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Personal Care at Home Bill

First, it is social care, not medical care, that is being provided. The hon. Gentleman's phraseology suggested that he was talking about medical care, and I want to make it clear that this is about personal care for people whose need is most critical and who need help with toileting, and so on. This is about intimate personal care. A number of guidelines and regulations are out for consultation, and they will need to be enacted when the Bill receives Royal Assent. People will qualify from 1 October this year. The process by which that will happen will also be the subject of guidance, to ensure a smooth transition as people who are currently in their own home and who qualify under the appropriate criteria start to qualify for free personal care. The provisions apply not only to new entrants; people who are currently living in their own home and paying for personal care because they failed the means test will now start to get their care for free. A further 130,000 will receive free reablement or rehabilitation to help them to recover their independence after a fall, a bereavement or a serious illness. I will say more about that when we discuss the later amendments. The Bill is based on the simple principle that we must do everything that we can to help people to live as well as they can and for as long as they can in their own home. That is what people tell us they want. This Government policy has been shared by both parties, at least since 1998 when the Griffiths report was produced. Indeed, the right hon. Member for Charnwood (Mr. Dorrell), when he was Secretary of State, supported the view that we should give as much support as possible to people in their own home, because that is what they want. I have listened to his remarks and those of his Front-Bench colleagues today, and I hope that that position has not changed. I hope that all parties in the House will support and respect the wishes of people—young adults as well as older people—to live in their own home. Amendment 9 would amend section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 so as specifically to list a number of settings in relation to which a six-week restriction on the ability of regulations to require provision of personal care for free would remain. The hon. Member for Eddisbury described it as a probing amendment, and I understand that, although I think that Labour Members listened quite carefully to ensure that that was the case and that the Conservatives' position had not changed. The list in amendment 9 is entirely inappropriate, as it includes some settings that are more appropriately described in the way that clause 1(2) describes them, and some settings that we would describe as falling within the notion of living at home—such as extra care housing, sheltered accommodation and warden-controlled accommodation, all of which are listed in the amendment. My hon. Friend the Member for South Thanet spoke from his experience as a Minister in this Department, and from his own professional experience, when he described the importance of extra care housing. I very much share his view. I listened carefully to the concern expressed by the hon. Gentleman that there might be game-playing among care home owners trying to change the status of their homes—[Interruption.] That was indeed mentioned on Second Reading; if I said this on Second Reading, I am certainly happy to put it on the record again. It is for the Care Quality Commission to register care homes and extra care housing. Only care homes that genuinely change the nature of the care they provide to create extra care housing would be registered as such. As my hon. Friend said, we do not need to write all that into the Bill, because we have a regulator to ensure that the kind of behaviour described by the hon. Gentleman would not happen. The right hon. Gentleman gave the example of granny annexes. People living in such accommodation would also qualify for free personal care because they are not in residential care accommodation. The Bill does not list all types of accommodation. Its provisions are straightforward. Apart from the one circumstance of adult placements—we will discuss an amendment on that later—we have excluded anybody in a residential care home from qualifying for free personal care. Everybody else is included by default because they are not excluded. That is how the Bill is designed. It is an elegant way—my hon. Friend described it as such—of achieving the policy goal that we want to achieve, which is to provide for and help people with the greatest possible needs who are living in their own homes. The right hon. Gentleman suggested that we have identified one group but ignored everybody else. The problem with his approach is that it would be a case of saying that we should either do everything or do nothing—that we should not introduce this extremely important measure to help people in the most need in their own homes. Why did we introduce a carers strategy? Why did we introduce a dementia strategy? Why did we introduce a strategy on valuing people with learning difficulties? We did those things because we are building on, improving and raising the quality of care step by step. The hon. Member for Poole (Mr. Syms) indicated, as he did on Second Reading, that he favours the Green Paper. I am delighted that I have a convert from the Conservative party. Indeed, many of his colleagues praised quite lavishly the Green Paper, which is being considered with a view to transforming the whole system. I am proud to be the Minister of State standing at this Dispatch Box leading on the proposal to create a national care service—how good can it get?—but that does not mean that I am going to stand still while I am waiting for that to happen; I want change now, as well. Step by step, the building blocks towards creating a national care service are being put in place, and this measure is a key part of that. Amendment 10, as an alternative to the approach that we are taking, would insert a definition of "care home" into the Bill. We regard that as unnecessary. The description that the Bill uses in amending section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 is""accommodation that an establishment provides to the person together with the care"." We do not propose to change that. The hon. Member for Eddisbury proposes in his probing amendment that we should use the definition in the Care Standards Act 2000, but that is not right in this context because it includes some exemptions and exceptions and therefore would not accurately reflect the range of settings that we want to exclude from free personal care. We think that our approach is the right way forward. In response to the hon. Member for North Norfolk (Norman Lamb), yes, direct payments would be a method of providing such free personal care if someone chose to go down that road. This is an important point about the very nature of the transformation of the care system. Increasingly, we want people to have more choice and more control over their care budgets, and direct payments are one way of doing that. Personal budgets, which are a development of that approach, are being rolled out across the country, with more than 100,000 individuals now receiving their care in that way, giving them choice and control. This is free care for the people in the most need. If they choose to have it through a direct payment or as a personal budget, that is absolutely the right thing to do. It will be up to local authorities to develop and implement this approach—that is what our extra £500 million for the transforming social care budget is all about. Some authorities are getting there quicker than others. I hope that the measure will provide an incentive for some of those authorities to start to develop their services in a way that we, and I hope the whole House, would like them to offer in taking forward their care provision.