Personal Care at Home Bill

I strongly support the amendment of the noble Lord, Lord Best. He is right about the importance of the built environment in order to support people receiving appropriate care. The other amendments all go to the difficulties of the definition of the problem and how it relates particularly to people suffering from mental health problems in addition to physical health problems. Activities of daily living were originally used to assess people’s physical states. It is not just dementia; dementia is merely the commonest and most obvious condition. Take, for example, an older person with a depressive illness or a paranoid disorder who is not eating or drinking without help because of ongoing delusional beliefs about food—or, even commoner, a person with cerebrovascular disease who apparently has nothing wrong with them at all but sits all day and does nothing as the result of profound motivational difficulties that are of cerebrovascular origin. The latter is a remarkably common complaint from families: "Me mum seems all right but she doesn’t actually do anything, doctor", is how it is usually described. It is a devil of a job sometimes to get this right. I refer to attendance allowance because that has been one of the great banes of the help that people have had available to them. I worry that we will have a rigid interpretation in the guidance that will make it easy to tick boxes and do the assessment, but will not be sensitive enough. So much will depend upon it. If we are going to have a dividing line between three ADLs, four ADLs and five ADLS, we have to be sure that this is a sensitive way of assessing people and that people have clear guidance. Personally, I think it will be a nightmare to make decisions of this nature. We should have some sort of definition in the Bill, and I support the amendment of the noble Baroness, Lady Barker, and the amendments of the noble Baroness, Lady Greengross, and her intention to get some support for people with more difficult assessment problems.