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That brings us on to what the Bill does to local authorities. Local authorities are being told that they must find the money to pay for their share of the cost from extra efficiency savings. I am all for efficiency savings, but how realistic is it to suppose that authorities which are already working to achieve 3 per cent efficiency savings a year, shortly to rise to 4 per cent-a very tall order for many of them-will suddenly be able to find an additional £250 million at practically no notice? Even the Government say that these savings are achievable only over time, but local councils are not being given time: the money has to be found as from October of this year. What is more, given the chasm of uncertainty underlying all the financial assumptions, the annual cost to them may be a lot more than £250 million. We are now led to understand, contrary to what was understood initially, that if the total cost of delivering the Bill should exceed the budget, local authorities will have to find whatever extra money is required; in other words, they are being landed with an open-ended commitment. I should like to hear from the Minister why she thinks that the funding arrangements needed to deliver the aims of the Bill do not run counter to the new burdens doctrine. When it comes to placing new financial burdens on local authorities, the Government have given clear and unambiguous undertakings. I quote from the website of the Department for Communities and Local Government:
"A new burden is defined as any new policy or initiative which increases the cost of providing local authority services ... Government as a whole are committed to ensuring new burdens falling on local authorities are fully funded. This commitment is called the New Burdens Doctrine".
The squeeze on local authority finances caused by the Bill will be of the severest kind, and it is not hard to imagine what will happen. In the first instance, there will be a stampede of applications for free personal care. When the money available has been used up, local authorities will do their utmost to avoid having to take more people on to their books, and we will find pressure being placed on the elderly to move into residential care instead of staying at home. It will prove harder for people to pass the test of eligibility. Alternatively, or perhaps additionally, in order to fulfil their obligations to those in critical need, councils will be forced to remove social care funding from those who are in lower categories of need. To the extent that this happens, it may drive some people out of their homes and into residential care, thereby serving to dilute the main benefit of the Bill, which is supposed to be to enable more people to avoid or delay entering a residential setting.
These are some of the perverse incentives which the Bill is likely to create. It is inevitable that the ability of the system to look after an increasing number of elderly people in their own homes, however that care is funded, will vary from council to council, if only because of the lack of available manpower. No thought appears to have been given to the training requirement implicit in these proposals or the need to deliver care to an acceptable standard of quality. One is led to the inescapable conclusion that the speed at which the Government are aiming to roll out this policy is grossly imprudent. It is bound to disappoint a lot of people and it will give rise to false hope among those in critical need who find that they are denied free personal care because they fall the wrong side of a certain definitional boundary. A spate of legal challenges seems almost inevitable.
A national policy for care of the elderly requires a long-term view. Hence, any new initiative has to pass one test above all, and that is the test of sustainability. I fear for this Bill because I do not believe that its provisions will prove sustainable in the long term. The haste with which it appears to be have been devised has led some to think that its arrival in Parliament is less about delivering long-term reform and more about playing to the gallery. For all the reasons I have given, I suspect it would not take a jury long to decide which view they preferred.
Baroness Thornton: My Lords, as we might have expected, we have had a lively and informed discussion about the important issues touched on by this Bill, and indeed beyond them. We know that while this is a short Bill with just one substantive clause, it will have great significance for thousands of the most vulnerable adults and older people. I acknowledge that many of the issues that have been raised are about the Bill's implementation, and that is absolutely right. I expected that and informed the Bill team and everyone else that that is what your Lordships' House would concentrate on.
Before I deal with the large number of comments that I want to take up, to make and to answer, perhaps I may remind noble Lords that 400,000 people with the highest needs will benefit from the Bill. Some 280,000 of those with the highest care needs living at home, many of whom have already been paying for a long time a great deal of money to fund the cost of their care, will be helped by the Bill, and it will help to end the lottery of personal care charges. It will enable us to give them and their families some reassurance that their personal care will be provided free of charge regardless of postcode.
I turn to reablement, and here I agree with the noble Baroness, Lady Gardner, who said that this was a new word for her. It was for me a month or so ago, but I cannot think of another word that describes what we are trying to do any better. I am sure the noble Baroness probably will be able to do so, but it means helping people to remain healthy and independent in their own homes for as long as possible, and at home is where most people tell us they want to be. It also supports the prevention that we want to put at the heart of the system and builds on the progress we have
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Several noble Lords made the point that they did not believe the Bill had received enough scrutiny in the Commons. The noble Baroness, Lady Barker, answered that extremely well indeed. The Bill received a full day on Second Reading and a full day for the Committee stage-for a one-clause Bill. There is no question but that Members of the other place had their say. One has only to look at the record to see that. I disagree profoundly with my noble friends Lord Warner, Lord Lipsey and Lord Joffe. We think that this Bill will enable us to do the right thing now. It will end the postcode lottery, remove financial burdens and give real help to those with the highest care needs.
What I should like to do is go through some of the remarks made by noble Lords. I shall deal with as many as I possibly can in the time available, but I am mindful of the hour and the fact that noble Lords may want to get to their dinner at some point. The noble Baroness, Lady Gardner, made a series of points about meeting the costs of training a larger workforce. The issue was also raised by many other noble Lords. The adult social care workforce is made up of 1.5 million workers who are all delivering these vital services. As the services evolve, it is important that employers respond to ensure that their workforce is deployed and equipped to deliver them. In the case of personal care at home, we intend to specifically support council employees through helping to devise training tools. These are being developed by the Social Care Institute for Excellence right now. I was also interested in the noble Baroness's wise words about her work as a local councillor. She talked about councils having to trawl through their records. The point is that councils are already aware of the needs of people who are already receiving care, but for new people there will of course have to be assessments. That is why we are providing an additional £27 million to cover the administrative costs.
The noble Baroness and other noble Lords raised the issue of where the funding is to come from. It will be provided by the Department of Health, not the NHS, and will come from budgets that are to do with research and development, communications and consultancies. It is not coming from any budgets that affect front-line services or indeed the essential research mentioned by the noble Baroness and the noble Baroness, Lady Masham, into cancer and other important commitments that the Government already have.
The noble Baroness, Lady Campbell, asked various questions. First, perhaps I may say that, as concerns her role in the commission for equality and human rights, of course we are seeking the commission's advice and we will be having discussions. We regard the commission as a partner in the consideration of how this Bill should move forward. She also asked if we have evidence about the cost and dependency reductions of reablement. The research we refer to is the "use of resources" report, published in November
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Both the noble Baroness and the noble Baroness, Lady Masham, asked whether people would be forced to do this, and I think that the noble Baroness, Lady Barker, raised the issue of people receiving palliative care. I agree absolutely with her that of course that would be inappropriate in terms of what we are intending to do here. However, it will be for local councils to decide whether an individual would benefit from reablement, and local authorities are best placed to work with service users. We in turn will work with local authorities to ensure that there is strong guidance on access to care, an issue we have discussed in the House on several occasions. It is important that the guidance produced as a result of this legislation is strong and coherent, thus helping to take forward joint working between the care services and the National Health Service.
The noble Baroness of course also asked if the care will be portable. We believe that there should be greater co-ordination between councils of people's care packages when they move. As she knows, we are in favour of a move towards the portability of packages and that is being looked at in the context of the care and support Green Paper. I suspect that we will return to this discussion in Committee, which is exactly why we need to move forward with the Bill.
On the guidance and regulations to ensure that service users are involved in the assessment, the guidance that will accompany the Bill will make it clear that councils should involve individuals in the assessment process to appropriately and sensitively consider their needs. We will introduce an assessment tool to help councils to work with individuals across the piece to assess those who have the highest personal care needs. By offering £130 million to councils to further develop their reablement services, we hope that people will be able to increase their ability to live more independently and reduce their levels of dependency.
I confess myself disappointed with the right reverend Prelate's remarks, as well as surprised. I take this opportunity to ask the right reverend Prelate, with every respect, to reflect on the letters to my honourable friend Phil Hope from carers' organisations, disabled people's organisations and Help the Aged, which urged this House to get on with its job, consider the Bill and take it forward. The right reverend Prelate asked what assurances there are that care will be provided in the most appropriate setting. The object of our proposals is to help people to live as independently as possible for as long as possible in their own homes. I shall return to the issue of homes, which noble Lords have asked about, because it is appropriate that we address that.
My noble friends Lord Warner and Lord Lipsey were very critical of the Bill and made a lot of remarks about why they disliked it. A lot of my remarks will cover some of the points that they made. My noble friend Lord Warner used the word "cruelty", but the cruelty that he mentions would be in not going ahead with this Bill and not benefiting the thousands of vulnerable adults and older people, as it seeks to do.
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I am very fond of my noble friend Lord Lipsey, so I can say with affection that he sometimes overstates his case about things that he feels strongly and passionately. Comparing a Bill that benefits so many vulnerable people to the poll tax Bill is a case in point. We are not rushing at this and I do not think that your Lordships' House will allow us to do so; we will want to have the discussions that are necessary to take this Bill forward. I urge my noble friend to use his undoubted talents to help us to do that and to make the reforms rather than try to halt the Bill's progress.
The noble Baroness, Lady Masham, asked a variety of questions about where the money will come from, and I hope that I have assured her about that. She raised the issue, as did other noble Lords, about the bureaucracy that might be involved in the assessments. That is a very legitimate point to make. I read the consultation document and have some sympathy with that view; it is exactly why we need to have the scrutiny that this House is so good at. We have a lot to say about that bureaucracy, and the Government need to listen to what noble Lords have to say about it.
My noble friend Lady Turner made some powerful points about the need for this Bill and rightly talked about the fact that this is about individual vulnerable people and their families. She rightly pointed out the firm support that carers' organisations have given to this Bill.
The noble Lord, Lord Best, and others mentioned housing and homes. I think that that is absolutely right. The cost of the package of reablement can vary, as such packages may involve a variety of interventions. Packages should be developed by the local authority in conjunction with individuals. The noble Lord will know that councils already have responsibility for making adaptations through the disabled facilities grant. It will be open for them to assist people with adaptations to find what is needed and how it is needed.
The noble Lord, Lord Joffe, raised a number of points. He is mistaken to cast doubt on the ability or willingness to implement this Bill. I remind him that most care workers and most local authorities do a very good job and strive to do better, and it is up to us to help them to do this. I disagreed with the noble Baroness, Lady Murphy, and her analysis of the Bill. She was a
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My noble friend Lady Pitkeathley rightly referred to the Joseph Rowntree Trust and I echo her remarks wholeheartedly about the motivation of carers. Guidance needs to be very clear about carers and we have to start the discussions about that in the next week. That is the commitment that I make to the House.
My noble friend Lady Wilkins asked about the Bill doing more about adaptations in people's homes. I have addressed that to a certain extent, but she is right to say that these are very important points about the state of people's housing and how we can reflect that in the implementation of the Bill.
The noble Lord, Lord Sutherland of Houndwood, spoke about crumbs and I am very grateful for them. We believe that this is a step in the right direction for the national care service. His remarks made me reflect on the fact that often the way to get people to work together across the piece is to get them to do something together in the first place, which this Bill will do. Taking money out of health and putting it into this limited area for the most vulnerable will help us along the road. We do not think that the Bill contradicts those wise words about support to the elderly and the need for equity and fairness in the Green Paper and the White Paper that is coming along. It will help us with the aims that we have over the larger issue.
I invite the noble Lord, Lord Low, to use his skills as a parliamentarian to work with us to make this Bill and its guidance stronger and more effective. We have not claimed everything for this Bill, but we claim some good for it. I hope that he will think about putting his shoulder to making the wheel turn better. He made comments about bureaucracy and who would benefit and extending the benefit. I very much want him to be involved in Committee.
The noble Lord, Lord Carter of Coles, made a wise contribution. He asked about the link to the national care service. As I have said, the Bill is not part of, but is a step towards, setting up such a service.
My noble friend Lady Gale spoke with passion about Parkinson's disease and the support for the Bill from those with Parkinson's. She talked about carers, and I am pleased that Carers UK and other stakeholders have given their support for the Bill. I add that the experience in Scotland has shown that many carers continuing their caring role were able to shift the balance of care that they were providing by focusing on other tasks to support and improve the lives of elderly and disabled people.
My noble friend asked about waiting lists for aids and adaptations to be addressed in regulations. Councils are responsible for managing waiting lists, and the use of aids and adaptations will be addressed in guidance.
The noble Lord, Lord Turnbull, made some highly political remarks, I think that he has misunderstood the point of the Bill; it is about those with the highest needs who should receive the greatest care, and I would have thought that we would agree about that.
The noble Baroness, Lady Barker, made several important points about eligibility, carers, reablement and people who need palliative care. I think that I have addressed most of the issues that she raised but, if I have not, I will certainly write to her. I agree with her remarks about the need to get on with considering the Bill and taking it to its next stage.
The noble Earl, Lord Howe, raised the issue of whether the Bill is in conflict with the Green Paper. We do not think it is; in a bit of a reversal of roles, we think that it is a redistributive Bill while the noble Earl does not, and I suspect that we will need to tease out in Committee why that is the case and what it is about. On the specific issue of new burdens in legislation, the thing about new burdens is that they are about unfunded initiatives. The cost of free personal care will not be unfunded, though; it will have £670 million of funding in its first year, of which £420 million will come from the Department of Health, so it does not fulfil the criteria of the "new burdens" issue.
I finish by telling noble Lords what other organisations have said to us about the Bill. RADAR welcomes the Bill, which it says has the potential to improve independent living opportunities for at least some disabled people with the highest care needs. The Equality and Human Rights Commission says that it broadly welcomes the Government's commitment to provide personal care free of charge in certain circumstances for people with the highest need. Counsel and Care, a charity for older people, their families and carers, says that it welcomes the Bill, which aims to introduce free care at home for people with the highest needs. Carers UK says that it supports the Bill, which will help thousands of families caring for people with severe conditions such as dementia or Parkinson's disease at home, and it has been calling for this for a long time. The Parkinson's Disease Society says that it welcomes the Bill with its focus on the immediate improvement of social care services, and particularly welcomes the commitment of new money into the social care system.
At end insert "and that the Committee shall not meet until Her Majesty's Government have completed, and published their response to, their consultation on the draft regulations which may be made under the Act, if passed".
Lord Warner: My Lords, I take my chastisement from my noble friend like a man, but I do not resile from a single word of what I have said; I would prefer to be in the company of some of those who spoke supportively because I think history will show us to have been right.
A very large number of concerns have been raised today about the affordability of this, whether we have the figures right on the funding, the administration of the complex new system and the sustainability of this proposal. However, we have not spoken much about the fact that it is only eight months from today that the Government have said that they will have the scheme up and running. Many of us have considerable doubts about our ability to implement this and not let people down after the promises that have been made.
I tabled this Motion because the Government have said that they will devote only one day to the Bill in Committee. A host of things are of great concern to many of the people who have spoken today about the practicalities of implementing it. It would be easier to get the Government's business through in one day if we had actually completed the process of consultation on the content of the regulations and guidance, and we had had from the Government their responses to it. As things stand, I understand that we will not have completed that process of consultation and we will not have that response from the Government about the outcome of it, so we will have to probe all that in Committee in one day without the advantage of the knowledge from the completion of that consultation. That strikes me as a very tall order, so I beg to move.
Lord Lipsey: My Lords, I will not detain your Lordships for long but when the House was a good deal emptier than, for some strange reason, it is now, the noble Lord, Lord Sutherland, suggested that this was a wrecking amendment. I make it clear that it is not. The responses to the consultation have to be in by 23 February, though the Government asked that they be submitted by 26 January. For the Government to respond to that consultation need not take more than a week or two at the most. We can be in Committee, even if my noble friend Lord Warner's amendment is accepted, by the second week in March, and the Government can have their Bill long before the date on which some other event might come along and interrupt our proceedings. It is not a wrecking amendment; it is an amendment to take the Bill in an orderly way, and I commend it to the House.
Lord Filkin: My Lords, I support the amendment. A number of us have been reflecting on whether the way that this House scrutinises legislation has yet reached perfection. One of the principles that we are looking at is the question of how the House looks at whether legislation is ready to come to this House. It is apparent to a number of us that the Government ought to make clear before they introduce legislation what their policy position is in sufficient detail to understand it, how they have consulted and what the consequences of that consultation are, and that the detail of the legislation is clear enough that the House is able to scrutinise whether it will actually achieve the policy objectives which the Government are advancing.
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