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Personal Care at Home Bill

I am delighted to follow the hon. Member for Crawley (Laura Moffatt). I think that the point she was making—I hope that I am correct—was that more people need access to top-quality services to ensure that they stay in their own homes for as long as possible. I do not think that there is any argument in the Chamber about that statement. The question is how we can best get there. I am very conscious of the question of whether the Bill is needed at all, given that the best evidence that the Secretary of State could give us concerned the work that is being done on the Isle of Wight. The hon. Lady mentioned what is happening in Crawley, and I am sure that we can all cite cases from our social services departments in which, over the years, they have become more involved in intensive rehabilitation. That shows that these services are already emerging. I often wonder why we need to pass legislation so that people can continue to provide best practice. If it is best practice, and if it is saving local authorities substantial sums of money, it is in their best interests to do it. They do not need the legislative burden that is being imposed. Although we agree that there should be better services for personal care delivery, the Bill is next to redundant. We should be moving much more towards deciding—as my hon. Friend the shadow Secretary of State for Health pointed out and as the hon. Member for South Thanet (Dr. Ladyman) implied, too—that there are a range of different ways in which to finance the achievement of better personal care. We would be better off, frankly, doing it comprehensively rather than piecemeal. The Bill has been referred to as a bridge and as a stepping stone, but I suspect that, in the long run, it will go on the statute book and will be ignored, not implemented or will have to be comprehensively reworked, should another care Bill be proposed. In one sense, I welcome the debate that we are having on such a short Bill—it is, fundamentally, one clause long. Most of the Opposition's contributions have certainly questioned how effective it will be. I represent a constituency in the London borough of Bromley, which is one of the wealthiest boroughs in London. It has, without doubt, the highest proportion of retired people of all the London boroughs. The hon. Member for North Norfolk (Norman Lamb) said that the Bill will mainly benefit wealthy people, and that is highly likely to happen in my borough. Apart from three main areas where we have genuine deprivation, the rest of the borough is relatively wealthy. People in the borough will have been meeting their needs using their own resources. The flaw of the Bill is, as he pointed out, that people who have been doing that, who might be in great need—I am not saying that they are not, and I sympathise entirely with their need to get proper care—have not been cared for in the public sector, and that the costs of care will therefore run completely out of control. I am also concerned that East Sussex—here I declare an interest, because my husband is the leader of East Sussex county council—has a high proportion of retired people. Those people are not, by any means, the wealthy retired. If whatever money that is forthcoming from the Government—from saving on ad campaigns and research money—is distributed according to the local government formula, that will penalise people in counties such as East Sussex that are already suffering because of the perverse nature of the formula. I suspect that the hon. Member for South Thanet could say the same about his part of Thanet, although it is in a very wealthy county. If the money is to be distributed on the basis of the needs of the population, I foresee some squawks from the friends in the north, because it is much more likely that money will go to areas in the south with high numbers of retired people, which are not necessarily Labour controlled—not that much of local government is these days. We foresee perversity emerging in a variety of ways in relation to this one-clause Bill. I have been advised by a member of the Association of Directors of Adult Social Services, who is such a director, that the costings have not been shared with the social services department or with a wider audience and that the estimates of need have not been shared. Estimates are therefore a wild approximation of what the demand, and hence the cost, will be. The Government could find themselves in a position that they do not want to be in of being unable to fund the programme that they have put in place. Another area that the Government probably have not worked through properly—my hon. Friend picked up on this point—is the sheer scale of need in relation to the professionals required to deliver the rehabilitation services that everyone is talking about. I use the word "rehabilitation" quite deliberately, as I think that "reablement" is another ghastly politically correct word and that we would be better off using a familiar one. There are already insufficient occupational therapists. Anyone who needs, or knows someone who needs, an occupational therapist knows how long people have to wait for one. Anyone who needs physiotherapy knows how long it takes to get a physiotherapy appointment unless they have an immediate medical requirement. We can forget about psychologists, given how long it takes to see one, particularly following the introduction of talking therapies. It will take years to get hold of the professional skills that will be required to deliver the rehabilitation services that we would all like, because we have to recruit professionals from schools, get them through their training and then through what are, in effect, apprenticeships. It is almost an unfair promise to say that comprehensive services will be delivered to elderly people who are in great need, because we will not be able to get those services to such people as they need them.