Examination of Witnesses (Question Numbers
620-639)
MR ANDREW
HARROP, MR
STEPHEN BURKE
AND MR
ANDREW CHIDGEY
26 NOVEMBER 2009
Q620 Charlotte Atkins: The Department
of Health seem to think it goes on Saga cruises, is that true?
And if it was true, does it matter?
Mr Harrop: I think we are in danger
of policy-making by anecdote.
Mr Burke: Actually, Attendance
Allowance is almost the original personal budget, so in a sense,
we have other examples about the way personal budgets are being
used, but the key point about it, as Andrew was saying, is that
1.32 million people in England over the age of 65 are claiming
Attendance Allowance. It is very popular, obviously because it
is not means tested as well, but look at other groups, so people,
for instance, with sensory impairment who rely on Attendance Allowance
to help with mobility, with communication and so on, are extremely
worried about the prospect of losing that, and not certain what
they are going to get in return. I think that is the big issue
for a lot of people, if we are going to lose Attendance Allowance,
what is it that the new National Care Service will deliver in
return? There is no clear evidence, from the fact we have not
had the modelling either, to suggest what it is that people will
be offered.
Q621 Charlotte Atkins: Do you think
it is sufficiently claimed? Do you think there are still a lot
of people out there who are not claiming it? I certainly, in my
case load, find quite a lot of people who really do not know about
Attendance Allowance, and are not aware that it is not means tested,
because obviously there is a reluctance to go down the route of
applying for something which might be means tested, and are not
fully aware that this is not means tested. I know that Age Concern
do a fantastic job encouraging people to take up these benefits,
but very often, unless—and I use the service all the time,
I try and get people to talk through those issues, but what is
your sort of impression about whether it is being sufficiently
claimed?
Mr Harrop: I am sorry, I was just
looking through my notes, because I thought I had a number on
the estimate of underclaimed Attendance Allowance. But it is very
significant, particularly with the over 80s, where an awful lot
of people have levels of disability that would warrant a claim.
You are right to say that local advice services like Age Concern
play a critical role. They try to look at the whole person, and
think about all the different types of support and entitlements
that they can be helped to access, be that through social security,
local government, or the health service. Information and advice
does play this critical role in wrapping together all the different
sorts of support and then making sure people claim what is their
due.
Mr Chidgey: I just wanted to add,
I think there was some quite interesting discussion going on in
previous evidence sessions about whether the support that people
currently get through attendance allowance would be protected
under a national care service. I just wonder what that protection
means, whether it means protection of the financial value or the
support that people would get, and also whether it means protection
for people who are currently getting Attendance Allowance, or
whether it means protection for all people who might be judged
to be in the same needs category in the future. I think one of
the big issues here is that if you—and I am sure you will
have had it in some of the evidence, if you currently do not meet
any of the criteria for local authority funded care, you still
might be eligible to get Attendance Allowance. So at the moment,
the reason people are getting so angry and heated about this,
is partly because they are often being assessed and then being
told, no, you do not meet the thresholds for any help, but they
still do nevertheless get Attendance Allowance, which is helping
them cover the costs of disability and living a better quality
of life, and they do not see the guarantee about what you are
going to get in return, and there is this great fear. The biggest
response we got back, as I know others did, in the consultation,
was: well, what guarantees are there that if this money is suddenly
taken away, I am going to ever see it ever again? So that I think
is the nub of it.
Mr Harrop: Andrew is absolutely
right, Stephen mentioned people with sensory impairments, but
the other key group is people with family carers, because the
suggestion is—Attendance Allowance is carer blind, it is
just based on your personal needs. The suggestion is that the
new system might be carer sighted; in other words, if you have
got family care, you would not receive help with the cost of your
disability through the new system.
Q622 Charlotte Atkins: What evidence
is that based—that is just supposition at the moment, is
it?
Mr Harrop: No, that is what the
Department have suggested through the analytical work underneath
the Green Paper.
Q623 Dr Taylor: Really going on on
the same subject, you have said the benefit is that it is carer
blind; could there not in fact be gains from making this better
targeted? Is it not poorly targeted at the moment, because it
is available for virtually everybody? Could there be gains if
it was better targeted?
Mr Harrop: Specifically thinking
about carers, this benefit to help with the extra costs of being
disabled, the sorts of things I talked about, and I do not think
these disappear just because you have family care. I think the
concern about reforming Attendance Allowance, as well as what
Andrew said about the assessment, is that this is a very easy
and flexible system. It is not administratively bureaucratic in
the way that care and support from your council is. We need to
try to make sure that the maximum number of people with an entitlement
are actually claiming it. That is not impossible under a new national
care service, but we need to be very careful that we set it up
right, so that it is easy.
Q624 Dr Taylor: Could you run through
the guarantees? In your paper, you give us four or five conditions.
Could you go through those?
Mr Harrop: Well, I guess those
five conditions really describe what Attendance Allowance looks
like today. The reason we set it out as a list is that our basic
position is that we want to see the statutory entitlements which
are in Attendance Allowance carried forward into a new system;
but we are not opposed to a repackaging or a rebadging of those
payments, so that they could come under the banner of a national
care service, as long as the underlying entitlement remained.
So we do not have any problem with, for example, a single assessment
process, as long as the entitlements that it gave you were the
same; or a personal budget which included your old attendance
allowance component and your social services component combined,
as long as our conditions were met, in terms of it being based
on entitlements; a minimum weekly payment that does not decline
compared to today; being carer blind; being completely flexible,
so you decide how you use it. Those are the sorts of things that
we think need to carry forward in a new system.
Q625 Dr Taylor: Still with you, we
are told that last week you welcomed the Conservative Party's
commitment not to reform disability benefits at all.
Mr Harrop: What we welcomed was
the commitment to the underlying entitlement that is in Attendance
Allowance. In all our public statements, we have said that we
want to see that statutory entitlement stay in any new system.
However, we are prepared to see that sort of rebadging that I
talked about. So we are up for a debate about better integration,
so that you go to one person and they tell you all your entitlements—and
it can be called the national care service. What we are opposed
to is the sorts of things that have been proposed about moving
to carer sighted eligibility; needing to be more disabled than
you are today; and about it being means tested. All those proposals
do seem to be live in the Department's thinking.
Q626 Dr Taylor: So as long as the
carer blind equivalent remains, whatever it is called, you would
be happy?
Mr Harrop: And non-means tested,
yes.
Q627 Dr Taylor: Any views?
Mr Burke: Let us not underestimate
the depth of feeling about this issue that has been stirred up
in the consultation process to start with, and the fact that many
people getting Attendance Allowance currently fall outside eligibility
criteria at the moment. I think that is the big concern, people
think a new national care service will have similar eligibility
criteria, and they will not be entitled to help under the new
proposals, and therefore feel they are going to give up something
without getting anything back, so we need to see much more evidence
in terms of modelling and the kind of guarantees that Andrew is
asking about. I do think though, if we are looking at long-term
reform of the social care funding system, we do need to look at
how we move towards a single pot of money that pays for care and
support, and we need to define that quite broadly in terms of
the level of support. That is what has happened in a number of
other countries where they have reformed care, they have moved
to a single pot, a single funding stream. The question is, why
has Attendance Allowance on its own been singled out to put into
this pot when there could have been a whole range of other sources
of funding which could have been added in as well. There is no
guarantee that that pot will keep pace with the growth in demand
in the future and so on, so people are right to be worried about
what they are going to get in the future, and why they should
be asked to sacrifice Attendance Allowance.
Mr Chidgey: I think it is really
important to recognise that families are the people who are providing
significant amounts of care round the clock, and they feel quite
angry because they feel they get a little bit of help, but actually
there is a proposal to take it away. When there are no guarantees
about what you might get instead, naturally, you grab at what
you have got, and try and protect it, and I think that is the
right response in the current circumstances, where there are not
clear guarantees about what you are going to get. So I think there
is a very rational explanation as to why you might think about
having various pots of money drawn together to think about people's
needs in the round, and to make sure that they are being supported,
to make sure it is about the best things to use it for, but at
the moment, there are no guarantees about particularly people
with low level needs, and the clarity that you are going to be
able to make choices with that money.
Mr Harrop: Can I briefly make
two further points about Attendance Allowance? Firstly `passporting',
by which I mean that Attendance Allowance gives you entitlement
to other things. It gives the carer entitlement to Carers Allowance,
and it gives people with disabilities entitled to increments on
their means tested benefits—Pension Credit, and other entitlements.
Secondly, age discrimination: the Secretary of State at the National
Children and Adult Services Conference last month said that under
65s' benefits would not be touched. We are very concerned about
widening age discrimination in the care and support system. Whatever
funding mechanism emerges, we will oppose any system where the
outcomes that it aims to achieve are very different for different
age groups. We worry that this could happen with these proposals.
Dr Taylor: Would the two Andrews agree
with Stephen in his submission, "The care challenge is an
issue for every citizen, we need a huge public debate and national
consensus about the best way forward for all of us"?
Q628 Jim Dowd: And are you against
sin?
Mr Chidgey: Well, yes, but I think
that the thing that is a bit missing in the discussion is I think
there is often a great concentration, what are we going to do
to sort out our care services and our healthcare services, when
actually the answer lies in how do we—where we have significant
numbers of people with long-term conditions, that are having an
impact for them on a daily basis in all the interactions that
they have with people, I am thinking particularly of cognitive
impairment, of course, but it relates to a number of conditions,
that the most effective response to support people can only come
from people themselves, from their families, from their communities,
and from some specialist support from services. So I would like
to see a bigger debate, because I think we need to understand
how communities as a whole can support people to live effectively.
I know it is a big aspiration, but I think that is what we need
to do, and I think that is not currently contained effectively.
What is the role of volunteer workers, for example?
Dr Taylor: I think we are actually coming
back to something on this.
Q629 Stephen Hesford: Andrew, just
remind me, what is the current rate for Attendance Allowance?
Mr Harrop: It is £70 at the
higher level of need and £47 at the lower level of need.
Q630 Stephen Hesford: You see, one
of the difficulties I have with this discussion is in my postbag,
I have a significant elderly population, nearly 25%, I have had
virtually no postbag about Attendance Allowance going at all,
and that interests me. In fact, what I have had anecdotally, certainly
in the earlier years when I was elected, is people would complain
about the amount Attendance Allowance was, that it was not enough,
and some people said, "Well, I do not bother claiming it".
Yes, this is anecdotal to me, but I am just slightly confused
as to why this agenda appears to be kind of special pleaded, and
whipped up in a way; on the ground, I just do not see it. Can
you help me?
Mr Harrop: Well, in terms of `on
the ground', I am quite pleased that people are not coming to
you, because what we do not want is lots of very anxious people
worrying that their money is about to disappear overnight.
Q631 Stephen Hesford: That is how
it is being reported.
Mr Harrop: That should not be
the case.
Q632 Stephen Hesford: That is exactly
what the press and others are saying.
Mr Harrop: Indeed, and I am really
glad that that is not playing through locally.
Q633 Stephen Hesford: That is why
Richard used your quote before.
Mr Harrop: All the debate is about
a long-term reform, rather than overnight changes. To the Department's
credit, it has said that there will be transitional protection
for people currently receiving these entitlements. The concern
is what happens to the person who becomes disabled in five years'
time, and what support they will get.
Q634 Chairman: Andrew, could I just
ask you, you gave a list of where you think Attendance Allowance
is spent at the moment; if the flexibility was taken away, would
you as an organisation feel competent in arguing the point that
gardening costs is something that should be part of a national
care plan?
Mr Harrop: Well, this is a debate
about personal budgets as well as Attendance Allowance, to what
extent should a social worker or some other professional dictate
what you should spend your resources on? There have already been
some relatively controversial cases of use of personal budgets.
Attendance Allowance was designed in the 1970s to give complete
flexibility, so people would decide for themselves what would
increase their quality of life. I think if you live in a family
home with a garden, and you can no longer manage the upkeep—compared
to the costs of having to move home, or the disruption that that
might cause—I think there is sometimes a case for relatively
modest levels of help around the home and garden coming from social
security.
Q635 Jim Dowd: You will have to excuse
me, my previous comment was—I sometimes think when people
ask for a national debate, they do not want a debate at all, because
we can debate things forever; what they actually want is some
conclusions. We need to also clarify what people's approach to
reform is; often as not, it is more, we will take what we have
got now, and we want some more, and what we have got now becomes
inviolate. I am not clear yet whether that is the position you
are adopting. If I could just ask a couple of questions before
I get to the main thrust, Mr Harrop, you mentioned the McDonald
case a couple of times, which authority was that?
Mr Harrop: Kensington and Chelsea,
but I do not want to single them out.
Q636 Jim Dowd: You just did!
Mr Harrop: I think councils are
under enormous pressure. They are stuck in the middle. So I think
it is dangerous to blame local authorities for having to administer
a system that is not working.
Q637 Jim Dowd: So you do not actually
think there was anything wrong with the decisions they took?
Mr Harrop: I am sure things were
wrong with the decision. I am just saying they are partly to blame,
they are not entirely to blame.
Q638 Jim Dowd: We all know how hard
up Kensington and Chelsea is, they are really strapped for cash,
so it must be difficult for them! Mr Burke, you mentioned postcode
lottery, you are the only one who has, actually. There are 152
social care authorities in Britain, how do you reconcile the priority,
or which do you regard as a priority: local commissioning, based
on an interpretation of local need, or uniform provision, because
you cannot have both.
Mr Burke: Certainly one of the
big issues that people come to our advice service about is about
the inconsistency or the lottery, however you want to define it.
They cannot understand why they—
Q639 Jim Dowd: You used the term,
how do you define it?
Mr Burke: It is about being eligible
for different levels of service and having to pay different levels
of charges, depending on where you live. Now we very much support
the proposal around developing a national care service, which
has a range of universal entitlements, which would apply wherever
anyone lives in the country. Now it is crucial that we have a
strong national framework to do that, but it would still have
to be locally delivered and responsive to local circumstances
and local needs, and there is no reason why that cannot—
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