Ann
McKechin: The hon. Gentleman makes a fair point. He is
right that there is a degree of tension because providing a day care
centre involves a built cost—the capital and revenue costs of
maintaining the building—and if someone wants a service provided
to them in their home, or at some other location that is not owned or
controlled by the council, that balance will have to be struck. That is
why we want the trailblazers and the consultation process to continue
throughout that period, so that we can build a body of evidence to
allow us to make appropriate judgments on what regulations might be
required if it is rolled out throughout the
country. The
clause means that an authority will be freed from its duty to make
direct payments if those payments would impose an unaffordable burden
on the service or support. The Bill’s framework ensures that we
can clarify in secondary legislation and in guidance what could be
interpreted as an unreasonable cost. We wish not to be too prescriptive
in primary legislation, but to develop workable guidelines in
discussion with public authorities and disabled
people. Meg
Munn (Sheffield, Heeley) (Lab/Co-op): I seek to clarify
this issue a little more, as I think we are dealing with two different
issues. There is the point that the hon. Member for Forest of Dean made
about the shift of services, and the implications for local authority
services of moving money around, and there is the separate issue that
any service provided by local authorities, if it were based just on
people’s desires and needs, could ultimately overwhelm their
budgets. Legislation, such as that covering community care, children
and the matter before us, needs some protection to ensure that local
authorities do not find that they are expected to pay for absolutely
everyone’s wish.
Ann
McKechin: My hon. Friend makes an excellent point.
Obviously, local authorities must be able to provide services to those
who are eligible under statutory provisions, and they must have
sufficient resources available to
meet that statutory obligation, in addition to trying to meet
citizens’ aspirations for the sort of service that they want in
general. Their statutory duties and their ability to provide them must
remain, and the sustainability of services, protecting public resources
and ensuring that the right is affordable must be at the centre of the
rights. There is no intention of preventing disabled people from
exercising the right to control in all circumstances. Authorities will
be expected to provide clear and compelling reasons for refusing a
direct payment, and we will issue guidance to make the intentions of
this clause
clear.
Paul
Rowen: I want to give the Minister an example to
illustrate some of the tensions that could arise when the provision is
applied more widely. A case in Oldham hit the national press, and I met
the people involved. A direct payment holder and his wife decided that
part of the money that was given to him would be used to employ a carer
to take him to watch Rochdale football club on a
Saturday. John
Mason (Glasgow, East) (SNP): Waste of
money.
Paul
Rowen: Some might say that. The press picked up on that
and used it as an example of someone wasting public money. It was not.
His wife had an afternoon off when she did not have to care for him.
The carer who took him to the football match was not interested in it,
but he wanted to go to it. When moving to direct payment, such issues
arise and one person’s “reasonable” may be another
person’s “unreasonable”. The press—I think
it was The Sun—thought that that was unreasonable.
I thought that it was reasonable, but that was not the media’s
attitude.
Ann
McKechin: The hon. Gentleman makes a good point, and I
have nothing against those who decide that retail therapy is better
than going to a football match on a Saturday. The point is that carers
are entitled to respite. That is the key element, not how the respite
functions. There is a choice of how the respite is taken, but a carer
who looks after someone 24 hours a day, seven days a week is entitled
to respite. That objective incorporates the personal desires of the
disabled person, their family and the people who care for
them.
Mr.
Harper: The person to whom the hon. Member for Rochdale
referred was a guy called Gavin Croft, and I had the pleasure of
meeting him when I visited Oldham metropolitan borough council to meet
some of the people with individual budgets. Apart from questioning his
judgment about which football team he supported, as the hon. Member for
Glasgow, East did, the example was a good one of an agreed outcome,
which was not the success of Rochdale football club, but giving his
wife a respite break. That was the objective, and it was achieved at a
much lower cost, so it was a much more effective use of finance than
some other
cases. As
the hon. Member for Sheffield, Heeley said, it is right that there
should be a back-stop to prevent unreasonableness, but the Minister was
right to say that the objective is achieving agreed outcomes. Nothing
in
the process should drive costs higher, and the evidence from the social
care pilots showed that when people were given transparency in the
funding spent on them and a choice in the way the money was spent, in
most cases people were realistic and motivated, and better outcomes
were achieved at less cost. In terms of financial success, and in the
difficult environment that we are in, the measure is a good thing and
we will often get better outcomes at a lower cost than we are currently
providing. 2.15
pm
Ann
McKechin: I entirely agree with the conclusion reached by
the hon. Member for Forest of Dean. Often, the alternative provision
will be achieved at lower cost and will provide better quality. In
turn, that will provide more funds for other areas of care that that
person may want. Ultimately, that is our objective. We are trying to
work in a way that gives us a basic framework that people know we are
working within, and that, over the next few years, as the trailblazers
start to succeed, allows us the flexibility to get into the detail of
how this will operate in practice and establish how we are going to
measure outcomes. It is not difficult in most cases to measure what
those outcomes will be. An outcome where someone gets respite care that
meets their individual taste is clearly more desirable that a
one-size-fits-all approach. That is the aim of the
Bill.
John
Mason: Although I support the idea of more right to
control—as other hon. Members do—does the Minister agree
that it is a matter of balance? We need to consider the needs of the
individual, but local authorities are under a lot of pressure these
days and their budgets are tight. They are elected and have a certain
amount of authority, so we have a duty to protect them from having
their services chopped up into
bits.
Ann
McKechin: With the greatest respect, local authorities are
there to serve the public who elect them and who reside in their area.
The idea is to provide the best quality of services at the best value
that can be reasonably obtained, using the services and skills of the
many local authority workers, particularly in social care. The aim is
also to work alongside voluntary organisations that operate within that
area, and with disabled people and their
families. This
is about achieving the best result for the taxpayer and the council tax
payer in terms of level of service. Local authorities should not be
afraid of that challenge or of co-operation. As hon. Members will be
aware, in Scotland we have approached the matter in a somewhat
different way in that, through the community planning partnerships, we
are trying to get public agencies to work together in a better way and
be more accountable to the people who pay for the services and vote for
them. On that basis, I urge the hon. Member for Forest of Dean to
withdraw the
amendment.
Mr.
Harper: We have had a good discussion, with a number of
interventions. Certainly, from what the Minister has said so far, I am
reassured that there will be some clarity about what unreasonable costs
are in the regulations and guidance. It is welcome that the Minister
recognises the tension that will inevitably arise as disabled people
make choices about what services they want compared
with what services are currently provided. That will be one of the clear
lessons of the pilots. Indeed, as those pilots are run, it might be
helpful to engage with the media and explain that people will make
different choices and that there will be creative solutions.
The
interesting thing about the case of Mr. Croft and his wife
was that—I had not seen the report in The Sun that the
hon. Member for Rochdale mentioned, but it was certainly covered in
other national newspapers in much more balanced way—feedback
from Mr. Croft, his wife and organisations indicated that
this was a good way to achieve the outcome, and if the outcome is
achieved at a lower cost than that of the official way of doing it,
what is wrong with it? There was more balanced reporting of that case
than I had thought might occur, so I think that we can be a bit more
optimistic about the way that some of this might be reported. People
are more open-minded than we might think when they consider what is
successful and what is cost-effective, while remembering that it has to
be for the agreed outcomes that the hon. Member for Sheffield, Heeley
correctly put her finger on.
With that
useful debate and the reassurances that the Minister has given about
the guidance and the way that the regulations will be made, I beg to
ask leave to withdraw the
amendment. Amendment,
by leave,
withdrawn. Clause
32 ordered to stand part of the Bill.
Clause 33
ordered to stand part of the Bill.
Clause
34Pilot
schemes
Mr.
Harper: I beg to move amendment 30, in
clause 34, page 41, line 15, leave
out paragraph
(c).
The
Chairman: With this it will be convenient to discuss
amendment 31, in
clause 34, page 41, line 20, leave
out subsection
(6).
Mr.
Harper: I shall try to move through the amendments
reasonably quickly, because we have discussed pilot schemes at the
evidence sessions and in an earlier debate today. The clause provides
for such schemes, making it clear that, under the previous clauses,
Ministers can make regulations for a pilot scheme and time-limit it for
a period not exceeding 36 months. These are probing amendments, and
amendment 30 tests how the schemes will run and what we may learn from
them.
Subsection
(4)(c) defines whom the scheme applies to, and it can apply either to a
geographical area or to a specific class of individuals. The provision
that I seek to delete states that the scheme can be applied even more
narrowly—to particular people by reference to prescribed
criteria or on a sampling basis. One danger with pilot schemes is that
if they are chosen to run in an area that is particularly hospitable to
them, where all the local authorities, primary care trusts and other
statutory bodies are gung-ho about making it work, it may be successful
but that will not give us a realistic view of what will happen if we
introduce it throughout the country, where those factors may not all
hold true.
Furthermore,
if we narrow too much the group to which the pilot applies, we may not
fully see what will happen in the real world. For example, if it
applies to a small number of people, other services, such as brokerage
and advice services, are unlikely to arise, because there will be too
few people to access them. Another problem is that if the local
authority has a small number of people to whom the new provisions
apply, but it still has to provide all its other services, it will
incur the costs of parallel running.
What areas
are the Government looking at for the schemes? Will they be only in
areas where the local authority and other statutory providers are
volunteers? That would be helpful, but it would not give us a very good
impression of what might happen if we introduced the scheme throughout
the country. The Minister alluded to the specified class as a person,
and, to see what works, we must ensure that different categories of
people are given the chance to use the services. For example, we want
to ensure that the schemes cover a significant number of people with
mental health problems and learning and other disabilities, so that,
across the range of disabilities, we get a fair picture of what works,
what does not and what might need to
change.
Amendment 31
would leave out an objectionable aspect of the clause—subsection
(6). The Minister knows from the evidence-taking sessions that I have
some impatience with pilot schemes—perhaps it is just from being
in opposition, and it will be knocked out of me in due course. I object
to the fact that once a pilot scheme has been running for up to 36
months, it can be replaced by a further pilot scheme making the same or
similar provision. I have a vision of perpetual pilot
schemes—without our ever coming to a decision. If we are going
to run a scheme, we should run it and then, at the end, or earlier if
we have some clear data, make a decision. We should decide either that
something does not work or is not practical and therefore stop doing
it, or that we have enough evidence, on the balance of probabilities,
to move forward—we should not have another pilot
scheme. The
thing that pilot schemes miss, which we kicked around a little in the
evidence sessions, is balance. It is right to make sure that, when we
roll out a new system of anything, it is well designed and will work.
Equally, we might have evidence, which we do from the pilots on social
care, that that way of designing things has good outcomes for most
people—it can deliver better outcomes at lower cost. There is a
cost involved in running lots of pilots and not rolling the system out
across the country for three or four years. The cost is for the
hundreds of thousands—perhaps millions—of people who
would be entitled to the new way of doing things, possibly giving them
better outcomes at lower cost to the taxpayer, but they are prevented
from doing so, because instead of rolling it out across the country we
are running a number of pilot
schemes. While
recognising that we need to get things right, we should also recognise
that we have already piloted individual budgets between 2005 and 2007
on the adult social care side. Those pilots have been evaluated and the
Department has the evidence. Certainly for working age adults, the
evidence was clear. As the Under-Secretary of State for Work and
Pensions, the hon. Member for Chatham and Aylesford, said earlier,
there were some concerns and some issues raised with older
people—in some cases the
pilots were not entirely successful. However, there is a fair bit of
evidence already that the stuff works, and that came through in our
evidence session, both from Liz Sayce and Paul
Davies. The
new pilots in the Bill will only commence in 2010 so, if they run for
the full three years, we are looking at the system not even starting to
be rolled out across the country in 2013. In the four years between now
and then there will be many people who could have benefited who will be
prevented from doing so. We need to have that at the back of our mind
as we press to go further and faster. I know Ministers want to do that,
but unless we push a little harder, we are in danger of never quite
getting to where we want to
be. If
we look at some of the other organisations involved, there is clear
pressure from outside about making this go faster. Sue Bott, the
director of the National Council for Independent Living, has said that
the pilots would cause “unnecessary delay,” given the
Department of Health’s piloting of individual budgets between
2005 and 2007. She said in a
brief: “I
feel that if there’s an acceptance of the principle, then
let’s get on with it and make
it” work. “There’s
enough information on the
ground.” Anne
McDonald, programme director for community well-being at the Local
Government Association, involved in the delivery of such services on
the ground, said that there was a danger that people could feel
“piloted out” and that the new pilots needed to be clear
in what they set out to
achieve. When
the Minister responds, she could set out—perhaps not in detail
now—what the objectives of the pilots are, so that we could know
when they have been successful. It would be helpful if the pilots in
the clause could only run for up to 36 months—it would be
interesting if the Minister could give us an indication of how long the
Government expect pilots to run for, and an assurance that if, as those
pilots are running, there is evidence early on about what works, there
would be no necessity to run the pilot right to the end. Ministers
should reserve the right to say, “We know what works, we know
what is successful, so we are going to get on with it and do the
job.” The
final authority that I would pray in aid would be the Equality and
Human Rights Commission, which I mentioned in my remarks this morning.
It stated
that “it
is disappointing that the
Bill”— or
the talk around
it— “only
proposes that this will be piloted in 2010 in a small number of
‘trailblazing’ public authority
areas.” The
EHRC clearly wants the process to go faster as well. I am sure that
Ministers are keen for it to do so, but the key is getting the balance
between caution and making it happen on the
ground. That
is the essence of my amendments. In conclusion, I again quote
Mr. Davies, when giving us
evidence: “I
can well understand why people would want to feel the comfort of a
pilot and see how that worked; I just do not agree with it. There is
more than sufficient evidence to justify going straight
ahead.”——[Official Report, Welfare
Reform Public Bill Committee, 10 February 2009; c. 19,
Q20.]
That is a man who has
delivered such things on the ground. He is not a visionary in a
think-tank, who does not have to make things work. He is the director
of adult social care at an authority with a fifth of the national
coverage of people with individual budgets, making this stuff work on
the ground and delivering those services. He is clear that there is
enough evidence to move ahead. Perhaps the Government could be a little
more ambitious about the timetable.
2.30
pm
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