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Respite Care

1.30 pm

Mr. Tony Baldry (Banbury): A little while ago, a constituent of mine, Mrs. Muriel Briggs, came to see me at a constituency surgery. Prior to that meeting, she had written to me to set out her specific concern. She wrote:

A recurring point in the various representations that I have had is that the 28-day limit causes much concern to many carers and results in a great deal of correspondence about disability living allowance benefits. Mrs. Briggs went on to ask:

The notice that Mrs. Briggs drew to my attention was from Oxfordshire county council social services, headed:

The notice states:

I genuinely did not understand that. It seemed extraordinary that Rachel should receive respite care on average once a week for 28 weeks and then suddenly not be entitled to any respite care at all for an arbitrary period of 29 days. I wrote to the Under-Secretary of State for Social Security, the hon. Member for City of York (Mr. Bayley):

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On 26 February, the Minister replied:

Having studied that paragraph several times, I think that I understand what the Minister is trying to say, but I have the benefit of a lifetime as a barrister spent trying to construe documents and regulations. I suspect that the Minister's explanation is rather difficult for claimants to understand.

For those of us who do not involve ourselves daily in the minutiae of social security regulations, they can seem like a secret garden. In order better to understand the matter, I approached Oxfordshire Welfare Rights, an extremely good organisation which is based in Oxford and is partially funded by, among others, the county council. It sent me its benefit bulletin, which states:

I shall say something about the definition of "special accommodation" in a moment. The bulletin continues:

Oxfordshire Welfare Rights also sent me a briefing, which states:

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Oxfordshire Welfare Rights recommends that the 28-day linking rule should be abolished for all benefits.

I have begun to understand that regulations have not kept up with changes in practice. In some cases the regulations go back to 1975, which was before the introduction of care in the community. Furthermore, the regulations tend to repeat themselves. For example, the Social Security (Hospital In-Patients) Regulations 1975 were drafted before care in the community, when people went either to hospital or--to use the phrase in the legislation--"a similar institution" for long periods. If someone goes into hospital for a long period, it is fair and proper that after 28 days they cannot continue to draw benefits that they may previously have received. However, the legislation was drafted before it was anticipated that people would increasingly live in the community and enter respite care for short periods of time.

I pray in aid the discussion in the 1975 regulations of "prescribed accommodation" where people reside as patients or inmates. Clearly, the legislation was drafted when people spent a long time in hospitals, sanatoriums or other institutions. It was not drafted for a time when care packages increasingly meet the needs of both carers and those for whom they care in a commendably flexible and appropriate way.

I ask the Minister not to explain again how the rules work because I now understand that. Having heard representations not only from Oxfordshire Welfare Rights, but the Disability Alliance and the Carers National Association, which I shall mention in a moment, I hope that he will feel it is worth examining the 1975 regulations to see whether they can be brought up to date to take account of modern practice, which includes care in the community.

The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley ): I have great sympathy with the hon. Gentleman's constituent. He acknowledged that someone who spends a long period in hospital at public expense should not simultaneously receive a welfare benefit that provides him or her with money that can be used to purchase care. I agree with him that in the case of a short stay in hospital of perhaps a week it would be unrealistic to cut off a benefit. Surely he agrees that there must be a dividing line between long stay arrangements--

Mr. Mike Hancock (in the Chair ): Order. You are stretching into your contribution, Minister. If you are making an intervention you must draw it to a close.

Mr. Bayley : I am grateful for your advice, Mr. Hancock. I am trying to debate the issue and search for a solution with the hon. Gentleman. Where would he draw the line if not at the present point?

Mr. Baldry : The line is not currently drawn between long and short periods of time. My constituent

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sometimes goes into respite care for a single night to give her mother some respite--it is respite care for both of them. However, after respite care for 28 nights--the number is arbitrary--over 28 weeks, my constituent is not entitled to any more.

Mr. Bayley : I want to correct one point which the hon. Gentleman has made several times. The regulations do not, in any way, prevent respite care after 28 days. They withdraw the benefit that is provided to a person to purchase care for those days on which respite care is taken. The issue is whether benefit should be withdrawn, not whether someone should receive respite care.

Mr. Baldry : Whether the issue is the denial of respite care or the benefit with which to purchase respite care is a quibble. The effect on most people will be the same.

The Disability Alliance recommends that the simplest solution is not to count days in hospital or respite care cumulatively, but to count only lengthy periods taken at one time. Regulations could be drafted to make that distinction, so that someone who goes into hospital for a month or more would lose benefit after the first 28 days, but someone who regularly goes into hospital for respite care for a few days at a time would not lose benefit. I hope that the Minister will explain the logic of denying my constituent disability living allowance benefit with which to purchase respite care. She is not a young woman who spends long periods in hospital or any other institution.

I am not being quirky about the matter, as there is broad consensus that something must be done about the regulations. The Disability Alliance stated that

I believe that the alliance also means respite care admission--

Finally, the Carers National Association made an almost identical point and stated:

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The association concluded:

It continued:

It is clear from everything that has been said that the existing regulations do not meet existing needs under care in the community. They cause much distress, and throw up anomalies and difficulties. Lines have to be drawn, but surely it is possible to consult on improving the regulations. Will the Minister consider consulting organisations such as the Disability Alliance and the Carers National Association about whether it is possible to bring the regulations up to date to meet the needs of carers and others, but in a way that does not fall foul of the needs of the Treasury to ensure that benefits are not abused or that people are not receiving double benefit? I do not believe that those who go into respite care receive double benefit. Such an anomaly needs to be examined.

1.51 pm

The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley ): I congratulate the hon. Member for Banbury (Mr. Baldry) on securing a debate on this important issue. He has put his case clearly, and the Government will examine it. I hope that he and those to whom he has been speaking will also consider why such arrangements are in place. The hon. Gentleman said that the simple solution would be to pay disability living allowance to people who have periods of respite care of less than 28 days. That would be the simplest solution, but it would also be costly, which is why it did not commend itself to his party when it was in power and why it does not commend itself to the Labour party.

As a Government, we are keen to improve support both through the amount of respite care that is provided and through financial support to carers. We want to enable those who care for someone with a serious disability to receive the respite care that they and that person need. We must make choices about what that money can best be spent on to give the greatest possible support to the disabled person and to the carer. Respite care, as the hon. Gentleman said, is essential for many carers and disabled people. It provides a much needed break for carers who are often elderly and unwell themselves. It can be a lifeline in an emergency when a carer suddenly needs to be away from home and from the person for whom they care. It also provides a valuable change of scenery for disabled people.

Carers as a group tend to experience higher levels of stress than others. Short-term breaks can have a significant impact by reducing stress and helping carers to continue to care. In that way, respite care can help

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disabled people to stay in their own homes or, in the case of disabled younger people, to remain in their parents' home for longer. People generally want to live in their own homes if they can. For some, going into long-term residential care can significantly impair their quality of life, and can lower their self-confidence. It can lead to a decline in activity and to a loss of independence. The Government are keen to promote independence by encouraging the provision of high-quality domiciliary and other community-based services, including respite care services and support for carers.

Disabled people and carers are all different, so their needs for respite care will be different. When we draw up regulations governing social security benefits, we have to do so on the same basis for everyone. We therefore face a conflict, which we have tried to resolve by a mix of regulations. As the hon. Gentleman knows, when a disabled person goes into a care home for a short period of respite care, which has been arranged by a local authority, we continue to pay the care component of the disability living allowance for 28 days. For that period, we disregard the fact that the cost of care is being subsidised by the local authority, even though the person or his or her family may pay a fee for the respite care break. We disregard the local authority contribution because people have on-going care costs at home, which need to be met. It can also be disrupting for benefit to cease for what may be a short period.

However, resources for benefits are not unlimited. It has long been a principle that when someone receives care in accommodation that is supported wholly or partly from public funds, he should not generally receive benefits in respect of care needs at the same time. That is the reason for the rules that have applied since the introduction of the national insurance scheme more than 50 years ago.

The great majority of people who go into respite care have that care arranged for them by their local authority, as in the case that provoked the hon. Gentleman's interest in the issue. It is therefore right that people going into settings other than hospitals--such as residential care homes--should have the same rule applied to them. We are aware, of course, that when people are being cared for in a family setting, as in the case that the hon. Member drew to my attention, the operation of the linking rule is difficult. As a result, we modified the rule last year to reduce the period for which people are disqualified from receiving benefit. Since last year, neither the day of admission to care nor the day of discharge from care--or hospital--counts as days in care in relation to loss of benefit. That assists 50,000 people a year.

The Government's commitment to improve services for carers was set out in our national carers strategy, which was launched by the Prime Minister in February 1999. Breaks for carers were seen as a key part of that strategy. We provided an additional £140 million for respite care breaks over a three-year period starting in 1999. Since then additional funding has been provided to cover the years up to 2004. The carers special grant will fund three times as many breaks for carers in 2001 as it did in 1999-2000. The money available will rise to £100 million a year by 2003-04. That initiative will enable up to 75,000 more carers to receive a break.

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As part of the national carers strategy, we agreed to review the financial support provided to carers through the benefits system, which is the issue raised by the hon. Gentleman. Towards the end of last year, we announced a package of improvements to disability and carer benefits worth £750 million over the next three years. In addition to the package for carers, we will extend the higher rate mobility component of DLA to severely disabled children aged three and four from April. That will provide extra help of £38.65 a week. This year, we will also increase the disabled child premium in income-related benefits to £30 a week, which is £7.40 a week more than normal uprating. The disability income guarantee will be introduced in April, which will help 130,000 of the poorest and most severely disabled people aged under 60, and ensure an income of at least

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£142 a week for a single person and £186.80 for a couple. The measure will also benefit 30,000 families with severely disabled children.

For carers, the carer premium in income-related benefits will be increased by £10 a week more than the normal uprating from April. We are targeting resources on low-income households in which long-term care is being provided. At the same time, we will raise the earnings limit in invalid care allowance from £50 a week to the lower earnings limit for national insurance contributions of £72 a week. Those benefits have been widely welcomed by many organisations. Diane Whitworth, the chief executive of the Carers National Association, said:

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