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"they would no longer be eligible for free personal care."-[ Official Report, 8 December 2009; Vol. 502, c. 295W.]
We are not talking about individuals who might get a bit better. We are talking primarily, I suspect, about the councils that might get a bit tighter. That is the worry. Has the Minister thought through both the pressure on individuals and the administrative problems for councils that will arise? I hope that in his response he will take the opportunity to spell out the details on the record.
New clause 5 was tabled by the Liberal Democrats. We look forward to hearing about the portability of their policy positions, given yesterday's announcement. In the light of their wish to reject their pledge of free personal care, how do they regard the funding of portability against standardised assessment needs? That is the issue
presented in the new clause that will have to be addressed, not least because the right hon. Member for Sheffield, Hallam (Mr. Clegg), as I understand it from yesterday's announcement, either downgraded or scrapped the £2 billion unfunded care guarantee that the Liberal Democrats announced when he became the leader of his party.
Leaving aside the various policy position changes, the serious point about new clause 5 is the postcode lottery that continues to exist across the country. Up till now, the Government were happy to say that that was the price of localism. There is a discomfiture that we are all caused by the tension between wanting to give local decision-making autonomy and ensuring that that does not result in unfairness, in the form of postcode lottery provision.
Last week the Secretary of State said that there were "limits to localism". Is he planning to abolish councils, or their powers in the process, as part of his way forward? It can be very disconcerting for people when the funding that they receive from one local authority is not matched by funding from a new authority that they move to. Can the Minister assure the Committee that anyone assessed as critical by one authority will be assessed as critical by all other authorities? As I pose the question, I think that the difficulty is apparent.
I am sure that the Minister has studied our proposals for common standards of assessment of need, which would be very helpful. If he wished to adopt that policy, we would be more than happy to let him do so. The case for new clause 5 will be presented by the Liberal Democrats. I urge the Committee to support all the other amendments.
Dr. Ladyman: I am rather sad to hear the hon. Member for Eddisbury (Mr. O'Brien) saying that this is a probing amendment, because I am quite attracted to the idea of removing discretion from local authorities in this matter. I also have a certain sympathy with the Liberal Democrats' new clause. If we are going to create a national care service, we shall have to create a common way of assessing people's needs and a common set of criteria against which to assess them, as was made clear in the Green Paper.
One aspect of this that none of the Front Benchers has tackled-the elephant in the room, perhaps-is that we will get genuine portability only if there is agreement on a standard level of funding. In other words, someone's condition would need to be assessed in the same way wherever they were, and they would then need to be funded at the same level wherever they were. That would take an awful lot of discretion away from local authorities.
This is going to be a difficult matter to tackle, but it must be tackled when we come to the White Paper. Although I do not believe that it is appropriate to address these matters in the Bill, I would like to hear my hon. Friend the Minister say that he understands that we are going to have to work to resolve them. I would like to suggest to him that, as well as having standard assessment criteria for people wherever they live, we might take the step, which I suggested on Second Reading, of making it compulsory for social care to be delivered from an adult care trust, in which the local authority and the local NHS are made to pool their resources and work together to deliver that level of care. That would go a long way towards resolving the tension between
localism and the need to have a standard package of care everywhere. It would also help to bring NHS resources into focus in regard to delivering this care.
Laura Moffatt: Does my hon. Friend envisage such a trust working in the way in which some of the very good, effective children's trusts are beginning to do? In them, people from different organisations and parts of the caring professions are really working together for the sake of the child. Does he believe that that would work in an adult trust?
Dr. Ladyman: Yes, absolutely. There are already good examples around the country of older people's trusts being set up. Torbay is a good example.
I had a conversation today with the Royal College of Nursing, which is concerned about how our community nurses will be involved in these provisions. I know that that subject is close to the heart of my hon. Friend, as she is a former nurse. If such adult care trusts were set up, community nurses would have a role in monitoring the care provided for people, either in their own homes or elsewhere. Those nurses would become more involved in the delivery of care, as well as in providing access to the resources of the national health service. They would be providing their skills alongside those of social workers from the local authority.
Mr. Dorrell: I agree with quite a lot of what the hon. Gentleman says about the benefits that can come from integrated trusts. Such trusts can ensure that an integrated service is delivered to an individual service user. Does he agree, however, that we should guard against believing that that is the only model that works? There are others that work equally well elsewhere in the country. Does he also acknowledge the danger of believing that, if something works well somewhere, all the problems will be solved if a Minister simply signs a piece of paper and insists that it should be done like that everywhere? Surely to goodness, the history of the past 30 years must demonstrate that that approach does not work.
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Dr. Ladyman: The right hon. Gentleman is right: we should have an open mind on what the right model is going to be as we move forward in these discussions. Whatever model or models we choose will have certain characteristics in common, however. One will have to be that the local NHS and the local social care services work closely together and that they have access to and flexibility over each other's funds. We must not minimise the difficulty of achieving that, however. I have said many times on the Floor of the House and in other forums that the only significant area of local government funding that is not ring-fenced for spending in a particular way is the money that the Government give to local authorities for adult social care. If we were to ring-fence that funding, we would take away a great deal of the localism, as we like to call it. We are going to have to address that issue as well, if we want to tackle this problem.
That is beyond the scope of the Bill, and of the amendment, however, and I believe that you would leap up and bring me to a halt if I went down that road, Mrs. Heal. I shall simply say that I am tempted by some elements of the amendments in this group. They deal with matters that we are going to have to face up to in
the near future. I do not think that they are appropriate for this Bill, but if we reject them today, we must not reject them for ever.
Greg Mulholland: I wish to speak briefly to new clause 5, which proposes:
"The Secretary of State shall make regulations to introduce a standardised assessment process to ensure portability of care packages between authorities."
That really is as simple as it sounds, but it is fundamentally important. I am seeking the Minister's reassurance that the proposal will be taken seriously, and perhaps looked at in the Lords. If that can happen, I will not press it to a vote. If not, I would be minded to do so.
The purpose of the policy behind the Bill is very simple. I have said that it offers only a partial solution, but it does guarantee free personal care for those with critical needs who live in their own home. In that case, surely someone who has been deemed to qualify under the terms of the policy should not be penalised if they move. People move to be closer to members of their family, for example. This applies often, but not exclusively, to older people, who move in order to get care from family members or to gain emotional support and greater contact.
I am sure that hon. Members have heard of many cases of people moving to a different area and having to jump through hoop after hoop, simply to receive the same level of care that they had been receiving before. It is bureaucratic nonsense, as well as a real injustice, when people with real needs are prevented from accessing the kind of care that they had been used to, simply because they have changed their postcode. It would be quite wrong for people to face that threat, as they might if the new clause were not introduced. Again, I ask the Minister to reassure me that that will not be the case. People could become marooned in a local authority area, afraid to move closer to their family or some other support network because they would have to go through yet another assessment process.
There are also costs associated with such reassessments. One can understand why a local authority might want to assess every new person moving into its area, but it does not make sense to do so if the assessment processes are as robust as they should be. A local authority should be able to accept the assessment or reablement process that has already shown that a person qualifies for free personal care at home. I firmly believe that we are talking about a very important element of the Bill, and I am concerned that this measure may be a flaw in making it work and a restriction on its potential positive impacts. I urge the Minister at least to reassure me and the Committee that that will be taken very seriously when the Bill goes to the Lords.
I am disappointed that the Conservatives, rather bafflingly, have chosen not to support the new clause, because it would not involve costs but in fact reduce costs at local authority level. If a local authority insisted on going through an unnecessary assessment process merely because it wanted to keep its own costs down, that would not make sense. The hon. Member for Eddisbury (Mr. O'Brien) chose instead to make rather spurious party political points, which had the whiff of hypocrisy about them given the criticism that the Minister and the Government have received to the effect that this is simply about electioneering. Let us at least be a little sensible when we are talking about such serious matters.
I do not wish to push the new clause to a vote. However, can the Minister reassure me that it very much reflects part of the Government's thinking and that the measures in the Bill will not be undermined but will work in the way that he has told us they will?
Mr. Tom Clarke: This has been an interesting debate. I want, if I may, to focus on the aspects that have dealt with the role of local authorities, with particular reference to amendments 13 and 16.
If the hon. Member for Eddisbury (Mr. O'Brien) had the same objectives as my hon. Friend the Member for South Thanet (Dr. Ladyman), I might even be convinced myself by the argument on continuing care, but I have to say, in all candour, that I am not. What we have established here today, perhaps not for the first time, is the existence of a big difference between the Conservatives and Labour in terms of how Governments work with local authorities. I cannot envisage a situation in which, in the absence of joint planning between local authorities and the NHS, we can deliver the kind of personal care that we have all agreed on.
In relation to amendments 13 and 16, I am afraid that I must be even more ungenerous to the hon. Member for Eddisbury. Amendment 13 seeks to limit the discretion of local authorities in setting the eligibility criteria for free care. The Conservatives frequently condemn direction from Whitehall and extol the virtues of localism and local control, yet they then table amendments that would remove local freedom. I am not at all persuaded by that approach. I think that this is an essential argument about what sort of democracy we want to live in. Given that day after day, week after week, we meet councillors, directors of social services and others who have to implement our decisions, we should be a bit clearer than these amendments suggest about the very important role that local authorities play.
Amendment 16 seeks to exempt local authorities from providing free personal care for those in a state of continuing care. If we spell that out, it means, in effect, extended care for a person over 18 to meet physical and mental health needs that have arisen as a result of disability, accident or illness. The amendment is difficult to understand if we take the view that we are to have a relationship between central Government and those responsible for delivery. I have never accepted that local authorities should see themselves as enablers rather than providers, which the hon. Member for Eddisbury hinted at. There will always be a case for both things on the part of central Government and on the part of local government, and that should be recognised.
The amendment would exempt a section of the most vulnerable people from receiving free personal care at home because they are in receipt of continuing NHS care. I ask this question: why? I have not heard a convincing argument for it. If highly vulnerable people were to be treated in this way, significant costs to pay for care at home would arise. They should be entitled to the same support as everyone else in that group. The fact that they are receiving additional care from other sources such as the NHS should not take away the relevance of addressing their problem, having proper assessments, having a greater degree of advocacy than we have managed to discuss today, and delivering to those who need the personal care that I believe is so essential.
Mr. Paul Murphy (Torfaen) (Lab): I want briefly to follow my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) by speaking to new clause 5, for which I have some sympathy, in relation to the portability of care packages.
I should like to talk about the extent of the Bill in so far as local authorities are concerned. Presumably, we are referring to English local authorities, not to Welsh ones, although the Bill extends to England and to Wales. I am slightly troubled about the view that the national care service that we are rightly discussing will be universal throughout the United Kingdom. I would not dream of talking about Scotland; however, in terms of the Bill's application to Wales, I am not yet convinced that there has been sufficient dialogue between Welsh local authorities and the Welsh Assembly Government about how this might operate. I believe that the Welsh Assembly Government would be very agreeable to the principles of this excellent Bill, and indeed some of its details. I hope that my hon. Friend the Minister can give me an assurance that proper discussions are taking place between Welsh local authorities, the Minister for Health and Social Services in the Welsh Assembly and, indeed, the Welsh Local Government Association about the parts of the Bill that impinge on the duties and activities of English local authorities.
In relation to the portability of care packages between English local authorities, there is a tremendous amount of movement across the English-Welsh border. Many people would find themselves in the same position as if they were to move from Derbyshire to Lancashire, as opposed to going back and forth into Wales from Gloucestershire or Merseyside. There are genuine cross-border issues, but also a worry that while benefits are UK-wide, the detail of local authority involvement in this package is for England only.
Mr. Stephen O'Brien: I am most grateful to the right hon. Gentleman for allowing me to intervene. He is making a very important point that is, to some degree, covered in amendment 28; if we are fortunate enough to reach it, he might want to take the opportunity to explore this a bit further. I endorse some of what he says, speaking as the representative of a constituency with a Welsh border, where there are many incidents involving people travelling across the River Dee to access some form of health service, continuing care, social care or acute services. That is causing a pretty big nightmare for all those of us concerned.
Mr. Murphy: Yes, indeed. Over the past few years, in my ministerial capacity, I have been able to try to resolve some of those issues, although it is not easy.
I ask my hon. Friend the Minister for an assurance that there is proper dialogue and discussion between the Welsh Assembly Government and Welsh local authorities with regard to these issues.
Phil Hope: Members have raised a range of issues, and I shall try to deal with them all. Amendment 13 would limit the functions that may be imposed on a local authority through regulations by removing reference to their
"including the exercise of a discretion".
That could severely reduce local authorities' ability to manage the costs of care. They are best placed to judge
what is appropriate in their own situation, depending on their clients and the availability of their services. It is right that functions imposed on local authorities relating to eligibility for free provision should include the exercise of discretion, so that they can effectively manage the provision of free personal care in their local area.
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The Bill will enable the Secretary of State to make regulations in specific circumstances, constrained by their having to relate to the provision of free personal care in certain settings. I draw Members' attention to the current consultation document on various regulations and guidance. I shall come to that in relation to new clause 5 in a moment. We need to include in the Bill the power to ensure that local authorities can properly be given a discretion, which will be specified in regulations. I urge the Committee not to support amendment 13, because we need to enable the Secretary of State to issue appropriate regulations.
Amendment 16 would enable regulations to exempt local authorities from providing free personal care to those eligible for or in receipt of continuing care. Continuing care means care provided over an extended period to a person aged 18 or over to meet physical or mental health needs that have arisen as a result of disability, accident or illness. An individual who needs continuing care may require services from NHS bodies and/or local authorities, and local authorities should also be able to provide free personal care to such people if they qualify for it. Where personal care is provided at home as part of a package of continuing care that it falls to the local authority to provide, there is no reason why the local authority should not be required to provide it free in the same way as personal care that is not provided as part of a package of continuing care. If an individual is entitled to services as part of NHS continuing health care, their package of care will be provided solely by the NHS and not by the local authority.
It is important that NHS continuing care and free personal care are recognised as different ways of delivering health and social care. In all cases in which it appears to a primary care trust that there may be a need for NHS continuing health care, the PCT has a duty to take reasonable steps to ensure that an assessment of eligibility is carried out. I hope that that directly addresses the concern of the hon. Member for Eddisbury (Mr. O'Brien).
On the Coughlan case, the position was confirmed in directions issued by the Secretary of State after the judgment. If a person is assessed for physical and mental health services under continuing care, that package should be provided solely by the NHS when the primary need is health-related. I hope that that clarifies the relationship between the two sets of funding.
Amendment 41 would provide the Government with regulation-making powers to authorise local authority transitional arrangements when a person moves to or from care home accommodation. Extending free personal care to care homes to cover transitional arrangements is outside the policy proposals that inform the Bill, which is about personal care at home, not care in a care home. Extending the policy as the amendment suggests would also substantially increase the costs of providing free personal care beyond the agreed financial envelope. For that reason, we cannot support it.
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