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Baroness Gardner of Parkes: I wish to speak to Amendment 29 in the name of the noble Baroness, Lady Campbell. It is right that people should have portable rights, but a valid point was made by the noble Baroness, Lady Barker, about capital costs. When someone dies, it is deplorable if all the wonderful appliances that have been put into a property are wasted. A neighbour had a stairlift for only two or three months. When she died, the executors were advised by the selling agents for her property, "Take out everything that could possibly look as if someone disabled lived here if you want to get the best price". The executors tried to get rid of the lift. No council or anyone else would take it or reuse it anywhere else. In
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It is important that if a property is adapted for special needs, if at all possible-and it should certainly be possible regarding social housing-that property should be passed on to someone else with special needs. Then the adaptations would not need to be so great and the loss to the council that had made the adaptations would not be so great.
As regards portability, apart from anything else, it would be of benefit to the receiving local authority if it had warning that someone who rapidly needed special care was coming. It would certainly reduce the need for reassessment. That is an important point.
Baroness Masham of Ilton: I have a query on Amendment 29. If a person moves from one authority to another, it might be because their condition has deteriorated or because they have become older or more disabled and might need more help or reassessment. Therefore there needs to be flexibility. Does the Minister agree with that?
Baroness Campbell of Surbiton: Before Report, we should certainly look at the concerns of the noble Baroness, Lady Barker. It is my understanding that if you have a significant adaptation to your house, you are not, as part of the criteria, allowed to move or resell the house within five years. Such issues should be looked into.
Baroness Thornton: My Lords, for the ease of the debate, it might be simpler first to deal with Amendment 29 and then to move on to the broader themes that the noble Lord raised in his introduction and other noble Lords raised in the debate. Noble Lords will know that we are very much aware of the issues around greater portability of care, and it is something that will be addressed in more detail both in the review by the Law Commission into social care law and in the White Paper.
The noble Baroness, Lady Campbell, raised the very important point about consistency of care and the difficulties faced by those who move between different local authorities' areas. This is an issue that we have discussed across the Dispatch Box and outside the Chamber for the past couple of years. I commend her persistence in her championship of this very important matter. We debated this during passage of the Health and Social Care Act, and I explained at that time that we certainly had a lot of sympathy and understanding about it. We do recognise the potential for disruption to patterns of care, which can be the reality for an individual who moves from one authority to another. We speculated about why people might do that, and the noble Lord, Lord Tebbit, did so as well.
One thing that has not been mentioned-although I know that the noble Baroness, Lady Campbell, would mention it-is that this is also about, for example, young disabled people who go to university or who want to find a new job in a different part of the
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This amendment seeks to reduce the impact of disruption by putting in place transitional arrangements so that an individual can retain their entitlement to free personal care until a new community care assessment can be undertaken by the receiving authority. I think that that addresses the point made by the noble Baroness, Lady Masham.
I am grateful to the noble Baroness for identifying this issue, and I can confirm to her today that we intend as a result of her representations to include provisions to effect this transitional protection in regulations. The reason that we can do that, of course, is that we are seeking in the Bill and its regulations to make the assessments more standardised. So it is in keeping with the Bill and the direction of travel in terms of the national care service.
This will mean that, in addition to being able to put into place emergency care services under Section 47(5) of the National Health Service and Community Care Act 1990 as at present, the personal care element must continue to be free until such time as the community care assessment is commissioned. So in bringing forward these regulations, we want to remove the requirement to amend the Bill. I therefore request that the noble Baroness, Lady Campbell, withdraw the amendment. However, I undertake to continue discussing the regulations with her and the organisations that support this activity.
I hope that that also answers the points made by the noble Lord, Lord Eden, because the key is to allow an assessment to take place. It recognises that an assessment should take place eventually, and that will allow that assessment to take place in the new location. I therefore hope that that answers the point about how we maintain the integrity and independence of local services at the same time.
I now turn to the other amendments in this group: Amendments 5, 6, 14, 16, 27 and 40, in the names of the noble Earl, Lord Howe, and the noble Baroness, Lady Morris of Bolton. I have a very long speaking note about local government finance, but since nobody has actually asked me about local government finance, I do not intend to inflict that on the Committee unless somebody asks me for it at a later date.
I would, however, like to reflect on the issue raised by the noble Earl, that we regard the Bill as a stepping stone to the national care service and, indeed, to the White Paper. I do not know whether he used the word "transition" or a similar word, but we are not far apart on the direction of travel or on the fact that the Bill's proposals will help us to achieve what we want to do in creating a national care service. At the conference last Friday-at which other parties were present though the noble Earl's party was not-my right honourable friend Andy Burnham expressed similar sentiments to those reflected in the remarks that the noble Earl made about what we are looking for and the consensus that we are seeking.
My right honourable friend said that the current system is unsustainable and unfair and that we wish to move to a system that includes preventive services and
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The Bill is a step towards setting up a national care service and is evidence of the Government's commitment to an area which has been neglected for far too long. It is a shame that the noble Earl's party chose to walk away from the discussions but I hope that it will walk back into them in the next parliamentary Session and that we can solve these difficult and important issues in the way that many organisations are calling on us to do; that is, together as a nation. There is no question but that there are still huge challenges in the care and support system. The Green Paper sought people's views on how we resolve those challenges and how we create a sustainable system in the long term. The White Paper will develop those proposals and will be available soon.
The noble Earl asked about the differences between three and four ADLs and how that would work. We recognise that there will be challenges in delivering care to people with the highest needs and that some people may be on the wrong side of that divide. We are also very mindful of the overall costs of this scheme. However, this is an interim measure before we introduce our proposals for long-term reform of the care and support system. This measure is designed to help those with the highest need. Our wider proposals on the transformation of social care will encourage investment in prevention, early intervention and supporting individuals.
The noble Baroness, Lady Barker, said that there was no evidence that personal budgets are cheaper. The IBSEN report showed that personalised services were no more costly than commissioned services, though user satisfaction was increased, and the evidence from councils introducing personal budgets is no less strong.
Baroness Barker: Unfortunately, that short statement does not encapsulate a very big, detailed report, which came out with some extremely tentative conclusions. For example, the costing for personalisation that the noble Baroness cited was predicated on the fact that there would be no significant increases in the cost of employing care staff. It is important that we are absolutely clear about the costs of what we are talking about and do not make sweeping assumptions. If we are not accurate about costing, we will head off into unsustainability in a different fashion. That would be equally as wrong as the faults in the Bill to which a number of noble Lords have already pointed.
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Baroness Thornton: I take the noble Baroness's point and recognise that she is much more expert on that issue, through her work and experience, than I am.
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I turn to the specific amendments. They seek to give powers to the Secretary of State to require local authorities to charge for personal care at a set rate. I accept that the noble Earl is testing whether that would be a preferred system. This would mean that a centrally set figure would be decided upon and an amount of personal care would not be provided free of charge, but rather would be charged at a prescribed or preferential rate. Any personal care requirements beyond this set figure would then be free of charge. Clearly, this proposed amendment is not in line with the purpose of the Bill. The Bill aims to provide free personal care at home to those with the highest needs, providing freedom from worry that they will be unable to meet the costs of their vital personal care. Should local authorities be able to charge for elements of care at a prescribed rate, it would continue, we believe, to add worry and distress to those who have the highest levels of personal care. They would be in fear of a bill landing at the door, as is indeed the case in the current system.
We are content with our estimates for the funding of this policy. We therefore believe that these amendments are unnecessary and would resist Amendments 5, 6, 14, 16 and 27.
Amendment 40 would broaden the regulation-making power under Section 15(5)(a) so as to expressly say that not only would regulations make different provision for different prescriptions of qualifying services; they could also make a different provision for different circumstances. We do not believe that this amendment adds anything of substance, because Section 15 already gives the Secretary of State power to make a different provision for different qualifying services. Coupled with other existing powers to prescribe circumstances in which services would be provided free, we therefore already have the power to prescribe different circumstances in which different qualifying services are to be provided free. I therefore ask the noble Earl and the noble Baroness not to press these amendments.
Lord Tebbit: The Minister must have lost the piece of paper, which I am sure she has been handed by her officials, giving the estimates that the Government have made of the costs involved and how much people will be able to draw under this. I am sure that the officials have passed a piece of paper to her. Would she be kind enough to give us the figures, if she does not have them in her head?
Baroness Thornton: I can give the noble Lord the overall costs of this scheme, which, as we are well aware, are £670 million. I can also tell him how that will be allocated across local authorities. It will then be down to local authorities to decide the best way-within the framework of the assessment, the tool that I referred to earlier-for that to be distributed and what people would get under, for example, the reablement scheme. Another noble Lord referred to adaptations, which we will be discussing in greater detail later. I think that that noble Lord referred to the cost of a lift. Of course that would have to be offset against the potential cost of someone being in a care home for many years. So it is not possible for me to say £10,000, £1,000 or £500, because it would depend on the individual circumstances of that person. It may indeed be cost-effective to spend thousands of pounds on installing a
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I did not have a piece of paper and I did not expect one which would tell me what the individual grant or availability would be for a person, because it would depend on the assessment for that person.
Lord Tebbit: I am most grateful to the noble Baroness, and understand some of her difficulties; but perhaps she could tell us how many people the Government estimate will benefit from this £650 million, or whatever it is?
Baroness Thornton: Our estimate is that 400,000 people will benefit. The estimate is not that 400,000 people will have all their care costs met: that figure is likely to be between 100,000 and 130,000 people. However, within the envelope of support in terms of reablement and the support that people could receive, our estimate, which has not been significantly challenged, is that 400,000 people would benefit from the programme.
Baroness Gardner of Parkes: Perhaps the Minister could clarify that. Am I correct in thinking that the number of people who will newly benefit from this-those who are presently paying their own expenses-will be about 130,000 and not 460,000?
Baroness Thornton: We have never said that 460,000 people will receive all their care costs. We estimate that the number of people who would receive the total care package of all their costs being met would be somewhere between 100,000 and 130,000. I will clarify that number, because I cannot find it in my notes. The total number of people who would benefit from this in different ways would be 400,000.
Lord Tebbit: My Lords, perhaps I might check with other noble Lords whether I have the decimal point in the right place. We are talking about roughly half a million people-400,000, but we will call it half a million-sharing the benefit of about £650 million. That would appear to work out at £1,300 per person. Have I got the decimal point in the wrong place?
Baroness Thornton: The noble Lord has not got the decimal point in the wrong place. The figures work. I am not sure what other information the noble Lord wants. I am happy to write to him with much more information. Four hundred thousand people will benefit; 130,000 will receive re-enablement; 110,000 will receive free care for the first time; and 170,000 will receive care entirely or partially free, based on a means test, and will continue to do so. The 280,000 figure plus the 130,000 figure add up to 400,000.
Baroness Campbell of Surbiton: Before the noble Earl, Lord Howe, responds, I thank the Minister for her extremely constructive response to my amendment. There is clearly a firm commitment on her part to breathe some life into the principle of portability that I have pursued for a number of years. I am not yet entirely sure whether the solution that she proposes would achieve all that my amendment would, but we
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Earl Howe: My Lords, I am grateful to all noble Lords who have taken part in the debate, and to the Minister for her reply. I am glad that she did not give us the benefit of a short talk on local government finance: no doubt we will come to those matters later when we talk about the affordability of the Bill.
I agree with her that there is only one way forward when it comes to reform of long-term care, and that is cross-party consensus. By definition, we should look at a long-term solution that will hold good for many decades to come.
I share her wish that the parties will come together and find a common way forward. It was partly for that reason that I wanted to see this Bill as a genuine bridge towards long-term reform, because I fear that to describe it as a bridge at present is an inaccurate use of words. The problem I have is that it is too narrow in its scope and too prescriptive. It might be worth my quoting to the noble Baroness a short extract from page 16 of the Government's Green Paper. It states:
"Because care and support costs can be so high, we think that the Government should provide some support to everyone who has to pay them. We therefore propose that, in the new National Care Service, everyone who qualifies for care and support from the state should get some help with paying for it".
That is a much more tenable and intellectually respectable approach than the one which the Bill invites us to take.
The noble Baroness, Lady Barker, asked me about the kind of preferential system that I was trying to advocate. Maybe she and other noble Lords were not here to hear me talk through that idea. You can achieve it in several ways with varying degrees of central prescription and local autonomy. My amendment would not rule out any particular solution. For example, you could have a graduated scale describing a varying acuity of need, defined centrally, as the foundation for a graduated charging system. That could be moderated at a local level by consideration of people's financial means and the affordability of certain charging bands.
Revised fair access to care services guidelines could well act as the basis for a more sophisticated charging structure, but you would leave it to local authorities to decide exactly how the available cake should be cut. Free care for those in critical need would not be precluded under my amendment. It could still be prescribed in regulations. However, you would at the very least avoid the cliff edge which the Bill will create in terms of its perceived unfairness towards those whose care needs are deemed to fall very slightly short of the level eligible for free personal care at home. That, in a nutshell, was where I was coming from. However, I have no fixed views on how one would structure this. It is for discussion.
That is as far as we can go at this stage. I am grateful for the noble Baroness's comments, upon which I will reflect. I beg leave to withdraw the amendment.
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The Deputy Chairman of Committees (Baroness Pitkeathley): If Amendment 7 is agreed to, I cannot call Amendment 8 for reasons of pre-emption.
Lord Lipsey: First, I apologise on behalf of the noble Lord, Lord Warner, whose name is first appended to this amendment. An ocean separates him from us at the moment, but he will be back to participate at Report stage. Actually, at 12 o'clock our time, an ocean also separated me from this House. So if I am a little less coherent than I would otherwise be, I hope I can crave your Lordships' indulgence.
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Noble Lords will realise that this amendment goes to the heart of the injustice that is built into the Bill. It is an injustice that was well described by the noble Lord, Lord Turnbull, in the debate on Second Reading. When the Bill takes effect, a very typical case of an older person will run like this. The person needs a bit of help at home, but they have money of their own so they do not get any help. More and more, councils are restricting the little bit of help that would enable them to stay at home. Suddenly the person reaches a threshold where they fail four activities of daily living-you have to be in pretty poor shape to fail four ADLs-whereupon the Government will pay for the whole of their care. The person can continue to live at home like that for a while, but there comes a day when they are not able to do so in any sensible way and they have to go into a home. On that day, not only does the person lose their home, not only are they suffering from extreme physical disability and often dementia, but they also have to pay in full.
This is an injustice that it is impossible to defend and it is why, when the Government published their excellent Green Paper on the subject, it produced the words just used by the noble Earl, Lord Howe, to the effect that whatever the setting in which someone gets their care, perhaps the state should meet part of the cost; that is, part of the cost if you need care at home and part of the cost if you are in a home and need care. That is not what is being proposed in the Bill. The proposal is that you get your care paid for in one setting only-at home.
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