Health and social care are devolved to the Scottish Parliament, so I rarely contribute to debates on those issues in the House, but one aspect of the Bill is very relevant to my constituents—the portability of care packages between England, Scotland, Wales and Northern Ireland.
My argument is best explained by reference to the case of my constituent, Neil Kenny, who raised his concerns about the lack of portability of care packages back in 2010, when I was first elected. Mr Kenny suffered a broken neck while serving in the Army. He is paralysed from the chest down and uses a wheelchair. Although he is originally from Edinburgh, he lived in London in the early 1990s, during which time he received funding for his care package from Greenwich council. In 1996, he decided he wanted to move back to Edinburgh to receive additional support from his family, but when he informed Greenwich council of his intentions it indicated that it would be unwilling to continue to contribute to his care package and that if he wanted to move he would have to contact Edinburgh council, which he did but which also said it was unwilling to support him.
The disagreement revolved around the two councils’ conflicting interpretation of the social work group Act 1968, particularly two clauses, one relating to the “authority of the moment” and the other to “ordinary residence”. This impasse continued from 1996 to 2000. In October 2000, Mr Kenny resorted simply to moving to Edinburgh, with help from his family physically to do so, and paying for his own care, which put him into a lot of debt. Although Edinburgh eventually agreed to pay for his care, he should never have had to experience such difficulties. Disabled people should be as free as anyone else to move from one local authority to another—something that simply is not possible at present, it would appear, owing to the ambiguity of the law governing this area.
When I took up the case with the Department of Health in 2011, the former Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), indicated that it would be addressed in the Government’s care and support White Paper. This was published in July 2012, but although it contained a short section on portability between local authorities in England, it made no mention of transfers between England, Scotland, Wales and Northern Ireland. When I raised the matter again in September 2012, I was told that a clause to facilitate cross-border placements would be put in the Care Bill.
Schedule 1 to the Bill makes provision for cross- border placements across England and the devolved Administrations, but this is limited to residential care and does not include community-based packages. As many people have eloquently said today, Government policy has long encouraged people with disabilities and health conditions to live in the community, integrated into society rather than segregated in residential accommodation, so the decision to facilitate the portability of residential packages and not community-based care packages is very disappointing. I wrote again to the Minister expressing my disappointment, and the response emphasised the differences in the care systems and the difficulties of applying rules across borders and suggested that officials were still working with the devolved Administrations to develop principles for how transferring community care packages might work in future.
Given that both the UK and Scottish Governments have known about this issue for a considerable number of years, it is deeply frustrating that it has not moved further forward. The difficulty of applying rules across borders appears to have been resolved within the Bill in respect of residential care, so it is unclear why it is impossible to do the same with community-based packages. I have been in communication with the Scottish Government as well, and they have given largely identical responses to those of the Department of Health. Clearly, both recognise the problem, but have yet to give it sufficient priority to find a resolution.
I hope that I can persuade the Government to recognise the issue fully, and they have the opportunity to do so with this Bill. I shall table an amendment either in Committee or on Report to facilitate the portability of community-based care packages. Today, however, I would be grateful if the Minister provided a more comprehensive explanation of why this has not been provided for in the Bill. That is the specific individual issue that I am particularly keen to see addressed, but let me also offer a few comments and observations from the perspective of north of the border.
In today’s debate and others I have heard during my time at Westminster, a great deal of discussion on the cost of care is about the “who pays?” element. Does the state pay? Does the individual pay? At what point do we take a decision? They are all important questions, but if we spent all our time looking at the cost of care only from that perspective, what would get forgotten is the need to put additional funding into care to make more care possible.
I can look at that from a Scottish perspective because we have been part-way down this route already, albeit only a very small part, with the introduction of free personal care in Scotland nearly 10 years ago. I emphasise that the Scottish provisions apply only to a relatively small part of personal care. After people have heard all the hype about free personal care in Scotland, they tend to assume that everything about it is free, but then discover that it clearly is not. Creating even this relatively small part of care and making it “free” meant that the financing was transferred to the Government, to the taxpayer, to all of us.
At the same time, however, not an extra penny was put into the care system at a time when, as much discussed today, demand was steadily rising. If we add to the mix the difficulties of local government in Scotland—we have had six years of council tax freeze and the reduction of councils’ overall budgets—the result is that my Scottish constituency is affected by exactly the same issues as people have raised here: rising thresholds for care, for example, which mean that only those with substantial and critical needs get any care at all.
I have seen items that can be charged for going up. I have seen the outsourcing of many care contracts to save councils money, but at the expense of the care workers and, indeed, the care recipients. I have seen the poorer conditions that lead to the 15-minute care times that we have heard about. We see them in Scotland, which was brought home to me very clearly when my mother-in-law was terminally ill, having been a fit person up until then. The first time when the care giver came and I was in the house, I thought I would go on the
computer and do a little work. The computer had only just fired itself up when the carer popped her head around the door and said, “That’s it, I’m off now”. It was barely 10 minutes. That situation is very real.
We should talk about who pays and how we divide the payment up—I am not saying that there are easy solutions—but if we do not address the question of the quantum of resource being put into care, we will continue to have these problems. I can assure everyone that this is exactly the situation in which we find ourselves in Scotland.
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