Personal Care at Home Bill

My Lords, this group of amendments deals, in one form or another, with the Bill’s provision on what counts as care at home. However, each amendment addresses rather different aspects of the provision. I shall therefore begin by making some general points about this aspect of the Bill. First, it is important, and has been an aspiration of this Government for a number of years, to support people in their own homes. That is what people tell us they want, and indeed it has been supported by the Audit Commission’s report Under Pressure, which was published just last week. This report highlighted that there is a growing trend towards care at home which meets the needs of people who need care and is something to which local authorities should aspire. We recognise that there are different residential settings, however, and so it is important to have a debate on what is classed as a person’s home. We want to retain the flexibility in our definition to maintain the intention of the Bill while recognising that different settings or models of care may emerge over the coming years—something which we all know will need to happen to meet the needs of our growing ageing population. The intention that underlies the Bill is that people with the highest care needs should be supported to live at home. We have made the specific point in the Bill that it is important that those adults who are part of an adult placement scheme, living in a family, do not miss out on this opportunity. It is therefore important to make it explicit that, for the purposes of the Bill, such adults are to be considered as living at home. In our opinion this is the only situation which is required to be excepted from the six-week restriction on free provision of personal care in accommodation where care is provided as an integral part of that accommodation. In other situations it should be clear that people are either living in accommodation where care is provided as an integral part of that accommodation—a residential care home—and are not eligible, or living at home and may qualify for free personal care. Some people have sought to argue that a residential care home could re-badge itself as extra-care housing and enable its residents to have their care free of charge. This is not about residential care or re-badging. We have always made it clear that it is about people living in their own homes for longer. Residential care is not the same. In any case, as was debated in another place and made clear there, where providers seek to change the provision of their services, it is for the regulator, the Care Quality Commission, to ascertain that they meet the relevant registration criteria. Others have argued that residential care is a cheaper option than helping people to live at home. However, the experience of many local authorities shows that appropriate interventions and support—the right housing, adaptations and equipment, including telecare—can help people to live at home at a lower cost than going into residential care. Indeed, as I said a little earlier, last week’s report by the Audit Commission, Under Pressure, made these points most effectively and forcefully. Local Authorities must invest in new models of care. It is no longer acceptable for them to invest in the same old models of care—home care and residential care—as they have in the past. For some people, and at the right time, entry to residential care may well be the only option. We do not want to close off this option. However, the majority of people say that they want to stay in their homes for longer, and the provisions in the Bill will enable them to do so. We recognise that, by introducing this policy, there may be perverse incentives for local authorities to encourage people who would otherwise have funded their own care to move into residential care, thereby saving the cost of free personal care. However, that would be a completely short-sighted approach. Not only does it not deliver what the individual or the family wants—a little extra help that would allow them to stay at home for longer—but we know that entering residential care prematurely can lead to individuals running down their assets and then becoming a charge on the local authority. Surely it is better for the person and the council to invest to deliver more cost-effective care at home and to support local citizens to fulfil their wishes to stay in their own homes for as long as possible. However, I also recognise that while it is important that this Bill supports people to stay in their own homes for as long as possible in order to live more independent lives, this does not mean that every care activity needed to support them happens inside their own home. Sadly, there may of course be situations where somebody is not able to leave their own home at all. For others, however, having support in the community is beneficial and maximises their ability for independent living in their own home. The Bill supports that principle and does not seek to prevent this; on the contrary, we will develop guidance which reflects that as good practice. I will talk a little further about that when I discuss in detail the specific amendments in this group. Amendment 7, in the name of the noble Lords, Lord Lipsey and Lord Warner, the noble Earl, Lord Howe, and the noble Baroness, Lady Murphy, is clearly a wrecking amendment. It wrecks the fundamental essence of the Bill by removing subsection (2), which is the linchpin of the Bill. To accept this amendment would prevent us being able to ensure that those in the highest need could receive free personal care at home for more than six weeks. This is clearly against the spirit of the Bill and should not be supported by anyone who supports the principles underlying this Bill. We therefore cannot accept this amendment and urge opposition to it. The Bill is about specific help for a specific group of people: those in greatest need. I believe that my noble friend said earlier that it would help 280,000 people, as well as the 130,000 who will be helped by reablement. It is about doing this now. It is the first step of a total package. We have confidence in the estimates, and we have gone through the figures with ADASS. The Bill is not the same as what is happening in Scotland. The other place has agreed to the basic concept. This House has given the Bill a Second Reading, which enclosed the basic concept, and I do not intend to participate in or respond to a further Second Reading debate at this point. Amendment 8 would require that regulations specified every setting that was not considered to be a person’s home for the purpose of provision of personal care, and therefore every setting of accommodation where the six-week restriction to provide free personal care would still apply. We consider that the proposed definition as set out in the Bill accurately describes and excludes a range of different settings that are not to be classed as a person’s home. These exclusions are necessary because we wish to encourage and enable people to remain in their own homes where that is what they wish to do. Were we to specify the specific different settings that should be excluded, that could require numerous changes to regulations as the nature of service provision changes over time. That seems unnecessary and undesirable. We are encouraging councils to look to provide care in a wide range of settings to meet people’s changing and longer-term needs. Where providers wish to be seen to change the provision of services to benefit from the provisions, it will be for the regulator, the Care Quality Commission, to ascertain that they meet the revised registration criteria. We are not willing to accept this amendment, as the proposed definition set out in the Bill is accurate. I therefore hope that the noble Earl, Lord Howe, will withdraw his amendment. The Bill seeks to remove restrictions on existing powers and will allow us to require people with the highest needs living at home to be provided with free personal care indefinitely. Amendment 10 from the noble Lords, Lord Warner and Lord Lipsey, the noble Earl, Lord Howe, and the noble Baroness, Lady Murphy, seeks to make it clear in the Bill that personal care for people living in extra-care housing can potentially be required to be provided free indefinitely. We believe that such an amendment is unnecessary. As the Bill already provides in new subsection (4D), a person should be considered to be living at home as long as they are not living in accommodation provided under Part 3 of the National Assistance Act 1948, or in accommodation where personal care is provided together with that accommodation. That definition of living at home would include a person living in extra-care accommodation as it would be neither Part 3 accommodation nor accommodation where personal care was provided together with that accommodation. That is because in extra-care housing, care and accommodation are provided not together but under separate arrangements made by the individual. We would certainly seek to encourage people who wish to stay and receive the care they need at home to consider extra-care housing, as well as other forms of supported living such as sheltered housing, because they allow individuals to continue living independently. Because this setting of accommodation is already adequately covered by the provisions of the Bill, I hope that the amendment will not be pressed. The noble Baroness, Lady Murphy, brought out a series of predictions and potential downsides. We have committed to review this legislation after 12 to 18 months and in that review we will see whether those predictions turn out to be true, but we believe that the predictions that we have made on cost and on numbers served are sound and will be borne out by experience. Amendment 13, tabled by the noble Baroness, Lady Barker, raises an important point: these provisions should seek to ensure that those living in their own home are supported to do so for longer. However, it is important to reflect on the fact that this does not necessarily mean, as I believe the noble Baroness wishes to indicate with this amendment, that all the support activities needed to help the person must be carried out in the home itself. The noble Baroness used the example of a person whose needs were best addressed through being bathed in a day centre because it was not possible to make the necessary adaptations to their own bathroom at home. They should certainly be offered that. We will ensure that this area is covered fully in the statutory guidance that we will be developing to provide support to local authorities. For that reason, I do not consider that this needs to be in the Bill. While I do not accept the noble Baroness’s amendment and ask not to press it, I very much agree and commit to taking forward its principle. The noble Earl, Lord Howe, as ever, made interesting points about the Bill. He was particularly concerned about "gaming" and language. That is a fair point, but we believe that many of the issues will be resolved in the development of regulations and guidance. With regard to the issue of residential homes being re-badged, we have said that the Care Quality Commission will create a definition that will stop that happening. We believe that the legal dividing lines will be practical, although we cannot go further into why we believe that. If it proves useful to elaborate on that in a letter, I will certainly send him one. The noble Baroness, Lady Gardner of Parkes, referred to the number of people who will be helped. As I said earlier, some 280,000 people will be helped with support at home and some 130,000 by reablement. I hope that some of the comments that I have made will meet the points made by the noble Lord, Lord Sutherland. The noble Baroness, Lady Turner, was perhaps giving us an insight into the broader picture that will be revealed in the coming weeks when we publish the White Paper.