Personal Care at Home Bill

My Lords, for the ease of the debate, it might be simpler first to deal with Amendment 29 and then to move on to the broader themes that the noble Lord raised in his introduction and other noble Lords raised in the debate. Noble Lords will know that we are very much aware of the issues around greater portability of care, and it is something that will be addressed in more detail both in the review by the Law Commission into social care law and in the White Paper. The noble Baroness, Lady Campbell, raised the very important point about consistency of care and the difficulties faced by those who move between different local authorities’ areas. This is an issue that we have discussed across the Dispatch Box and outside the Chamber for the past couple of years. I commend her persistence in her championship of this very important matter. We debated this during passage of the Health and Social Care Act, and I explained at that time that we certainly had a lot of sympathy and understanding about it. We do recognise the potential for disruption to patterns of care, which can be the reality for an individual who moves from one authority to another. We speculated about why people might do that, and the noble Lord, Lord Tebbit, did so as well. One thing that has not been mentioned—although I know that the noble Baroness, Lady Campbell, would mention it—is that this is also about, for example, young disabled people who go to university or who want to find a new job in a different part of the country. So we are not just talking about the elderly and elderly disabled. We are also talking about young people and their rights to fulfil their potential. This amendment seeks to reduce the impact of disruption by putting in place transitional arrangements so that an individual can retain their entitlement to free personal care until a new community care assessment can be undertaken by the receiving authority. I think that that addresses the point made by the noble Baroness, Lady Masham. I am grateful to the noble Baroness for identifying this issue, and I can confirm to her today that we intend as a result of her representations to include provisions to effect this transitional protection in regulations. The reason that we can do that, of course, is that we are seeking in the Bill and its regulations to make the assessments more standardised. So it is in keeping with the Bill and the direction of travel in terms of the national care service. This will mean that, in addition to being able to put into place emergency care services under Section 47(5) of the National Health Service and Community Care Act 1990 as at present, the personal care element must continue to be free until such time as the community care assessment is commissioned. So in bringing forward these regulations, we want to remove the requirement to amend the Bill. I therefore request that the noble Baroness, Lady Campbell, withdraw the amendment. However, I undertake to continue discussing the regulations with her and the organisations that support this activity. I hope that that also answers the points made by the noble Lord, Lord Eden, because the key is to allow an assessment to take place. It recognises that an assessment should take place eventually, and that will allow that assessment to take place in the new location. I therefore hope that that answers the point about how we maintain the integrity and independence of local services at the same time. I now turn to the other amendments in this group: Amendments 5, 6, 14, 16, 27 and 40, in the names of the noble Earl, Lord Howe, and the noble Baroness, Lady Morris of Bolton. I have a very long speaking note about local government finance, but since nobody has actually asked me about local government finance, I do not intend to inflict that on the Committee unless somebody asks me for it at a later date. I would, however, like to reflect on the issue raised by the noble Earl, that we regard the Bill as a stepping stone to the national care service and, indeed, to the White Paper. I do not know whether he used the word "transition" or a similar word, but we are not far apart on the direction of travel or on the fact that the Bill’s proposals will help us to achieve what we want to do in creating a national care service. At the conference last Friday—at which other parties were present though the noble Earl’s party was not—my right honourable friend Andy Burnham expressed similar sentiments to those reflected in the remarks that the noble Earl made about what we are looking for and the consensus that we are seeking. My right honourable friend said that the current system is unsustainable and unfair and that we wish to move to a system that includes preventive services and provides the right support to enable people to stay independent for as long as possible. A national assessment should be established whereby care needs are assessed and paid for in the same way across the country. Services should work together smoothly and information and advice should be available to enable the care system to be easily understood and easy to navigate. Personalised care and support should be integrated and based on people’s circumstances and need and there should be fair funding. Money will be spent wisely and everyone will get some help to meet the high cost of their care needs. The Bill is a step towards setting up a national care service and is evidence of the Government’s commitment to an area which has been neglected for far too long. It is a shame that the noble Earl’s party chose to walk away from the discussions but I hope that they will walk back into them in the next parliamentary Session and that we can solve these difficult and important issues in the way that many organisations are calling on us to do; that is, together as a nation. There is no question but that there are still huge challenges in the care and support system. The Green Paper sought people’s views on how we resolve those challenges and how we create a sustainable system in the long term. The White Paper will develop those proposals and will be available soon. The noble Earl asked about the differences between three and four ADLs and how that would work. We recognise that there will be challenges in delivering care to people with the highest needs and that some people may be on the wrong side of that divide. We are also very mindful of the overall costs of this scheme. However, this is an interim measure before we introduce our proposals for long-term reform of the care and support system. This measure is designed to help those with the highest need. Our wider proposals on the transformation of social care will encourage investment in prevention, early intervention and supporting individuals. The noble Baroness, Lady Barker, said that there was no evidence that personal budgets are cheaper. The IBSEN report showed that personalised services were no more costly than commissioned services, though user satisfaction was increased, and the evidence from councils introducing personal budgets is no less strong.