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Personal Care at Home Bill

My Lords, this Bill has given me much to think about, which is why I have added my name to the speakers list for today’s Second Reading debate. I had intended to listen to other speakers and welcome the wide variety of points that had been raised, but speaking so early in the debate I am not in a position to do that. It was helpful to meet the Minister and her team last week to discuss the Bill, but that left me with a number of concerns. I intend to present my own personal view, as I have had some relevant experience through local and regional government. I declare a personal interest in that my eldest daughter was diagnosed with multiple sclerosis 28 years ago, so she has a long-term disability. It is easy to welcome the concept of free personal care at home, and I do so without hesitation. Everyone is in favour of motherhood and apple pie, so who could oppose the idea behind this Bill? To take any other view would be opposing kindness and humanity. What concerns me is that this is being brought forward in an ill considered way and that the money will simply not be available to honour the promises of the Bill and the expectations that are being raised for the people who stand to benefit. The timing and speed of the Bill are also unfortunate. Bringing it forward at the last moment of this Government raises my suspicions that it is just electioneering. A long time ago, I was chairman of social services at Westminster City Council and I represented the Greater London Council on the Association of Metropolitan Authorities’ Social Services Committee. The relevance of the Social Services Committee, in particular, was that it coincided with the first disabled persons’ legislation, championed and introduced by Alf Morris MP, now a Member of your Lordships’ House. We were faced with suddenly having to find all the people who would qualify for help under the new Act. It was clearly impossible for us to achieve this 100 per cent at once, as we had neither the staff nor the means. As a first move, we set out to survey 10 per cent of our residents, and during this time many people previously not known to us came forward. It took years and a large part of our budget even to begin the process. It is no different now. Ensuring that those who need help are the people who get it is a perennial problem. Today, many of the people who would benefit from the Bill would be known to social services, but not all. Those meeting their own costs at present may have been assessed years ago and their cases will have been filed away after it was decided that they did not qualify for free care. It will be a time-consuming process to trace these records, which could be long out of date. The cost for local authorities simply of determining exactly who is to be covered under the Bill will be high. I do not underestimate the work involved and I am concerned that local authorities’ budgets are already hard-pressed. Sadly, I am concerned that those who stand to benefit from the Bill will be let down when their expectations are not met. Members of the House will have had briefings from many different groups which will be closely involved in implementing the law. They mostly seem to welcome the concept, as I do, but they all seem to raise different concerns. I shall quote some of them. Age Concern says: ""We are concerned whether local authorities will be able to achieve a further £250 million efficiency savings without any detriment to services for other people"." I heard on the radio today that it is believed that the cost will be double that estimate. The Royal College of Nursing seeks, ""assurances that this potentially temporary measure will not adversely impact on the plans for longer-term reform which all parties recognise is needed"." On funding, the royal college asks, ""which Department of Health budgets the contribution needed to fund the measures in the Bill will come from"," and adds that, ""there is still no clear indication where the remainder of the money needed will be found"." It asks: ""What will happen if local authorities, whose social care budgets are already under significant pressure, cannot find their share of the budget needed to deliver the Bill’s commitments?"." It also says: ""The RCN is particularly concerned about the possibility of unintended consequences caused by the proposed joint funding arrangements"." Again, I recall very clearly from both my social services and my health experience that joint funding was one of the most difficult things ever on which to get agreement. The Equal Opportunities Commission puts forward 27 points. I shall not go through them all but point 6 states: ""The Commission has some concerns about the practical issues that might arise"," and, ""It is difficult to see how local authorities could meet the cost of this measure from efficiency savings, without any detriment to social care services and other local services"." It is also concerned about reablement, regarding it as unfair that, ""making free personal care conditional on the take-up of a reablement package raise"—" I think it should be "raises", but I am quoting from its text, so I am using the word "raise"— ""serious inequity issues"." Reablement is clearly a new word, as whenever I put that word into my computer, it rejects it as incorrect. In its point 12, the Equal Opportunities Commission urges the Government to ensure that the forthcoming White Paper covers, ""how it will be properly funded"." I agree with its point 17, which states that, ""some fundamentally hard decisions need to be made to achieve long-term solutions, and they can only be made through debate and consensus"." That is what I think is essential: debate and consensus. Why this rush now after so many years of this Government? I am less happy about the EOC’s point 23. It wants to ensure that, ""persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement"." I agree that it should be on an equal basis with others, but what exactly does that mean? Most people do not have unlimited choice as to where they live, so perhaps that phrase does not mean too much. People are constrained in their choice, often by their personal income and, sometimes by access to work or other reasons. Many people like to stay where they are, where they are familiar with their surroundings or have happy memories. Some of those people are now living alone in large properties which are not really suited to their needs. In some cases, the properties cannot have the necessary adaptations made to make them practical for a person in need of personal care. In London, in particular, there is a desperate shortage of family-sized social housing, and many, particularly older people, continue to live in large properties with very high costs for heating and maintenance. I suppose we could consider such persons as the equivalent of "bed blockers" in National Health Service hospitals. It is not easy to face moving after decades in a property, but it must be in the local authority’s and the community’s interest to provide suitably sized units adapted for disabled living or personal care, and ideally with warden supervision. I believe that many people would be willing to move if such alternatives were available. That would free up some of those large homes for families who desperately need them. I have met a number of people who are delighted with how much easier living is when the accommodation is suited to their needs. For those living alone, it is very reassuring to have someone check daily that you are all right. In Australia, I saw a number of properties where an individual could buy a lifetime occupancy of one such property in a sheltered community, which was bought back by the charity or other owning body on the death of the occupant at an agreed value according to the number of years of occupancy. There was quite a waiting list for those homes. There were similar schemes for rental homes, but some people who have owned their home are very reluctant to go somewhere where they feel that they would lose that ownership. I thought that that scheme was a good one. To cite Carers UK, "" this is the first time that people who have savings or assets such as a house, will be entitled to free care from the state … at a cost of £670 million per year"." Carers UK has called for greater clarity about the expectations placed on carers, as it believes that in many cases the assessment process makes assumptions about carers' availability and willingness to provide care. It makes the point that, ""it is also important that local authorities do not now focus on personal care needs to the exclusion of the wider needs of the person receiving care and their family"." I frequently meet people whose family members are now in receipt of care. Although they appreciate the help that they are receiving, the often elderly person complains that their carer comes at six o'clock in the evening to help them get to bed. They really want to stay up until they have seen the 10 o'clock news, they have no wish to go to bed so early, but it is the only way to fit them into the crowded schedule of visits that the carer has each evening. A 24-hour service will be necessary to provide care to suit all receivers of care. If it is intended to help people to live in their homes in the way they wish to, and to satisfy the new extra demand, it will be necessary to have a large number of extra carers and nurses. How and when will these be trained? Who will meet these costs and how long will the training take? Carers UK asks, ""will the process of assessment ensure that all people who need assistance with personal care receive the value of this care—either paid through a direct payment or through the delivery of free care—even if the family currently provides this care, but needs assistance with other services"?." The issue of assessment processes is raised by many organisations in terms of time, reliability and regular updates. It seems that even cases currently receiving benefit will have to be reassessed. How will the Government help local authorities to limit the number of times reassessment will be required? There are so many questions that can be asked and so much need to go into these matters more thoroughly. I have quoted briefly from organisations that have sent me their comments and I am sure other speakers will pick up different points from those briefings. One day in the Commons has not been enough to consider the Bill properly. I hope your Lordships will ensure that it gets the full and careful consideration that is essential.