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Mr. Hammond: Is not the hon. Gentleman saying that the procedures under clause 2 will inevitably be subject to precisely the same eligibility criteria to which he referred in relation to other social services provision?
Dr. Turner: I thank the hon. Gentleman for that intervention. He is basically right: everything in the Bill and the 1990 Act is subject to eligibility criteria and matching to resources. There is no way of arguing around that. However, we can argue about how much resource we put in and how much its intelligent use can save in the long term.
My point to the Minister--which relates to the issue raised by my wise and right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke)--is that sustaining carers will make care arrangements more sustainable. Sustaining carers for more years than they might otherwise be able to keep going without adequate care and support may save the domiciliary care arrangement from breakdown. Because when it finally does break down, either because the carer becomes unable to continue caring, or the cared-for person gets beyond the capacity of the carer
to care for him or her and has to take up an institutional placement, the social services costs will increase considerably. There is virtue in putting more money into carers. I hypothesise that spending, say, £1 billion on carers would not mean an extra £1 billion in global spending because we would save in other ways--although the complexities involved make it difficult to prove that argument.
Money has already been put into the carers charter, but more is needed. The only figures that I can cite are those for Brighton and Hove, my own authority, which invests roughly £4.8 million in support for carers. That all-embracing figure covers day centres where carers are involved, and so on. In addition, the carer special grant is £128,000 for the coming financial year. In effect, the authority can increase by one third the amount that it spends on residential respite care, but there will be no significant increase for existing clients because more carers are receiving respite care. This means that no one is receiving the desirable amount of respite care. To achieve the care that highly stressed carers require, we should need a lot more money. I do not envy the Minister his task of pleading for carers in the next comprehensive spending review. A significant sum is needed both for carers and for community care as a whole.
This debate must be related to the Government's response to the forthcoming royal commission on continuing care. I share the view of directors of social services and others involved in social care that the current system, which resulted from the Community Care (Residential Accommodation) Act 1992, will not be sustainable. We must consider whether we should separate social care from nursing care, and that question has considerable implications for Government spending and for the charging of individuals who give or receive care. I do not expect the Minister to address those complex issues today. They are too big, and I am straying beyond the context of the Bill. However, the Bill must be related to the global picture.
Mr. Steve McCabe (Birmingham, Hall Green):
I apologise, Mr. Deputy Speaker, for not being in the Chamber at the start of the debate. I was in the building, but I had to deal with a pressing constituency matter. I congratulate my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) on introducing the Bill.
Although the practical content of the measure is vital, what is even more important is that it offers us an opportunity to make a cultural or psychological shift in our attitude to carers and to people with disabilities. As a former social worker, with some experience in the field, I have no desire to bash the social work profession--plenty of people have been doing that for many years.
However, it is important to realise that, although we constantly talk about enabling and empowering people, the professionalisation of caring has had the opposite effect.
We have emphasised the needs of professionals, organisations and services and have taken the focus away--not intentionally--from the needs of the carers and those who need assistance. One of the effects of the measure will be to shift that focus back where it should be--on the needs of those doing the caring and those in need of services.
One obvious example of that is the voucher scheme. It is ludicrous that people can be caring night and day, all week, and cannot ask their local authority for a break at a time of their choice. When they ask for a break, the local authority replies, "Well, you can have one at this time, in that month." That is nonsense; the priority is given to those who organise the service, not to those who need it.
The vouchers would make a significant change by putting the focus where it should rightly be--on giving respite and relief to a person who is exhausted. When a person is reaching breaking point, it is of no use to be told, "In three or four weeks, you might have a weekend off." The whole point of respite is that people should be able to decide when they need a break and should be able to have access to relief.
The direct payments scheme is welcome. It is a massive step forward in our approach to caring. In our attempts to provide higher standards of care and better quality services, we have over-professionalised some aspects of caring. In many cases, we have created a crude, paternalistic service.
I used to have the unhappy task of telling people what the local state was prepared to offer them and what it thought was appropriate for them. Perhaps I was not a particularly good social worker--although I was not alone in that--but I did not listen to what people said they needed. The brief was to tell them what was available and what they could have. That paternalistic approach has damaged the relationship between social workers and the people who need help and support. Over time, that has ground down carers and produced the feeling that people do not listen and do not care. Carers are merely talking to a local machine that is churning out the available services.
Direct payments are the way forward. They are the greatest gift that the Bill offers, because it recognises that people know what they need to make the quality of their lives better. They know how often and what type of services they require, and, by providing resources, the Bill will enable them to select them in the form that they want. That is one of its greatest strengths.
My hon. Friend the Member for Brighton, Kemptown (Dr. Turner) also referred to resources. They are critical and I hope that the Minister will be able to offer us some reassurances about clause 9. I do not suggest that he should tell us exactly how much money will be available.
Mr. Hammond:
One of the hon. Gentleman's colleagues drew attention to the explanatory memorandum which suggests that, apart from the administrative costs of assessment, the Bill is unlikely to
Mr. McCabe:
I said that we had lost our focus when we organised and professionalised these services, so I think that quite a lot of money is wasted in the existing administration of them. That money does not directly benefit the carer or the person who needs the services; it is lost in the local state machine. Although I do not attempt to deny that costs are attached to direct payments, it strikes me that there could be a shift of resources. If we were to put less emphasis on the local state bureaucracy and the local social worker's role and more emphasis on what individuals need, there may be scope for a transfer of resources. Nevertheless, money must be made available if direct payments are to be introduced, and I hope that the Minister will say a little more about the availability of resources.
Local authorities are generally resistant to direct payments for two reasons. They see them as expensive and as something that will lead to the loss of their power. When services are directly provided by the local state, it has immense control and power and it builds up a self-perpetuating bureaucracy. People are always needed to perform extra tasks or to do extra paperwork and administration. Local authorities are reluctant to have direct payments because they see them as a threat to their existing power and control.
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