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Personal Care at Home Bill

I confirm that amendments 13 and 16 are probing amendments, the former about what the discretion in the Bill might entail, and the latter about how the policy will work in respect of continuing care funding. It is vital to obtain clarification from the Government on both issues. I hope the Minister will be able to tell me and the rest of the Committee what discretion is referred to in proposed new subsection (4B)(a). On amendment 16, in the last quarter almost 45,000 people across England were in receipt of continuing care—a number that is likely only to increase. It represents about 10 per cent. of the total number of NHS beds in the country. What proportion of those would qualify as FACS critical? FACS is shorthand for the fair access to care services guidelines published in 2003 to provide councils with a framework for setting their eligibility criteria for adult social care, and thus to lead to fairer and more consistent eligibility decisions across the country. The guidelines are being revised in the light of the Commission for Social Care Inspection report entitled "Cutting the Cake Fairly" and give the criteria for low, moderate, substantial and critical categories. The Bill deals only with those with critical assessed need. I assume that many of those in receipt of continuing care would qualify as FACS critical. If that assumption is right, will not the policy of free personal care seem to primary care trusts the perfect opportunity to offload people back on to local authorities? That is important, particularly as we face such tightened fiscal and financial conditions in the coming months and years. Whether the Minister or any of us likes it or not, there will be temptations for anybody in charge of a budget to see where they can offload their responsibilities. Will the Minister also clarify whether the Coughlan judgment in the Court of Appeal in July 1999 makes the NHS specifically, or the state in general, liable for the funding of care, so long as it is free? The continuing care funding question points to a wider question of how the policy will work across the health and social care divide. Could the free personal care fund be rolled up into a joint budget? Given that we are talking about the crossover between NHS and social care, will the Minister give some clarity to the noise that we have been hearing in the Health Service Journal about the Secretary of State's plans to hand social care over to the NHS in toto, in order—in the words of an "unnamed source"—to""rip the heart out of Tory councils"?" He seems to have retracted from that position, I am glad to say, but is now saying:""I'd feel very comfortable with primary care trusts increasingly merging functions with adult services."" The Minister hinted at something along those lines in response to the previous group of amendments. That is nothing new. Its progress has been hindered so far only by the Government's constant reorganisation, as we have argued, of the institutions within our NHS. I am glad to see that the Secretary of State said last Thursday in his evidence to the Health Committee:""I am an integrationist on health and social care."" I look forward to the Minister's progress reports on that. Amendment 41 addresses transitional arrangements. I promised the hon. Member for South Thanet (Dr. Ladyman) that we would return to that. Has the Minister thought about how transition might work, particularly as people will be moving from free care to care for which they are charged? Transition also raises the question of what happens if someone ceases to have critical care need. The Minister has confirmed in written answers to my parliamentary questions:""Councils are under a duty to regularly assess"—" let us leave aside the split infinitive—""an individual's needs"," and that if no longer critical,""they would no longer be eligible for free personal care."—[Official Report, 8 December 2009; Vol. 502, c. 295W.]" We are not talking about individuals who might get a bit better. We are talking primarily, I suspect, about the councils that might get a bit tighter. That is the worry. Has the Minister thought through both the pressure on individuals and the administrative problems for councils that will arise? I hope that in his response he will take the opportunity to spell out the details on the record. New clause 5 was tabled by the Liberal Democrats. We look forward to hearing about the portability of their policy positions, given yesterday's announcement. In the light of their wish to reject their pledge of free personal care, how do they regard the funding of portability against standardised assessment needs? That is the issue presented in the new clause that will have to be addressed, not least because the right hon. Member for Sheffield, Hallam (Mr. Clegg), as I understand it from yesterday's announcement, either downgraded or scrapped the £2 billion unfunded care guarantee that the Liberal Democrats announced when he became the leader of his party. Leaving aside the various policy position changes, the serious point about new clause 5 is the postcode lottery that continues to exist across the country. Up till now, the Government were happy to say that that was the price of localism. There is a discomfiture that we are all caused by the tension between wanting to give local decision-making autonomy and ensuring that that does not result in unfairness, in the form of postcode lottery provision. Last week the Secretary of State said that there were "limits to localism". Is he planning to abolish councils, or their powers in the process, as part of his way forward? It can be very disconcerting for people when the funding that they receive from one local authority is not matched by funding from a new authority that they move to. Can the Minister assure the Committee that anyone assessed as critical by one authority will be assessed as critical by all other authorities? As I pose the question, I think that the difficulty is apparent. I am sure that the Minister has studied our proposals for common standards of assessment of need, which would be very helpful. If he wished to adopt that policy, we would be more than happy to let him do so. The case for new clause 5 will be presented by the Liberal Democrats. I urge the Committee to support all the other amendments.