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Personal Care at Home Bill

My Lords, this is a small Bill with one substantive clause, but it will have great significance for thousands of the most vulnerable adults and older people. I want to start by considering who this Bill is intended to support. For those with the highest care needs, this Bill helps to end the lottery of personal care charges. It enables us to give them the peace of mind that their personal care will be provided free of charge, wherever they live. The Bill means that those who have been through a significant incident—an operation, a bereavement, an accident—will be encouraged to receive intensive support to prevent their needs deteriorating. It will enable them to be helped to remain healthy and independent, in their own homes if they wish, and to extend their quality of life and years of life. It is important to set out what the Bill does. Its substantive clause will amend the Community Care (Delayed Discharges etc.) Act 2003 so that the Secretary of State is enabled, by regulations, to require local authorities to provide personal care free of charge indefinitely to people with the highest care needs living at home. The criteria for defining those with highest care needs will be set out in regulations, with further detailed workings of the scheme to be placed in statutory guidance. These regulations are intended to come into force from October 2010. We have had and continue to have a wide-ranging discussion about the Bill. A consultation process is taking place. A wide range of stakeholders have joined the debate and added their support to the Bill, and are working with us on the best way to implement it. We issued a consultation document in November which outlined the principles of our proposals. This week we intend to make available a working draft of the regulations, as they might look when laid, based on these proposals. These will assist stakeholders in their understanding of the details of the scheme. The draft regulations are subject to further change in the light of the stakeholder responses as we continue with the consultation process until the end of February. The consultation will close on 23 February, at which point the Government will analyse and consider those responses. We expect the final regulations to be laid soon after Royal Assent. The NHS was created to end the unfairness that people with the greatest needs faced the highest costs, and that people who had the least were in danger of going without their needs being met at all. Today we all agree that this unfairness exists in social care. If you develop dementia—rather than cancer or heart disease—in old age, you are yet to find the freedom from fear that was promised by the NHS. Reform of care and support is the only fiscally responsible strategy. Failure to reform will lead to huge unmet need and pressure on public finances, within both the NHS and local government for years to come. We all know that the demographic pressures are rising. Year by year, more people will come into a care system which cannot fully cater for their needs. When the NHS was created there were eight working adults for every person retiring. Today there are four. By 2050 that figure will have fallen to just two. We can expect that by 2026 there will be 1.7 million more adults who need care and support. One in five of us will need care that costs less than £1,000 during retirement. One in five will need care that costs more than £50,000 and, in the worst cases, it could exceed £200,000. We cannot predict our risk, so it is hard to protect ourselves against it. The need for bold, far-reaching reform is undeniable. That is why we have proposed to create a national care service, but this is a major reform and, while it is essential, the earliest possible date that this can be implemented is 2014. The Bill will enable us to do something—the right thing—now: to give real help to some of those with the highest care needs, and to take steps towards a greater reform. These steps follow the progress that has already been made in recent years with respect to social care. The Bill will build on that progress to create an unstoppable momentum as we move towards the greater reform of social care that is so clearly needed. For those who point to the rising costs of free personal care in Scotland, I point out that the situation there is not comparable to what we are proposing here. The Bill is a step towards greater reform of social care, but is also targeted at helping only those with the highest care needs. The first aim of the Bill is immediate action for 280,000 people with the highest care needs, including those with dementia or Parkinson’s disease. Many of these people will already have been paying large amounts out of their own pockets for a number of years to fund the cost of their care. Currently, an estimated 80,000 older people in the highest need receive free personal care, but 40,000 pay part of their costs and 50,000 pay all their costs. Among younger adults, an estimated 90,000 receive free care, while 20,000 pay all or part of their own costs. The Bill will help to end this lottery and remove the enormous and unfair financial burden on these people and their families. Take the example of an 89 year-old woman from Lowton, near Warrington, with very high personal care needs as part of her overall care package. She has a number of visits during the day and one later in the evening, with a care worker attending all visits to ensure safe moving and handling. The overall cost of the care package is extensive. Under measures enabled by the Bill, her personal care—the greatest proportion of that care, estimated at 85 per cent of home community care costs—will be free of charge. Currently, charges for all personal care at home are potentially means-tested, whereby local councils can determine the amount that people have to pay, in accordance with national guidelines. Community care assessments are carried out to determine the level of a person’s needs, based on the criteria laid out in guidance. Despite this, levels of support and charging vary widely across the country. The Bill is about trying to create a fairer system by continuing to provide support that people may use flexibly to support them in the way they want. The Bill does not in itself contain any provisions related to direct payments because it does not need to. The existing legislation ensures that this flexibility of support can continue in relation to free personal care at home, if that is what people want. We want to ensure that support goes to people who need it most. Those facing the greatest burden are often those on middle incomes who have savings which will last just a year or two. While these people who are currently funding their own care have relatively high incomes for their age group, they are by no means among the most well off in society. Indeed, the main beneficiaries will be those on middle and below-middle incomes. Typically, the people who require personal care services are likely to be more than 75 years old, live alone and be generally in poorer health. This measure is not just compassionate but progressive and redistributive. The second feature of the Bill is to encourage reablement support to help another 130,000 people after a fall, when their health deteriorates, or following a period in hospital. Reablement may mean physiotherapy and personal support to help people learn how to perform daily tasks again after an illness or injury. This could, in some cases, mean using technology such as alarms or electric pill dispensers to improve safety. Often such measures have significant outcomes. In other cases, there could be adaptations to make a person’s home more suitable for them to live there comfortably. In some places this work is already going on and showing its worth. I give an example from the Wirral, where a lead on reablement is being taken. A 77 year-old woman had been dependent on carers for two years when she was admitted to hospital for aortic valve surgery. She had become used to doing very little for herself. She was sleeping downstairs, and used a bowl of water in the lounge and a commode to meet her personal care needs. On discharge, she received three visits a day from the home assessment and reablement team to help with her personal care. They helped her to practice using the stairs and encouraged her to undertake daily tasks such as opening the curtains, putting on the washing and making her own lunch. Over a six-week period, the visits gradually decreased and she is now living independently with no interventions from social services. That intensive support has absolutely paid its way. In this way, the Bill aims to enable people to retain their independence and reduce costs, with potentially beneficial effects on their health. The Bill will ensure support for people to remain economically active by enabling the provision of support and control which families and carers need to balance work and their caring role. As we know, it is the carers who are often the unsung heroes. As someone’s mobility and general health deteriorates, it is they who step in to offer greater and greater support. We want to build on the invaluable work on prevention and intervention that many councils have already begun to support people to live independently in the community. This is a vital part of these proposals. It must rely on sensible and effective partnership and decision-making between local authorities, by people who need care services and with their care partners. The solutions must be dignified and not imposed insensitively. The research indicates that investment in interventions across the partnerships for older people pilot programme has produced an average £1.22 saving in emergency bed days for every £1 spent. These projected efficiency gains are on top of the £1 of additional service benefit from addressing older people’s presenting needs. By extending a hand to those with lower-level needs, we can help to reduce isolation and keep people active and, by doing so, we can prevent people slipping to the point where more intensive care and support is required. This will reduce the costs of care for individuals, including those who continue to fund their own care. It will help people to avoid hospital admissions—and, perhaps, a premature move to residential care—and to stay independent and well in their own homes. I turn to funding. There has been a great deal of speculation and misinformation about this Bill, particularly on funding. I should like to take this opportunity to explain our approach. We estimate that the measures will cost £670 million in the first full year, £240 million of which will be provided from the Department of Health’s central budget—not from the NHS—and the rest by local government efficiencies. We know, as many of your Lordships will, that the Association of Directors of Adult Social Services, or ADASS, has some concerns about that overall figure and has recently conducted a survey. The response that it received was from fewer than half of its members. We continue to have confidence in our estimated figures; perhaps I might set out why. First, our figures were the result of independent analysis undertaken by the Personal Social Services Research Unit at the London School of Economics. To reach those estimates, detailed modelling was undertaken across the population to try and estimate those people who are currently not receiving services. We have always been clear that it is an estimate and that, naturally, there have to be some inherent uncertainties with that. Indeed, in some areas there may be less of a cost impact than we are estimating; in other words, we have erred on the side of caution. For example, the ADASS survey shows that estimated hourly costs of care are lower than those that we have used. We also believe that there will be some reduced demand as a result of the reablement services that we are putting in place. Along with the scope for further efficiency gains, this will be considered as part of the normal spending review process. It is right that councils should play their part alongside central government to help deliver this commitment to free personal care, and they have been widely involved in the consultation and stakeholder events which have so far accompanied the Bill. I reiterate the point made by my right honourable friend the Secretary of State for Health in another place: it is completely incorrect to say that any of that money is coming from cutting disability benefits, nor is it coming from the cancer research budget. I should like to put that scaremongering to bed right now. The Bill is about putting more money into the social care system now. The funding is much needed, prudent and targeted at those with the highest care needs, helping them to live at home for longer, which is where the great majority of them tell us that they want to be.