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12 Jan 2010 : Column 575

Mr. Dorrell: With respect, I think that the hon. Gentleman is being disingenuous. My recollection is that the six-week limitation was introduced specifically to prevent policy from migrating in this direction, while still allowing the discharge of patients from hospital when they should no longer be in there. It was introduced to facilitate orderly discharge out of the NHS, rather than as precursor to the development of free personal care in the social care sector.

Dr. Ladyman: I certainly was not trying to be disingenuous. The legislation that is being amended says that the Government can tell local authorities in certain circumstances to provide people's care for free in their own home for a period of six weeks. The measure simply takes the six-week limit away. The rules and precedents that define the system are already established, so this is actually quite a neat and elegant way of achieving the aim quickly.

Mr. Dorrell: I genuinely listen to what the hon. Gentleman has to say, and I recognise that he has knowledge in this area, but I think that he is wrong on this point. He says that the measure simply removes a bureaucratic rule, but doing so changes the nature of the rule on free personal care at home. The six-week rule was designed to facilitate the discharge of patients at the end of their NHS care in NHS hospitals. It was not designed as a means of funding social care for anything other than the shortest terms in that context.

I have spoken about people changing their behaviour and so forth, but they will not do that in anything other than the most convenient way to ensure that they qualify for the six-week limit. Social care can go on for years, or even decades in some cases, so all the points that I have made about changing behaviour and the pattern of provision apply in a way that they do not in the context of the six-week rule.

My final question to the Minister is very important. Under the direct payments legislation, individual beneficiaries of social care can convert their entitlement to social care into a direct payment, but will that apply to personal care provided in the context of this pledge? If so, that is another extremely powerful incentive for people to change their behaviour in order to qualify under the rules.

The Minister of State, Department of Health (Phil Hope): Of course it will.

Mr. Dorrell: The Minister says that of course it will, but I challenge the Government on that. If the direct payments legislation does apply to care provided on this basis, I simply do not believe that, beyond the first few months, the cost of the scheme could be limited to anywhere near the £530-odd million that the Government have estimated for the scheme as a whole.

Mr. Syms: I am generally in favour of one-clause Bills, and most of us have sat in Committees considering Bills of 200 or 300 clauses. Nevertheless, such a short Bill means that trying to find out its implications presents a problem, and that Opposition Front-Bench Members must show ingenuity in engendering a debate that allows information to be put on the record. That information is needed so that the people who provide and receive the care can learn a little more.

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I agree with my right hon. Friend the Member for Charnwood (Mr. Dorrell). I listened to what the hon. Member for South Thanet (Dr. Ladyman) said, and he has participated in this debate for a long time, but the change in the six-week rule does make quite substantial differences to the overall pattern of care.

If Opposition Members are cynical about the proposal that may be because one of the first things that the Government did after 1997 was to set up a royal commission that recommended free personal care, but that got dropped. Now here we are at the fag end of a Parliament and we get this rushed Bill, with questionable costings, which will fall after the election, and big implications for many of our constituents. Although amendments 9 and 10 may not be perfect, they at least allow us the opportunity to raise important questions.

The Government themselves produced the Green Paper, and I thought that it was a good effort at looking at the whole system comprehensively. The Select Committee on Health is looking at personal care, so it is a pity that we are rushing ahead with this option without taking a comprehensive look at things. When one rushes ahead one creates cliff edges and biases in a system that benefit some and exclude others. As I think the hon. Gentleman said, the implication is that, subject to the funding arrangements, we will have to add another bit to the Bill to make it more comprehensive in the future. Definitions are very important, and I am still not sure that we have got to the bottom of that argument.

Costings are also very important, and the Government are using the "magic pot of gold" argument that I have heard time and time again. The efficiency savings that they propose will be made at the expense of local government, which is going to have a difficult time over the next few years. Amendments 9 and 10 give us the opportunity to say a few words about that.

When the Minister responds, I hope that he can answer some of the very important questions that have been raised and give some reassurance that the Government have thought through the Bill's implications rather more comprehensively than seems to be the case at first glance. However, I fear that perverse incentives are now going to be built into the system. If local authorities have to provide more money but do not have the budget to do so, my concern is that they will deal with the changes by spreading what they have rather more thinly. That could mean that although 380,000 people will benefit from the legislation, if the funding is not sufficiently robust, they will not benefit to the extent expected.

Norman Lamb: May I pursue briefly the point raised by the right hon. Member for Charnwood (Mr. Dorrell) with regard to direct payments? The Minister, from a sedentary position, said that of course the Bill provided for the support to be given by way of a direct payment, but when we sought to table an amendment to clarify that, we were told that it was outside the money resolution, and that that was not what the Bill provided for, because it provided for care at home.

If that is the case, the Bill will pursue policy in a very different direction from that which the Government have followed up till now, and the outcome will be the perverse situation that someone receiving care under means-tested arrangements will be encouraged to receive their care by way of a direct payment, giving them maximum flexibility in how they chose to spend that
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money, whereas someone receiving care as an entitlement by virtue of the Bill will be entitled only to receive care imposed on them, in a sense, by the local authority.

It is self-evidently important for the Minister to clarify whether the Bill provides for the provision of support by way of a direct payment. If it does not, it is clear that an amendment needs to be tabled by the Government if it is beyond the scope of Opposition parties to do so.

Mr. Lee Scott (Ilford, North) (Con): May I emphasise, as other hon. Members have done, that it is vital that whatever pressures are put on local government, it is given the full funding by central Government to pay for the measures, and that that funding is not expected to come from existing budgets, or it will not be viable and will not happen?

Phil Hope: I am pleased to be taking the Bill through its Committee stage on the Floor of the House. In addressing the amendments, I should like to place my remarks in a slightly wider context.

The hon. Member for Leeds, North-West (Greg Mulholland) said that the Bill was very small, but I can tell him that it will have a very big impact. As the Minister of State with responsibility for care services, I am hugely proud to take the Bill through its Committee stage and Third Reading this evening. The Bill will provide support and relief to some 400,000 older people with the greatest personal care needs in their own home-people with advancing conditions such as Parkinson's, dementia and motor neurone disease-and 280,000 people who require high levels of intimate personal care on a day-to-day basis at home will now get those services free.

As has been remarked, many of those people have faced the burden of paying large amounts of their own money-they do not lose their own homes; my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly corrected the hon. Member for Eddisbury (Mr. O'Brien) on that-for care as their conditions deteriorate. The Bill will remove that millstone.

Norman Lamb: Is it not the case, though, that a significant proportion of those people whom the Minister identifies as benefiting already benefit by way of the means-tested system, that the net number will be significantly smaller than the number that he cites, and that, as the Government's own impact analysis demonstrates, the wealthiest group of pensioners will benefit most?

Phil Hope: I do not want to stray from the amendments, but the hon. Gentleman is right to say that a number of people who will benefit for the first time are self-funders, and a number of people who pass the means test and qualify for free personal care will have that free personal care safeguarded as a result of the Bill. That is particularly important, given the uncertainties of the future.

Mr. Simon Burns (West Chelmsford) (Con) rose-

Phil Hope: I am happy to give way, but I should like to start to address the amendments.

Mr. Burns: I am grateful to the Minister for giving way. On a point of information, if the Bill were to become law and came into effect on 6 April, would people who are currently self-funding their care qualify,
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or would only new patients with medical conditions developing who required help be covered by the Act, as it would then be?

Phil Hope: First, it is social care, not medical care, that is being provided. The hon. Gentleman's phraseology suggested that he was talking about medical care, and I want to make it clear that this is about personal care for people whose need is most critical and who need help with toileting, and so on. This is about intimate personal care.

4.45 pm

A number of guidelines and regulations are out for consultation, and they will need to be enacted when the Bill receives Royal Assent. People will qualify from 1 October this year. The process by which that will happen will also be the subject of guidance, to ensure a smooth transition as people who are currently in their own home and who qualify under the appropriate criteria start to qualify for free personal care. The provisions apply not only to new entrants; people who are currently living in their own home and paying for personal care because they failed the means test will now start to get their care for free. A further 130,000 will receive free reablement or rehabilitation to help them to recover their independence after a fall, a bereavement or a serious illness. I will say more about that when we discuss the later amendments.

The Bill is based on the simple principle that we must do everything that we can to help people to live as well as they can and for as long as they can in their own home. That is what people tell us they want. This Government policy has been shared by both parties, at least since 1998 when the Griffiths report was produced. Indeed, the right hon. Member for Charnwood (Mr. Dorrell), when he was Secretary of State, supported the view that we should give as much support as possible to people in their own home, because that is what they want. I have listened to his remarks and those of his Front-Bench colleagues today, and I hope that that position has not changed. I hope that all parties in the House will support and respect the wishes of people-young adults as well as older people-to live in their own home.

Amendment 9 would amend section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 so as specifically to list a number of settings in relation to which a six-week restriction on the ability of regulations to require provision of personal care for free would remain. The hon. Member for Eddisbury described it as a probing amendment, and I understand that, although I think that Labour Members listened quite carefully to ensure that that was the case and that the Conservatives' position had not changed.

The list in amendment 9 is entirely inappropriate, as it includes some settings that are more appropriately described in the way that clause 1(2) describes them, and some settings that we would describe as falling within the notion of living at home-such as extra care housing, sheltered accommodation and warden-controlled accommodation, all of which are listed in the amendment.

My hon. Friend the Member for South Thanet spoke from his experience as a Minister in this Department, and from his own professional experience, when he described the importance of extra care housing. I very much share his view. I listened carefully to the concern
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expressed by the hon. Gentleman that there might be game-playing among care home owners trying to change the status of their homes- [ Interruption. ] That was indeed mentioned on Second Reading; if I said this on Second Reading, I am certainly happy to put it on the record again.

It is for the Care Quality Commission to register care homes and extra care housing. Only care homes that genuinely change the nature of the care they provide to create extra care housing would be registered as such. As my hon. Friend said, we do not need to write all that into the Bill, because we have a regulator to ensure that the kind of behaviour described by the hon. Gentleman would not happen. The right hon. Member for Charnwood gave the example of granny annexes. People living in such accommodation would also qualify for free personal care because they are not in residential care accommodation.

The Bill does not list all types of accommodation. Its provisions are straightforward. Apart from the one circumstance of adult placements-we will discuss an amendment on that later-we have excluded anybody in a residential care home from qualifying for free personal care. Everybody else is included by default because they are not excluded. That is how the Bill is designed. It is an elegant way-my hon. Friend described it as such-of achieving the policy goal that we want to achieve, which is to provide for and help people with the greatest possible needs who are living in their own homes.

The right hon. Gentleman suggested that we have identified one group but ignored everybody else. The problem with his approach is that it would be a case of saying that we should either do everything or do nothing-that we should not introduce this extremely important measure to help people in the most need in their own homes. Why did we introduce a carers strategy? Why did we introduce a dementia strategy? Why did we introduce a strategy on valuing people with learning difficulties? We did those things because we are building on, improving and raising the quality of care step by step.

The hon. Member for Poole (Mr. Syms) indicated, as he did on Second Reading, that he favours the Green Paper. I am delighted that I have a convert from the Conservative party. Indeed, many of his colleagues praised quite lavishly the Green Paper, which is being considered with a view to transforming the whole system. I am proud to be the Minister of State standing at this Dispatch Box leading on the proposal to create a national care service-how good can it get?-but that does not mean that I am going to stand still while I am waiting for that to happen; I want change now, as well. Step by step, the building blocks towards creating a national care service are being put in place, and this measure is a key part of that.

Amendment 10, as an alternative to the approach that we are taking, would insert a definition of "care home" into the Bill. We regard that as unnecessary. The description that the Bill uses in amending section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 is

We do not propose to change that. The hon. Member for Eddisbury proposes in his probing amendment that we should use the definition in the Care Standards
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Act 2000, but that is not right in this context because it includes some exemptions and exceptions and therefore would not accurately reflect the range of settings that we want to exclude from free personal care. We think that our approach is the right way forward.

In response to the hon. Member for North Norfolk (Norman Lamb), yes, direct payments would be a method of providing such free personal care if someone chose to go down that road. This is an important point about the very nature of the transformation of the care system. Increasingly, we want people to have more choice and more control over their care budgets, and direct payments are one way of doing that. Personal budgets, which are a development of that approach, are being rolled out across the country, with more than 100,000 individuals now receiving their care in that way, giving them choice and control. This is free care for the people in the most need. If they choose to have it through a direct payment or as a personal budget, that is absolutely the right thing to do. It will be up to local authorities to develop and implement this approach-that is what our extra £500 million for the transforming social care budget is all about. Some authorities are getting there quicker than others. I hope that the measure will provide an incentive for some of those authorities to start to develop their services in a way that we, and I hope the whole House, would like them to offer in taking forward their care provision.

Norman Lamb: I am grateful to the Minister for clarifying that narrow point. However, should there not be an entitlement for the person to receive the help by way of a direct payment instead of leaving it up to the local authority to decide?

Phil Hope: We will discuss issues to do with local authority discretion under subsequent amendments, so I will deal with that question then.

I think that I have answered all hon. Members' questions. I have explained why the Bill is framed as it is and why amendments 9 and 10 are inappropriate and unnecessary. I therefore ask the hon. Member for Eddisbury to withdraw the amendment.

Mr. Stephen O'Brien: The debate has been extremely helpful and constructive in bringing out precisely what the amendments were intended to probe and elucidate. It has been acknowledged that where the dividing line falls is an issue to consider, and that we need greater clarification. It is possible that as the Bill progresses through its next stages in the other place, their lordships may wish to take up some of our questions to get that clarification, but we have had a good exploration of the matter.

As I said, these are probing amendments. I am glad that the hon. Member for South Thanet (Dr. Ladyman) felt reassured by the way in which I dealt with his concerns about whether there is mutual understanding on extra care communities and the home settings to which they relate. However, at one point he asserted that there was a principle that people do not get free board and lodging, as though that were somehow not to be challenged. That is not true either in a hospital setting or in many other settings. We need to be careful about announcing principles as though they were inviolate, when I am not sure that they stand a true examination.

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