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Personal Care at Home Bill

We all know why the current Government, and indeed former Governments, have not moved rapidly on personal care—it is horrendously expensive. If we look for a moment at the economic situation, we see that the country is accumulating a large debt. If we look at the pension situation, we see that people are living longer than ever and if we look at the care situation, we see that because people are living longer and are frail, there is potentially a large bill for the Government, local authorities and individuals. There is no easy answer. Earlier in the debate, one or two Members suggested that we should just lump the costs on to taxation and that might do the job, but of course the British tax system tends to hit people at a lower and poorer level than is sensible. All the surveys on poverty show that young families with children fall into the bottom poverty quartiles—at least for a period, when one parent cannot work. It would have been far better had the Green Paper in July been allowed to take its course and if we had accepted representations from a range of people and taken a decision about where we wanted to go in the future. The Government could have introduced a degree of certainty in the debate, so that both the private and voluntary sector and local authorities could plan and work to it. If we want any kind of insurance scheme to be a success, we have to be sure that the boundaries are clearly drawn—what the state will do and what individuals are expected to do. I have the privilege of representing a constituency that is probably in the top 35 in terms of older electors. It is not unusual for an elderly couple to come to see me at my surgery about their parents who are even frailer. The problem is that the system relies greatly on carers, some of whom are very elderly and unable to lift their loved ones or look after them. It is a good thing that families care for the elderly, and it needs to be encouraged. One of the things we need to look at as a state is whether if we gave individuals personal budgets, they could use that money to pay their relatives to look after them. From my understanding of the situation in Holland and one or two other states, I think that would be a good thing. Because of the sudden rush of blood to the Government's head, we have a partial change that will have perverse incentives on the rest of the system. We have not managed to ascertain tonight quite what the demand will be—until the service is implemented we shall not know—and as my hon. Friend the Member for Beckenham (Mrs. Lait) said, we do not know whether there will be full back-up. A big problem in Poole is that if somebody wants to stay in their own home, they need adaptions, which sometimes need planning permission, but the budget seems to be limited so it takes some while to get the adaptions that people need. That is one of the factors that will cause a problem. I am a little concerned about the funding, which seems to be calculated on the back of an envelope. In all my time in both local and national Government, there has been something called the magic pot, which is usually somebody else's efficiency savings projected over a period of years. If somebody else works a bit more efficiently, we can fund a particular service in the full knowledge that if local government cannot provide it efficiently, it will have to put up council tax. I spent longer in local government than I have as a Member of Parliament, and in my humble opinion local authorities are, on the whole, quite efficient at delivering services. They are certainly better at controlling money. They are better at dealing with a limited amount and getting what the Government want from it. It may not be everything the Government want, but local authorities manage to deliver an awful lot. I am not sure that the measure is being properly funded. The council element is questionable, as are one or two other elements, so the problem is that we shall come back to the pinch point of eligibility. At the end of the day, if councils do not have enough money, they will use eligibility criteria that fit the funds they have. Local authorities have been capped and are expected to make savings. On top of that they are now expected to deliver a major reform, which will require a great deal of investment—for example, in physiotherapists and adaptions to homes. It will also require funding, and ultimately if the funding is not there, the legislation cannot be carried out. Another perverse incentive is that, to some extent, the measure would discriminate against people going into care homes, which may be the best thing for some people to do. Families may try to keep someone in their own home when it is inappropriate because they do not want to burn up the value of the house by moving that person into a care home. We need to think carefully about the measure. I am glad that my hon. Friends have said that they intend, if given sufficient time, to scrutinise the Bill fully to ensure that we have answers to some of the major questions that have been raised. The hon. Member for North Norfolk (Norman Lamb) made a very good point; there is a lot to be said for all-party consensus. Whatever is agreed needs to be agreed for between five and 20 years. We do not need somebody coming in with their new version and reinventing the wheel. We need long-term arrangements, so it is a pity that the Government rushed off in their own direction and did not listen to the opinions of the consultees, who initially thought they were genuinely being asked and were a little upset that the Government had already made up their mind—certainly on one aspect. My hon. Friend the Member for Beckenham made an important point about the distribution of the money on the basis of grant. Many of us have a heavy weighting of elderly, but also low grant levels, which will create a difficulty in delivering services. If the money is distributed on the basis of an older population, it would be welcome but there will clearly be losers, who might have an opinion. There are some very wealthy areas of Poole, but although many of my constituents have an asset in the form of a home that is worth a lot, their income is low—not least because people's pension arrangements have not been quite what they expected, for various reasons. Keeping people in their own home if they have no income or savings will be at a high cost, even if we can find enough people to run around and look after them. At present, many members of the Polish community do a great job looking after the elderly in most of the care homes in my constituency, but there will be a real problem finding people with adequate training to provide those services. In the past, as we all know, because of staff turnover and the terms and conditions both for those who work in care homes and for those who deliver care to individuals in their own home, the commitment to training has not been all it should be. If we are serious about providing a care package for people who remain in their own home, we have to increase the pay, rewards and training for those who look after the elderly, so that they receive the best care and so that caring is seen as a proper career and people do not go into it because they cannot do, or are not skilled enough to do, anything else. The Bill is interesting and I am glad that my hon. Friends will scrutinise it fully. We have a major problem, however. This is yet another initiative that, however worthy, needs to be funded against the background of a country that is spending rather too much. Unless we get a grip on that, there will be problems in the long term not only for our fellow citizens but for the children and grandchildren of some of the people we have been talking about in the debate.