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Personal Care at Home Bill

It is a pleasure to follow my hon. Friend the Member for Norwich, North (Chloe Smith), because I agreed with a great deal of what she said. May I apologise to you, Mr. Deputy Speaker, and to the House for missing part of this evening's debate? I was chairing a meeting of the all-party group on dementia. As the Secretary of State said, many people with dementia will be directly affected by what the Government propose. I wish to start my contribution, as many have done, by applauding the Government's intention—it is right that we should do so. There are few more important issues than social care and it is right to make a start on this, but we cannot accuse the Government, over most of their term of office, of legislating with breakneck speed on it. The Wanless report, which asked a number of important questions about social care, was followed a considerable number of years later by a Green Paper that asked all those questions again, and now we have before us a Bill that proposes to answer part of one of them. If the Bill is even to do that, it needs to deliver on its promises, and that is where I am in entire agreement with my hon. Friend the Member for Norwich, North and with others who have made this point. If the Bill is incapable of meeting the expectations that it has raised, not least by its title, it will be a cruel deception for those who are most reliant on social care and who will hope for most as a result of what the Government are proposing to do. That is why the uncertainty over the potential demand for free social care—the Government have not set out the terms of that in the Bill, but I hope that they will do so in the regulations that will follow it—is so important. This is about the unknown impacts on those currently funding social care themselves who may subsequently approach the state for free social care, of those who will not subsequently choose residential care as otherwise they might have done, and perhaps even of those in residential care who may choose to leave that care and return home to be cared for there—as we know, many prefer such an option. As my hon. Friend said, if we do not know what the demand will be, we do not know what the cost will be. We have heard that the estimate of the cost for the first year is £670 million, £250 million of which is expected to come from local government efficiency savings—one can only imagine the joy with which that news was greeted in town halls up and down the land. The remaining £420 million is expected to come from the Department of Health's research and development, marketing and consultancy budgets. I refuse to believe that the Government spend anything like £420 million on the Department of Health's marketing and consultancy budgets, so a substantial amount of the sum must be expected to come from the research and development budget. I hope that the Minister will be able to reassure me, and the House, that that will not affect the crucial work that goes on, not least in the field of dementia, where we already spend too little on research. If we do not spend a great deal more, it is very unlikely that we will find the cure that we hope for or, failing that, effective treatments, which will reduce the demand on our social care system in the first place. If there is a gap in funding—it is at the very least foreseeable that there might be, given the uncertainty, as we have heard, about the figures—who will pay for that gap? Will it be local or national Government? I rather agree with my hon. Friends who suspect that the answer is likely to be local government, once again. We must be sure, if that is the case, that it will be given adequate support to enable it to meet that burden. Let me say a word or two about the detail of the Bill. I agree with many who have spoken that reablement—although I am with my hon. Friend the Member for Beckenham (Mrs. Lait) on the elegance, or lack thereof, of that term—is a crucial point. It is vital that we get people back into being able to deal with their own daily lifestyle needs to the extent that we can and to the extent that they can. However, I am concerned about the practical implication of that. It seems to me to be inconceivable that in order to move to a process of helping someone with reablement, there should not first be some form of assessment to ensure that they will benefit from the process. That means that there will be one assessment to ensure that somebody is suitable for reablement, a process of reablement and then another assessment, assuming that that is appropriate, to decide whether they are entitled to free social care under the criteria. We all know that assessment takes a long time—we all deal with constituency cases weekly that involve long-running processes of assessment, assuming that there are enough people to carry out the assessments in the first place, as my hon. Friend said. We also have to assume that we are capable of withstanding the extra pressure on the system that will inevitably be caused by the extra demand for the extra social care provision. That will include many people who have substantial care needs, but not quite the critical care needs required for the free social care, who will ask and expect to be given a reassessment. A great deal more assessment will suddenly need to be done, and if that assessment and extra demand on the assessment system is going to cause further delay, that is a concern. There will be a big step between those who are assessed as having substantial care needs and those assessed as having critical care needs, in much the same way as we experience with NHS continuing health care. Let us be charitable, however, and assume that we can establish whom we will be paying under this scheme and how we will pay for it. We still have to answer the question of what we will be paying for. I do not want to revisit the debate that we had last week on attendance allowance and disability living allowance, but the freedom to spend the money that one receives in the way that one chooses was crucial to that debate and, I suggest, it is important in this one, too. The Minister will have seen, as I am sure many other hon. Members have, that Carers UK, in its response to the Bill, which I accept broadly welcomed it, also expressed concern about the situation of those families where family members are prepared to offer care in the home but would value assistance with other things such as gardening, shopping, transport and so on. We have to ask whether the provisions will enable such families sufficient flexibility to have what they need rather than what the Government wish to give them. We come back to the question of how committed the Government are to their personalisation agenda, to which I fully subscribe. There are broader issues, too, about what we pay for. The Minister has heard me talk before about what is commissioned. That point applies to residential care but, in this context, it applies particularly to domiciliary care. We must consider not only how we pay for this, but, alongside that, what we are paying for. We must ask ourselves whether commissioners are commissioning the right things and whether they should, as they do all too often now, be commissioning for blocks of time—such as commissioning 15 minutes for a particular task—or whether there is a better way of commissioning good quality care. We have to ask whether it is acceptable for a different agency care worker to arrive on someone's doorstep every day of the week, when the advantages of having someone they know and trust and for whom they can leave the door open while they take the dog for a walk are considerable. Those are substantial issues that are as fundamental as the question of who pays for the care that is delivered. That is why it is regrettable that we are dealing with these issues piecemeal and we do not have the opportunity to consider what is being provided on domiciliary care, as well as who should pay for it. This issue is, as others have said, too important to deal with in a piecemeal fashion. We should not have had to wait for 12 years, from when one Labour Prime Minister said in a conference speech that it was very important to deal with social care and that it would be a disgrace if we did not. Now, suddenly, because another Labour Prime Minister wanted an eye-catching initiative to fill a passage in a speech, we have to legislate in haste to make things happen. A potential problem with the Bill is the fact that it has a big title but not much content beneath it. Aside from raising hopes unduly, it would be tragic if we were to miss the opportunity to discuss more substantially, even at the end of this Parliament, the big issues surrounding social care. Another problem with the Bill is the fact that it does not answer with authority questions about whom exactly it would help, how it would help them and how much it would cost to do so. It does not even try to answer the bigger questions that are thrown up by the social care debate for us all to address. That is a shame, and we could and should do better.