---

Personal Care at Home Bill

Indeed—and still with no picture on the lid. I want to make one more point about costs before I deal with other aspects of the Bill. According to answers given to my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the Government's contribution is not connected with whatever action they want to take in relation to attendance allowance and disability living allowance. I am almost tempted to ask, "If that is the case, why?" Either the Bill is connected with the Green Paper and therefore connected with those benefits, or it is not. That is another question that the Minister must answer. Let me now raise the issue of fairness. I believe that the worst risk posed by the Bill is that it endangers real reform. It pays for what is, on the overall scale of things, almost a minor reform, and it potentially helps people who are not the poorest in society. As my hon. Friend the Member for South Cambridgeshire pointed out, that principle is not in the Green Paper. The Government seem to be operating on the basis of two entirely different principles, at a time of soaring national debt. It is not as if there are spare pounds floating around that can be thrown any which way. Nowadays we must be particularly careful to scrutinise any item of public spending, and Members are wary of poor quality. Many of us welcome the idea of free personal care at home, which is a wonderful principle, but the poor quality that we risk with legislation such as this may be the enemy of the people whom the Government—and we—are so keen to help. Other Members have already spoken about the aspect of quality that I wish to dwell upon: the staffing implications of these measures. My hon. Friend the Member for Beckenham made the point very strongly. In an intervention on her, the hon. Member for South Thanet (Dr. Ladyman) said that we must find staff to make this change happen anyway, but that will not necessarily be the case. It is much easier to find staff to operate a well planned, well oiled and well funded system than it is to find adequately trained staff to operate a system such as that planned for October of next year, which, frankly, looks like a black hole at present. The Royal College of Nursing says:""It is essential that those with the highest needs receive the highest quality of personal care. With only 10 months until these measures come into force the RCN is concerned that there may not be sufficient numbers of properly trained social care staff and community nurses to meet the undoubted increased demand for care, which will follow from the introduction of these measures."" I fully agree. There is a real risk that a hasty introduction of these measures will lead to a gap in the provision of properly trained and funded staff, which will imperil some of our society's most vulnerable people, whom all Members wish to help. Time and again, MPs hear horror stories on this topic from their constituents. I suspect that I have heard fewer than many other Members, but the message comes across loud and clear none the less. There are stories about carers who leave the elderly person in their care alone for most of the day, and turn up when they think that it is time for breakfast, which might be noon or 7 pm—or whatever time chosen by the carers who have been found to fill those personal care gaps. That is not a vision of personalised care; rather, it is a nightmare for many of our constituents. We risk that becoming a reality by introducing these measures with such haste. In this debate, all Members should be focusing on the value of good care staff. I am not sure that such a hasty introduction of these measures will allow us to fit that into the system, however. Proper planning for the requisite training takes years, but this Government have done the following things to hinder that. They have let the Learning and Skills Council go bust. They have also let my local further education college become stranded with insufficient classrooms because of a capital funding crisis—I am sure many other Members' FE colleges are in the same situation. This Government have let higher education students—some of whom may be involved in providing more specialist needs—suffer with no funding until Christmas. Also, the apprenticeship system has been asphyxiated, and a huge variation in training has developed—in the experiences that people are able to access, in whether red tape holds them back and prevents them from training properly, and in what places can be promised to younger people seeking training or to older people seeking to do their best for society. That is our current training picture, and we must ask ourselves how it will affect the system that the Minister is looking to have in place in 10 months' time. I am tempted to conclude by asking the Minister whether he agrees with me that the following very simple precautions would assist the Bill in its passage. It should be part of a larger reform. It should also help, rather than hinder, local authorities. It should give the Minister the opportunity to ask his colleagues to provide clarity and consistency in other sectors around this one, such as further education. The Minister might also consider instituting a licence to practise, or any other measures that could improve the safeguards in this area for vulnerable people, whom we all care about. The sad truth is, however, that the Minister cannot agree to those simple precautions, because, as Members have already picked up, he does not know the numbers. None of us knows how many people will be involved in this system. We can estimate the number of people who pay for their own care at present, but we cannot estimate how many more will come forward when such an incentive is offered. We cannot therefore estimate the full costs of this policy, or the number of trained staff that will be required to fulfil it and make the dream that we all wish for, of proper social care and personal care in the home, become a reality. There is a final thing that, through this Bill, the Minister is not allowing local authorities such as Norfolk county council to do. I am pleased to see the hon. Member for North Norfolk (Norman Lamb) back in his place; he is the third Norfolk Member in the Chamber, so we are doing well. The legislation does not allow local authorities to deal with the demographics of the future. An enormous squeeze is coming down the line, not only in public spending—we all are, or should be, painfully aware of that—but in the number of people who will require such care in the future, whatever the incentives to provide it or to pay for it. The numbers are the key, but this Bill contains almost none. It certainly does not contain the numbers to allow us to scrutinise it properly. As the Bill is not connected to the bigger picture, it does not allow us to look ahead to the challenges coming down the track. I can but look forward to the day when the Minister looks up and gives us that bigger picture.