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Dr. Ladyman: I can probably find common cause with the hon. Member for Eddisbury (Mr. O'Brien) in certain respects. I understand his desire to probe the Government and secure greater clarity. As was observed by the right hon. Member for Charnwood (Mr. Dorrell), a former Secretary of State, it is plain that at some point the Government will have to go further. I see no moral justification for excluding a group of people with fairly serious care needs from Government help, whether they are in their own homes or in residential accommodation. At some point in the near future, we will require a personal care not at home Bill to address that need.
I might part company from the hon. Member for Eddisbury on this point: he and his party have proposed the idea of a home protection system, under which, for a fee, the totality of a person's residential costs will be met. I believe that that would create a strange precedent, because for the first time an individual in this country would not be responsible for providing their own board and lodging. It has always been a principle that we are all responsible for providing our own board and lodging. Even if we have to pay for it out of benefits, that is still taken into account. The Opposition's solution to the problem would go against that principle.
In probing the matter before us, the hon. Gentleman has set running some hares that perhaps need not be set running. I am particularly concerned about the fact that he is attempting to exclude extra care housing, because I believe that it is a model for the provision of care for older people in the future. Indeed, the huge majority of older people tell us they would aspire to such an arrangement were they to develop a care need because it means that they could live in their own accommodation.
If the hon. Gentleman looks at the Department of Health website, he will find a clear definition of extra care housing, not least in the guidance for a competition in which developers were invited to bid for an £80 million fund to build extra care accommodation. One of the key elements of the definition is that the individual lives in their own home. They might have bought their extra care accommodation or be living in it as a tenant, but they will have security of tenure; they will have self-contained facilities so that they can cook and have access to their own bathroom and sanitary facilities; they will have their own front door that they can close to the world if they so wish, and they will be able to arrange their care needs themselves.
The current system of means-testing people has the added advantage that, given that the accommodation will be the person's own home, the value of that home cannot be taken into account in the means test. The person might be looking to protect some of their savings, and that is a good way of preserving equity and passing it on to children-that might be important to them. I believe passionately, therefore, that extra care housing is a model that we need to promote. I believe that the Government have accepted that, and until we started debating the Personal Care at Home Bill and amendments to it, I always thought that the Opposition wanted to promote it as well. However, in the light of Second Reading and-on the face of it-amendment 9, I am now seriously worried about whether they understand the nature of extra care housing and its importance in the future.
Mr. Dorrell: Is the hon. Gentleman not missing the point? We all agree that the desirable developments being debated represent the direction of travel that we should be encouraging. However, given the artificial divide in such services that the Government are creating, my hon. Friend the Member for Eddisbury (Mr. O'Brien) was seeking to establish on which side those listed in the amendment will fall.
Dr. Ladyman: I understand the purpose of the probing amendment, but I would be less worried had the shadow Secretary of State not shown on Second Reading what to my mind was a vague understanding of what extra care housing is all about. He seemed to misunderstand completely the function and nature of extra care accommodation. I became doubly worried when I read amendment 9 and saw that once again the Opposition were seeking to list it as one type of accommodation that should perhaps be excluded from free personal care.
I was reassured to hear the hon. Member for Eddisbury say that this is a probing amendment and that he did not intend to exclude extra care from the provisions. I look forward to engaging with him later in the debate about transitional arrangements when perhaps we can explore the matter a little more, and I encourage my hon. Friend the Minister, when he responds to the amendment, to provide the clarity that the Opposition are seeking about the types of accommodation in which one would be eligible, under the Bill, for free personal care, and to reaffirm the Government's support for extra care accommodation. If that is his response to the amendment, I hope that later in the day we might hear an acknowledgement from the Opposition that they also understand the importance of extra care, and that they, too, will support it in their future policy.
Greg Mulholland (Leeds, North-West) (LD): Although I am pleased that we are having the Committee stage of a Bill on social care, I must begin by saying that the Liberal Democrats, too, have real concerns about the timing and process in respect of this Bill. The Bill has one clause and covers less than two sides of A4 paper. The way that it was announced was regrettable; it was announced not to the House, but to the Labour party conference. It is also only one piece of the jigsaw in terms of the great social care crisis. It was announced mid-Green Paper consultation and pre the White Paper that is supposed to be published in a few years, and came with a clearly inadequate impact assessment. Regardless of what the policy is, this is, as Lord Lipsey said,
"a very bad way to do policy".
Turning to the amendments, it is very important that we start with accurate definitions, not only of what is a care home, but of what we mean by personal care. I regret that the amendments that were selected do not include one that probes what we mean by personal care. An understanding of that definition is even more fundamental than what we mean by people living in their own homes, or care homes. I draw the House's attention to the detailed and interesting definition of personal care suggested by Help the Aged and Age Concern, and I regret that we will not get a chance to debate that.
We must also look at the experience in Scotland-at the situation that has developed there arising from a lack of clarity about what is meant by personal care. This Bill presented us with a great opportunity to look again at, and clarify, what we mean by personal care, but that opportunity has been missed.
Dr. Ladyman: The definition of personal care is already very thoroughly covered in existing legislation, which is why it does not need to be in this legislation, and why the hon. Gentleman's criticism of the Chair for not choosing an amendment on that is rather unfair.
The Chairman: Order. The hon. Member for South Thanet (Dr. Ladyman) should not presume a degree of censoriousness on the part of the Chair, which the occupant of the Chair had not leapt to make clear. So I think the hon. Member for Leeds, North-West (Greg Mulholland) has got away with it.
Greg Mulholland: I thank you for that, Sir Alan. The hon. Member for South Thanet (Dr. Ladyman) is entitled to his opinion, but Help the Aged and Age Concern are equally entitled to theirs, and I know who I would listen to first and foremost when discussing policy of this nature.
Turning to the two amendments of the hon. Member for Eddisbury (Mr. O'Brien), I share the concern that there is insufficient clarification of what is meant. The right hon. Member for Charnwood (Mr. Dorrell) has put his finger on the key point: what is crucial to consider is who is excluded by the Bill. It touches only a tiny number of the people who are affected by the problems of the social care crisis, which has been getting worse for many years.
In terms of the amendments, however, I have some concerns about the definition offered. Concerns have rightly been expressed about what is meant by extra care housing, but we must also consider the meaning of "sheltered accommodation" and "warden controlled accommodation", which are mentioned in the list in amendment 9. What do we mean by "sheltered accommodation"? Is there an absolute definition of that? I suggest that there probably is not-there certainly is not from a legislative point of view. Is it not possible for someone to buy and own or, indeed, to rent what is clearly their own home in which they live but for it to be subject to some oversight from an organisation and thus fall under the category of "sheltered accommodation"? We are in danger of entering a minefield here, so we must be clear on this issue.
As the hon. Member for Eddisbury made clear, this is a probing amendment, so I just ask the Minister to give the Committee clarity. He must show that the Bill and the Government are clear about what is meant by people who are "at home" and need to receive this accommodation. They must make it clear that there is no possibility, in respect of sheltered accommodation, extra care housing or warden controlled accommodation, of people who are clearly living in their own home-in a way that any normal person would recognise-falling outside the remit of this Bill.
Mr. Dorrell: I congratulate my hon. Friend the Member for Eddisbury (Mr. O'Brien) on his amendment, and not because I think that he is seriously suggesting that it should be included in the Bill-he has made it explicitly clear that that is not his intention. He intends to focus the Committee's attention on the large group of people who are defined out of, or excluded from, the category of beneficiaries of the Prime Minister's pledge; as I said in my intervention, these are the people who are excluded from benefiting from the pledge.
Of course, across the House, we all acknowledge that this long-standing aspect of public policy has not been satisfactory. It was the former Prime Minister who, soon after the 1997 election, made it clear that payment for social care needed to be the subject of rigorous and profound examination. That is not the purpose of this amendment; it is an attempt to define clearly the large group of people who are excluded from benefiting from this Prime Minister's pledge, rather than focusing attention on the relatively small number who will benefit from it. The reason for focusing on the people who are excluded is to remind the Committee of the very much larger group of people who remain, as they have since 1997, suffering from a system of payment for social care that Members from across the House acknowledge to be inadequate.
Norman Lamb (North Norfolk) (LD): The right hon. Gentleman is right to point out the large number of people who are excluded from this Bill, but this goes further than that, does it not? The imposition of the duty in respect of the small group of people who will be included within the terms of the provision could well adversely affect all those who are excluded, particularly those who are currently benefiting from care provided by local authorities on a discretionary basis-they could well see their care cut back.
Mr. Dorrell: The hon. Gentleman is entirely right, because of course the cost of even this limited pledge is significant in public expenditure terms and the Government have made it crystal clear that no additional money will be provided to local authorities to allow them to meet the additional burdens that this pledge imposes on them. Thus, it must be assumed that somebody, somewhere else, who benefits from local government expenditure-as he says, it is likely to be other people who benefit from social service expenditure-will pay for this pledge from the Prime Minister.
As a result of the amendment tabled by my hon. Friend the Member for Eddisbury, I wish to focus on the implications of creating this distinction between the small group of people who will benefit because they receive "personal care at home" and the much larger group who will still have to pay for personal care under the old rules. What are the implications of creating that new distinction? I suggest that there are three such implications on which the Committee should focus.
The first is the short-term implication. A group of people who change their care arrangements according to their requirements will suddenly find themselves taking decisions based on a major cost implication that ought to be taken based on their care need. There will be two categories: those who are at home, who get all their personal care free; and those who are defined as out of the "at home" category, who will still have to pay for their personal care according to the old rules. It
therefore matters hugely who is "at home" and who is not "at home", and the amendment tabled by my hon. Friend the Member for Eddisbury is an attempt to define precisely who is not "at home".
The former Minister, the hon. Member for South Thanet (Dr. Ladyman), reacted to my hon. Friend's amendment by saying, "Oh, these people who receive extra care ought to benefit from the pledge." Perhaps they ought to benefit from the pledge, but if they do, the cost will go up immeasurably from the £500-odd million that the Government say that it will already cost. My hon. Friend is drawing attention to the fact that the much larger group of people who do not receive personal care "at home" will be the losers from this prime ministerial election pledge.
That is the first implication: where there is currently a logical development of care provision, in future there will be two categories and an anomaly created by the move from one category to the other. That is the first and immediate consequence. The second consequence, which is, in my view, much more malign, is that if this policy were to endure for any length of time, people would change their behaviour to ensure that they fell on the right side of the line to benefit from the pledge rather than on the wrong side of it.
Let me pose a few questions to the Committee. If personal care at home is free, but personal care delivered not at home is not free, is somebody allowed to move their home in order to ensure that their personal arrangements move from one side of the line to the other? Members of this House have learned over the past 12 months the dangers of moving their house from one place to another in order to qualify under rules under which one did not previously qualify. If we create a group of people for whom personal care is free and say that it is available only to those who are at home, we should not be surprised if people who receive personal care and do not qualify immediately change their arrangements in order to ensure that they qualify. The definition of what constitutes "at home"-of who is included and who is excluded-will be the subject of constant challenge as people change their arrangements to ensure that they qualify, although they originally did not.
"the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care".
If I provide accommodation and personal care to my parents in my grannexe, will that be included or excluded? Is a grannexe where I or my family provide personal care to my elderly relative included or excluded? Is my grannexe an "establishment" according to the definition in this statute? It is unclear to me.
Mr. Robert Syms (Poole) (Con): My right hon. Friend makes a very important point. He also raises the issue of whether the provision of personal care by a relative is likely to be acceptable, as it is in the Netherlands and some other countries within Europe, or not.
Absolutely. If, as I profoundly hope given all the pressures on public expenditure, we are not going to get into the business of using taxpayer resources
to pay relatives to give care, where will the dividing line be drawn, given that we are creating a very powerful incentive to people to change their behaviour?
Norman Lamb: The right hon. Gentleman makes a very good point about the danger of a partial solution changing behaviour and having perverse consequences, but does he not agree that the Conservative proposal carries the same risk in that the pledge relates only to providing for the cost, through insurance, of care in residential homes? That is also a partial solution that would influence people's decisions.
Mr. Dorrell: The difference is that my party is committed to moving quickly to the development of a total solution. We have made it clear, and it has been clear in our thinking right back to my days as the Secretary of State, that we cannot do that by landing the bill, in either small or large stages, on the taxpayer. The Government also took that view until the summer; indeed, until a day in October the Government took the view that this was an unaffordable bill for the taxpayer. That conclusion must underlie sensible policy in this area, but it is under challenge as a result of the Prime Minister's pledge.
Mr. Stephen O'Brien: May I take my right hon. Friend back to the difficulties that he rightly outlined about the definitional point and how things might change? Earlier, I gave an example about how an owner of accommodation might be able to change things by having two companies. I am reminded that on Second Reading the hon. Member for South Thanet (Dr. Ladyman) helpfully described as extra care accommodation a specific type of accommodation in which people might buy into a retirement village and be able to move around within it as tenants and leaseholders. It is precisely because such arrangements can be changed both by the owners and, as has been pointed out, by the tenants that we are having to raise these doubts through this probing amendment.
Mr. Dorrell: I am grateful to my hon. Friend for his comments, and I agree with him. What is clearly illustrated here is that any attempt to write into the statute book crude rules that create one category of free personal care and another of paid personal care will be fraught with difficulty, particularly when one is trying to do it at 20 minutes' notice, on the run, on the way to the podium at the Labour party conference. I agree with Lord Lipsey that that is one way not to make policy.
Dr. Ladyman: The right hon. Gentleman is making some important points, but will he reconsider his statement that this is a crude way of achieving the objective? The measure simply removes the six-week limitation on free care from another piece of legislation that has been operating very successfully for some years. It is therefore anything but crude. The precedents and definitions have all been set, and all that the clause does is say that instead of the free care being limited to six weeks, it can be provided for much longer.
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