---

Personal Care at Home Bill

It is interesting to follow the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), who is from Conservative-controlled Lancashire. As the former Prime Minister, John Major, might have said, this is not an insignificant day. It was another former Prime Minister, Tony Blair, who promised at the 1997 Labour party conference that no one should have to sell their home to fund their long-term care. Twelve years on we are debating the first bit of relevant legislation. There were three Labour Back-Bench speeches, none from the Liberal Democrats, and no fewer than six from Conservative Back Benchers. If ever there was a true benchmark of care, that is it. One question that Ministers must ponder is how they could do more through the Bill. Which? called it "a missed opportunity". The House will recall that the policy behind the Bill was announced by the Prime Minister in his speech to his so-called comrades at the Labour party conference. Cleared just 20 minutes before the Prime Minister's announcement, there was no hint of the policy in any of the preceding debate. It undermines the Green Paper process, and the speed of its gestation puts the policy on infirm evidential ground. Take, for example, the use of a blog as an authoritative source in paragraph 5.27 of the regulatory impact assessment:""see http://healthcare-legislation.blogspot.com/2009/11/does-acturarial-value-trump-medical-loss.html"." That must be a first. Lord Lipsey, who sits on the Labour Benches in the other place, branded the Bill a "gimmick" and said that ""it is a bad policy but also a very bad way to do policy just to find a nice highlight for your Labour Party conference speech."" If Ministers can churn out that policy in a couple of days and try to rush it through Parliament with only a single day in Committee of the whole House—patently a ruse to bypass questioning and to bang it through for, as some say, electoral purposes; surely not—and if they can expedite the Bill, could they not also, given that the Green Paper consultation has concluded, support legislation to address some or all of the other parts of the social care waterfront? As my hon. Friend the Member for Bournemouth, East (Mr. Ellwood) asked in a trenchant speech, "Is that it?" One way that the Government could show their earnest in their call for a consensus is by agreeing to amend the Bill to bring into effect our home protection scheme, a policy that deals with another part of the social care agenda, for which the costs can be much more catastrophic to individuals than even those for the critical level of domiciliary care. We never claimed that our scheme would solve all the issues, but it is an essential part of such a solution. The House must remember that the Bill deals only with those with critical needs. Those whose needs are substantial, moderate or low are ignored. It addresses only those who stay at home. Those who opt for, or have to go into, residential care are left out. In the Green Paper, the Government said that in 2012 there would be 6 million people with care needs. The policy that we are debating claims to help just 270,000, and even that figure has been called into question. It represents less than 5 per cent. of the total. The point was highlighted against his own Government by the hon. Member for South Thanet (Dr. Ladyman), who said that the Bill covered only a small part of care need, not the total architecture. It is our hope that the Government will expand the Bill's horizon and ambition. The Government must do more to assure us that the Bill will not fall foul of the Human Rights Act. It has one of the longest depositions to the human rights committee that I have ever seen. The Government must work hard to suggest that it is not unfair to give people a differing amount of state support, depending on where they live. Many organisations, such as the Learning Disability Coalition, have expressed concern at the perverse incentive that the Bill could provide for people, who would be better in residential care, to stay in domiciliary care against all personalisation principles—the very issue about which the hon. Member for Blackpool, North and Fleetwood expressed concern. According to the impact assessment, the purpose of the Bill is""Funding care to those in need at the time of their need"—" close to what the Prime Minister said at his conference, and uniquely for a policy of this Government, seeking to provide peace of mind to everybody. However, the Government changed the purpose for the European convention on human rights sign-off to""enabling, supporting and encouraging more people to avoid or delay entering residential accommodation"." The former and, some might say, real purpose of the Bill might well fall foul of the courts, so we need to ensure that the Bill does not proceed through the House on a flawed basis. That is just one more reason for more time in Committee than the proposed day on the Floor of the House. In the course of a comprehensive, tour de force of a speech by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who opened for the Opposition, the concern was also raised that the legislation incentivises care homes to re-brand as extra care. The hon. Member for South Thanet picked up that point, too, although in an otherwise very fair-minded speech, he did not seem to grasp the argument that the Opposition have cogently made. Given how the Bill might operate, there is no indication that a care home will have to do anything more than bill its residents separately for accommodation on the one hand and care on the other to qualify, under the terms of the Bill, as an establishment that does not provide accommodation together with care. That could bring the whole 500,000-person strong, £1.2 billion cost of residential care within the ambit of the scheme. There are questions about reablement, a word that my hon. Friend the Member for Beckenham (Mrs. Lait) found difficult to deal with. Let us call it occupational therapy, if she prefers. Will it be available to those with palliative care needs who can live for many years? Why have the Government assumed that one quarter of people will not be processed—a worrying enough word in itself—each year? Will the Bill's stipulation that reablement must come before free care create a perverse incentive to councils to delay reablement work? That is another key area, and it clearly needs deep Committee scrutiny if we are to get to the bottom of it. There is little joy for carers in the Bill, as the assessments will not be carer-blind. The Government have put ever-increasing pressure on carers, and the Bill is likely to exacerbate that. My hon. Friend the Member for Braintree (Mr. Newmark) echoed that concern in his interventions on value and, even, non-financial value—something about which the Secretary of State was concerned when he was a Minister. The Secretary of State has also spread confusion about the NHS "taking over" social care. Despite the pre-briefing, nothing new was announced, but now councils think that they are about to be shot of the problem. Furthermore, the narrow focus on care rather than support might mean that people who could stay in their homes will be driven into residential care. That is the very mischief that the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope) persistently, wrongly and, I am sure, without any party political slant at all seeks to portray as the problem, as he perceives it, with our very well-received home protection scheme. Scope says:""By overlooking the needs of deafblind people to communication support, the government is in effect excluding a group of people who are most at risk of having to enter residential accommodation."" Another area with which the Government are, frankly, playing fast and loose is the finances of the scheme, a point clearly and compassionately made by my hon. Friend the Member for Beckenham on behalf of her constituents. They include my elderly parents-in-law, who are in receipt of the very good services in Bromley and, let it be said, vitally, the attendance allowance that helps them to stay in their own home—with all the benefits that that brings. The impact assessment provides costing only for two and a quarter years. I have never read an impact assessment that has not costed a policy for at least 10 years. The period of two and a quarter years brings us to a certain magical part of the calendar and is clearly another part of the impact assessment's panic drafting. The Government's own Green Paper looked to 2050, and, in this vital area, that is the span that we all know we must consider. The impact assessment confesses that there is "inherent uncertainty" in estimating the costs. I asked the Government, through parliamentary questions, to extrapolate the amount, even using contemporary assumptions, but they repeatedly refused. Doing it myself, therefore, I found that the policy will cost at least £1.2 billion a year by 2030. If their assumptions are wrong by just 1 per cent., and that is almost guaranteed with this Government, that will add about £40 million to a £650 million cost in the first year. The Local Government Association is particularly concerned that the Government have "underestimated". If the Government are serious about this policy being part of the reform of the system, they must bring forward the proper costings, as my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes) said in a wide-ranging, exemplary and significant contribution that had his constituents' interests at heart throughout. During the general debate on health and social care reform on 29 October, in response to some pressure from Members on the Government Benches, the Secretary of State ruled out funding from general taxation because it would not""be fair across the generations to ask the working-age population to pay for the costs of care"" and""it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation."—[Official Report, 29 October 2009; Vol. 498, c. 479-481.]" Those reasons were also cited in the Green Paper. He therefore needs to explain why it is "honest" or "fair" to do that through this policy but not the whole reform, and how a policy clearly at odds with the principle of the Green Paper can be said to be in its direction of travel—a point ably highlighted in a comprehensive speech by my hon. Friend the Member for Norwich, North (Chloe Smith). It was precisely this tension that led my hon. Friend the Member for Poole (Mr. Syms), in a clear and caring speech that focused on his constituents' needs, to argue so powerfully for the detailed and adequate scrutiny of the Bill—that is, in a proper Committee stage instead of one day on the Floor of the House. Furthermore, Ministers have not yet come clean on exactly which budgets they are slashing to pay for this measure. Some £250 million, which was spun as a real-terms cut in the pre-Budget report, is set to come from as yet unrealised local government "efficiency savings"; in other words, they are going to spend it on this instead. Many organisations, including the Learning Disability Coalition, Age UK and Sue Ryder Care, have pointed out that this""could mean cuts for other people with care needs"." The LGA has said:""It is difficult to see how local government could meet the cost of this proposal from current plans for efficiency savings, without the lifting of other burdens."" When pressed through parliamentary questions, Ministers have given the reply, devoid of hope for these organisations, that setting charges for social care is a matter for local authorities. We know that the Government are also taking it out of research budgets but have not yet identified which ones, generating great concern particularly among cancer charities and—as highlighted by my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), whose speech was, as always so focused given the information and expertise that he has in chairing the all-party group on dementia—among dementia charities, to whom the Minister of State only recently pledged more funding. The Government are also taking it out of the NHS IT budget, which funds a programme that, according to Ministers, was all about patient safety, patient care and a more efficient use of public money—until last weekend, when it became, to quote the Chancellor,""frankly…not essential for the front line"." It is important that Ministers clarify exactly where the money is coming from. The House will see that this scrabbling together of money from different pots shows that the Government seem to have no idea of how to fund this measure in the long term. On the positive side, one of the exciting additions to the Bill could be legislation to underpin our home protection scheme. This would enable every 65-year-old to buy into a risk pool at the cost of £8,000 or so, insuring them against the catastrophic costs of admission to residential care. It delivers on Tony Blair's promise in 1997 to stop people having to sell their homes to pay for their long-term care; last year, 45,000 people had to do just that. These people probably did not grow up with parents who owned property but have been enabled to get on to the property ladder, many in the 1980s, and who could have given their children and grandchildren a start in life that they themselves could never have dreamed of. Instead, once again, the Government have got rid of a driver of social mobility. Of course, the policy will be attractive only to those who would otherwise fail the means test; it is right that those with assets under £23,000 should continue to be supported by the taxpayer. This is not the time for a litany of failure on social care—the point is made by the gap between Tony Blair's 1997 pledge and this Bill, which shows only the first glimmer of full-scale reform. So much for the demand made, not least by Conservative Members, that truth be given to the aspiration allegedly contained in the Green Paper. In the last general debate, the Secretary of State spoke of his desire to create "unstoppable momentum" for reform. It is a somewhat plaintive cry as he positions himself, I would argue, for the future and his campaign for the Labour leadership. We wish him well; he would be a great asset to us. If he truly wants to create that momentum, he will work with us, not against us. Despite his confession to me, some months ago, that he is tribal at heart, I hope that he can none the less see a way to working with us. A beginning would be to give the Bill due time in Committee, not just a day on the Floor of the House. Of course we must and will divide the House to oppose the programme motion, while not opposing Second Reading. As I have said and as my hon. Friend the Member for South Cambridgeshire said in his opening speech, the Bill contains some worthwhile provisions but should be set in an overall architecture, rather than the Government taking this spatchcock approach to legislation. My favourite part of the regulatory impact assessment is paragraph 5.29, which notes the risk that""current research and evidence available does not accurately estimate the true numbers who may come forth to seek assessment and services."" The archaism "come forth" suggests a draftsman who sees the policy for what it is, but it also gives us some ground for optimism—those are, after all, the words that brought Lazarus from the grave. I hope that if Ministers are willing, we can resurrect social care reform across the whole spectrum of care in this Parliament rather than be forced to wait for the next, when the House can be assured that if given the chance, we will act.