---

Personal Care at Home Bill

My Lords, I agree with every word the noble Lord, Lord Warner, has said—not surprisingly, since we have been working non-stop on this for several weeks now—and with his remarks about the right reverend Prelate the Bishop of Norwich, who hit the nail on the head. Not every piece of legislation that goes through this House is perfect but some pieces of legislation stand out because, by common consent, they prove disastrous. I am thinking of the Local Government Act 1988, which introduced the poll tax, and of the Dangerous Dogs Act. I could go on, but that would bring me into the term of office of the Government of which I have hitherto been a loyal supporter. However, as someone who has worked in and around these Houses for 38 years, I believe that this Bill will prove to be a contender for the worst of the lot. Bad legislation has certain characteristics. When first proposed, it sounds great. Behind it usually rests an overtly political purpose. It usually has the dogmatic backing of the Prime Minister of the day. It is usually subject to insufficient consideration in Government and rushed through Parliament. We legislate in haste; we repent at leisure. All these are characteristics of the Bill before us today. There was no policy process. Or rather, there was but it was usurped by the Prime Minister’s rabbit-from-a-hat trick at the Labour Party conference, which I was unfortunate enough to witness. There was no government consideration or any ministerial collective consideration worth the word. As the Government were consulting on the Green Paper on the subject—a very good Green paper produced by the Secretary of State, Mr Burnham—the Prime Minister announced as the Government’s firm policy one which directly contradicted that Green Paper. Then, after a few days during which Whitehall reeled in unparalleled confusion, this Bill was cobbled together with costings which have disintegrated under scrutiny and regulations which leave all the vital decisions to be taken without parliamentary scrutiny, not even the affirmative resolution procedure in the two Houses of Parliament. After Second Reading, the Bill was rushed through the Commons in a single day of perfunctory debate and now the Government want to rush it through the Lords. That brings me to the role of your Lordships’ House. We are rightly wary of challenging the will of the elected House but we are charged with a duty to ensure that legislation is well scrutinised and as fit for purpose as it can be made. This is particularly the case when a general election is pending and the temptations facing elected politicians are so very great. Our role is not necessarily to say no, but to give space for pause and reflection. If ever there was an area where cross-party consensus was desirable, it is long-term care. There is a parallel here with pensions, which for years were bedevilled by party conflict but have now fortunately been resolved in the wake of the Adair Turner commission. If people are to plan for their future, they need to know where they stand—not for today, not for tomorrow, but for decades to come. If some of the most vulnerable people in society are to be protected, there has to be clarity and consistency—not for today, not for tomorrow, but for decades ahead. I am sure I share a part of the blame for this, but progress towards such a consensus has been slow, dating back to the division in the royal commission, chaired by the noble Lord, Lord Sutherland, on which I and my noble friend Lord Joffe sat. Milestones along the way included the Wanless report in 2006 and, notably—I have said how much I support it—the Green Paper published by the Government. Hope was there; a route map to a consensus solution was there; but the Prime Minister chose at his party conference to tear it up. Everybody who knows anything about long-term care knows that it needs more money. The 2 per cent real increase in budgets being provided by the Government is not enough to cope with the ageing of the population, let alone to provide the better services that older people deserve—that goes just as much, if not more, for disabled people. If the Bill provided a decent sum of money—perhaps not £670 million—to improve care services, no one would cheer more loudly than me and its other critics. However, we are not getting more care; we are getting free care. As the Government’s own impact assessment for the Bill shows, that will benefit the wealthiest among older people and not the less wealthy. I shall say a word in supplement to what my noble friend Lord Warner said about Scotland, which has adopted an experiment in free personal care, including free personal care at home. I am aware that whenever I refer to this the noble Lord, Lord Sutherland of Houndwood, whom I greatly respect, rebukes me for getting it wrong, so, rather than quote myself, I shall quote two independent researchers, Margaret and Jim Cuthbert, members of the Public Interest Research Network at the University of Strathclyde, writing in Public Finance magazine. They confirm the figure given by my noble friend Lord Warner, showing that the cost in Scotland has doubled. They note a further fact about Scotland: that it is the cost of care at home that has gone through the roof, not the cost of care in residential homes. Taking account of the danger that, because of the Bill, people will choose to come out of residential homes and stay in their own homes, they expect that the cost in England will rise from £580 million in the first full year to £1.73 billion five years later. The cost will have trebled and it may treble again. There is no easy way to stop that cost exploding, this at a time of the most difficult fiscal retrenchment. The researchers refer to the unintended consequences in Scotland; namely, that those who get a little help with lighting the fire or getting groceries have had their services squeezed to pay for free care. Expenditure of this kind has fallen 24 per cent in the past two years despite the rising elderly population. I could go on. It is a fiasco for Scotland, which the Prime Minister’s Government now want to repeat for England. Can we please call a truce on saying that the Bill will be paid for through efficiency savings? Local government and central government have eye-watering efficiency savings to make already. If Ministers think that, every time they dream up a new policy which they think could win some support, they can wave a magic wand called "efficiency savings" and the money will come flowing into the Exchequer, and the money tree will blossom in the Department of Health, they are talking complete rubbish. This Bill, if we allow it to go through in its present form, will mean increases in taxation or cuts in services or both, and that at a time when we are already going to get increases in taxes or cuts in services or both to deal with the nation’s fiscal crisis. I ask the Government, if they have a shred of honesty left about them any more, to come clean about the cuts that will follow from this Bill and not pretend that, somehow or other, the money that Gordon Brown wants will drop from this tree in the Department of Health. Some noble Lords may say, "Yes, it is costly, but there is a price for fairness; these people near fair treatment", and, of course, I agree with that. I shall therefore outline for noble Lords the fairness encapsulated in the Bill. Councils will have to spend far more on care, so they will have to intensify what they are already doing: cutting back, as they have in Scotland, on the little bit of care that people need to stay fit and healthy in their own homes in favour of concentrating resources on those with the greatest care needs. Is that fair? Let us look at the people the Government are helping. There comes a time when people with the greatest care needs such as those with advanced dementia and so on reach a point where care at home is no longer an option, certainly not an affordable one when 24-hour care is required, and they need to go into a care home. On that day—and for many it is the saddest day of their lives—they will find that not only do they have to leave their home, they have to dig into their pockets to pay the full cost of the care they are moving into. Is that fair? What of families who find themselves torn between the desire to do the right thing by mum and the fact that if they do—by letting her go into a care home when she needs to—their inheritance is going to be blown away? Is that fair? What of local councils that want to respect the rights of people to remain in their homes wherever possible, but know that if they can get them to go into a care home, their care will be paid for by themselves as individuals and not by the council? Is that fair? What of the hard-pressed taxpayer who will have to pay for all this? Is that fair, when the money will go largely to benefit better-off old people in the last years of their lives? There may be arguments for this Bill, although I find it difficult to discern them, but fairness does not seem to me to be among them. I referred earlier to the fact that I have spent 38 years in and around the Houses of Parliament. For two of those years I had the great privilege of working as a lowly adviser to James Callaghan, whom many noble Lords will remember in this House, at No. 10. Many of your Lordships will also remember the winter of discontent, even if many outside this place have forgotten it, and the Government’s appalling poll ratings with an election coming near. The Government were facing a vote of no-confidence in the Commons. We advisers cobbled together a scheme whereby we could win that vote with the support of the Ulster Unionists—at a price. It was £80 million to provide a gas pipeline under the North Sea. Rather pleased with ourselves, we put it to Jim. His response—he put it bluntly so I will paraphrase—was that he was not going to do something contrary to the national interest in order to try to get his party out of a hole. I know what would have happened to any aide who had dared to suggest to Jim Callaghan that he should adopt the policy encapsulated in the Bill before the House today as his election loss leader.