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"Estimating the costs of re-ablement is difficult. We do not know for certain how many people are already receiving re-ablement services. In addition, we do not know exactly what proportion of individuals require no further care following re-ablement or for how long they derive such a benefit".
The impact assessment says in terms that the costs of this scheme are based on estimates. One or two estimates at the margin might be all right, but basing just about every costing assumption on an estimate where there are no underlying data at all makes this exercise unacceptably risky. We know that financial modelling is still going on. Consultations with stakeholders about the costs are still going on. In the absence of much clearer information, it is impossible as of today to say that the Government's policy is affordable, which is why this amendment is absolutely right and appropriate.
Baroness Thornton: My Lords, this amendment in the name of the noble Lord, Lord Warner, supported by the noble Baronesses, Lady Barker and Lady Murphy, and the noble Earl, Lord Howe, would require an independent review of the affordability of the provisions contained in the Bill to be carried out and a report laid before Parliament before the Bill could come into force.
I fear that my remarks will be tedious, as I am about to say pretty much what I have said on the two previous occasions when we discussed such an amendment. Given the considerable scrutiny that this Bill and the costs of measures enabled by it have had in the other place and more widely, we feel that this amendment is not necessary. I do not intend to burden the House by repeating for the third time the discussions that we had on Second Reading and in Committee.
We have looked in detail at the concerns raised by the Association of Directors of Adult Social Services. We remain confident that our estimates, of £670 million, are robust, based on the independent analysis by the London School of Economics. Clearly, we disagree with ADASS and its interpretation of the discussions. I can only repeat what we believe to be the case. The ADASS survey, by the association's own admission, overestimated some aspects of the costs through a misunderstanding of the Government's figures. I would like to clarify that it is correct that ADASS has not admitted to this position publicly. This was a position that it took in informal discussions with officials and the ADASS resources committee. While there is no official record of these conversations, we think that it is disappointing that the association is now distancing itself from what we believe was a previously agreed position.
However, we have listened to the concerns expressed. In the government response to the consultation, we have provided additional clarity about the £210 million of additional funding that will be allocated for the coming year, covering the six months from October 2010 to March 2011. We have circulated a letter to all councils about this so that they are now clear about exactly
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We are confident in our costings and have been open and transparent about the funding available with our stakeholders. In addition, we are fully committed to reviewing the costs of this scheme within 12 to 18 months of implementation and we will be working closely with local government representatives to ensure successful implementation. We are committed to collecting data from October and we will work with the councils to ensure that they have the necessary information.
Given that, we cannot see how an independent review prior to implementation would achieve anything. Where there is uncertainty-and we have been open and transparent about the uncertainties that exist-it is because the evidence is not there yet. Much of this involves assumptions about how people will behave and we cannot know whether they are right until the scheme is in place. We will need to work with councils to collect that information from the start, once the scheme is in place, and respond accordingly. That is the commitment that we have made. The net effect of this amendment would be to delay or jeopardise the implementation of this policy in October and the assistance that it would afford to the most vulnerable who need it. I therefore ask that the amendment be withdrawn or, failing that, be opposed.
Lord Lipsey: Before the noble Baroness sits down, may I ask her a question? She says that the Government are confident in their costings. Will she therefore explain to the House why they twice denied the Health Committee of the House of Commons sight of those costings and why she told me in Committee that she would provide me with the costings but in fact provided me with a manual to the London School of Economics model, which predated the Prime Minister's announcement by several months?
Lord Warner: I am going to be equally tedious, but, before that, let me say one thing to my noble friend. Where there is this level of uncertainty about something, those of us who have been around in the public service for a long time usually try a pilot scheme in order to work things out and get more reliable data. We do not whack a Bill through both Houses of Parliament as emergency legislation. She might like to digest and brood on that issue with some of her colleagues. However, having listened to her, I remain totally unconvinced and I wish to test the opinion of the House.
(2) The condition is that regulations made under section 15 of the Community Care (Delayed Discharges etc.) Act 2003, having the effect of requiring the provision of personal care at home free of charge for periods of more than six weeks, are in force."
Baroness Barker: My Lords, Amendment 7, tabled in my name and those of the noble Lords, Lord Lipsey and Lord Warner, and the noble Baroness, Lady Murphy, concerns what is commonly known as a sunset clause. It would impose a time limit on the effects of the Bill which is specified at two years. Why do we seek such a measure? Having listened with great interest not only to the discussions in your Lordships' House but also to a variety of briefings from the Association of Directors of Adult Social Services and the charities, as well as from the Government, I still think there is too much about the Bill which is unknown. What it should be is a pilot measure, and I will come on to explain why I believe that this amendment is the most effective way to turn it into a pilot.
As the noble Lord, Lord Lipsey, said, the Health Select Committee report of another place is a pretty devastating critique of the Bill. I recommend noble Lords to read it all, but would direct them in particular to the section that talks about unmet need. I refer to the paragraphs in which the Secretary of State and officials set out in various ways the extent to which they cannot be sure how many people there are at the moment who might be eligible for care but who pay for themselves, and the number who might be eligible with or without assistance from a carer. I have to say that of our debates in Committee, the ones I thought were the least satisfactory were those in which we discussed the process of assessment and the involvement of carers.
During the passage of the Bill, I have become used to the term "carer-blind assessment", but when I read the Select Committee report, I came across a term that was new even to me, and I know a lot of jargon in this field; and that is "carer centred". It is where carers are not involved in the assessment of someone's abilities but, I believe, carers themselves are taken into account in terms of assessing the services that will be provided. I may be wrong, but that is what I understand.
Throughout our discussions I have said that I have a fear that is different from that expressed by many noble Lords. They are concerned that the Bill will lead to an opening of the floodgates and that large numbers of people who are currently paying for their own needs will now believe themselves eligible for personal care. I have said consistently that I think that there is a completely different danger to consider. The number of people who will be assessed as being FACS-critical and in need of substantial assistance with four activities
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Officials in front of the Select Committee admitted that councils do not regularly hold data on unmet need, and indeed there is a school of thought, backed by In Control, which says that assessment of need by councils is unnecessary because people themselves are best equipped to know their own needs. Therefore, unmet need simply is not recorded.
In her response, the noble Baroness will say, as I would if I were she, that this Bill has the support of a number of different charities. Not surprisingly, those charities are doing their job, which is exactly the job I would do if I were in their place. They are attempting to secure some help for some of the people with whom they work. But all of those charities have noted that the legislation is deeply flawed at various different points.
We should go for a sunset clause for the following reason. The noble Lord, Lord Lipsey, is right to say that an incoming Government-I would include an incoming Liberal Democrat Government in this-will be faced with one of the most difficult political decisions to be made in a long time. It is so difficult that this Government ducked it 10 years ago. It will be extremely difficult to convince people not only that there must be restraint in public expenditure, but also to agree the priorities for the resources that are available. Governments of any hue find it intensely difficult to take away an entitlement that so far has been given for free. That is why, at this stage, we should add this clause to the Bill so that two years after the enactment of the legislation, whoever is right-whether it leads to an unmanageable level of demand for free personal care or whether I am right and the eligibility criteria have been drawn up in such a way that the Bill does not fulfil its intended purpose-a Government of any hue will be free to look again at the overall context of personal social care.
My colleague, Norman Lamb, has done a sterling job over the past few weeks in making the point that there has to be reform of social care and that, whatever the detail of that reform, it has to reflect a universal basic entitlement to care, a partnership model between the state and individuals, and some role for private insurers, all based on common criteria. I think that any incoming Government will work towards that. Perhaps the Minister will be able to tell us, when the White Paper is published, that her Government are moving in that direction. So far all that she has been able to do is assert that this is a step towards that kind of process, but she has given us no evidence. In the
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Lord Lipsey: My Lords, I thoroughly agree with every word the noble Baroness, Lady Barker, has uttered. Let us face it, depending on this afternoon's decisions in this House, after the election there will be a further debate to refine the arguments and discuss the costings and administrative implications. At the end of that process, the Government of that day may decide to proceed with the Bill. In that case, this amendment is otiose. It will have no effect because the Bill will be in force within two years. The other way things could go is that the Government, after an election and after that due process of debate, may conclude that this Bill is unaffordable or irredeemably unfair. In that case, I hope we will be looking for a consensus in the way forward. But if this Bill is still on the statute book, that is going to be harder. There will be organisations for the elderly, which, as the noble Baroness, Lady Thornton, has said, support the Bill in principle but not always in practice, and which keep on hankering after it, saying, "If only we could persuade the Government to implement it". They will not be inclined to go along with the search for consensus. The sensible thing is for the Government of that day to conclude that this scheme is not going to work and is not the way forward and that not only should the scheme die but also the legislation which gave birth to it so that we can move on to the next stage of designing the kind of policy for the long-term care of the elderly that they need and deserve.
Baroness Thornton: My Lords, this amendment in the name of the noble Baroness, Lady Barker, inserts what is known as a sunset clause and would require the Act created by this Bill to lapse automatically after two years if the powers within it have not been used to make regulations. It is our intention to use the powers enabled by this Bill to introduce regulations that will come into force from 1 October 2010 so that those most vulnerable and most in need can benefit. We have made a working draft of the regulations publicly available at an early stage and have been working with stakeholders to develop these in order to successfully implement the scheme. This is a strong indication that we intend to use these powers as soon as is practicable. We will seek to publish a further draft of the regulations shortly which reflect the outcome of the consultation. As I have said, this Bill is the first stage of a reform agenda towards a national care service. As we develop those plans, we will, of course, need to look at the bigger picture, but the future direction of travel is quite clear. It is our view that there is no reason for the Act to lapse after it is given Royal Assent and placed on the statute book. I therefore ask for the amendment to be withdrawn by the noble Baroness or, failing that, for it to be opposed by the House.
Baroness Barker: My Lords, I understand the noble Baroness's predicament. None the less, I am not persuaded by her argument. Whatever the next Government's hue, they are going to have to have the political capacity to, I hope, lead a consensus towards some very difficult decisions. A great deal of historical
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The Archbishop of York: Before the noble Baroness sits down, does she not agree that we should legislate on questions of principle and not in anticipation of the colour of the Government likely to come into being? Otherwise, we would never legislate. If the principle is right that restrictions should be removed on who can be provided with care free of charge, we should legislate for it. If an incoming Government find that difficult, that will be their business. But a legislative body should legislate on the principle of whether the Act is right and not because it is anticipating the difficulties of another Government coming into being.
Baroness Barker: The most reverend Primate raises an entirely fair point. He will forgive me for saying he did not take part in the previous debates. Had he done so, he would have seen that noble Lords in all parts of the House have major objections to this Bill on grounds of both principle and practicality. My own disagreement on point of principle is not that I do not believe that older people need personal care but that this Bill currently stands to favour many people who can pay for their care themselves, rather than targeting those who cannot, and I rather fear that will be at the expense of services for people who are poorest in our society. So it has been a matter of both principle and practice and I wish to test the opinion of the House.
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