Personal Care at Home Bill

My Lords, on my way here today I tried to work out how I would explain and justify to people what I had spent my afternoon doing. I set myself a goal: I would go through today’s proceedings as though I were somebody who needed social care services, a carer or someone in the unenviable position of trying to organise this for a local social services department. I would try to get to the end with greater clarity and understanding about what the social care system in this country is. However, I have to say that it is not looking good at the moment. In fact, it is becoming more confused. That is an inherent problem when people talk of such things as a national care service without clarity about what it means. It is not about unanimity of provision; it is about agreeing about what care services are, who is entitled to them and how they are funded. That leads me directly to both of these amendments and to ask a question. I can see the intent behind the amendments of the noble Earl, Lord Howe, and I have a great degree of sympathy with it. We are, after all, talking about a system which has never met—and never will meet—all the social care needs of the country, and about trying to find an equitable way of ensuring that such resources as we have are best applied to people who have needs. My question for the noble Earl, Lord Howe, is: who would set the preferential rates for services? When we talk about care services, by and large we talk about people carrying out care tasks for individuals. The cost of employing people does not vary much, whether they are in the private sector or the public sector, or whether they are in different areas of the country. It might vary ever so slightly. What is the rate for a care attendant in one area of the country? It may differ, but only very slightly, in another. I ask the noble Earl, Lord Howe, how this would work in practice. Would it be up to local authorities to set different rates for different services, as they deemed them to be needed in that area? That would be interesting. I draw the attention of the noble Baroness, Lady Campbell, to the issue of portability. She said that we are not asking for more money. Care, in the terms of the Bill, applies not just to people providing care for others but to adaptations. The capital expenditure of adapting somebody’s home might well be doubled if they moved. Both the noble Baronesses, Lady Campbell and Lady Wilkins, said, in relation to this amendment and Amendments 2 and 4, that personalisation and self-directed support now has a body of evidence behind it that proves that it is cost-neutral and cost-effective. I wonder whether they could both point me to that, as I have not yet seen evidence as strong as that. The IBSEN report on the pilots did not go that far. Given that cost is at the absolute heart of this debate, I should very much appreciate seeing the evidence behind both those statements. That will help noble Lords when we come down to doing what we ultimately all have to do—to work out what we believe to be the best use of finite resources for the best benefit of the most people. Noble Lords who listened to the "Today" programme with as much attention as I did this morning will know that my colleagues and I have concluded that this Bill does not represent that. We would use the resources in other ways that we think would be to the greater benefit of the greater number of people. In that context, I believe that these are fair questions and I would appreciate some answers.