---

Personal Care at Home Bill

My Lords, I was a member of the Royal Commission on Long-Term Care for the Elderly, which reported in 1999, and with my noble friend Lord Lipsey, co-authored the minority report of that commission in which we opposed the case made by the majority for free personal care for all, financed from taxation. The opposition came from us despite our high regard for the chairman of the commission, the noble Lord, Lord Sutherland, and other members of the commission. While we were naturally attracted by the concept of free personal care for all who needed it, the rationale of our opposition was that, having regard to the constraints on government expenditure, all available funds should be spent on improving the quality and range of care of those who could not afford to pay for it rather than to provide free care for those who could afford it. I emphasise to the noble Baroness, Lady Campbell, that this opposition to the Bill has nothing to do with opposing free personal home care, but everything to do with the equitable allocation of available resources for all those who need such care. After the commission reported, the Government agreed with our minority approach and in a statement to the House on 2 July 2002, my noble friend Lord Hunt of Kings Heath, then Parliamentary Under-Secretary at the Department of Health, said in rejecting the recommendation of the majority of the commission on this view: ""We chose a different course because we believed that if we instituted free personal care, we should not produce a single extra service as a result but would benefit many better-off people".—[Official Report, 2/7/02; col. 122.]" That has been the policy of the Government for the past 10 years and it is difficult to understand why at this stage government policy is being changed. When in July last year the Government published for consultation their Green Paper Shaping the Future of Care Together, which was to be followed this year, after consultation, by a White Paper, it seemed that a carefully considered and appropriate process was being followed by the Government to determine future strategy and funding for such care, which in practice covers a wide-ranging, complex and interlocking set of issues. Against that background, the Bill before the House, which piecemeal addresses the single issue of funding free personal care at home for those who can afford to pay for it, cannot seriously be addressed without taking account of the funding for other interrelated parts of social care. The Green Paper considered in great detail the various funding options for social care, and until a government decision is made on which option is to be followed, it is irrational to decide on additional funding for extending free personal care. Indeed, if the funding option for care finally chosen by the Government is insurance, which is one of the three recommended options in the Green Paper, there will be no purpose whatever in having put in place the legislation proposed by the Bill, which seeks to make it free. The failure of the Bill to be set in the context of a holistic policy of social care will create inconsistency in an area where none exists at the moment, leading to a number of perverse incentives. Presently, people who can afford to pay for care are obliged to do so both for care at home and in care homes. Making home care free will create an incentive to demand such care even where it may not be in the best interests of the individual. Malcolm Johnson, Visiting Professor of Gerontology and End-of-Life Care at the University of Bath and Emeritus Professor of Health and Social Care at Bristol University, has worked on these issues for 35 years. His research concludes that for old and often sick people towards the end of their lives, going into a care home is often not the worst option. He points out that the majority of such people—some two-thirds—are women living alone. Their social networks will have been eroded, including by the death of contemporaries. They are unlikely to have family members living close enough or willing to visit daily. They may be blind, have lost their hearing, be incontinent singly or doubly, or have lost mobility. Frequently they will suffer from two or more of those disabilities. Public services typically offer these people little more than six hours of care a week, and nothing at weekends. For such people life is isolated, consisting of large chunks of time sitting around, perhaps in physical and often in mental discomfort, waiting for carers who may or may not turn up on time. One could reasonably conclude from this research that it would be in the interests of some elderly people to be provided with free care in care homes rather than free care at their homes. This issue needs to be considered as part of a coherent care policy. Other perverse incentives arise from the Government’s funding proposals. I will not dwell on the injection of significant additional funding by the Government at a time when their own funding is under such pressure, as so incisively analysed by the noble Lords, Lord Warner and Lord Lipsey. Rather I shall focus on the proposal partially to refund the cost by relying on efficiency savings from local authorities. Many cash-strapped local authorities will be unlikely to find these savings and will resort to perverse incentives such as diverting those with the highest need into means-tested residential care, increasing charges for non-personal care, or limiting free care to those with the most severe needs, thereby denying access to individuals with moderate or in some cases substantial care needs. Previous experience also suggests that some of these local authorities will seek to make cost savings by decreasing the fees they pay to independent care providers, which provide 80 per cent of care homes for patients. This in turn will impact adversely on their lower-paid workforces, where there is already an annual staff turnover of 24 per cent. This will adversely affect the quality of care that the elderly folk in these homes receive. For these and all the reasons raised by noble Lords who have already spoken, in particular in the eloquent address by the right reverend Prelate the Bishop of Norwich, it would damage the Government’s reputation for responsible legislation to proceed with a Bill on an issue that they put out for consultation before the conclusion of that consultation process and which fails to take account of their own overall policy on social care—yet to be determined. I urge the Government not to proceed with this Bill.