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Personal Care at Home Bill

The purpose of amendment 15 is to probe again the £250 million efficiency savings on which this Bill depends. Can the Minister tell the Committee how he has calculated that figure? We worry that, as the impact assessment suggests, he has just plucked that figure out of the air. Amendment 48 would give the Secretary of State flexibility to limit the cost to local authorities. The question is who is exposed if the Government have got their calculations wrong? Would it be the Treasury or local authorities? Should the Exchequer—the national taxpayer—bear the costs of any mistakes or should it be local taxpayers or even the recipients of care services? The Local Government Association, in its briefing on the Bill, expressed its concern that the Government are not confident about the accuracy of their cost estimates. Many councils have already planned their savings and budgets for the year that the policy will start—2010-11. Councillor Ken Thornber, the leader of Hampshire county council—with West Sussex and Kent, it is one of the Conservative-controlled councils giving a good lead on social care—has said that his council would have to find between £5 million and £10 million above present projections. This morning, I received a letter from the chair of the Learning Disability Coalition, Anthea Cox, which stated:""We remain extremely concerned at what the implications for local authorities will be in terms of finding £250 million a year from efficiency savings. We are most anxious that these savings do not mean cuts in services for other needy people. It makes no sense to direct extra funding towards people who have their own significant resources as increasing the numbers of people who will become eligible for personal care funding at the highest level of need will reduce the funding available for those with substantial levels of need. There is considerable anxiety where the cuts may be made and the impression that care is being rationed for people with moderate needs. If an outcome of the Bill is further pressure on social care budgets this could well lead to further rationing."" The blunt truth is that if these savings cannot be found from the efficiencies somewhat loftily urged by the Government—but with no specific plan for achieving a penny piece of them—they will have to come from cuts or increases in charges. The biggest concern is that increases in charges will fall on those with substantial, moderate or low care needs. I asked the Minister in a written question whether charges are likely to be raised. He replied:""Setting charges for social care is a matter for local authorities."—[Official Report, 10 December 2009; Vol. 502, c. 553W.]" That does not provide much clarification. There are equally serious questions about the £420 million central funding. Thus far, the Minister has confirmed that he will cut £50 million from public health campaigns, £60 million from management consultancy, £20 million from administrations costs—that is easy to say, but I wonder whether it will be his Administration—and £62 million from research into cancer, dementia and other debilitating diseases. That is worrying given his recent claim that he is seeking to match our promise to increase research into dementia because of demographic changes and the profile of disease occurrence. Those savings add up to only £192 million, so I ask the Minister where the rest will come from. Can the Minister explain why the summary of the impact assessment says that the annual enforcement cost of the policy is not applicable, but in a written answer to me on 14 December 2009 he said that it is estimated to be £27 million? How did he make that estimate? Are the illustrative grant allocations weighted, or are they simply produced according to the probable numbers in receipt of care at the critical level? How will the formula work? What will the Government do to upskill and, if necessary, grow the work force to meet the demands of this measure to bring care to an extra 100,000 people? That is not strictly a local authority cost, but it will be a local cost. The Royal College of Nursing is""very concerned about the impact that these reforms will have on the nursing workforce."" It claims:""These changes will affect the workloads of health visitors, community nurses and specialist nurses—professionals who are already overstretched. The community nurse workforce, in particular, is ageing, with many due to retire in the next 10 years. With only 10 months until these measures come into force the RCN is concerned that there may simply not be sufficient numbers of properly trained social care and nursing staff to deliver the commitment to free personal care in the Bill."" Does the Minister plan the substantial investment in community nursing that will be necessary if these changes are to be successful? Has he found a source for the funding required?