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14 Dec 2009 : Column 670

That is a very direct example of how the health service is moving into supporting carers more directly-I think that was the point that the hon. Gentleman wanted me to answer-and it shows the specific, practical support that the health service can give. Hon. Members will know, if their constituencies are like mine, that respite care is under-provided for and that there is more we can do to give people those little breaks that make life tolerable. That was why we included that funding requirement in the operating framework of the NHS, and I assure him that we will be repeating it when the framework for next year is published.

Dr. Ladyman: My right hon. Friend might need to have a think about this point and come back to me on it. The Bill works by amending the Community Care (Delayed Discharges etc.) Act 2003, which provides that when somebody is discharged a carer's assessment also has to be carried out. If that assessment indicates that a carer needs additional support, within the framework of what we are doing today will we also fund the support of that carer?

Andy Burnham: We will certainly look at the detail of what my hon. Friend is saying. My initial response is that that would be included as part of the overall care plan that the individual would receive, but I shall respond to him in detail on that point to ensure that the carer's needs are properly taken into account.

Currently, all personal care at home is potentially a means-tested service; local councils can determine the amount people have to pay within national guidelines. Community care assessments are carried out to determine the level of a person's needs, based on the criteria laid out in guidance. Nevertheless, levels of support vary widely across the country, so this Bill is about creating a fairer system. We want to ensure that the support goes to those who need it most. It is estimated that of those who will benefit, some 60 per cent. are in the middle quintile of the income distribution of the general population, about 30 per cent. are in the second quintile and about 10 per cent. are in the bottom quintile.

Pete Wishart (Perth and North Perthshire) (SNP): Can the Secretary of State clarify his intentions on attendance allowance? He will know that when Scotland introduced free personal care, £30 million of attendance allowance was cut from the Scottish budget, and that got in the way of our being able to deliver our service. However, I believe that he intends that existing claimants in England will continue to secure their attendance allowance. Why the difference between Scotland and England?

Andy Burnham: I am sorry to say to the hon. Gentleman that this Bill does not deal with the reform of benefits. We debated that in the House last week, and the hon. Gentleman would have received very full answers to those questions had he been here. This Bill is not funded by the reform of attendance allowance or disability living allowance.

The beneficiaries of extending free personal care as proposed in this policy will be those on middle to below-middle incomes relative to the overall population. We believe that that will have a small, but positive, redistributive effect.


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Mr. John Hayes (South Holland and The Deepings) (Con) rose-

Andy Burnham: I shall give way in a moment, but this is an important point. The Bill answers one of the key issues identified by the 1998 royal commission:

The Bill is a direct answer to that criticism.

Mr. Hayes: The intervention by the hon. Member for South Thanet (Dr. Ladyman) draws attention to an important aspect of the Bill and perhaps to a gap in it. When the legislation that this Bill amends was introduced in 2002, the Secretary of State at the time argued that it would bridge the gap between health and social care. However, if this Bill is inadequate in bridging that gap in the way that was inferred by the hon. Gentleman-the gap also applies to support for organisations that might facilitate or enhance care at home-it is surely premature and would have been better as part of a bigger Bill to take advantage of the opportunity to do exactly what the hon. Gentleman said and what was heralded with the introduction of the earlier legislation.

Andy Burnham: I understand the hon. Gentleman's point, but I believe that the Bill does exactly what he is calling for. It will drive further integration between health and social care. It will encourage the health service to spend more of its resources on supporting individuals in the home. In that way, it will help local government, which has too often been faced with a very difficult job in balancing resources at a local level to give people the support that they need. I do not say at all that this Bill is the final answer and the whole solution-it is not. We have said that it is a partial step that will move the system forward and make it fairer today, as well as make it more preventive in character. It is worth doing for those reasons, but I agree that we need more fundamental reform. We would look for support from the Opposition to reform the system more fundamentally. I believe that the demographics of the country now demand it. If we do not reform the system soon, the unfairnesses will grow year by year. I do not think that any of us would want to contemplate that prospect. Typically, the people who require personal care services are over 75 years old, live alone and are generally in poorer health. This measure is not just compassionate; it is progressive.

The second aim of the Bill is to help another 130,000 people by encouraging reablement support after a fall, when their health deteriorates or following a period in hospital. Reablement might mean adaptation to make a person's home wheelchair-friendly, the use of technology such as alarms or electronic pill dispensers to improve safety, or physiotherapy and personal support to help people learn how to perform daily tasks after illness or injury.

Mr. Lansley: The Secretary of State is being generous in giving way. I merely seek a point of information. Can he explain why this legislation is required to provide reablement services?


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Andy Burnham: This legislation is not required to provide reablement services. However, we are clearly linking it to the support provided to people receiving free personal care, as it will be a gateway to that support. We want to place the emphasis at all times in spending public money on encouraging prevention-on putting prevention at the heart of the system. We think that that is the correct link to make. If we are to consider somebody for free personal care in the home, we should first give them the opportunity of an intensive period of support. There is good and growing evidence from around the country that that support can reduce people's reliance on care and support down the line.

Mr. Lansley: I am grateful to the Secretary of State for his clarification that the purpose of the reference to reablement in the legislation is not to provide reablement when people leave hospital after an operation, for example, but to make it a condition of their subsequent receipt of free personal care that they have accepted such reablement services. Would that apply to those who would currently receive free personal care on a means-tested basis-that is, would all those receiving free personal care be required to comply with that?

Andy Burnham: Strictly speaking, the Bill provides the local authority with discretion to provide that support, but that is clearly the direction in which we want to see care services develop. In answer to the hon. Member for Beckenham (Mrs. Lait) I used the example of the Isle of Wight, and it is an instructive example. It shows that by investing early on and supporting people better when they need it most, long-term reliance on care and support can be reduced.

Norman Lamb: I am grateful to the Secretary of State for giving way again. Does he accept that there are some cases in which a requirement of reablement would not be appropriate? For example, someone in their last days needs personal care but it would be entirely inappropriate to go through some false process of reablement that would not benefit that individual. I am concerned that councils might be in a position where they might exclude someone in those circumstances.

Andy Burnham: The hon. Gentleman makes an important point. There are some people for whom reablement, or intensive support, would not be appropriate. He gave as an example people who receive palliative care, and that is obviously true for them. Nobody would want anything in the Bill to place pressure on people or put them through a process that they must and should not go through. The regulations under the legislation will make that clear. Of course, the measures should not deny such people any support should they qualify under the relevant terms.

We believe that by investing in reablement we can prevent emergency admissions to hospital, prevent people from ending up in crisis situations and help people live independently in their homes for longer. I have mentioned the Isle of Wight a few times. It has had a 40 per cent. reduction in residential care placements since it introduced free personal care in the home. That work is already going on in other places and showing its worth. The Wirral is also taking a lead on investment in reablement services. Let me give an example.


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A 77-year-old woman who had been dependent on carers for two years was admitted to hospital for aortic valve surgery. She had got used to doing very little for herself; she was sleeping downstairs and was using a bowl of water in the lounge and a commode to meet her personal care needs. On discharge, she received three visits a day from the home assessment and reablement team to help her with personal care and meal preparation. The team helped her to practise using the stairs and encouraged her to undertake daily tasks such as opening the curtains, putting on the washing and making her own lunch. Over six weeks, the number of visits that were required gradually decreased, and she is now living happily and independently without any intervention from social services. Such inspiring examples show how we can help people to regain independence and how we can spend public money more effectively.

In that way, the Bill aims to enable people to retain their independence, as well as aiming to reduce costs and prevent ill health. It will help to ensure that people remain economically active by providing the support and control that families and carers need to balance work and caring. We want to build on the work that many councils have already begun on prevention and intervention to support people in living independently in the community. The Bill encourages, but does not require, councils to offer a reablement package. The offer of free personal care and better use of resources will push authorities to bring in alternative models of care and will embed prevention and reablement, all of which have been shown to be more cost effective and to offer better outcomes. That approach could help authorities to generate by 2013 the £250 million that early estimates suggest will be the additional cost of free personal care. It will reduce the cost of care for individuals, including those who continue to fund their own care, and will help people to stay independent. By extending a hand to those with lower-level needs, we can help to reduce isolation and help to keep people active. In doing so, we can prevent people from slipping to the point at which more intensive care and support are required.

There has been a great deal of speculation and misinformation about how the Bill will be funded, so I shall take this opportunity to explain our approach again in the clearest terms possible. The measures we are proposing will cost £670 million in the first full year, which will be provided entirely from the Department of Health budget and by local government. Some £420 million will come from the Department, and the remainder will be met by local authorities. That funding, along with the scope for further efficiency gains, will be considered as part of the normal spending review process. It is right that councils should play their part alongside central Government in helping to deliver the commitment on free personal care. We will be consulting on the distribution mechanism for local authorities. I repeat that it is completely incorrect to say that any of the money will come from cutting disability benefits or from cutting cancer research or any other important research.

Mr. Robert Syms (Poole) (Con): Will the £250 million from local government be a one-off cost or a recurring cost year on year? I note that some of the money will come from the Department of Health's research,
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development, marketing and consultancy budgets. Will those be recurring or one-off costs, and is all this in the pre-Budget report?

Andy Burnham: Local government efficiency is in the pre-Budget report, and it is a recurring cost; but the savings are also recurring. It is about spending public money better than we do at the moment. As the Joseph Rowntree Foundation acknowledged, too many people are pushed into residential care as a result of crisis, when actually with appropriate support they could be helped to regain independence. If we help someone to regain independence at that critical moment in their life, it is good not just for that individual but for the public purse, because it means that people do not require care in a residential setting in the long term.

Mr. Lansley: My hon. Friend the Member for Poole (Mr. Syms) made a good point, which I am afraid the Secretary of State has not properly answered. In the pre-Budget report, the £250 million efficiency saving is scored as a reduction in residential care costs, but it is treated as a saving from local government that contributes to the overall level of efficiency savings. It is not disclosed in the PBR as additional expenditure elsewhere. Furthermore, from what the Secretary of State says, in 2010-11 there will on the face of it be a £210 million transfer from the NHS line in the departmental expenditure limit to the Department of Health line. That has not happened. Why not?

Andy Burnham: The savings identified in the pre-Budget report will remain with local authorities and can then be used to meet their contribution towards providing free personal care for those with the highest need, as we have said all along. Of course, there is an incentive for local authorities in the form of the extra resources I have found from central budgets in my Department, but as I said a moment ago, we believe that by making that investment we can make savings down the line. We believe that giving people intensive support at home can reduce overall costs to the public purse, as one of the hon. Gentleman's local authorities-the Isle of Wight-has discovered. Perhaps he should take a trip there and cheer up a bit.

Hywel Williams (Caernarfon) (PC): Can the Secretary of State tell the House what the Barnett consequential from the spending will be for the National Assembly?

Andy Burnham: There is no Barnett consequential from the spending. It is spending that is already allocated and has been reprioritised.

Mrs. Lait: Will the redistribution of the money the Secretary of State has found from his departmental resources be done on the basis of the local government formula or on the basis of need in each local authority?

Andy Burnham: I encourage the hon. Lady to look at the Bill's impact assessment, which proposes a number of options for the distribution package. We are consulting on the best distribution mechanism. Obviously, there are always strong views in local government about whether a package should be needs-led or per capita. We shall want to work through those issues with local government- [ Interruption. ] My hon. Friend the Minister
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is nodding. There is time for the Local Government Association to feed in its clear views, as I am sure it will, and we shall pay close attention to what it says.

Norman Lamb: The consultation on the regulations makes it clear that the sum available is finite-it will not be increased-yet the impact assessment makes it very clear that there are considerable uncertainties about total costs and the total numbers of people who may benefit and qualify for help under the Bill. If the cost is significantly more, what will happen? If the sum is finite, who loses out in those circumstances?

Andy Burnham: As I was saying to the shadow Health Secretary, there is discretion for local authorities under the Bill, but we have costed the Bill and we are absolutely clear about the people we expect to benefit from it. We are confident that the costings we have given will pay for the benefits that I have described this afternoon.

The Bill is about putting more money into the social care system now. I do not think that anyone in the House seriously disagrees-unless I am about to discover otherwise-with the fact that the measure is much needed, prudent and fair. It is targeted on those in England with the highest needs who face the highest costs. As I said earlier, many people have had to use their own funds to pay towards the cost of their care.

Reform of care and support is fiscally responsible in the long term. Failure to reform will lead to huge unmet need and pressure on public finances and public services in both the NHS and local government for years to come. The demographic pressure is rising. Year by year, more people will come into a care system that cannot fully cater for them. When the NHS was created there were eight working adults for every retired person. Today there are four. By 2050, that will figure fall to just two. We can expect that by 2026 there will be 1.7 million more adults in England who need care and support.

One in five of us will need care that costs less than £1,000 during our retirement. One in five will need care that costs more than £50,000, and in the worst cases the cost can exceed £200,000. We cannot predict our risk, so it is hard to protect ourselves against it. That is why we need a reform that shares the costs and risks of care and does not leave those in the most difficult circumstances facing catastrophic costs for care. The need for bold, far-reaching reform is undeniable. That is why we propose to create a National Care Service, and why we will bring forward a White Paper in the new year.

This is a major reform and, although it is essential, it will take time to deliver. [Inte r ruption.] I hear the hon. Member for Hemel Hempstead (Mike Penning) say from the Front Bench that it has taken time. We have not done nothing for the past 11 years. We have introduced major reforms to social care in England. We have introduced the dementia strategy, the drive towards personalisation and direct budgets, the Putting People First reform. We have had the prevention for older people pilots, which have laid the ground for the present reform. It is not as if we have been doing nothing. We have been taking steps to improve the system.

I did not hear whether the hon. Gentleman agrees that a fundamental reform in the next Parliament is necessary, but I shall be interested to hear whether he has the courage to commit to that. People have waited long enough. We are not saying that we have got everything
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perfectly right, but we have the courage and the confidence to introduce a Bill. In the interim we are introducing the Personal Care at Home Bill, recognising that those with the greatest needs cannot wait and should not be asked to wait to receive greater fairness. The Bill is not the whole answer, but it is a bold first step, and I commend it to the House.


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