o'clock at night because that is the way the local authority service is geared." By excessive charging, we could rule out many people who want to make use of that facility.
"I can't do without that service, no matter what happens. You know, when push comes to shove I've got to go to the toilet."
That is why the service is needed. If the charges are raised for such a service, there is no way that someone can say, "Well, that charge is too high and I'm going to drop out of it."
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