The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, the Social Services Inspectorate sent advice to all directors of social services in England and Wales 12 months ago. The advice concerned the factors that they should consider when reviewing or devising a charging system. There are no plans to issue further advice.
Lord Campbell of Croy: My Lords, I thank my noble friend for her reply. As local authorities have had that responsibility for the new community care system for a short time only, and in order to set general standards on a national scale, should not more guidance be issued in addition to what was really only an outline issued by the Social Services Inspectorate a year ago?
Baroness Cumberlege: My Lords, social services departments have had the power to charge for domiciliary services since 1948, so that is not a new element in the way in which they run their business. We sent out the guidance and we are monitoring very carefully what is going on. At the moment we feel that that is sufficient.
Lord Ashley of Stoke: My Lords, is the noble Baroness aware that those charges are inequitable and unfair? They are inequitable because they vary widely throughout the country for the provision of precisely the same service. They are unfair because local authorities take account only of the income of disabled people and not their expenditure, and some disabled people incur very heavy costs because of their disability. Therefore, the guidance issued by the Government and by the inspectorate is being ignored. Will the Minister please consider recommending to the Government that they should set national standards and insist on realistic assessments?
Baroness Cumberlege: My Lords, no, we shall not consider that. We believe that local authorities should have discretion. Different services are provided in different parts of the country. Local authorities are best placed to identify the strengths in their areas and indeed to provide flexible systems. If we introduce something
Baroness Faithfull: My Lords, what is the position with regard to people who are still ill but who have been discharged from hospital and therefore need to go into a nursing home? Who is responsible for the financial costs of the nursing home?
Baroness Cumberlege: My Lords, this Question is about domiciliary services. Local authorities do not have discretion with regard to residential care. The way in which the charges are made is laid out quite clearly. I shall go into the detail if my noble friend wishes me to, but it takes into account the capital of individuals, the costs of the home and their income; and in some cases quite a lot of assistance is given through income support.
Lord Dean of Beswick: My Lords, is the Minister aware that when that responsibility last rested with local authoritiesand I was involvedthere was a specific component within the rate support grant for that particular service for elderly and disabled people? That was identified quite clearly. The component granted was based on the needs of the area. Why cannot the Government revert to that and save all this trouble, because they would then target the assistance on areas of greatest need?
Baroness Cumberlege: My Lords, all local authority expenditure works on a formula the standard spending assessments. A great deal of consultation takes place with local authorities on how those assessments are drawn up year on year and the formulae required to do that. Charges for services are not part of the assessment. It is for local authorities to charge as they wish. Many of them accrue quite a lot of income from that, which enables them to give services to a wider range of people. We have no problem with the proposition that people who can afford to pay for services should pay for them.
Lord Carr of Hadley: My Lords, does not another matter underlie the question of such services? I refer to the great variability in the efficiency of the staffing methods and services provided by different local authorities. I do not believe that I am alone in feeling that the system leaves a lot to be desired and that there needs to be a great deal of improvement if we are to provide those vitally important social services on the scale and with the humanity which we should all like to see.
Baroness Cumberlege: My Lords, my noble friend is quite correct. When one looks at how local authorities manage their business, there is a great variation between those which provide high quality, efficient services at lower cost and those which do
Baroness Jay of Paddington: My Lords, is the Minister aware that I am very pleased that she was asked such a Question by her noble friend? It precisely reflects the concerns that have been expressed many times from these Benches, not least by my noble friend Lord Ashley of Stoke in introducing earlier debates on community care. Is the Minister also aware that the base of those concerns is the worry that there are no national eligibility criteria for where free health care and means-tested social care starts? Why cannot the Government find a way to define national eligibility criteria? After all, they are firm in their belief and in their expressions that the National Health Service should remain a national concern.
Baroness Cumberlege: My Lords, we have had long debates on the subject. The noble Baroness will know that a consultation paper has been sent out to the National Health Service, to local government and to a wide range of people on the differentiation between health care and social care. Responses to the consultation paper are now being considered by the department. We have had a range of responsesmany of them very helpfuland we shall be producing a firm document very shortly.
Lord Campbell of Croy: My Lords, I entirely accept a system of charging, because some elderly people are very well off and can contribute; but they also need care. However, is my noble friend aware that in other cases charging may discourage people from continuing in or seeking employment, as earnings would be reduced or nullified by the present system?
Baroness Cumberlege: My Lords, I am sure that many people would like a free service and would prefer not to have to pay towards it. However, as I said, we believe that local authorities must consider whether a reasonable charge should be made. They have to consider the cost of the service and the ability to pay. There is an appeals procedure when people feel that they are not being properly treated. Those considerations are all part and parcel of the Acts under which local authorities work. In that regard, we wish to give them discretion. However, there is no discretion in respect of residential care, where there is a statutory formula.
The Lord Chancellor (Lord Mackay of Clashfern): My Lords, a total of £2.8 million has been paid on account. However, the principal legal aid certificate issued in respect of proceedings between Dr. Hashim and the Arab Monetary Fund has now been revoked and, subject to any appeal Dr. Hashim may successfully make against revocation, no further work can be done. The Legal Aid Board remains liable for payment for work done up to the date of revocation. The final cost has yet to be determined.
Back to Table of Contents
Lords Hansard Home Page