Local Government and Public Involvement in Health Bill

moved Amendment No. 238LZA: 238LZA: Clause 222, page 154, line 43, at end insert— ““( ) enabling people to monitor and review the provision of care services and local care services for persons moving their place of ordinary residence into the area.”” The noble Lord said: Never mind the opacity of parliamentary draftsmanship; the numbering of amendments that I have come back to from three weeks away in the States is mind-boggling enough. Noble Lords will see that Amendment No. 238LZA is grouped with Amendment No. 245B, which adds a new clause to Part 16, which deals with miscellaneous provisions. Both are probing amendments. Although they relate to distinct parts of the Bill, they are closely connected and, with the Committee’s agreement, I will speak to them together. Hundreds—potentially thousands—of disabled people are being prevented from moving home or moving from residential care to independent living each year because of bureaucratic delays and disputes about who should pay for their care. The root cause of these problems is the definition of someone’s place of ordinary residence. This is a means by which local authorities and primary care trusts determine which authority has responsibility for personal support for disabled people who live in their area. Local authorities are responsible for assessing the needs of and providing social care to people who are ordinary residents within their area. However, it is quite common for one local authority to place someone in registered accommodation within another local authority’s area. Under these out-of-area placements, it is the placing local authority that pays for the personal support costs. If the individual then decides to move into more independent accommodation, their place of ordinary residence is deemed to have changed to where their new accommodation is located. The local authority should then take responsibility for their assessment and for funding personal support. However, there is no legal definition of ordinary residence and the guidance is unclear. The Department of Health said that it would update the guidance in 2004 but has not so far done so. Some local authorities are using this confusion to delay or avoid paying the costs of the care of those for whom they should be responsible. Situations in which disputes about ordinary residence arise include the following: first, when someone is funded as an out-or-area placement in a care home that ceases to be registered as a care home; secondly, when someone funded out of area leaves a residential college but wishes to stay in the vicinity of the college; thirdly, when someone receiving support to live in the community wishes to move to another authority area, perhaps just a mile or two away; and, fourthly, when someone who is assessed by a local authority moves to a home in another area on a self-funding basis and within a few weeks or months approaches the original authority for help with funding. I have been personally made aware of another complication in my role as chairman of RNIB, in respect of which I of course declare an interest. RNIB’s Rushton School, which is now located near Coventry, receives numbers of children who are placed out of area from diverse regions of the country. Their educational and social care costs are met by the placing authority but for some reason Coventry PCT is expected to pick up the bill for the healthcare costs of all the children from around the country. These situations have major implications for local authorities. The current system creates clear winners and losers. Some local authorities have very few residential care facilities and therefore make a lot of out-of-area placements. Others are well served by residential care facilities and therefore receive a lot of out-of-area placements. There are perverse financial incentives for placing authorities to encourage disabled people living in registered care homes to move into the local community, or to encourage homes to de-register so that they no longer retain financial responsibility for their clients’ personal support costs. Those authorities in which large numbers of people have been placed face a significant increase in the numbers of disabled people needing support, with consequent budgetary implications. It is therefore essential that arrangements are put in place to ensure that these funding inequalities are resolved. Giving LINks the task of monitoring and reviewing provision in this area would help to give a voice to those stuck in the middle of these inter-authority disputes, many of whom are among those least able to make their voices heard. This is the purpose of Amendment No. 238LZA. Amendment No. 245B seeks to put in place a mechanism for arriving at a more systematic approach to resolving these problems. The Voluntary Organisations Disability Group, in a recent report entitled No Place Like Home, urges the Department of Health to take three urgent steps. First, to establish and enforce the principle that a person should receive appropriate social care and support from the authority where they are currently living or wish to live, regardless of circumstances. This would not deal with the Rushton problem, to which I referred, where the issue is one of disproportionate costs falling on a single authority because it happens to have within its boundaries a facility with a significant out-of-area—for example, national or regional—catchment. Perhaps a better way of putting it might be to say that it is a fundamental principle that the ability to change one’s place of ordinary residence should not be contingent on health or social care needs. Secondly, guidance to social services and PCTs should be updated to ensure that they implement this principle in a person-centred way that removes barriers to choice and independence. Thirdly, a framework should be put in place for the transfer of funds between authorities so that the issue of ordinary residence can no longer be used as a basis for refusing to provide care and support. I hope the Minister will be able to give us some indication of the Government’s approach to these matters, and how they propose to disentangle the intricacies to which they give rise. It cannot be doubted that there is a range of knotty problems overdue for solution here. If the Minister does not have an immediate answer, perhaps she would agree that it could be beneficial to meet with local authorities and the other bodies involved in providing social care and health services, with a view to finding a way forward that commands general assent. I beg to move.