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It is an acknowledged role of this House to seek greater time for reflection where flawed legislation or flawed implementation is put before us. In my view this is precisely such a case where we need more time to get the policy, its funding and implementation right. I therefore support this amendment.

Baroness Turner of Camden: I rise because I fully support the Bill and have done from the very beginning. I also have some information from the Government about the work that they have already been doing with councils to ensure that councils have as much information as possible about the policy, the support that will be provided and the amount of central funding that they will receive. Moreover, we are talking here about people with the highest needs. Most of them have been anticipating that they will have a service from 1 October 2010 and I do not really think that we should disappoint them when they have been expecting an improved service. In point of fact, of course, one of the most important groups is the people who actually care for them. I have been a carer myself; I know how one waits and hopes for some assistance and is very unhappy when one does not get any. The amendment from the noble Lord, Lord Best, should not be accepted. We should proceed as fast as we can to get this policy operating so that people who have high needs get some assistance as soon as possible.

Baroness Howarth of Breckland: I had not intended to speak but, listening to some of the debate, I want to add a very short comment.

I am certainly concerned for carers and users and the disappointment that they might face if this is not implemented as soon as possible. As someone who works in the sector all the time, I think that we have to face the reality of who will be disappointed and who will receive the service. What is absolutely clear is that, whatever happens, there will be rationing. We have heard the arguments-I shall not repeat them-from the noble Lord, Lord Sutherland, the noble Baroness, Lady Barker, and others, about the situation in local authorities. We all know that at the moment there are not enough domiciliary carers to meet the need. Those providers of domiciliary care services know that currently they are sending people in at six o'clock at night to put people to bed and at six o'clock in the morning to get them up, because that is the only time slot that remains. If we introduce the legislation immediately, a range of people who are currently receiving services, but who are not at the heaviest end in the community, and will therefore lose those services because the services will be moved to people who can afford to pay for them but who will have a right to them. My worry is for those carers. I declare an interest as someone with responsibility for someone with serious Alzheimer's in the community in the north of England and who may well benefit from this change. I think that we have to think very carefully.

My other reason for speaking is that I do not wish the Bill to fail. I do not want to support what might be a wrecking amendment. We have long waited for social care to be on the agenda-for those who need that type of social care to have the same kind of benefit as they would if they went into hospital. Many

17 Mar 2010 : Column 614

of them are the same patients/clients; they are the same people who need that kind of service. I hope that we will not lose the side of the Bill that takes us into the Green Paper.

Local authorities need time. Practically, they will have to sort out who does and who does not receive a service. Although I find it hard to disagree with some of my colleagues who support carers and carers' associations, some of those people will lose out because there simply will not be enough money to go round.

Baroness Thornton: The amendment in the name of the noble Lord, Lord Best, refers to a commencement date of 1 April 2011. It is worth clarifying that this would prevent the making and laying of regulations before April 2011. The effect of the amendment would therefore be to delay implementation of the scheme until June 2011. That probably was not the noble Lord's intention; indeed, it was not the effect of the amendment that he tabled in Committee.

I am sure the House will be pleased to hear that I do not intend to repeat the remarks that I made at previous stages of the Bill but will instead address the issue of how the Government want to address the concerns expressed about councils' readiness to introduce these measures from October 2010.

I note briefly that we are supported in our ambition to take action by key charities, which recognise that the Bill provides a real opportunity to individuals and their families. I thank my noble friend Lady Pitkeathley for reminding the House that we are not starting down this path with a blank sheet of paper.

We do not think it right to delay support to individuals because of local implementation issues-we think it is right to tackle those issues. However, we have listened to the concerns expressed, both in this place and in our widespread consultation on the proposals. Taking those concerns on board, we have already confirmed in our response to the consultation that we will ensure that councils are able to phase in the implementation of free personal care between October 2010 and March 2011, to take account of both local issues and potential peaks in demand for assessment.

It is, however, our firm intention to introduce the scheme from October so that people can begin to benefit from this offer. In recognition of the large number of assessments that may need to be done initially, we propose to include in regulations a measure of backdating for individuals already assessed as needing personal care. Our intention is that, between October and April, councils will be able to delay the full assessment for free personal care of people who are already in the system and have been assessed as needing council care. These people will be able to have an assessment later and have any payments for free personal care backdated. Councils will be able to assess those people who are approaching social care for the first time-say, on discharge from hospital-in the normal fashion. Councils will, however, have to assess those people currently funding their own care and not currently known to the system when they make an approach from October.

In that way, we are offering councils which feel that they will not be fully ready by October the opportunity to have a staged approach to implementation. They

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will be able to focus on meeting the needs of people who have funded their own care, safe in the knowledge that those within the system will not be disadvantaged if they are not ready to fully assess them from the date of the introduction of the scheme. I will be circulating draft regulations before Third Reading that will give effect to these flexibilities for councils.

We are marrying two important objectives, recognising the practical difficulties that might be faced by some councils but ensuring that those with the highest care needs in our society receive the personal care that they need free of charge, as eloquently explained by my noble friend Lady Turner.

In addition to the specific new provision, offering flexibility while committing to provide for those in the highest need, we have published a clear implementation plan in our response to the consultation. We will be working closely with local government representatives to support councils in implementing the new arrangements, including a new commitment from the Department of Health to provide some centrally funded training for councils.

The government consultation response also sets out our proposal for the allocation formula to be used to distribute the specific extra grant of £210 million to cover the six-month period from October 2010, including an indicative allocation for each council. This gives local authorities greater clarity on the funding available, and a greater ability to plan for the implementation of this scheme.

Extensive discussion has taken place on the Bill, and we have announced flexibilities around implementation to ensure that councils provide free personal care from October. I ask the noble Lord to withdraw this amendment and engage with us in discussions to ensure that we have the best support possible for councils to help them through this implementation. If he does not wish to do so, I ask the House to reject his amendment.

Lord Warner: Will the Minister confirm, for the record, that the Government believe that they should ignore the advice of the professional body whose members will be responsible for implementing this-namely, ADASS?

Baroness Thornton: My Lords, we are not ignoring the advice of ADASS; we are in continuous discussion with it. We disagree with some of its members about how this can be implemented.

Lord Best: My Lords, I am grateful for support for this amendment from right round the House. The Minister's point that the excellent concession that would allow councils to phase in the assessment of eligibility over time and then, later on, pay the individual the sums back to the date when they applied does not unfortunately negate the need for councils to complete a vast range of other preparatory activity of the kind that I listed earlier. It would be wrong to assume there is any less pressure on councils to complete all these tasks by 1 October simply because they can backdate individuals' entitlements.



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I can see local authorities incurring a good deal of opprobrium if the implementation date remains 1 October but nobody gets any cash for several months. The complaints that councils would receive would be very unfair when they are making it clear in advance that these deadlines are quite unrealistic. The noble Baroness, Lady Barker, explained the huge changes that are overloading those in local authorities. The noble Earl, Lord Howe, noted how the financial burden of this measure will force a number of councils to make horrible choices on what to cut elsewhere in their budget. The noble Baroness, Lady Howarth, expresses her anxieties that others in real need of care will suffer. The noble Lord, Lord Sutherland, adds that this amendment does no harm to the Bill's direction of travel.

If there are technical flaws in the wording, I apologise. No doubt, if passed by your Lordships, this can come back to us from the other place with a better turn of phrase. I detect widespread agreement that more time is needed before this Bill should be implemented. I would like to test the opinion of the House.

4.31 pm

Division on Amendment 2

Contents 208; Not-Contents 127.

Amendment 2 agreed.


Division No. 1


CONTENTS

Aberdare, L.
Addington, L.
Alderdice, L.
Allenby of Megiddo, V.
Alton of Liverpool, L.
Anelay of St Johns, B.
Arran, E.
Astor, V.
Astor of Hever, L.
Attlee, E.
Avebury, L.
Ballyedmond, L.
Barker, B.
Bates, L.
Bell, L.
Best, L. [Teller]
Bew, L.
Bilimoria, L.
Blackwell, L.
Boothroyd, B.
Bowness, L.
Bradshaw, L.
Bridgeman, V.
Broers, L.
Brooke of Sutton Mandeville, L.
Brougham and Vaux, L.
Burnett, L.
Buscombe, B.
Byford, B.
Caithness, E.
Cameron of Dillington, L.
Campbell of Alloway, L.
Campbell of Surbiton, B.
Carrington, L.
Cathcart, E.
Chidgey, L.
Chorley, L.
Colwyn, L.
Condon, L.
Cope of Berkeley, L.
Cotter, L.
Cox, B.
Craig of Radley, L.
Craigavon, V.
Crathorne, L.
Crickhowell, L.
De Mauley, L.
Dear, L.
Dholakia, L.
Dixon-Smith, L.
D'Souza, B.
Dundee, E.
Dykes, L.
Eden of Winton, L.
Elliott of Morpeth, L.
Elton, L.
Erroll, E.
Falkland, V.
Falkner of Margravine, B.
Feldman, L.
Ferrers, E.
Fookes, B.
Fowler, L.
Freud, L.
Garden of Frognal, B.
Gardner of Parkes, B.
Geddes, L.
Glasgow, E.
Glentoran, L.
Goodhart, L.
Goodlad, L.
Goschen, V.
Greaves, L.


17 Mar 2010 : Column 617

Griffiths of Fforestfach, L.
Hamilton of Epsom, L.
Hamwee, B.
Hanham, B.
Hanningfield, L.
Harris of Peckham, L.
Harris of Richmond, B.
Henley, L.
Higgins, L.
Hodgson of Astley Abbotts, L.
Hooson, L.
Howard of Rising, L.
Howarth of Breckland, B.
Howe, E.
Howe of Idlicote, B.
Howell of Guildford, L.
Hunt of Wirral, L.
Hurd of Westwell, L.
Hylton, L.
James of Blackheath, L.
Jenkin of Roding, L.
Jopling, L.
Kerr of Kinlochard, L.
Kimball, L.
King of Bridgwater, L.
Kirkham, L.
Kirkwood of Kirkhope, L.
Knight of Collingtree, B.
Laird, L.
Lamont of Lerwick, L.
Lawson of Blaby, L.
Lee of Trafford, L.
Lester of Herne Hill, L.
Lipsey, L.
Listowel, E.
Livsey of Talgarth, L.
Low of Dalston, L.
Lucas, L.
Luke, L.
Lyell of Markyate, L.
McColl of Dulwich, L.
MacGregor of Pulham Market, L.
Maclennan of Rogart, L.
McNally, L.
Maddock, B.
Maginnis of Drumglass, L.
Marland, L.
Marlesford, L.
Masham of Ilton, B.
Mayhew of Twysden, L.
Meacher, B.
Methuen, L.
Miller of Chilthorne Domer, B.
Monson, L.
Montgomery of Alamein, V.
Montrose, D.
Morris of Bolton, B.
Moynihan, L.
Naseby, L.
Neuberger, B.
Neville-Jones, B.
Newton of Braintree, L.
Nicholson of Winterbourne, B.
Northbrook, L.
Northover, B.
Norton of Louth, L.
Oakeshott of Seagrove Bay, L.
O'Cathain, B.
O'Loan, B.
O'Neill of Bengarve, B.
Palmer, L.
Patten, L.
Pilkington of Oxenford, L.
Plumb, L.
Ramsbotham, L.
Rawlings, B.
Reay, L.
Redesdale, L.
Rennard, L.
Renton of Mount Harry, L.
Roberts of Conwy, L.
Roberts of Llandudno, L.
Rogan, L.
Ryder of Wensum, L.
St. John of Bletso, L.
Sandwich, E.
Scott of Needham Market, B.
Seccombe, B. [Teller]
Selkirk of Douglas, L.
Selsdon, L.
Sharp of Guildford, B.
Sharples, B.
Shaw of Northstead, L.
Sheikh, L.
Shrewsbury, E.
Shutt of Greetland, L.
Skelmersdale, L.
Smith of Clifton, L.
Soulsby of Swaffham Prior, L.
Steel of Aikwood, L.
Sterling of Plaistow, L.
Stern, B.
Stevens of Kirkwhelpington, L.
Stevens of Ludgate, L.
Stewartby, L.
Stoddart of Swindon, L.
Strathclyde, L.
Sutherland of Houndwood, L.
Taylor of Holbeach, L.
Tenby, V.
Teverson, L.
Thomas of Gresford, L.
Thomas of Walliswood, B.
Thomas of Winchester, B.
Tombs, L.
Tonge, B.
Tope, L.
Tordoff, L.
Trimble, L.
Trumpington, B.
Tugendhat, L.
Turnbull, L.
Tyler, L.
Ullswater, V.
Vallance of Tummel, L.
Verma, B.
Waddington, L.
Wade of Chorlton, L.
Walpole, L.
Warner, L.
Warnock, B.
Wilcox, B.
Wilkins, B.
Williamson of Horton, L.
Willoughby de Broke, L.

NOT CONTENTS

Acton, L.
Afshar, B.
Andrews, B.
Archer of Sandwell, L.
Bach, L.
Barnett, L.
Bassam of Brighton, L. [Teller]
Berkeley, L.
Bhattacharyya, L.


17 Mar 2010 : Column 618

Bilston, L.
Borrie, L.
Brett, L.
Brookman, L.
Brooks of Tremorfa, L.
Campbell-Savours, L.
Carter of Coles, L.
Christopher, L.
Clark of Windermere, L.
Clarke of Hampstead, L.
Clinton-Davis, L.
Corbett of Castle Vale, L.
Corston, B.
Crawley, B.
Cunningham of Felling, L.
Davidson of Glen Clova, L.
Davies of Abersoch, L.
Davies of Oldham, L.
Desai, L.
Dubs, L.
Elystan-Morgan, L.
Evans of Parkside, L.
Evans of Temple Guiting, L.
Falkender, B.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Finlay of Llandaff, B.
Gale, B.
Gibson of Market Rasen, B.
Gordon of Strathblane, L.
Goudie, B.
Gould of Potternewton, B.
Graham of Edmonton, L.
Grantchester, L.
Grocott, L.
Harris of Haringey, L.
Harrison, L.
Haskel, L.
Hattersley, L.
Haworth, L.
Henig, B.
Hilton of Eggardon, B.
Hollis of Heigham, B.
Howarth of Newport, L.
Howells of St. Davids, B.
Hoyle, L.
Hughes of Woodside, L.
Hunt of Kings Heath, L.
Janner of Braunstone, L.
Jay of Ewelme, L.
Jones, L.
Jones of Whitchurch, B.
Jordan, L.
Judd, L.
Kennedy of The Shaws, B.
King of West Bromwich, L.
Kingsmill, B.
Kinnock, L.
Kirkhill, L.
Lea of Crondall, L.
Levy, L.
McDonagh, B.
Macdonald of Tradeston, L.
McIntosh of Haringey, L.
McIntosh of Hudnall, B.
MacKenzie of Culkein, L.
Mackenzie of Framwellgate, L.
McKenzie of Luton, L.
Martin of Springburn, L.
Massey of Darwen, B.
Maxton, L.
Moonie, L.
Morgan of Drefelin, B.
Morgan of Huyton, B.
Morris of Handsworth, L.
Morris of Manchester, L.
O'Neill of Clackmannan, L.
Patel of Blackburn, L.
Paul, L.
Pendry, L.
Pitkeathley, B.
Ponsonby of Shulbrede, L.
Prosser, B.
Quin, B.
Radice, L.
Ramsay of Cartvale, B.
Rea, L.
Rendell of Babergh, B.
Richard, L.
Ripon and Leeds, Bp.
Rosser, L.
Rowlands, L.
Royall of Blaisdon, B.
Sawyer, L.
Scotland of Asthal, B.
Simon, V.
Smith of Gilmorehill, B.
Snape, L.
Strabolgi, L.
Sugar, L.
Taylor of Blackburn, L.
Temple-Morris, L.
Thornton, B.
Tomlinson, L.
Tunnicliffe, L. [Teller]
Turner of Camden, B.
Uddin, B.
Wall of New Barnet, B.
Warwick of Undercliffe, B.
Watson of Invergowrie, L.
Wedderburn of Charlton, L.
West of Spithead, L.
Whitaker, B.
Whitty, L.
Williams of Elvel, L.
Woolmer of Leeds, L.
Young of Norwood Green, L.
Young of Old Scone, B.
4.46 pm

Amendment 3

Moved by Earl Howe

3: Clause 1, page 2, line 12, at end insert-

"( ) For the purposes of this section, where a person has been assessed as deafblind, provision of personal care to a person living at home shall include the provision of communication and mobility support."

Earl Howe: My Lords, with this amendment I return us briefly to an issue I raised in Committee and one which the Minister has since been kind enough to talk

17 Mar 2010 : Column 619

to me about privately. I refer to the fact that this Bill and its implementing regulations look likely, if nothing is done, to sideline the needs of deafblind people.

Perhaps I may remind the House why this is such a concern. To be both deaf and blind is surely one of the cruellest of disabilities. It is impossible for any deafblind person to live a normal life without receiving some measure of care, and for the worst afflicted it would be difficult to describe their level of need as anything other than critical. Indeed, under the current FACS guidance, deafblind people are frequently assessed as having a critical need under the category which relates to involvement in family and wider community life. If the care needs of deafblind people are not addressed, they are at extreme risk of having to go into residential care.

The problem is that, deserving of help as these individuals may be, the people whom this Bill is designed to benefit are not the deafblind but rather the frail elderly or those younger people who are severely physically disabled. The kind of personal care which the frail elderly typically require-dressing, help with toileting and bathing, assistance with eating and so on-is often not relevant to a deafblind person whose needs centre above all on help with communication and the whole business of interacting with the outside world. The draft regulations published by the department effectively narrow the definition of personal care so as to exclude this kind of personal care.

In Committee, I pointed out what I felt was the unreasonableness of this narrow definition of personal care, bearing in mind the vulnerability and acuity of need of the deafblind. I invited the Minister to take time to think about this, which I know she has done, having been good enough to see me together with representatives of Sense a few days ago. I have therefore tabled this amendment as a means of asking her whether on reflection she believes that anything can be done to ensure that those deafblind people who have the most critical care needs and who are at greatest risk of requiring residential care if their needs are not met can, after all, qualify for free care and support. I beg to move.

Lord Low of Dalston: My Lords, I do not want to come between the House and hearing what the Minister has to say for any longer than necessary, but I wish to offer my support for the amendment moved in similar terms by the noble Earl, Lord Howe, in Committee. Unfortunately, I was not able to be here to do so, which is why I want to say a few words to indicate my warm support for the amendment before us today.

Deafblindness is a combination of disabilities both of hearing and sight. In this condition they are multiplicative and not just additive. Deafblindness is not just deafness plus blindness. The two disabilities compound one another in such a way as to give rise to a distinct disability which is different in kind, not just in degree, from the disability of either deafness or blindness.

Most of what we learn about the world comes through our eyes and ears, so deafblind people face major problems with communication, access to information and mobility. Without support, deafblind

17 Mar 2010 : Column 620

people are frequently unable to access basic information, maintain social contact, cook for themselves, go to work, exercise, engage in leisure activities, get out to the shops or the bank, visit the doctor, deal with post and bills, and even get around their own home in order to carry out household chores. Without communication and mobility support, many deafblind people do not feel safe going out of their house alone. They are, thus, effectively prisoners in their own home. Inside the house, they may be unable even to speak to anyone on the telephone, read, watch television, or listen to the radio. In this condition of extreme isolation, it is not surprising that they often develop higher rates of ill health with consequent cost to the National Health Service. They have a higher incidence of falls and a greater likelihood of developing conditions such as strokes, arthritis, heart disease, depression, and mental distress.

Those who suffer from deafblindness have a very serious level of disability. It is just about as serious as it is possible to conceive of. But, as the noble Earl explained, deafblind people are often able to perform the bare minimum of tasks of daily living, such as getting themselves up, washing, dressing, and maybe even feeding themselves by one means or another, even if they are unable to cook for themselves. This means that, according to the definition of personal care customarily employed, a deafblind person would not qualify for free personal care under the provisions of this Bill. The definition of personal care needs to be broadened to include the mobility and communication support which deafblind people so desperately need. That is why I so strongly support this amendment.

Baroness Finlay of Llandaff: My Lords, I also strongly support this amendment. Like the noble Lord, Lord Low, I was unable to be here at the Committee stage because of other commitments. I just seek clarification from the Minister about reablement. The Bill says free provision is,

I hope the Government are going to concede something in this area. Many of these people will have already had maximum independent living support prior to this Bill. I am concerned about what happens if somebody has a condition which is so severe that it is envisaged that no improvement can be made towards their independent living, or if they have already undergone a process, as part of their care management, which takes them to the maximum level. I hope we do not end up with the tokenism of some kind of reablement package.

Lord Tunnicliffe: My Lords, I thank the noble Earl, Lord Howe, for raising this issue and the noble Lord, Lord Low, for the passion he expressed. I also thank the noble Earl for the time he has spent with my noble friend discussing this. As he knows, we will ask for the amendment to be withdrawn. However, we have discussed the assurances that I will give, and I will briefly go through them.


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