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Personal Care at Home Bill

My Lords, like the disability organisations with the main interest in this Bill, I welcome its intention to support severely disabled people to remain living in their own homes and the fact that it highlights the urgent need for a national care service that is fair and sustainable to be established. But, like other noble Lords, I have serious concerns about the perverse incentives contained in the Bill. These have been sufficiently rehearsed and I shall not repeat them. I will, however, cover much the same ground as that referred to by the noble Lord, Lord Best, in his excellent speech. I hope noble Lords will agree that it is worth re-emphasising. The Bill focuses our attention on providing better help for people with high support needs to be able to remain in their own homes. I greatly welcome that. However, what is notable is the absence of any reference to the adaptation of the home in which the person with high care needs is to be supported in order to live. In my view, any new arrangements to meet the cost of personal care at home must also integrate a system for fast, effective provision of home adaptations. That, at the moment, is sorely lacking in many parts of the country. My noble friend Lady Andrews did a great deal to rectify this situation during her time at the Department for Communities and Local Government with the excellent strategy report, Lifetime Homes, Lifetime Neighbourhoods. That work needs to be built on and fully integrated into the health and social care support available for disabled and older people. As Care & Repair England points out in its latest report, Time to Adapt, the issue which makes the greatest contribution to enabling independent living for disabled and elderly people for as long as possible, and reducing the cost of their care, is housing adaptations. Not surprisingly, making sure that someone can, for instance, get to and use a bathroom, to wash and go to the loo, is often pivotal in enabling people with high care needs to remain living at home. That is the purpose of the Bill. Adaptations impact directly on the cost of care because they enable the disabled person to do as much as possible for themselves and they make the giving of personal care much easier for paid staff and unpaid carers. It is in the interest of the best use of public finances, let alone in the interest of the dignity of the individual, that adaptations are fully integrated into the proposed system of free personal care. The research undertaken by the University of Bristol for the Office for Disability Issues in 2007, entitled Better Outcomes, Lower Costs, set out the evidence for this. It showed that timely adaptations and appropriate equipment can produce direct savings to the public purse in terms of the amount of home care required, hospital admissions and delays in discharge. Adaptations also directly lessen ill health among care givers; for instance, by reducing the numbers of strained backs from lifting. That report also showed how better outcomes for the individual can be achieved with the same level of expenditure. For example, if for the same amount of money a disabled person can have frequent visits by a carer to help them to use the loo and wash, or can have an automatic loo and level access shower to use whenever they please, the latter will, for the vast majority of people, be far preferable. In short, if free personal care is to be provided for those with the highest needs, then, in order to make best use of public funds and to ensure that the care at home is of the best possible standard for the individual, housing adaptations have to be an integral part of the assessment and provision that is made. The Government propose that this Bill is, ""the first step towards setting up a new National Care Service—a simple, fair and affordable care system for everyone"." This is laudable and in keeping with one of the most broadly welcomed proposals in the social care Green Paper—that of clearly defined, universal entitlement. If the Bill is the first step towards a national care service and a move away from the uncertainty of variable local provision, then steps also need to be taken to create an integrated, health and social care linked national adaptations service. The need for such a service was argued by Sue Adams of Care & Repair England at a recent meeting of the All-Party Group on Housing and Care for Older People, and I am indebted to her for her help. Currently, disabled and older people face a bewildering array of possible local systems when they need help with urgent home adaptations. While there is indeed a national legislative framework in place defining eligibility for help with adaptations through disabled facilities grants, the degree of flexibility for local housing authorities in the implementation of the framework results in highly variable local delivery. As the Audit Commission noted at the same all-party meeting, while there have been improvements in the provision of assistance with small items of equipment and minor adaptations, larger disabled facilities grant-funded adaptations systems are, in a significant number of authorities, simply not fit for purpose. Many disabled people have to wait years for adaptations help. The result is not only extra costs to health and social care, but suffering for individuals. Older and disabled people face the undignified situations of living, sleeping and eating in a single room with a commode in the corner and being strip washed in the kitchen. Carers are put at risk by having to carry people upstairs and lift them in and out of bed, when, for a few thousand pounds for a stair lift or hoist, their lives would be transformed. Changes to the disabled facilities grant system, announced in 2008 and phased in over 2008-10, offered local authorities even greater local flexibility. While this will result in improvements in some areas—the Foundations report, Adapting for a Lifetime, cites a number of positive examples—in other areas, DFG help will decline. The ending of the legal obligation to match government funding for DFG has already resulted in some local authorities reducing their DFG budgets. More are expected to do so in the next financial year, despite the very welcome increase in national grant. The adaptation help that a disabled person can expect will become determined by where they live. This is totally contrary to the aims of increasingly universal provision of personal care at home that this Bill heralds. While home adaptation is not currently in the Bill as drafted, the Bill could still provide the incentive for reform to remedy the current incoherent pattern of provision—a reform that is urgently needed. I hope that my noble friend the Minister will acknowledge the necessity that, in shaping the future of personal social care, the central role of home adaptations must be integrated into any new systems.