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Dr. Ladyman:
My reading of this amendment is slightly different to that of the hon. Gentleman. Will he help me? Proposed subsection (4C)-the bit of the clause that is removed-states that a local authority "may" make this measure conditional. It does not say
that it has to do so. I read it as a mechanism by which a local authority may-if it feels that, by getting somebody to undergo an intensive period of support, that person might have a lower care need that would have to be funded by the state and the local authority, or if it feels that making the person accept certain technologies in their home and making them use them would ensure a lower cost of ongoing care-insist on the person having that level of support. In other words, it is a way of ensuring that somebody does not avoid doing something that would reduce the local authority's costs in the long term just because they are too lazy or too wilful to do it.
Mr. O'Brien: The hon. Gentleman is obviously carefully thinking through the way in which this will operate, and I respect that. The difficulty is that this provision is the trigger mechanism. I am concerned that there should not be any chance for the trigger to be delayed by the actions of local authorities if they postpone the time at which reablement is, in the word proposed by the legislation-it is not my word at all-"undergone". I am seeking to ensure that local authorities cannot delay because of the words used in the legislation. That is what we are here for, after all. I want to replace "undergoing" with "undertaking to undergo" in order to make it clear that it should start at the point at which an assessment is incepted. I hope that our amendment makes that a lot clearer and a lot more certain. I hope that that helps the hon. Gentleman.
Dr. Ladyman: The hon. Gentleman's aim is laudable, and I can understand it, but if a local authority were to delay providing support for somebody on the basis that it had not done something or made something available, surely no court would allow the local authority to get away with that. The ombudsman certainly would not.
Mr. O'Brien: That might well be the case if the person for whom care and support was needed was the cause of the delay. I suspect that that would cause some of the support that would otherwise be given free of charge not to be available anyway, because the person would not be ready to accept that level of care. The issue is the provision of care and what starts the requirement, under law, to make that care, which will be free of charge, available. That is what we have been concerned about. There is an ambiguity, to say the least, and probably an uncertainty, in the way in which the legislation is drafted. I do not think that this amendment is hugely challenging or controversial. It is, I hope, trying to give the Government's intent a better chance of being borne out in how the wording leads to decision-making behaviour from the people who will interpret the Bill in an administrative or legal capacity rather than necessarily any behaviour from those who are looking to receive the care.
Amendment 21 is a probing amendment to ask the Minister to clarify who will be eligible for such care, and amendment 43, tabled by the Liberal Democrats, who will address the points that it raises, is on the question of palliative care. I am in sympathy with it and supportive of it. The regulatory impact assessment says that people receiving palliative care would be excluded from reablement. That seems quite harsh. As Help the Hospices has said,
"people can receive palliative care alongside curative treatment (it's certainly not an either/or) and people can also receive palliative care for prolonged periods of time (for some, such as younger people with life limiting conditions, such care can go on for many years)".
I shall ensure that the Liberal Democrats have the chance to develop that point, but I think that it is important that we recognise it. It is a powerful point and we are grateful that they have tabled that amendment.
The Minister stated in an answer to a parliamentary question on the number of cases in which people received palliative care that he had no idea what the median, mean and maximum life spans are for people receiving palliative care. I hope that he will be able to expand on the answer that he gave me on 7 December. That issue, in itself, will be of concern.
In conclusion, as I want to keep the introduction to these amendments relatively brief, I think that the technical way to do this will be formally to suggest that although I will be happy, with leave, to withdraw the lead amendment in this group, I hope to have the opportunity to push amendment 18 to a vote and to test the opinion of the Committee on it, unless we hear some staggering response from the Minister, which is not expected.
The Second Deputy Chairman: I am grateful to the hon. Gentleman for making that point, but we will return to it when we have finished the debate.
Phil Hope: I want to respond to the debate-I am disappointed that nobody else wanted to contribute-
The Second Deputy Chairman: Order. Does the hon. Gentleman wish to contribute?
The Second Deputy Chairman: With the greatest of respect, I am not a mind reader. Hon. Members must rise in their seats if they wish to contribute.
Greg Mulholland: Thank you, Sir Michael. I think that I was as confused as you were by the lack of anybody who wanted to discuss the amendment.
I want to speak briefly about amendment 18, which the hon. Member for Eddisbury (Mr. O'Brien) wants to press to a vote. We would clearly all support the reablement process in principle, but it has to be done in a way that reassures people that it has not been done unnecessarily and that it is not going to be a burden to people. If it is pressed to a vote, we might need to support it, but we will wait to hear the Minister's comments.
Amendment 43 is designed to protect people for whom a medical professional thinks that reablement would not be appropriate. That group would include the terminally ill or anyone on whom the process might have a detrimental effect. The idea behind the amendment is that, although we support the idea of reablement, it must not be possible for a local authority to refuse someone free personal care at home on the ground that that person refuses to undergo a process of reablement if a qualified medical practitioner has said that the process could realistically do more harm than good. We have to acknowledge that, given the huge cost implications for local authorities, there is a possibility that they might seek to push people into undergoing reablement, or repeat reablement, and that they might threaten to withdraw services if an individual refuses to reply.
The amendment would give the option of an exemption for those people who, for good reason, feel unable to take part in the reablement process, particularly those who are in possession of a doctor's note or another form of recognised medical advice recommending that that would not be suitable. Making people go through that process could cause them great anxiety or even physical harm. We believe that the measure should be a vital part of the reablement process if we are to have confidence in it, and I reserve the right to push the amendment to a vote at the appropriate time if I do not hear a satisfactory response from the Minister.
Dr. Ladyman: The hon. Gentleman's amendment gives the impression that any letter signed by a GP and giving the effect he has described would mean that a local authority could not insist on a reablement process going ahead. As we all have examples in our constituencies of GPs who are prepared to sign virtually anything that their patients ask them to sign, what right of appeal would a local authority have, under his amendment, to challenge such a situation and say that reablement would be an appropriate course of action?
Greg Mulholland: That is a fair point; clearly, such a mechanism would need to be built in. There are sometimes concerns about the use of doctors' notes, but that issue needs to be addressed separately rather than being allowed to turn this idea on its head. We should not say that the exemption should not be there because of other concerns. We tabled the amendment to raise the principle for discussion. It is then for the Government to consider how best to build such an exemption into the system. I shall wait to hear the Minister's response.
Phil Hope: This is an important group of amendments. The policy that underlies the measures in the Bill has two clear strands-free personal care for those with the highest needs who live in their own homes, and a package of intensive support or reablement to help people to remain at home for longer. Reablement services are offered by some councils, but it is important that local authorities across the country continue to develop and improve those preventive services. We know that with a six-week package of appropriate reablement measures many people would be able to reduce their dependency on care services and therefore live more independently. It will not always be appropriate for someone to undergo a period of intensive support, depending on their individual circumstances. That is why we think that local authorities should be given the discretion to make that judgment and to provide a reablement package as a precursor to arranging a package of personal care for the individual where that is thought to be necessary. I want to make it clear that, as my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly said, the measures give local authorities permission to choose to operate in that way.
On the worry that the hon. Member for Eddisbury (Mr. O'Brien) described, and the example he gave, the immediate needs of individuals would be met while they were undergoing reablement. A more detailed assessment would then be undertaken once reablement was completed. The detailed work on the scheme would not be included in the Bill but would be a matter for guidance, drawing on professional expertise and the views of various stakeholders. Removing such an express power by accepting amendment 17 would, I fear, do nothing to encourage
local authorities to develop further their reablement services. It would also fail to encourage investment in services that help people to improve their personal situation and help to prevent it from deteriorating and their care needs increasing. That is one crucial reason why I urge him to withdraw that amendment.
8.15 pm
Amendment 18 would similarly fail to encourage individuals-I think this is the point that my hon. Friend the Member for South Thanet was making-to make the best use of the reablement services available to them. The amendment would mean that a local authority could make free personal care conditional not on an individual undergoing reablement, but merely on undertaking to do so. In other words-this is an important point, and my hon. Friend was right about this-individuals would not need actively to undertake reablement to receive free personal care, but would need merely to undertake to local authorities that they would do so. Therefore, that reablement might never take place.
Effective reablement relies upon sensible and effective decision making by local authorities, by people who need care services and by their care partners. Reablement packages need to be put in place and need to be undertaken to assist people in living their lives fully and in reducing their dependence. The amendment could result in a reduction in partnership working between the individuals who need care and their local authority. It could also result in authorities beginning to work up reablement packages that the relevant individuals have no intention of taking up. The amendment would not have the effects that we would wish to see of ensuring that people access and use reablement packages as a critical part of the whole system of improving care for people and, indeed, providing free care for the people with the highest greatests needs.
Amendment 19 would change the description of one of the potential eligibility criteria that may be set out in regulations. It would change the words
"a process designed to maximise the person's ability to live independently"
"at least one process designed to maximise the person's ability to live independently".
That process, which is described in new subsection (4C), is more commonly referred to as reablement. Details of what might be included in a package of reablement will be laid out in regulations or in guidance. We intend for the process to be a single process, but it could involve a range of interventions and support such as home adaptations, the installation of telecare and sessions with an occupational therapist or physiotherapist. There is a risk that, if the amendment were accepted, local authorities could use the wording "at least one" to delay giving people the free personal care that they need indefinitely. Clearly, that is not the intention underlying the Bill.
The effective and appropriate use of reablement services can help individuals to reduce their dependency on care services and can increase their ability to live independently at home. However, where an individual still has high personal care needs following reablement, they should receive the support they need to meet those personal care needs. That is why we ask that amendment 19 be withdrawn.
Amendment 20 addresses the issue of carers. It would insert the wording:
"Any process under subsection (4C) may not be contingent on the activity of, or acquiring, a carer."
The amendment does not make clear the extent to which carer activity, which is what it describes, would be excluded. Would knowledge and expertise be excluded, or only direct help with day-to-day living? If the amendment seeks to exclude carer involvement when reablement packages are designed, that could lead to a reduction in partnership working, which we all agree is vital, between the local authority and the carer. That could result in a diminished outcome for the individual who uses the services. We all know that the role that carers play is absolutely vital, because they often have invaluable knowledge about the care requirements of the person for whom they are caring. Those requirements need to be taken into account when a reablement package is designed.
Even in a situation where carers would still be able to input their knowledge and expertise to design reablement packages, it would be difficult for them to be assured that that was being carried out appropriately if they were not involved in the reablement activity, where they wished to be.
Carers' involvement in reablement is crucial, when that is beneficial to the individual being cared for. They have an invaluable role in supporting the people for whom they care, and in working with local authorities and care providers.
I emphasise that the Bill does not seek to place additional burdens on carers, but neither does it seek to exclude them from working with councils to achieve the best outcomes for the people for whom they care. Therefore, we believe that it is important that local authorities continue to work with carers on behalf of those with the highest needs who are eligible for free personal care at home. Given my explanation of the clause, I ask the hon. Member for Eddisbury to withdraw the amendment.
Amendment 21 purports to extend the potential for local authorities to offer reablement to all those with care needs under the guidance issued under section 7 of the Local Authority Social Services Act 1970. The concern, apparently, is that the guidance should set out how the care is to be made available, and how needs are to be assessed. However, local authorities are already required to act under the general guidance of the Secretary of State in discharging their social services functions as set out in the 1970 Act. That includes guidance covering the principles of assessment and the commissioning of services.
The details of reablement services will be set out in guidance, but the services are designed to help people maximise their skills for living more independently. We all know that they are a valuable part of helping people to live at home for longer. Local authorities are free to offer reablement to anyone whom they feel may benefit. Amendment 21 potentially restricts local authorities' provision of reablement services only to those who have existing care needs. I think that that would go against the very important trend towards universal and preventive services.
Amendment 43 would prevent regulations from authorising local authorities to make reablement a condition
of free personal care in certain circumstances, namely when a "registered medical practitioner" or other "registered practitioner" thinks that the process will be of
"limited or no benefit, or detrimental to the health of the patient, or will not alter their care needs."
I hope that the hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, agrees with me that local authorities are best placed to decide whether a package of reablement would be beneficial before an individual receives personal care support free of charge.
It is obviously important that local authorities do not force people to undertake a reablement package unnecessarily. We expect councils, when they are deciding whether reablement is appropriate, to consider in a sensitive fashion the overall benefit and impact of such a package, and to work with the patient's family, GP and others to assess that person's suitability for reablement. That may be particularly important when a person is undergoing palliative or end-of-life care.
I know that one of the concerns about the Bill is that reablement will not be available for those undergoing palliative care. I can assure the Committee that, where councils believe that reablement might benefit a person undergoing palliative care, they may offer it. However, if the person is unlikely to benefit, he or she should not be forced to undergo reablement merely to qualify for free personal care. All the detail of that will be covered in guidance.
Ultimately, local authorities assess people's care needs and their eligibility for care and support, so it is right that they should be able to make decisions about the services that might be appropriate, in conjunction with other relevant partners in care.
Greg Mulholland: I thank the Minister for that explanation, in which he has made it clear that the Government's intention is that people should not be pressed into undergoing reablement. As long as that is the case, I shall not seek to divide the Committee on amendment 43.
Phil Hope: I am grateful to the hon. Gentleman for that response. I think that it is right that local authorities should be able to make decisions about which services are appropriate, but they must do so in conjunction with other relevant care partners.
I thank hon. Members for raising these issues to do with reablement. I have spoken at length because it is important that the whole Committee understands our intent and how the proposal will operate. All the details will be addressed more fully in the guidance accompanying the regulations, and I hope that what I have said will persuade the hon. Member for Eddisbury to withdraw his amendment.
Mr. Stephen O'Brien: I am grateful to the Minister, who sought to address a number of issues that we raised in relation to this group of amendments. I note that on his amendment, the spokesman for the Liberal Democrats, the hon. Member for Leeds, North-West (Greg Mulholland) expressed himself relatively satisfied with the Minister's approach.
I indicated earlier in my remarks that the amendment on which we should test the opinion of the Committee was not 17, which happens to lead the group.
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