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Care Services: Older Adults and Disabled People

My Lords, I add my thanks to those given to the noble Baroness, Lady Fookes, for securing time to debate these very important questions. I shall confine my remarks to the long-term care of older people. The disability case was so well put by my noble friends Lord Rix and Lord Tenby that I shall focus on the older section of the community. I declare two interests: I am president of Alzheimer Scotland, where I see marvellous things being done on a voluntary basis by those who care, by those who need care who provide support for others and by those members of the wider community who have become involved in their excellent work. I am also an adviser to Scottish Care and to English Community Care Association, organisations devoted to improving the professionalism and quality of care homes in our community. Where are we now? Several years have passed since 1996-97, when the Labour Party assessed the big issues in the light of the forthcoming election and included as a very high priority in its manifesto the need to address long-term care of the elderly. Reference has been made to the previous Prime Minister’s attitude to this issue. A Royal Commission was established, but here we are, in 2009, essentially facing the same questions. That is a scandal and a disgrace. The Government have had plenty of advice. They did not like the Royal Commission’s advice. The Joseph Rowntree Foundation has produced two reports and the IPPR has produced a report, as have the King’s Fund, Derek Wanless and others. They have had plenty of advice. What is lacking is the will to create a policy that will drive direction. My basic question to the Minister has to be, when will we have a policy? Let it not be after the next election, as a further two years would be wasted, with their attendant misery. A key principle enunciated by the Royal Commission is the need to have equity, which I do not think anyone doubts. One could argue about what this means. I pin my colours to the mast when I say that it means spreading the risk across the whole community. As has been said, you may have liver failure, lung cancer or a broken arm, but care will be provided by the state, whereas if you have dementia, a form of brain disease, you are in a very different position indeed. That is appalling. If we cannot afford to cover all these conditions, we should at least ensure that the risk is spread so that there is equity between various forms of illness. As some noble Lords have said in their excellent speeches, a single pattern of assessment with a single common set of criteria of need that operates without postcode intervention and local authority change is required. The lack of such an assessment causes much agony and annoyance across England. It does not happen in Wales, and we should ask why. It is not that there is more money or a different policy, rather that they seem to be able to make it work. It does not happen in Northern Ireland, and I shall come back to Scotland in a moment. A single pattern of assessment and definition of needs, accompanied by a single point of commissioning, is required—what my noble friend Lady Greengross referred to as the one-stop shop. Those in need, carers or those who need care desperately call for a single point of contact, a single reference, where they can be dealt with as whole human beings, not as a series of bureaucratic items spread round various Civil Service departments. Behind that lies the need for a single budget, which was recommended by the Royal Commission more than 10 years ago. The local authorities that are most successful in this regard in these difficult times are those that have managed to bring together health provision and social care provision, sometimes through a single chief executive appointment. This has happened at key points throughout the country. It works well, everyone benefits and money is spent more efficiently. Will the Government ensure that this best practice is spread more widely? The range of funds available can cause uncertainty for those in need of care. No one attempts to co-ordinate health service funds, social care funds, attendance allowance, disability allowance and housing adaptation budgets. I challenge the Audit Commission to determine whether we are getting value for money in that regard. Huge sums are involved but often different criteria are applied to them, which means that they do not constitute best value for the community or the individual. The noble Lord, Lord Lipsey, used two mischievous —or worse—expressions in regard to funding in Scotland. He said that Scotland had runaway costs and severe rationing. On the best interpretation, that is the product of irresponsible headlines. I will not tell noble Lords the worst interpretation as it would be unparliamentary to do so. However, the provision of care in all its forms for older people in Scotland costs £2.5 billion, of which personal and social care accounts for £225 million—that is less than a tenth. Of that, £30 million in attendance allowance is saved, so you can knock that off. The difference between Welsh policy and Scottish policy amounts to 14 per cent of total costs paid from the private sector. That means that the gap as regards what is not provided in Wales but is provided in Scotland is about £40 million. However, there is a £30 million saving in attendance allowance alone. What happens to the attendance allowance money? It stays with the Department for Work and Pensions and does not go back into care. I am being signalled that I have spoken for nearly seven minutes. I end with the single message that we should look at the numbers and find out what the net cost is, not the headline cost. I hope that the Government will soon define their policy.