Personal Care at Home Bill

My Lords, I speak to Amendment 32 in this group, which might be called the housing amendment as that is what it covers. Alongside social care and health, housing represents the equally important third leg of the stool; without the housing leg the stool falls over. It is no good assessing an individual’s personal care needs and switching funds from health to pay for personal care if the critical problem is the unsuitability of that person’s home. You cannot discharge someone from hospital safely if the fall that they are recovering from is likely to recur when they get back to the unsafe premises that they came from: if they cannot get up the front steps; if they cannot get upstairs to the bathroom; if they need assistance in the home; if it is freezing cold. These are all ways in which the property may make someone a prisoner within it or debar someone from living there and force them into residential care. This amendment calls first for an assessment of the individual’s eligibility for free care to have alongside it an assessment of the suitability of the home for that individual to receive their personal care. This would do the joining-up which the noble Baroness, Lady Andrews, as Minister, did so helpfully in the government report, Lifetime Homes, Lifetime Neighbourhoods: A National Strategy for Housing in an Ageing Society. It also builds on the new report from the audit commission, Under Pressure, which explains that money is extremely well spent on the home in preventing people from requiring more care or a move into a residential establishment. We may well argue that it is the extra-care housing that the noble Baroness, Lady Gardner, referred to earlier that is the ideal, or retirement villages and retirement communities, but these will serve only a very small minority of people. For the great majority, it will be aids and adaptations to their existing accommodation that will mean that care can be provided safely, sensibly and happily within the home. Perhaps I could just take a moment to give your Lordships an illustration from my own life, as I suspect that a lot of other people will have similar stories surrounding their lives as well. After Christmas, I had an elderly relative move into residential care. She was not actually receiving any formal care and was getting very little informal care in her own home, being a fiercely independent woman, but it was the house that drove her out and required her to move into expensive residential care. It was just unsuitable. It was a cold house and one with steps in every possible direction—upstairs, downstairs and all around. She is suffering from quite severe arthritis, finding it extremely difficult to get around and to turn the taps. There are no grab rails on the walls. I could see the expenditure that might do the trick, but it is too late as she has gone into residential care. The real problem that she faced was a housing problem, even though she now finds herself in an institution, receiving expensive care. I think this joining-up of housing with health and social care is an underlying principle that this piece of legislation with its words "personal care at home" should embrace. I recognise that this is something of a probing amendment. I would argue for more funding for the disabled facilities grant programme, which is very underfunded, and more resources for the home improvement agencies, such as Care and Repair. Money can be so well spent in housing in its relationship to care within the measures enshrined in this legislation. I understand that it is in the reablement section that one finds the opportunity for some funds for aids and adaptations to people’s homes, including telecare censors and alarm systems that can alert care providers elsewhere. However, on looking at the numbers, I note that the funding for reablement at £130 million for 130,000 people at £1,000 per head, based on 30 hours at £30 per hour with £100 to spare for little extras, does not leave any room for the aids and adaptations that one would hope to see as part of a package providing the support that older people are going to need.