Community Care (Delayed Discharges etc.) Bill

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Ms Meg Munn (Sheffield, Heeley): The hon. Lady is making a case, but does she realise its full implications? Many people who need low levels of care are unable to get them if excessive amounts of money go into providing high-level care in residential and nursing homes. Her proposal would prevent such people from receiving the low level of care that they would need in order to remain at home.

Mrs. Calton: I thank the hon. Lady for her intervention, but I do not accept her point. Need

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should govern what people get, not arguments that one person's needs should not be met because another person will miss out.

New schedule 1 defines the types of social care that the Liberal Democrats believe should not ordinarily be charged for, such as shaving, cleaning teeth and providing assistance in rinsing the mouth, keeping fingernails and toenails trimmed and assisting the person to go to the toilet or to use a bedpan or other receptacle.

Liz Blackman (Erewash): In developing the argument, the hon. Lady should say how much the proposals will cost and which services she proposes to cut in order to pay for them.

Mrs. Calton: I thank the hon. Lady for another helpful intervention. Once again, the argument can be made. Are the Government saying that people's needs should not be met, as the royal commission said that they should? Obvious needs should be met, and the costing has to be made and dealt with.

Ms Munn: Will the hon. Lady give way?

Mrs. Calton: I should like to make some progress. I was discussing the new schedule, although I shall happily give way when I have finished doing so.

As well as such assistance—with going to the toilet, or using a bedpan or other receptacle—someone who is fitted with a catheter or stoma will need assistance to ensure cleanliness so that the skin is kept hygienic. Someone who is incontinent will require consequential provision and the changing of incontinence pads—caring for their skin to ensure that it is not adversely affected. Often too, they will require assistance with the administering of food.

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People who are immobile or substantially immobile will need assistance in dealing with the problems caused by that immobility. Some will require medical treatment or assistance with medication—for example, the applying of creams or lotions or the administering of eye drops, or applying dressings if it can be done without the physical involvement of a registered nurse or a medical practitioner. To ensure their general personal well-being, some people may need assistance with getting dressed, or with surgical appliances, prostheses and mechanical and manual equipment. Some will need assistance when getting up and going to bed. We need from the Government greater parity and an expansion in services not charged for.

Ms Munn: The hon. Lady seems to be developing an argument that suggests that needs just exist ''out there'' and that there is no way of determining exactly what level of resource will be allocated to services. Will she say which Liberal Democrat councils do not operate eligibility criteria?

Mrs. Calton: I am not altogether sure what that question points to. I understood that pretty well all local authorities were forced to operate eligibility criteria. No doubt the hon. Lady will correct me if I am wrong.

We need greater clarity and an expansion of services not charged for. I hope that the Minister will listen not

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only to the Liberal Democrats but to the royal commission's findings and to older people and their representatives.

The Minister of State, Department of Health (Jacqui Smith): I welcome you back to the Chair, Mr. Conway, for what I hope will be a more precise and more rigorous debate than we have had so far.

One of the challenges of scrutinising legislation, as well as of implementing it, is that we need to be precise about what we propose, how much it will cost, what its implications will be and what constraints will be imposed on it. The Government accept that challenge. Unfortunately, it seems that the Liberal Democrats do not. As my hon. Friends the Members for Sheffield, Heeley (Ms Munn) and for Erewash (Liz Blackman) pointed out, the Government take seriously their responsibility to ensure that we improve the range and quality of care available for older people, not just take a simplistic approach, as the hon. Member for Cheadle (Mrs. Calton) did.

That is why, on 23 July, my right hon. Friend the Secretary of State announced that we would remove charges from intermediate care and community equipment. The clause enables us to do that. We have also made it clear that the purpose of the Bill is specific. In July, we set these reforms in the context of the expansion in services that is meant to help support social services, to provide more community-based services and to improve hospital discharge arrangements. In his statement, my right hon. Friend told the House why we had chosen intermediate care services. It is, as he said, because they help avoid older people going into hospital or help them to leave hospital speedily. Community equipment services are important, because they

    ''can make the difference between older people becoming dependent or remaining independent in their own homes.''—[Official Report, 23 July 2002; Vol. 389, c. 871.]

In other words, the Government have a clear idea of the objective to be achieved through the provisions in the clause.

Mr. Burstow: Has the Minister's Department estimated the costs that will arise as result of the policy of free equipment and free intermediate care?

Jacqui Smith: Yes. As it says in the explanatory notes, the cost, on our generous assumptions, will be some £18.5 million. If the hon. Gentleman would like me to go through with him why that is so, I would be happy to do so. We cost our decisions; the Liberal Democrats do not.

Both services rely on co-ordination between the NHS and social services. That is why we made integrated community equipment services across the country a national service framework milestone by 2004. That is also why we recommended a jointly appointed intermediate care manager across the NHS and social services, responsible for a pooled budget wherever possible. However, charging can be a barrier to pooled budgets and integrated services. Even where those things exist, it is sometimes hard to explain why integration still means that people are charged for an aspect of a service that is supposedly integrated. The removal of charging will therefore further support

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those places that have not yet integrated services and where it contributes to delayed discharge.

Perverse incentives will also be removed. Income from charging is often offset by the administrative costs of making the charge, and charging perpetuates inequity for users in different parts of the country. Sometimes, because services are not integrated, the person is left without equipment—one agency has all its hoists out on loan, for example, while identical hoists are sitting on the other side of the store, but cannot be issued because they belong to the other agency and are charged for. The clause seeks to ensure integration and more effective community and intermediate services provision for those who need it.

The amendments tabled by the hon. Lady seek to reopen the debates on providing free personal care. Points on that debate were made during proceedings on the Health and Social Care Act 2001, in the 2000–01 Session. In response to some of the hon. Lady's points, I reiterate the Government's objections, and raise the issues of choices and responsibility, both of which were absent in her contribution.

The Government have made a choice to spend new resources made available in the spending review on improving the quality and range of services provided for older people. Those services will support old people in their own homes, are tailored to their needs, and will mean that they will not remain in hospital unnecessarily when they need further care, whether in their own home or a care home. We have made the choice to change and extend the system, not to perpetuate the status quo, albeit with extra amounts of money thrown at it.

Personal care is currently provided on a means-tested basis. That means that seven out of 10 people in residential accommodation receive all or some of their personal care free. If we focused resources on free personal care, we would be making a distributional choice to direct funding away from people on lower incomes and towards people who are, by definition, at the higher end of the distribution of income under discussion, although I entirely accept that they are needy none the less.

However, we made other changes in response to the royal commission. I take very seriously the concerns of older people who feel that they must sell their property, and we have raised capital limits so that people are entitled to keep more of their capital before they are charged. The value of people's homes will also be disregarded for their first three months in residential accommodation so that those who are moderately well off have more of their care paid for from the public purse and have longer to consider the implications of their long-term care needs for their home.

We have also introduced a scheme to reduce the number of people who need to sell their home to fund their care. Deferred payments agreements will allow them to keep their homes on admission to residential care. Such agreements will allow the council to make up the difference between the care home fees and what

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residents can contribute from their income. Guidance on fair access to care services will be introduced in April and will ensure that assessments reflect individuals' needs. It will also give guidance on risks arising from immediate and future needs, which should be reflected in councils' eligibility criteria.

I am not clear whether the amendments' aim is to promote equity, but we are already doing plenty of work and spending money in various care settings to make care services more equitable. If the amendments are about personal care per se, however, we simply do not agree with them, for the reasons that I have spelled out. The proposals made by the hon. Member for Cheadle would mean that no one received a better service. They would do nothing to improve the quality of services that older people received. Nor would they increase the quantity of services. More important, the investment that we are making in services would not be possible.

That is where the issue of choice comes in. I am afraid that the hon. Lady gave away the fact that when the Liberal Democrats control local authorities and have the opportunity to make the hard choices that must be made in government, they do not do so, but simply talk generally about the issues. That is the crux of the matter. We have made a decision and answered the question as to whether we want to spend £1 billion on personal care.

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Prepared 12 December 2002