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Personal Care at Home Bill

According to the Secretary of State, the Bill is supposed to be associated with the Green Paper and to be a bridge to it. I am grateful to my hon. Friend the Member for Eddisbury (Mr. O'Brien) for reminding me that the noble Lord Warner said:""We need a more bipartisan and coherent approach than is provided for in this Bill…I am resigning myself to the fact that many of us will have to try to make the Bill more sensible and realistic about costs and funding arrangements"," and I agree. He continued:""Good places to start would be some national rules on service eligibility criteria to avoid a postcode lottery and making local assessments of individuals portable to other areas."—[Official Report, House of Lords, 26 November 2009; Vol. 715, c. 541-2.]" So the idea of portability of assessment is rightly being pursued in the other place. The second difficulty with the Bill is that the Government just do not seem to have an idea of how many informal self-funders there are. The Local Government Association, in its response to the Bill, said:""We are concerned that the actual number of beneficiaries (and therefore costs) could turn out to be very different from the Government's estimates. The Impact Assessment which accompanies the Bill provides little reassurance. We are particularly concerned that the estimated number of people with high care needs who self-fund their care may be too low."" Counsel and Care said, similarly:""We need to see exactly who will be helped as a result of free personal care at home. To this end, the following areas require further definition…what are 'critical' as opposed to 'substantial' care needs, what 'personal care at home' will cover in full, when the NHS should step in and fund the care."" Age UK said:""We would like clarification about the definition of personal care at home, especially when services described may be better delivered outside the home or where personal budgets are currently used to deliver similar outcomes. There is significant uncertainty about the true costs of the proposals as we do not know how many people who do not currently receive services might come forward."" That is why we cannot have any confidence about what the cost of this Bill will be. By their own admission, the Government have nothing other than a gross estimate—a generalised estimate—of how many people are receiving informal or family care, or who are self-funding but not using council-arranged care. The evidence from Scotland demonstrates that large numbers of those people start to become claimants of free personal care if it is offered to them. The Bill appears to be unfunded. In the explanatory notes to the Bill, which sometimes explain and sometimes do not, I was astonished by a sentence in paragraph 17:""The Government's view is that the Bill has little overall effect on public sector manpower and public expenditure."" So £670 million—on the Government's estimate—is of little effect. Convert that figure into dollars and we really have arrived at a billion here or a billion there. Soon that adds up to real money, but that does not seem to matter to the Government. Where will that money come from? In response to an intervention, the Secretary of State seemed to be completely unable to explain why, in last week's pre-Budget report, what should have been represented as a £200 million transfer from the NHS in England into the Department of Health's expenditure simply does not appear in the Red Book. I am astonished that the Secretary of State could not explain that. He was at pains to mention the "myths" about where the money would come from, so perhaps he can explain where it will come from. He has been quoted as saying that some £60 million of it will come from "lower priority research projects". Which are these lower priority projects? Which such projects did the Government see fit to fund in the first place? I have seen a long list of research projects, and the Government used to make considerable play of the fact that they had increased the NHS research and development budgets. Which advertising campaigns will the Secretary of State stop to pay for this Bill? Will it be tobacco control, the current swine flu campaign, next year's seasonal flu campaign, the sexual health campaigns or the Department's contribution to "Frank", the drug campaign? And which local authority activities will contribute the £250 million? On the face of it, the Government are arguing that it will come from a reduction in residential care home payments, but the impact assessment does not suggest that anything like that number of people will switch from residential care. The Department think that only 2,700 people would transfer from residential to domiciliary care. Nor does the Green Paper offer a credible way forward in relation to insurance funding. The compulsory process is not really a basis for consensus because, in effect, it would just transfer into compulsory insurance something that would, to all intents and purposes, be just a taxation per head. Compulsion and tax amount to much the same thing.