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Personal Care at Home Bill

My Lords, I declare an interest as president of the Local Government Association—I here express support for amendments to the Bill that the LGA will be promoting but which time does not permit me to address now—as chair of the All-Party Parliamentary Group on Housing and Care for Older People and chair of the Hanover Housing Association, the country's largest provider of extra care housing for older people. At this stage of the Bill, I must confine my remarks to my specialist subject of housing. The Personal Care at Home Bill is predicated on the home being suitable for high-level care to be delivered there. Regrettably, the design and/or construction of many homes makes them quite unsuitable for those with the highest care needs. If you need help with washing, toileting, dressing and so forth, you are likely to need a home that is highly accessible. There must be no steps to the front door that become hazardous in icy weather and which are impossible for anyone with a Zimmer frame let alone a wheelchair, and no inadequate heating systems, poor insulation or huge fuel bills that can all render a property too cold or damp for a frailer occupier. Personal care at home is not a realistic proposition in a house with no downstairs bathroom where the recipient of care has to crawl or be carried upstairs. If the design or condition of the property makes it impossible for someone with care needs to stay there, a move to residential care can become an expensive and usually unpopular necessity, so entirely commendable efforts to support personal care at home must start with an assessment of whether the home in question rules that out as a practical proposition. Of course, the ideal may well be a move to a well designed, light, bright, fully accessible and adaptable, highly energy-efficient apartment with care available if and when it is needed. Such places are far more common on the European mainland, as I saw in the summer when visiting Sweden, Switzerland, the Netherlands, Denmark and Germany as chair of the governmental Housing our Ageing Population Panel for Innovation—HAPPI for short. We have some excellent examples in the UK, including high-quality extra-care apartments where personal care is on tap as required, and a few retirement villages that can also supply a range of health, fitness and social facilities. I am grateful to the noble Baroness, Lady Gardner, for speaking eloquently on the value of building excellent retirement housing for sale or rent thereby helping younger families by freeing up underoccupied housing. However, for the great majority of older people it will be by adapting their existing accommodation that personal care at home becomes feasible—such as adding a downstairs bathroom, putting in handrails and easy-to-turn taps, better heating, emergency call systems to summon help, stairlifts and so on. Because we know that the cost of adaptations in these cases can be repaid by savings to the NHS budget, switching more resources from health is well worth while. Andy Burnham, the Secretary of State for Health, talks rightly of joined-up thinking and integration of providers and provision of health and care, but the third leg to the stool, housing, must also be addressed. Of the £670 million rather loosely estimated as needed to fund the Bill’s measures, I note that £130 million is to be set aside for re-ablement, which is excellent work in helping people, including some of those leaving hospitals and residential care establishments, to live at home. I am told that the pot of funding incorporates something for home adaptations, including installing assistive technology with sensors to monitor those, for example, with early dementia. But I note that the calculation of £130 million is based on each of 130,000 recipients getting £1,000, equating to 30 hours of specialist home care. On the face of it, that leaves no room for any spending on the home itself and without any such spending there will be considerable difficulty in implementing the Bill. My plea, therefore, is for the third leg of the stool—housing as well as health and social care—to receive recognition in the Bill, with proper assessment of the suitability of the home as well as of the individual and with funding for home adaptations, perhaps switched from the health budget, where these are necessary. After all, it cannot be too much to expect the Bill to address housing concerns when it has the word "home" in its title.