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Personal Care at Home Bill

H.G. Wells famously once said:""In England we have come to rely upon a comfortable time-lag of fifty years or a century intervening between the perception that something ought to be done and a serious attempt to do it."" Perhaps that is a little harsh, but we all remember Tony Blair's pledge at the 1997 Labour party conference that he would sort out social care, and yet now, nearing 13 years later, the Government are still dealing with only a relatively small part of the overall picture, of the demand that has been coming from all quarters for many years. Broadly, we have had a good series of discussions this afternoon. Time constraints have, however, been placed on us by the Government's somewhat bizarre programming decisions. This is not a free-vote issue, and nor is it a matter of national security, so it is puzzling that we have been given only this brief opportunity of one day to cover all the remaining stages of the Bill on the Floor of the House, rather than having the fuller scrutiny it would have received with a longer Committee stage upstairs and potentially a full Report stage. Frankly, we have ended up little, if any, closer to the clarity we need on some issues, such as the true costs of this measure—not only the basis for many of the estimates, but the costs post-2012 and the potential costs if the estimates are wrong. We expressed sufficient doubts to raise some serious questions about that. The Government have given little hope to local council tax payers and service users, who are set to bear the brunt of any funding shortfall. The potential legal loopholes in the Bill are very worrying for the added costs they would bring, such as in respect of care homes restructuring, residential care qualifying as "home", and, of course, the human rights implications of the measure, which we have rightly discussed at length. A number of questions remain about reablement: who will get it, whether it is carer-dependent, and whether the costings are accurate and who will pay if they are not. Most disturbingly, the Government have refused to budge on their position regarding people with palliative care needs, although the discussion we had on that gives us some grounds for optimism that the situation may improve. The proportionality of this legislation remains in serious doubt. The benefit estimated—that word again—by the Government is only £190 million a year, less than a third of the cost. The measure impacts on only 279,000 people, of whom 166,000 already receive care for free. It makes a difference to only 110,635, less than 2.5 per cent. of what the Government have said are the 6 million people in England with care needs. The Bill makes no attempt to allow the whole gamut of social care to be addressed in the future. The Government have our home protection scheme before them. They have made various criticisms, but none of them amounts to anything other than the usual political rhetoric. As we have made clear, that scheme only addresses residential care, but their policy addresses some very narrowly defined domiciliary care. One could seek to put those two together and build a more consensual approach to trying to plug all the gaps and address the whole waterfront, as it were, of social care. In that, one can see the prospect of an opportunity for an approach that is a little less adversarial than, sadly, we have experienced, particularly in terms of the last group of amendments, which was a shame. The Government have done little to reassure us that they know the meaning of the word "free" in terms of public policy: "free" means that somebody else pays. In this instance, they are pledging to cut money. A number of budgets have been mentioned, and they have sought to give rebuttals. We will study very carefully the rebuttal put forward at the Dispatch Box on research budgets, such as those targeting diseases such as dementia and cancer. There has also been a pledge to cut some money from the NHS IT programme. As Ministers are aware, I have been ferreting around, using parliamentary questions to try to get some answers, but the Government have never come clean about what contractual break clauses there are in NHS IT, or in some other contracts to do with the supply of swine flue vaccine, which I know my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State, looks forward to receiving in terms. It was important to make sure it is recognised that the Government have not pledged to support this policy with money from the centre, other than some proportion of it. They are also relying on the efficiency savings they simply announce can be made from local government—a full quarter of a billion pounds. Of course, I wish that the Government had taken the opportunity to look beyond the narrow confines of this particularly electorally inspired Bill, whose provenance was the Prime Minister's comments at the time of his Labour party conference last September. With the money resolution being as tight as it was, there was not the opportunity for them to undertake full and proper consideration, not least of our home protection scheme. We would have enjoyed having the opportunity to debate and propose that. However, that is how it is, and we recognise that it will be difficult to persuade this Government to do what we hope they will do, which is to bring together a number of us to try to find some way to deliver on the very legacy that the Secretary of State claims he is trying to secure. The Secretary of State says that he seeks some "unstoppable momentum for legislation" in this area. It is impossible to know now whether the Bill will complete all its stages, given that it must go through the upper House and that we have no idea when the general election, which must come before June, will be called. Thus we cannot be sure whether this Bill is "unstoppable" or whether it represents "momentum"—we are not even sure that it will be legislation. What we do know is that establishing unstoppable momentum requires a degree of consensus. If the Government genuinely wish to take that approach, I would be more than happy to be asked to participate in such a discussion, as I dare say those from other Opposition parties would. As the measure goes strongly against what the Government set out in their Green Paper, we have faced the difficulty of trying to understand how to place the Bill in the context of the wider reform that so many of us seek and know must be addressed—our political generation has no option but to do that. In our consideration of this Bill in the time available to us, we have faced particular difficulty in understanding the true evidence that lies behind it and the calculations of the costs. A lot of us, including many outside this place, have had desperate concerns about the thoroughness and robustness of the impact assessment, even when the Government have sought to reissue some of the numbers. None the less, we have tried to give the Bill reasonable scrutiny. Interestingly, the Bill may face its biggest difficulty when it goes to another place. The Government may well have a tougher time of it there, where they have some noble "Friends"—I assume that that word still applies—in Lord Warner and Lord Lipsey who have certainly, in comments to date, been squaring up for something of a fight on this. Lord Lipsey has called the Bill a "gimmick" and said that it is""bad policy but also a very bad way to do policy just to find a…highlight for your Labour Party conference speech."" Who knows, perhaps everything has changed in Lord Lipsey's mind after the apparently rousing call to arms by the "Mr. I'm a team player" Prime Minister at the parliamentary Labour party meeting last night—we will wait and see. In advance of what might be considered in the other place, what matters is that we have done our very best to try to unearth what truly lies behind this Bill and how it will in fact be made to work, given that it is proclaimed to service the needs of some—only some, not all—of the most vulnerable in our country. I am grateful not only to you, Mr. Deputy Speaker, and to all those who have assisted us in going through the process of scrutinising this Bill, but particularly to my many Conservative colleagues who have taken the opportunity to contribute to this extremely well-informed and responsibly discussed debate on an important matter.