Personal Care at Home Bill

First, I apologise on behalf of the noble Lord, Lord Warner, whose name is first appended to this amendment. An ocean separates him from us at the moment, but he will be back to participate at Report stage. Actually, at 12 o’clock our time, an ocean also separated me from this House. So if I am a little less coherent than I would otherwise be, I hope I can crave your Lordships’ indulgence. Noble Lords will realise that this amendment goes to the heart of the injustice that is built into the Bill. It is an injustice that was well described by the noble Lord, Lord Turnbull, in the debate on Second Reading. When the Bill takes effect, a very typical case of an older person will run like this. The person needs a bit of help at home, but they have money of their own so they do not get any help. More and more, councils are restricting the little bit of help that would enable them to stay at home. Suddenly the person reaches a threshold where they fail four activities of daily living—you have to be in pretty poor shape to fail four ADLs—whereupon the Government will pay for the whole of their care. The person can continue to live at home like that for a while, but there comes a day when they are not able to do so in any sensible way and they have to go into a home. On that day, not only does the person lose their home, not only are they suffering from extreme physical disability and often dementia, but they also have to pay in full. This is an injustice that it is impossible to defend and it is why, when the Government published their excellent Green Paper on the subject, it produced the words just used by the noble Earl, Lord Howe, to the effect that whatever the setting in which someone gets their care, perhaps the state should meet part of the cost; that is, part of the cost if you need care at home and part of the cost if you are in a home and need care. That is not what is being proposed in the Bill. The proposal is that you get your care paid for in one setting only—at home. In response to an earlier debate which touched on this subject, the Minister said that the kind of care you get should depend on your care needs. That sounds very plausible. I can imagine the person writing the words for the brief perhaps even believing them as they did so. But of course that is largely a nonsense because for the great majority of people it would be possible to be cared for in their own home until they die if sufficient resource was applied. It would be possible if they had full-time care from trained nurses working eight-hour shifts. I once saw a woman aged 101 receiving such care in Northern Ireland. With full-time care, the doctor popping in as often as needed and the complete re-equipment of the home into a sort of mini nursing home, it could be done, but it would be unaffordably expensive. It is simply not economic to provide one-to-one care 24 hours a day to someone in that situation, but it could be done. Equally, it is possible for people with rather low care needs to go into residential care. Some individuals prefer residential care, odd though that seems to most people. It is not a question of the need that determines this; rather, it is a question of what is best when reviewing both the expert assessment and the wish of the person themselves about where they want to be cared for. I put particular emphasis on the latter half of that remark: the view of the person themselves is terribly important. What we are doing in this Bill as drafted is to build up a terrible conflict. The person is almost bound to want to be cared for in their own home. Not only is it perhaps a nicer place to be, but everything in the home is free. The local authority, on the other hand, has every incentive to put the person into a home because then they will have to pay for their own care. If they are in their own home, the local authority has to pay for the care. I am sure that we will come back to this at some length later in the day. It is perfectly evident to anyone looking at the figures with an ounce of objectivity that the Government’s assessment of the cost of this policy to local authorities is a grotesquely unrealistic underestimate. It makes no allowance for what will certainly happen, which is that many people who at present are paying for their own care at home or not getting any care will suddenly emerge as claimants. Anyway, we need not speculate because we know what has happened in Scotland. There the cost of care in someone’s own home has doubled in just five years, leaving the original cost estimates in tatters, as will be the estimates of this Government. That is why this inequity in the treatment of people in their own homes and in homes cannot be allowed to persist. I am not arguing that care should be free everywhere—far from it. I say that the Government should be making whatever contribution is felt to be affordable and appropriate whatever the setting in which people are receiving care. I want to add a second leg to the argument, which is as follows. We have not begun to conceive of the process that is going to be let loose by this piece of legislation. We heard about the Local Government Ombudsman and the Health Service Ombudsman already being swamped by appeals as to who should pay, but when this piece of legislation comes in with this built-in, grotesque unfairness, where will people go? Are they going to say, "Oh, I am sure this local authority officer who has come to see us is right—mum should go into a home and run down our inheritance"? Of course they are not. Today, we have personal injury lawyers stamping the land, offering their services to people who get hurt in accidents. I see a lot of their adverts because they are always on during the horseracing in the afternoon, where people are trying to look at ways to pay their gambling debts. Just as we get those personal injury adverts, up and down the country firms of solicitors will be set up seeking judicial review of every case that comes before them. The case of extra care homes—the second of the amendments in this group I have tabled—is an example of the kind of thing that will happen. Systems like this get gamed; we know this. People will start gaming the system to try to turn whatever accommodation they are in into something that can be described as their own home. For example, care homes might start selling the rooms in which residents live to the individual within them, so that the rest of the care can be free. It is far from clear that extra care homes will be properly eligible—it depends on the nature of the care coming in. I read the Commons debate on this matter, which went on for some time. The answer given by the Minister—Mr Phil Hope, a man for whom I have some admiration—would not convince anybody that the Government are on top of this problem. The definitional changes and the ranks of lawyers looking to cash in on human misery as a result of these provisions will be absolutely enormous. As so often, I finish in the same place as the noble Earl, Lord Howe. We need a consensus on this matter; I believe this would include a contribution from the state to care, whether it is in a care home or care at home. We need a consensus above all, but this Bill cannot provide a consensus. That is why, in the amendments that will be tabled this afternoon and in voting at subsequent stages, we shall have to make provisions to ensure that the Bill cannot go through before there has been a general election, which may well lead to a situation where the support of a single party—perhaps I should say a single Prime Minister—is not enough to determine what the right state of the law in our land should be.