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15 Jan 2003 : Column 734—continued

Ms Munn: This time last year, my father needed care at home, and because of his level of disability at that time he was entitled to claim a higher rate of attendance allowance. Both my mother and father considered it only right that that allowance be used to contribute towards the services that they received, and it is clear that many people are in that position. Is the hon. Lady suggesting that that is not a legitimate way for the Government to proceed?

Mrs. Calton: I am grateful for that intervention, but I need to make progress as we want to press several of the amendments tabled to a vote. Obviously, there will be those who feel able to pay, but I am talking about the most disadvantaged, who are not able to do so.

Andy Burnham: Will the hon. Lady give way?

Mrs. Calton: No. As I said, I intend to make progress. I have taken several interventions.

Successive Governments have been disingenuous on this front. It suited them to blame local councils, whereas in reality they were pulling the strings. We should remember that we are talking about services that involve assisting people in going to the toilet, using a bedpan, keeping the skin around catheters and stomas clean, changing incontinence pads, and keeping their skin clean because of their incontinence; assisting people with food; dealing with immobility; and medical treatments such the application of creams, lotions, eye drops and dressings. At the moment, people have to pay for all those things. Dressings, surgical appliances, prostheses, getting up and going to bed—all of those count within free personal care.

The Liberal Democrats have never suggested that such care could be provided without funding, and it was covered in our last costed manifesto. Given that it is a priority for us, it will undoubtedly be costed for the next manifesto as well.

In Scotland, all parties—Labour, the Conservatives, the Scottish National party and the Liberal Democrats—universally supported that move forward.

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It is a great pity that the Government have not used this opportunity to ensure that free personal care is provided for those who need it in England and Wales. Indeed, they have made it impossible for themselves to do so without further primary legislation.

Jacqui Smith: Opposition Members have made much of their concern for individuals and carers, but perhaps I should return to the very principle of the legislation, which they oppose. We introduced the Bill precisely because we recognise that the prime concern of many older people who are trapped in hospital—they tell us this when they come to our constituency surgeries—is that they want to get out, but that the facilities that they need to do so are not available. I am afraid that when it comes to concern about individuals and carers, talk is cheap for Opposition Members. As my hon. Friend the Member for Leigh (Andy Burnham) pointed out, it has to be cheap for the Conservative party, given their plans to cut the public spending that we are pledging.

As we shall see later, the Liberal Democrats seem to think that the problem can be solved with a few more plans. I am sorry, but every single older person who is trapped in hospital and wants to get out is an argument for a change to the system. Opposition Members can talk as much as they like about individuals, but if they are willing neither to invest nor to reform in order to make the necessary difference, that talk is hollow.

Andy Burnham: When I intervened on the hon. Member for Eastbourne (Mr. Waterson), he responded that he was not aware that any Opposition Member was suggesting public spending cuts. I draw my hon. Friend's attention to a comment made by the Opposition's Treasury spokesman:

That was what he told The Daily Telegraph on 28 December.

Jacqui Smith: My hon. Friend makes a very important point. That is why I say that talk is cheap for Opposition Members.

There has been much talk about carers and issues relating to consent. I should like to address some of those issues, and I hope to provide some reassurance. My hon. Friend the Member for Hampstead and Highgate (Glenda Jackson) said that the Government's attitude to carers was different from that of previous Governments. We are committed to supporting carers in the vital care that they provide. Between 1999–2000 and 2001–02, the number of carers' assessments carried out increased. The carers grant introduced by the Government in 1999 provided an extra #140 million over three years to increase the number of breaks for carers. It has now been extended to provide #85 million this year and #100 million next year, and will continue to 2006. During that time, it will more than double to #185 million to provide extended care and 130,000 further breaks for carers.

This is a Government who are willing to put resources behind concern about carers. However, I understand the concern that the Bill may not have taken into account some of the previous legislation that we introduced in

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relation to carers' rights. We tabled Government amendments Nos. 27, 28, 29, 30, 32, 33, 34, 39 and 40 to remedy an omission from the Bill that would have meant that carers and carers' services were not fully provided for. As the Bill is drafted, the financial incentive promptly to carry out an assessment and provide services will apply to individuals in hospital, but not to their carer.

It was never our intention that the services that need to be provided to the carer to ensure safe discharge should be considered a lesser priority than the services to be provided to the individual. As my hon. Friend the Member for Hampstead and Highgate rightly pointed out, there may well be important cases where services provided to a carer are crucial in order to enable the safe discharge from hospital. Carers' needs are important in ensuring that an individual receives the services that he needs when he needs them and in the most appropriate place.

3.45 pm

The amendments add the carer's assessment—upon request from the carer—and decision about provision of services to the carer to the duties of a local authority when it receives a notice under section 2. Amendment No. 27 states that a carer's assessment should be carried out either when it has been requested by a carer—in response to the hon. Member for Sutton and Cheam (Mr. Burstow), I can say that we have issued section 7 guidance, alongside the Carers and Disabled Children Act 2000, which outlines carers' entitlement to be informed about their right to assessment—or when a carer has had an assessment in the previous year, in order to check whether the carer's needs have changed or to identify those services specifically necessary for the safe discharge of the person cared for.

The amendments therefore mean that if any carer's services necessary for a safe discharge are not in place by the end of the relevant day, the local authority will incur a charge in the same way as if community care services were not in place, and provide a strong incentive for local authorities to ensure that the needs of the carer are given priority when the patient discharge from hospital is being arranged.

I am pleased to say that the amendments are strongly supported by Carers UK, which rightly raised the concerns that I have outlined. It believes that they will do much to improve current practice with respect to carers and hospital discharge. The amendments will ensure that carers' needs are taken into account, looking holistically at what they realistically can and cannot manage, and that services are put in place to meet those needs prior to the patient's discharge from hospital.

The hon. Member for Sutton and Cheam raised a point that I made in Committee: that, although services are provided free to individuals, under the Bill as drafted equivalent services provided to a carer would not also be free. Amendment No. 36 rectifies that error, which has the effect that, although local authorities will no longer be able to charge individuals for the provision of certain community care services, they will still be able to charge their carers. It was never our intention that local authorities should remain able to charge carers for the same services that could be provided free of charge to

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the individuals themselves. The amendment will ensure that those services, whether provided to carers or to individuals, will be free in a similar way.

Given those Government amendments, I agree with my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) that new clause 3 is otiose. It seeks to overload the Bill with unnecessary definitions. The definitions in the first two subsections are taken into consideration by Government amendments. Subsections (3) and (4) place further duties on local authorities that are unnecessary and achieve nothing over and above what the Government have achieved through their amendments.

The Carers and Disabled Children Act 2000 already provides that carers are entitled to request assessment of their ability to provide care, and I can assure hon. Members that statutory guidance on the Act will state that carers are entitled to be informed that they have that right.

Similarly, section 1 of the Carers (Recognition and Services) Act 1995 already provides that the local authority is under a duty to take into account the results of any assessment of the carer's ability to provide care when deciding what community care services it will provide to the person cared for. It is unnecessary to repeat that duty here. The single assessment process and the hospital discharge workbook will also reinforce that good practice.

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