Personal Care at Home Bill

My Lords, Amendment 19 is intended as a means of raising a series of questions to the Minister about the kind of personal care which will and will not be covered by the free care at home policy. It is often the way in politics that Governments receive no thanks at all for the good things they do. Here, I think we have on our hands the potential for good intentions to bounce back in Ministers’ faces. The way the Government are setting up this scheme is, I am afraid, bound to lead to disappointed expectations on quite a large scale. They have led the public to think that people who have been through a reablement process, and whose needs are assessed as critical, will be eligible to receive free personal care at home—we know that is not so. Free care will only be available to those in critical need who require significant assistance with four or more activities of daily living. So then, is it correct that someone whose needs are critical and who requires significant assistance with four or more activities of daily living will be eligible for free personal care in the home? They may but, on the other hand, they may not, and that is because in the regulations to be laid under the Bill personal care and activities of daily living will be carefully defined in ways which exclude a whole range of important personal care activities. For example, cleaning, laundry and driving someone to the doctor are services for which a charge will continue to be made. To some people that will not come as a welcome piece of news; to others it will simply be confusing. The issue of potential public disappointment and discontent is wider than this because, whenever lines in the sand are drawn and definitions set in stone, someone will always end up on the wrong side of one or other of them. The difference between someone having care needs that are substantial and care needs that are critical is often quite small. The difference between needing help with an activity of daily living and needing significant help with that activity can be equally tenuous and is often quite subjective. What is meant by "significant"? It could be a significant amount of help or it could be help which achieves a significant result. Neither the regulations nor the current guidance provide clear and simple answers to these key questions of eligibility. The scope for disputes between local authorities and service users will be much greater than it is at the moment because much more will be at stake. A lawyer who deals in this field of the law said to me that he knew solicitors who were rubbing their hands in anticipation of dealing with the litigation that lies ahead. Let me make clear that I repeat that remark with no relish whatever. Disputes and litigation will be a tremendous distraction for all concerned, other than the lawyers, and a waste of resources. However, it looks like coming about because the Government have rushed at this policy and have not allowed themselves and everyone else to make sure that it is deliverable without unintended adverse consequences. The Equality and Human Rights Commission and a number of other organisations have questioned the definition of personal care contained in the draft regulations. They have pointed out that the categories of personal care listed do not dovetail with the six categories of activities of daily living. For instance, the definition of personal care makes no reference to helping people with mobility problems, or managing and monitoring medication, or basic food preparation, even though these things feature in the activities of daily living. What is the reason for that mismatch? Should not the draft regulations be clearer about what is intended? I beg to move.