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Personal Care at Home Bill

This has been an interesting debate. I want, if I may, to focus on the aspects that have dealt with the role of local authorities, with particular reference to amendments 13 and 16. If the hon. Member for Eddisbury (Mr. O'Brien) had the same objectives as my hon. Friend the Member for South Thanet (Dr. Ladyman), I might even be convinced myself by the argument on continuing care, but I have to say, in all candour, that I am not. What we have established here today, perhaps not for the first time, is the existence of a big difference between the Conservatives and Labour in terms of how Governments work with local authorities. I cannot envisage a situation in which, in the absence of joint planning between local authorities and the NHS, we can deliver the kind of personal care that we have all agreed on. In relation to amendments 13 and 16, I am afraid that I must be even more ungenerous to the hon. Member for Eddisbury. Amendment 13 seeks to limit the discretion of local authorities in setting eligibility criteria for free care. The Conservatives frequently condemn direction from Whitehall and extol the virtues of localism and local control, yet they then table amendments to a Bill that would remove local freedom. I am not at all persuaded by that approach. I think that this is an essential argument about what sort of democracy we want to live in. Given that day after day, week after week, we meet councillors, directors of social services and others who have to implement our decisions, we should be a bit clearer than these amendments suggest about the very important role that local authorities play. Amendment 16 seeks to exempt local authorities from providing free personal care for those in a state of continuing care. If we spell that out, it means, in effect, extended care for a person over 18 to meet physical and mental health needs that have arisen as a result of disability, accident or illness. The amendment is difficult to understand if we take the view that we are to have a relationship between central Government and those responsible for delivery. I have never accepted that local authorities should see themselves as enablers rather than providers, which the hon. Member for Eddisbury hinted at. There will always be a case for both things on the part of central Government and on the part of local government, and that should be recognised. The amendment would exempt a section of the most vulnerable people from receiving free personal care at home because they are in receipt of continuing NHS care. I ask this question: why? I have not heard a convincing argument for it. If highly vulnerable people were to be treated in this way, significant costs to pay for care at home would arise. They should be entitled to the same support as everyone else in that group. The fact that they are receiving additional care from other sources such as the NHS should not take away the relevance of addressing their problem, having proper assessments, having a greater degree of advocacy than we have managed to discuss today, and delivering to those who need it the personal care that I believe is so essential.