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Personal Care at Home Bill

This is an important group of amendments. The policy that underlies the measures in the Bill has two clear strands—free personal care for those with the highest needs who live in their own homes, and a package of intensive support or reablement to help people to remain at home for longer. Reablement services are offered by some councils, but it is important that local authorities across the country continue to develop and improve those preventive services. We know that with a six-week package of appropriate reablement measures many people would be able to reduce their dependency on care services and therefore live more independently. It will not always be appropriate for someone to undergo a period of intensive support, depending on their individual circumstances. That is why we think that local authorities should be given the discretion to make that judgment and to provide a reablement package as a precursor to arranging a package of personal care for the individual where that is thought to be necessary. I want to make it clear that, as my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly said, the measures give local authorities permission to choose to operate in that way. On the worry that the hon. Member for Eddisbury (Mr. O'Brien) described, and the example he gave, the immediate needs of individuals would be met while they were undergoing reablement. A more detailed assessment would then be undertaken once reablement was completed. The detailed work on the scheme would not be included in the Bill but would be a matter for guidance, drawing on professional expertise and the views of various stakeholders. Removing such an express power by accepting amendment 17 would, I fear, do nothing to encourage local authorities to develop further their reablement services. It would also fail to encourage investment in services that help people to improve their personal situation and help to prevent it from deteriorating and their care needs increasing. That is one crucial reason why I urge him to withdraw that amendment. Amendment 18 would similarly fail to encourage individuals—I think this is the point that my hon. Friend the Member for South Thanet was making—to make the best use of the reablement services available to them. The amendment would mean that a local authority could make free personal care conditional not on an individual undergoing reablement, but merely on undertaking to do so. In other words—this is an important point, and my hon. Friend was right about this—individuals would not need actively to undertake reablement to receive free personal care, but would need merely to undertake to local authorities that they would do so. Therefore, that reablement might never take place. Effective reablement relies upon sensible and effective decision making by local authorities, by people who need care services and by their care partners. Reablement packages need to be put in place and need to be undertaken to assist people in living their lives fully and in reducing their dependence. The amendment could result in a reduction in partnership working between the individuals who need care and their local authority. It could also result in authorities beginning to work up reablement packages that the relevant individuals have no intention of taking up. The amendment would not have the effects that we would wish to see of ensuring that people access and use reablement packages as a critical part of the whole system of improving care for people and, indeed, providing free care for the people with the highest needs. Amendment 19 would change the description of one of the potential eligibility criteria that may be set out in regulations. It would change the words""a process designed to maximise the person's ability to live independently"" to""at least one process designed to maximise the person's ability to live independently"." That process, which is described in new subsection (4C), is more commonly referred to as reablement. Details of what might be included in a package of reablement will be laid out in regulations or in guidance. We intend for the process to be a single process, but it could involve a range of interventions and support such as home adaptations, the installation of telecare and sessions with an occupational therapist or physiotherapist. There is a risk that, if the amendment were accepted, local authorities could use the wording "at least one" to delay giving people the free personal care that they need indefinitely. Clearly, that is not the intention underlying the Bill. The effective and appropriate use of reablement services can help individuals to reduce their dependency on care services and can increase their ability to live independently at home. However, where an individual still has high personal care needs following reablement, they should receive the support they need to meet those personal care needs. That is why we ask that amendment 19 should be withdrawn. Amendment 20 addresses the issue of carers. It would insert the wording:""Any process under subsection (4C) may not be contingent on the activity of, or acquiring, a carer."" The amendment does not make clear the extent to which carer activity, which is what it describes, would be excluded. Would knowledge and expertise be excluded, or only direct help with day-to-day living? If the amendment seeks to exclude carer involvement when reablement packages are designed, that could lead to a reduction in partnership working, which we all agree is vital, between the local authority and the carer. That could result in a diminished outcome for the individual who uses the services. We all know that the role that carers play is absolutely vital, because they often have invaluable knowledge about the care requirements of the person for whom they are caring. Those requirements need to be taken into account when a reablement package is designed. Even in a situation where carers would still be able to input their knowledge and expertise to design reablement packages, it would be difficult for them to be assured that that was being carried out appropriately if they were not involved in the reablement activity, where they wished to be. Carers' involvement in reablement is crucial, when that is beneficial to the individual being cared for. They have an invaluable role in supporting the people for whom they care, and in working with local authorities and care providers. I emphasise that the Bill does not seek to place additional burdens on carers, but neither does it seek to exclude them from working with councils to achieve the best outcomes for the people for whom they care. Therefore, we believe that it is important that local authorities continue to work with carers on behalf of those with the highest needs who are eligible for free personal care at home. Given my explanation of the clause, I ask the hon. Member for Eddisbury to withdraw the amendment. Amendment 21 purports to extend the potential for local authorities to offer reablement to all those with care needs under the guidance issued under section 7 of the Local Authority Social Services Act 1970. The concern, apparently, is that the guidance should set out how the care is to be made available, and how needs are to be assessed. However, local authorities are already required to act under the general guidance of the Secretary of State in discharging their social services functions as set out in the 1970 Act. That includes guidance covering the principles of assessment and the commissioning of services. The details of reablement services will be set out in guidance, but the services are designed to help people maximise their skills for living more independently. We all know that they are a valuable part of helping people to live at home for longer. Local authorities are free to offer reablement to anyone who they feel may benefit. Amendment 21 potentially restricts local authorities' provision of reablement services only to those who have existing care needs. I think that that would go against the very important trend towards universal and preventive services. Amendment 43 would prevent regulations from authorising local authorities to make reablement a condition of free personal care in certain circumstances, namely when a "registered medical practitioner" or other "registered practitioner" thinks that the process will be of""limited or no benefit, or detrimental to the health of the patient, or will not alter their care needs."" I hope that the hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, agrees with me that local authorities are best placed to decide whether a package of reablement would be beneficial before an individual receives personal care support free of charge. It is obviously important that local authorities do not force people to undertake a reablement package unnecessarily. We expect councils, when they are deciding whether reablement is appropriate, to consider in a sensitive fashion the overall benefit and impact of such a package, and to work with the patient's family, GP and others to assess that person's suitability for reablement. That may be particularly important when a person is undergoing palliative or end-of-life care. I know that one of the concerns about the Bill is that reablement will not be available for those undergoing palliative care. I can assure the House that, where councils believe that reablement might benefit a person undergoing palliative care, then they may offer it. However, if the person is unlikely to benefit, he or she should not be forced to undergo reablement merely to qualify for free personal care. All the detail of that will be covered in guidance. Ultimately, local authorities assess people's care needs and their eligibility for care and support, so it is right that they should be able to make decisions about the services that might be appropriate, in conjunction with other relevant partners in care.