Personal Care at Home Bill

My Lords, Amendments 22 and 41 in my name are grouped here. I echo a great deal of what the noble Baroness, Lady Barker, said. I also take fully on board the points made by the noble Baroness, Lady Pitkeathley. However, the amendment of the noble Baroness, Lady Barker, is not quite right because it is ambiguous. Before a person can be deemed eligible to receive free personal care at home there are three assessments which he or she must undergo. The first is an initial assessment that will usually be the precursor to a course of intensive reablement. The second is a community care assessment designed to identify the range of the person’s needs and what level of banding they fall into under the FACS definitions. The outcome of that assessment will in part be influenced by the result of the reablement exercise. Anyone placed in the highest FACS banding, "critical", would be assessed on the number of activities of daily living for which they required personal care to be delivered to them by social services. In practice, as I understand it, the second and third assessment legs will often be rolled into one. However, for decision-making purposes they are quite separate. The single assessment tool which the Government are bringing forward will be designed to inject national consistency into the assessment of need—in other words, whether a person’s needs are critical, substantial, moderate or low. It will not be able to take account of the particular living conditions in which the person finds himself. To take a simple example, a man whose needs are assessed as critical may need help with four activities of daily living if he is living in a house with stairs. If he then moves to a bungalow his needs will remain critical under the national assessment process but he may only require assistance with three ADLs. This means that complete portability of benefits, which, in the abstract, many of us are keen on, cannot be delivered because it will always be necessary to assess someone by reference to their actual living conditions. So the noble Baroness’s amendment is flawed because it fails to draw a distinction between the single assessment to be carried out under national criteria and the assessment of eligibility for personal care which depends on the person’s individual circumstances and is a matter for the local authority concerned. The question is whether the presence or absence of a carer should have any relevance in the various processes of assessment. My own view—and I hope the Minister will confirm this—is that in the assessment of a person’s overall level of need, which is what the national assessment tool will be used for, the presence or otherwise of a carer has no relevance or bearing whatever. The level of someone’s need is their level of need. However, when it comes to that person’s entitlement to personal care, whether free or paid for, it could well be that the presence of an unpaid carer affects the person’s eligibility for some elements of personal care. For instance, if an unpaid carer were able and willing to supervise a person taking their prescribed medicines at certain times of day and the person himself was happy with that, there is no good reason for social services to assume responsibility for this task. So when deciding on someone’s eligibility to receive free personal care it is not unreasonable to take account of any assistance which can readily be provided by an unpaid carer. On the other hand, we do not want to see situations arising in which unpaid carers are unfairly exploited. Local authorities should not be able to impose unreasonable demands on carers as a way of avoiding their legal obligations to provide personal care. After all—and the noble Baroness, Lady Barker, effectively made this point—it is often when carers feel that they can no longer cope with looking after somebody on their own that local authorities are requested to provide help. To what extent are would-be service-users entitled to insist that their eligibility to receive personal care in the home should take no account of whether a carer is willing and able to provide help with activities of daily living? This seems to be quite a difficult question because, if, as I believe, there is a difference between reasonably relying on a carer and unreasonable exploitation of that same carer, there is at the same time no obvious or easy way of making that distinction clear in regulations or guidance.