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Personal Care at Home Bill

My Lords, I cannot match the fervour of the analysis of the Bill made by the noble Baroness, Lady Murphy, but I start by saying that it is doubly objectionable. It is objectionable in process and it is objectionable in substance. The issue of how long-term care is provided and financed has been controversial for more than a decade. The Department of Health, working with the rest of Whitehall, is to be commended on a substantial piece of work which was edging us towards a consensus in the country and across parties. A set of well considered options was laid before Parliament in July, with a consultation process which was due to end in November last year. At a time when the Government have been criticised for weakness in dealing with cross-departmental issues, the Green Paper was a model of its kind. It was signed by seven Secretaries of State, plus the Prime Minister. That must be a record. However, what then happened? Even before the consultation process had ended, one of the signatories, the Prime Minister, in a political forum—the party conference, not Parliament—repudiated the consensus, unilaterally striking out the new proposal, which cut across the options developed in the Green Paper. The Green Paper had rejected taxpayer funding but this Bill reintroduces it and confines it to one sector, and one sector only, of the care universe without regard to the rest. My noble friend Lord Butler and I have attended or written briefing for dozens of Cabinet meetings immediately before party conferences. They always contain a sermon from the Prime Minister or the Treasury about avoiding new announcements to conference which are not costed and collectively agreed. Rather than making us wait 20 years, I wonder whether the Minister will tell us whether this proposal went through that process. Not only is the option in the Bill ill considered—I will give an example of that shortly—it illustrates something that is going wrong with governmental processes. By chance, on Friday, this House’s Select Committee on the Constitution produced a report on the Cabinet Office and central government. One of its conclusions—you will find it in paragraph 97—was that the increase in the power of the Prime Minister had not been kept pace with by the accountability mechanisms on the Prime Minister. This is a perfect example. The Prime Minister has launched a proposal whose genesis was not in the lead department but from his coterie in No. 10. The responsibility for defending this has not rested with the Prime Minister, but has fallen, under our parliamentary system, to the Secretary of State in the Commons, and to the Minister in this House. The Secretary of State has been undermined, left trying to defend something not of his making and, to judge by his performance on the radio this morning, he was finding that difficult. The Bill is a classic Gordon Brown dividing line. It is not drawn on merits but has been chosen to set a trap for the Opposition, who either oppose it and are accused of being heartless, or accept it against their better judgment. Looking at the density of population on the Opposition Benches, they have obviously elected to sidestep this challenge, although that means that they are unable to enter into the substance of the debate. The proposal is equally objectionable on substance. Let me illustrate that from the experience of my family. It is an example which, I believe, has quite wide applicability. My mother-in-law, now 94, has lived on her own for more than 20 years. In recent years, she has been growing frailer, but was coping. Then, as is often the case, she suffered an illness which set her back. The family managed, however, with the help of the NHS and social services, to get her back into her own home, supported by a local care agency, paid for by her. That worked well for 18 months, until she had a fall and broke her arm. That so reduced her mobility that independent living, other than by provision in her home of 24-hour care, became impossible. That is the moment that all families dread, but there was no realistic alternative to her moving out of her home into a home. Happily, she is much better cared for, and she is living much closer to us. The point of that example is that, at the very moment that her care needs went up from, perhaps, 30 hours a week to 168 hours a week, her eligibility for financial support went down. That cannot make any sense. Crucially, it fails the test set out by the Minister when she said that those with the highest needs must receive the greatest help. It is that injustice, more than the issue of cost, which I find so objectionable. We are being asked to vote on a Bill whose details are still unclear and which has received perfunctory scrutiny in another place. It is often the case that a Bill is fleshed out by the details of regulation, but in this case, key principles, which should be in the Bill, are still missing. What is the basis of assessment? Is it the four ADLs—activities of daily living—which do not seem to include cooking, incidentally? What is the true duty of the social services department? Is it to provide care or merely to fund it? What does it cost? Is it all a cruel deception in which hopes are being raised way beyond our ability to deliver? The effect of the Bill is to pit people’s pockets against their better judgment. In many cases, increasing the care to extend living at home will be the right answer. Many others have correctly argued that. It was for us for a time, but for others, as the example I have given shows, there will come a time when it is no longer the right answer. A financial obstacle is being erected to prevent decisions being taken which are in the best interest of the elderly person. The Bill, in my view, is so badly constructed, so poorly costed and so weakly scrutinised that if, as is traditional, it receives a Second Reading, I hope that the House will subsequently not allow it to proceed until the unanswered questions are answered. We can then return to the better-thought-out proposals in the original Green Paper.