Personal Care at Home Bill

My Lords, the noble Lords who have proposed Amendment 7 make a very important point—that one of the great dangers of the Bill is that it drives an even deeper wedge between so-called care at home and care in residential contexts. As the noble Baroness, Lady Murphy, made plain, all the efforts of those working in detail in this field have been devoted to trying to break down a very rigid distinction between being cared for at home and being cared for in a residential institution. They explored extra care in the community, the use of residential homes for other purposes and a whole range of options, including the possibility of housing associations being involved in creating sheltered accommodation of an even higher standard. The risk is in the Bill. I hope the Minister can indicate how it will be dealt with. The point has also been well made that, however pure, kind and noble you are—and I have worked for years in the academic world, where the intellectually pure apparently multiply—you soon learn how to follow the money. The Bill will suggest ways of following the money, which is another great danger. People are very inventive, often for the best of motives and reasons. I get fed up speaking about Scotland, but I have to say that the increase in expenditure on care at home in Scotland is not a mistake but a deliberate policy, because the Scottish Government have set out to meet the wishes of people, which is, if possible, to remain in their own home and to reduce the costs. One of the ways in which they are doing that is by making it more attractive to remain at home than to go into far more expensive residential and nursing-care accommodation. That is the reason for the shift in cost, and you can see that the cost of residential care has pretty well stabilised. To do that is quite an achievement, but it is being done because they are finding cheaper and more appropriate ways of providing care. There is, however, a real lesson from Scotland here, and I think that this relates to the point that the noble Earl, Lord Howe, was making. Scotland does have a divide between what you might call hotel costs, or accommodation costs, and care costs. The hotel or accommodation costs for those in residences are still means-tested. The picture of freedom and free supply of cash for everything is not the case. These costs are means-tested. They have ways of dividing them off from the actual costs of care, and in Scotland they make a contribution to the cost of care. So the danger to which he points—that such a division will be brought into place here in a way which distorts the system; it does not distort it in Scotland, it is deliberate—is real, and there is an example of how to do it.