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The hon. Gentleman talked in passing about a slightly different issue of transition-people who qualify for free care in their own home but whose situation improves to the extent that they may no longer need it. We believe that it would be unreasonable to continue to provide it. People are regularly assessed as their needs change, and that would apply in the circumstances that he described.
New clause 5 would place a duty on the Secretary of State to make regulations to introduce a standardised assessment process for free personal care, so that a centrally standardised process could ensure that care packages were portable between different local authorities. I hope that I can reassure the hon. Member for Leeds, North-West (Greg Mulholland) and others who expressed support for the idea. We believe that to make free personal care fair and simple to understand, it will be necessary to develop a standardised assessment tool to assist councils in applying the eligibility criteria fairly, which I believe is exactly what the new clause is designed to achieve. We have already suggested that in our consultation document on regulations and guidance. I draw the hon. Gentleman's attention to page 16, which describes our intention to develop a standardised assessment tool for that purpose. That will be set out in regulations and guidance that will accompany the Bill, and we will begin commissioning for such a tool very shortly, so we do not believe it is appropriate to include that level of detail in primary legislation.
Greg Mulholland: That certainly goes some way towards reassuring me, but will the Minister be specific? Once an individual has gone through the standard assessment process in one area, will it not need to be done in another area? That is the key question.
Phil Hope: It will be a standardised assessment tool described in regulations and guidance. There will still need to be local application of it, but the tool itself will be standardised in the way that I believe the new clause describes. That is what we are consulting on now through the consultation document. I hope that that reassures the hon. Gentleman that we understand the need that he describes.
That is a slightly different point from the one about the fair access to care criteria, which the hon. Member for Eddisbury mentioned. We have just completed consultation on fair access guidance, because there was concern that the level of local interpretation was such that unacceptable differences between areas were being created. New guidance, based on the consultation that we have put out, will be issued in March and will reduce the level of interpretation-I would describe it as misinterpretation-that was allowing for those differences. The combination of the revised guidance and the new standardised assessment tool will achieve the outcomes that he and the hon. Member for Leeds, North-West seek.
My hon. Friend the Member for South Thanet (Dr. Ladyman) took the opportunity provided by the new clause to make a point about the integration of health and social care, and the right hon. Member for Charnwood (Mr. Dorrell) echoed that. It is true that we are seeing different styles and different approaches to that integration in different parts of the country, and the right hon. Gentleman was right to suggest that there is more than one approach. He made some very good
points about that. My hon. Friend made a strong bid for a particular model and described its characteristics, and I will take it as a contribution to our thinking about a national care service. It is not a matter for today, but we will have to address the dilemmas about ring-fencing and so on as we go forward.
I turn briefly to the questions that my right hon. Friend the Member for Torfaen (Mr. Murphy) asked about the applicability of the Bill. I can assure him that we have conversations at official and ministerial level about that, although I would distinguish between the current Green Paper and White Paper developments and the Bill. The provisions in the Bill are only for England, and provisions in relation to Wales will simply give the Welsh Assembly Government the powers to take forward the proposals that we are making, should they wish to do so. We will get to amendment 28 later, but I wish to put it on record now that good practice is exchanged. I understand that the Welsh Assembly Government are consulting on their own Green Paper, and we need to ensure that we collaborate and co-operate across the nations to get the best possible outcome for all involved. We must also deal with the problems that the hon. Member for Eddisbury mentioned of people living very close to the border on either side.
I hope that I have answered all the questions that I was asked and, given my replies, I ask hon. Members not to press their amendments.
Mr. Stephen O'Brien: This has been a useful group of amendments for extracting some helpful information-not least that we should have the result on the FACS problem that I mentioned by March. My question on new clause 5 had nothing to do with any lack of support for it, but concerned our anxiety about the lack of a copper-bottomed assurance that there was no cost differential. That underlines the importance of the Government noting the concern that, as this Bill is rushed through, we do not have even the draft guidance and regulations that will accompany it. That makes a big difference, because it would aid interpretation.
I hope that the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) will give the same weight to my words as he does to those of the hon. Member for South Thanet (Dr. Ladyman). I am sure that, given the values that the right hon. Gentleman seeks to espouse, he would not seek to discriminate as to our credibility just because we travel under different political colours. We used the same language, and the important point to note is that the questions that we asked about transitional and continuing care are difficult and have not gone away despite the Minister's fair stab at answering them. We will have to return to those issues, as they involve relationships with local authorities and whether they have the autonomy to deliver the high quality services that we all want while at the same time ensuring fairness and predictability. I beg to ask leave to withdraw the amendment.
Amendment, by leave, withdrawn.
Mr. Stephen O'Brien: I beg to move amendment 15, page 1, line 20, at end insert-
'(4BA) Any local authority not in receipt of funds from central government equivalent to the full cost of providing personal care to people living at home shall not be obliged to provide such care.'.
The First Deputy Chairman: With this it will be convenient to discuss amendment 48, page 2, line 4, at end insert-
'(4DA) The Secretary of State may by regulations restrict the cost to local authorities of providing personal care to people living at home.'.
Mr. O'Brien: The purpose of amendment 15 is to probe again the £250 million efficiency savings on which this Bill depends. Can the Minister tell the Committee how he has calculated that figure? We worry that, as the impact assessment suggests, he has just plucked that figure out of the air.
Amendment 48 would give the Secretary of State flexibility to limit the cost to local authorities. The question is who is exposed if the Government have got their calculations wrong? Would it be the Treasury or local authorities? Should the Exchequer-the national taxpayer-bear the costs of any mistakes or should it be local taxpayers or even the recipients of care services?
The Local Government Association, in its briefing on the Bill, expressed its concern that the Government are not confident about the accuracy of their cost estimates. Many councils have already planned their savings and budgets for the year that the policy will start-2010-11. Councillor Ken Thornber, the leader of Hampshire county council-with West Sussex and Kent, it is one of the Conservative-controlled councils giving a good lead on social care-has said that his council would have to find between £5 million and £10 million above present projections.
This morning, I received a letter from the chair of the Learning Disability Coalition, Anthea Cox, which stated:
"We remain extremely concerned at what the implications for local authorities will be in terms of finding £250 million a year from efficiency savings. We are most anxious that these savings do not mean cuts in services for other needy people. It makes no sense to direct extra funding towards people who have their own significant resources as increasing the numbers of people who will become eligible for personal care funding at the highest level of need will reduce the funding available for those with substantial levels of need. There is considerable anxiety where the cuts may be made and the impression that care is being rationed for people with moderate needs. If an outcome of the Bill is further pressure on social care budgets this could well lead to further rationing."
The blunt truth is that if these savings cannot be found from the efficiencies somewhat loftily urged by the Government-but with no specific plan for achieving a penny piece of them-they will have to come from cuts or increases in charges. The biggest concern is that increases in charges will fall on those with substantial, moderate or low care needs. I asked the Minister in a written question whether charges are likely to be raised. He replied:
"Setting charges for social care is a matter for local authorities."-[ Official Report, 10 December 2009; Vol. 502, c. 553W.]
That does not provide much clarification.
6.45 pm
There are equally serious questions about the £420 million central funding. Thus far, the Minister has confirmed that he will cut £50 million from public health campaigns, £60 million from management consultancy, £20 million from administrations costs-that is easy to say, but I wonder whether it will be his administration-and £62 million from research into cancer, dementia and other debilitating diseases. That is worrying given his
recent claim that he is seeking to match our promise to increase research into dementia because of demographic changes and the profile of disease occurrence. Those savings add up to only £192 million, so I ask the Minister where the rest will come from.
Can the Minister explain why the summary of the impact assessment says that the annual enforcement cost of the policy is not applicable, but in a written answer to me on 14 December 2009 he said that it is estimated to be £27 million? How did he make that estimate? Are the illustrative grant allocations weighted, or are they simply produced according to the probable numbers in receipt of care at the critical level? How will the formula work?
What will the Government do to upskill and, if necessary, grow the work force to meet the demands of this measure to bring care to an extra 100,000 people? That is not strictly a local authority cost, but it will be a local cost. The Royal College of Nursing is
"very concerned about the impact that these reforms will have on the nursing workforce."
"These changes will affect the workloads of health visitors, community nurses and specialist nurses-professionals who are already overstretched. The community nurse workforce, in particular, is ageing, with many due to retire in the next 10 years. With only 10 months until these measures come into force the RCN is concerned that there may simply not be sufficient numbers of properly trained social care and nursing staff to deliver the commitment to free personal care in the Bill."
Does the Minister plan the substantial investment in community nursing that will be necessary if these changes are to be successful? Has he found a source for the funding required?
Greg Mulholland: In many ways these amendments go to the heart of the Bill and its core problems. The Prime Minister announced the policy at the Labour party conference-we all have our views on why it was announced at that time and in that way. The Government announced the shiny, new policy and then said that they would fund only part of it, with the rest of the cost falling on local authorities that are already obliged to find huge efficiency savings-3 per cent. this year, rising to 4 per cent. next year. That is unacceptable, especially given how this policy was introduced. It is supposed to be implemented from October this year, but most councils have already set their budgets for 2010-11. All the savings that they have identified have already been earmarked.
The impact assessment has been roundly criticised, but the phrase that strikes most fear into those concerned about this area of policy is "inherent uncertainty", which is used about the costs of the implementation of this Bill. Simply to proceed on that basis, and to give an open-ended commitment to local authorities, which is precisely what the Bill will do, is entirely unacceptable. If the Government want to press forward with that policy, they are entitled to do so and to justify that. However, surely they should at least restrict the total contribution that must be made by local authorities, so that they can budget sensibly, as the Government rightly suggest they must.
There are other implications. The UK Home Care Association has raised concerns that the measure will put downward pressure on prices paid to independent sector providers, which provide 81 per cent. of publically
funded home care, and that home care will be seen as a low-cost option compared with residential care. There is a danger that we would see a further deterioration in wages in the home care sector as a result of local authority pressure. There is already a huge turnover of staff in the care home sector-the rate is nearly a quarter. That is not good for the kind of care for older people that we would like.
The message from the home care sector-this is from UKHCA's very good briefing-is simply that
"there are no more pips to squeak"
out of it to meet that kind of shortfall. If the hon. Member for Eddisbury (Mr. O'Brien) pressed amendment 48 to a Division, the Liberal Democrats would support him. We all accept that we are in a difficult time of recession, but should the Government say, "We expect that large contribution of £250 million from local authorities, but we are not going to expect more"? Simply put, it seems that the sums in the impact assessment cannot be relied on, and therefore, if the measure goes through, local authorities can expect it to cost them significantly more than the Government's estimate.
Phil Hope: Amendment 15 would effectively exclude local authorities from the duty to provide free personal care to people living at home on the ground of a lack of central funds. That cannot be acceptable. Local authorities have a duty to meet the eligible needs of their clients. They may take their available funds into account when deciding the level of resources allocated to social care for adults, but they may not refuse to meet a person's eligible needs on financial grounds.
It is true that, currently, councils may charge for non-residential services. When doing so, they should employ a means test to help them determine the charges to be recovered. However, it is right that the provision of personal care to those with the highest needs living at home, which will enable them to continue living at home, should be exempt from such charges. It is also right that local councils play their part in the provision of personal care to those living at home with very high needs as a way of supporting their local communities. I hope that alongside the measures in the Bill, councils continue to develop their universally available preventive services for those in their local communities. Such services offer local authorities the chance to invest in prevention and reablement now to prevent higher care costs in future.
I draw Members' attention to "Use of Resources in Adult Social Care", a comprehensive assessment of the ways that local councils make best use of those resources, which the Department published in October 2009. It enables a comparison between councils on their performance regarding how they go about using their resources. Councils can look at a number of examples of excellent practice, and find ways to deliver higher quality services at a lower cost. I highly recommend the document. Indeed, hon. Members might want to sit down and discuss it with their local authorities to ensure that the best practice we see in certain parts of the country is repeated in others, and indeed across the whole country.
An integral part of the Bill is the proposed offer of reablement. That is a package of intensive support measures to help somebody to become more independent and to continue to live in their own home. As the document to which I referred and others tell us, the
development of reablement services is already under way in many areas. We are providing some £420 million of funding in the first year of implementation, to help councils both expand that best practice and meet the costs of providing free personal care to those who are eligible.
I should like to place on record my rebuttal of the work of fiction on Department of Health research funding that the hon. Member for Eddisbury (Mr. O'Brien) repeated at the Dispatch Box a moment or two ago. Let me assure him and the Committee that cancer and dementia funding will not be affected in the way he described. We are providing more funding than ever for health research-a £1 billion budget is ring-fenced for research. We are committed to this: we are not cutting funding for cancer research to fund free personal care, as we have made clear. Indeed, our research budget has doubled since 1997.
Our social care proposals will be funded in part by making efficiency savings on Department budgets that are outside the ring-fenced NHS research and development budget. Those efficiencies will therefore not affect vital front-line projects in areas such as cancer and dementia. The research budget that funds the National Institute for Health Research and the Department's policy research programme will increase to more than £1 billion in 2010-2011. I hope I have put our position clearly on the record.
Amendment 48 would allow the Secretary of State to make regulations to put a cap on the amount of personal care that local authorities may be required to provide to people living at home. Although local authorities can use cost ceilings as a guide when deciding on the best and most cost effective way to meet a person's care needs, they have a duty to meet those needs regardless of costs, and they cannot use such cost ceilings rigidly. As such, the amendment would be inappropriate-it would enable the Secretary of State to make regulations that would impose a blanket requirement on local authorities to restrict their provision of vital personal care services to people living at home to a particular amount, which could result in unmet needs.
Let me be clear on the accusations about the impact assessment and the robustness of our figures. We have not underestimated any hourly rates for buying the care: we are using the figure of £15.75 per hour at 2011-12 prices, which is well within the expected costs. In addition, we have not underestimated the number of hours of care needed, as some have alleged: we have used the average number of hours based on Personal Social Services Research Unit modelling for people with highest needs-that is to fund the personal care element of an individual, not all the services for those who meet the criteria. We are now consulting on three possible approaches to a distribution formula, which will make allocations as fair as possible. Some authorities might have higher costs, but others, where there are fewer people, will fund their own care locally. We propose to review the workings and the costings of the scheme within the first 18 to 24 months.
I know that things have been said by other organisations and I am pleased to have had the opportunity to put on the record here in the Chamber our view that our
costings and funding assessments are robust. I therefore ask the hon. Member for Eddisbury to withdraw the amendment.
Mr. Stephen O'Brien: I am very glad that the Minister felt able to seek to rebut the criticisms of his calculations and workings, not least on the impact assessment, by simply stating them at the Dispatch Box. That is precisely what I was able to do about the various highly spurious fictions and assertions that he used to criticise the Conservatives' home protection scheme. We are equal now that we have corrected one another.
Clearly, the amendments were probing. I am sorry that the hon. Member for Leeds, North-West (Greg Mulholland) feels that we should press amendment 48 to a Division, and I am grateful that he indicated that he would have supported us had we done so, but there is a risk that that would be irresponsible, because the cost implications of the amendment are unclear, and we must all operate under very severe constraints in the current conditions.
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