Personal Care at Home Bill

My Lords, I will speak at the same time to Amendments 6, 14, 16, 27 and 40. One of the main concerns about this Bill which emerged at Second Reading was the deeply unsatisfactory way in which its provisions cut across the key arguments and principles articulated in the Government’s Green Paper of last July, Shaping the Future of Care Together. For my own part, I found that Green Paper to be an extremely helpful analysis of the issues that should be uppermost in our minds as we consider the long-term reform of social care provision. Two conclusions from the Green Paper were inescapable. The first was that, as a nation, we cannot afford to deliver free personal care to all who need it and fund this out of general taxation. Any attempt to do that will not prove sustainable over time because of the demographic trends which are already in evidence. Therefore, as the paper says, the foundation of the new system lies in the partnership option—that is to say, in co-payment of one sort or another. The Government are holding fast, as far as I know, to the conclusions of that Green Paper, but they are at the same time bringing forward a Bill which is completely at odds with it. The Bill is said to be a "bridge towards" a fully reformed social care system, but it is hard to see that phrase as anything more than just words. If the Government had been a bit straighter with us and said that the Bill was designed as a temporary stopgap in advance of long-term reform, that might have been a more credible and accurate description. I would have liked the Bill to point a clearer way towards the vision set out in the Green Paper; in other words, to be a genuine bridge and a genuine building block to long-term reform. To be that bridge, the Bill needs to open up the way to a much more varied and flexible set of options. We have already considered some of the pitfalls that look set to await us as a result of the lack of clarity in some of the definitions that will determine eligibility for free care. In any decision about eligibility, so much will be at stake that people are unlikely to take a refusal lying down. I genuinely fear an explosion of complaints, appeals and litigation. The obvious way forward is to preserve the core idea of a more generous deal for those in critical need of care, but to cut the cake differently so that there is a more graduated scale of preferential charging and therefore much less incentive for people to dispute the results of an assessment. The difference between having substantial needs and having critical needs will often be quite narrow. The difference between requiring help with four activities of daily living and requiring help with only three may be equally narrow. Therefore, I ask the Minister what thought the Government gave, as an alternative to offering free personal care to all those people with critical needs, to the idea of a graduated preferential scale of charging under which local authorities would be able to take into account not only the acuity of a person’s need but also their personal financial means. I mention means-testing here with no apology. The cost-benefit analysis contained in the impact assessment seems to me the loudest warning bell, if any were needed, that we are in danger of creating an unsustainable system. People who can afford to bear some or all of the cost of their personal care cannot in the current climate be considered a more important priority than those without financial means whose need for care may be only very slightly less acute. I am no advocate of the postcode lottery, but I believe in local authorities having discretion to manage their finances in ways that they consider fair and affordable. The Bill takes that discretion away from them in a material sense, and it does so, as we will debate later, in a very unstructured and ill planned way. I have spoken up till now about the short term; the longer term should concern us equally. What are the ingredients of a sustainable and fair system of social care provision over, let us say, the next 100 years? To my mind, they are these. We should aim for a personalised service to enable people to buy the care that suits them best. One of the problems with the Bill, despite what the noble Baroness said earlier, is that it seems to cut right across the personalisation agenda, which, up to now, the Government have done rather well at. We need consistent national standards for the assessment of care needs. The Government are right about that, and I shall support them in their efforts to introduce them. We need to help people stay in their homes for as long as they can—again, the Government are right about that. We need also to find a way of protecting people from having to sell their homes to pay for long-term care. I should like to think that there is no disagreement between my own party and the Government on any of those four principles. I do not want to exacerbate the public spat which has been going on between members of my own party and Ministers in another place, but I would simply say that we on this side part company with the Government over their apparent enthusiasm for schemes and ideas which directly cut across one or more of the four principles that I have mentioned. For example, we do not think that it is helpful to disempower people by removing national benefits from them, such as attendance allowance, and disability living allowance. A national care service is a great idea, but if you mandate the service from the centre, and fund it centrally, it becomes inflexible and depersonalised. I do not think that that is the way to go. Equally, a compulsory state insurance scheme takes us in the wrong direction if we believe in empowering people through choice. It also acts as a strong disincentive to informal care, and I worry greatly about that. If this Bill is to act as a bridge towards a flexible and personalised system of social care, under the banner of a national care service, it needs to offer a greater range of possibilities than it does at present. It needs to factor in the likelihood that people will wish to provide for their critical care needs by means of voluntary insurance, and to allow for those who wish to engage in preventive health programmes, not simply reablement. To incentivise the take-up of those programmes, it needs to protect those who cannot afford to pay for personal care, while at the same time giving due recognition to those who are prudent enough to provide for part of the cost of their care from their own resources. It also needs to recognise the value of informal carers. In general, it needs to be more enabling towards local authorities, and less prescriptive in terms of the structure of care services which they commission and fund. It is against that background that I beg to move Amendment 5, and I hope that the Minister will feel able to move at least a little way in my direction.