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Personal Care at Home Bill

The hon. Gentleman is right in one sense, because he is advocating a comprehensive system that applies to everybody; when we start applying a process to one group of people, we create perverse effects and bureaucracy in determining whether somebody falls into or outside a category. He rightly identifies the need for a comprehensive solution. The hon. Member for South Thanet also accurately identified the risk of a disincentive for people to take out insurance. It is almost inevitable that insurance will be part of the overall solution that we seek to achieve—if we can build a consensus. The Bill inevitably amounts to a disincentive for people to take out insurance to protect against potential need. Who benefits from the measure? Remarkably, paragraph 5.21 of the impact assessment identifies the group that will benefit most as the "wealthiest older people". It is bizarre in the extreme and it is extraordinary that the Government have chosen a partial solution—rather than a comprehensive one—that, according to their own impact assessment, benefits most the wealthiest older people. There is also uncertainty about the cost and the number of people who will benefit. The impact assessment is riddled with uncertainty about the cost, and the Local Government Association has highlighted the point. First, the impact of take-up by people who are funding their own care is unknown; we do not know how many of the people who are currently funding their own care would come into the system. All we have is an estimate—that is all it can be. The Government say that they are confident that the figures are accurate, but they have no basis for that confidence. The impact of behaviour change with regard to residential care is unknown. The Conservative spokesman highlighted that the figures in the impact assessment are inconsistent with each other on that point. We do not know how many people will move from residential care to being cared for at home to take advantage of the offer of free care. The data on the number of those who are classified as "critical" and the relative distribution of their needs and disabilities are not collected centrally, so again we have no idea how many people we are talking about. We also do not know how many people are already receiving reablement. We do not know the proportion of those who after receiving reablement would not require care. Thus, the central assumption on cost and numbers in the impact assessment is uncertain. If the Government are wrong on their assessment of the total cost, what would be the consequences? We know from the consultation paper on the regulations that there is a fixed total sum available, so who would lose out if the figures were wrong? Will the criteria be tightened even more—beyond the calculation of "critical" need? Something has to give and the Government have not said what that would be. The LGA also raises serious concern about the potential for local government to fund its £250 million a year contribution. It is already making substantial efficiency savings, regardless of the £250 million that would be required. We know that over the past decade social care has been the poor relation of the health service in funding increases. At each spending round the health service receives a substantially greater real-terms increase than social care, and now the Government expect social care to come up with £250 million of efficiency savings to contribute to the cost of this measure. We have no way of knowing whether the system is capable of delivering that sort of sum. There is a real risk that it will amount to robbing Peter to pay Paul, taking care away from one vulnerable person to provide it to another whose financial resources may mean that they are actually better able to pay. The Secretary of State has today conceded that the total number of people who will benefit is 110,000—not the 400,000 that has been talked about. As the hon. Member for South Thanet said, the Bill benefits a very small subset of people. On specific issues relating to the Bill, I would be grateful if in winding up the Minister would deal with concerns that some groups have about the meaning of "critical". Will meeting just one of the critical areas, as defined, be enough to allow someone to qualify? What is the meaning of the "significant help" needed for the four daily activities? There is surely a need for greater clarity on that. Sense, the organisation representing deafblind people, refers to the fact that personal care, as defined in the Bill,""excludes the type of communicator guide support which is so vital to deafblind people."" That group is one of the most at risk of having to go into residential care, but it is excluded from help—surely that cannot be justified. Where do we go from here? There are serious concerns about the perverse impact that this unsatisfactory measure could have. The most pressing priority is to put in place a comprehensive, sustainable system—one that will last, as has been said—that will guarantee care for those who need it most, funded in a way that is fair and recognising the reality of the public finances. There is an urgent need to build consensus. Any Government coming to power next year, of whichever party or parties, have a massive challenge ahead of them in resolving this issue—such a resolution is overdue. Given the state of public finances, there is a real risk that this issue will be pushed, yet again, into the long grass. Surely we should all commit now to a process to secure a consensus. It is in the interests of any incoming Government that a process is already in place to achieve that. We should establish now—we should not wait until the next Parliament—a cross-party commission with a defined remit of achieving consensus in a tight time scale. Let us just imagine how the public would react if they saw the three main parties agreeing to come together to recognise that this challenge must be faced and must be met without further delay. That is necessary and it is of acute importance, so I urge all sides to agree to a process that secures that consensus on a sustainable system that will last into the future.