2nd reading in the Lords
- Speaker
Baroness ThorntonLabour- Quote
- That the Bill be read a second time.
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- Speaker
- Baroness ThorntonLabour
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- My Lords, this is a small Bill with one substantive clause, but it will have great significance for thousands of the most vulnerable adults and older people. I want to start by considering who this Bill is intended to support. For those with the highest care needs, this Bill helps to end the lottery of personal care charges. It enables us to give them the peace of mind that their personal care will be provided free of charge, wherever they live. The Bill means that those who have been through a significant incident—an operation, a bereavement, an accident—will be encouraged to receive intensive support to prevent their needs deteriorating. It will enable them to be helped to remain healthy and independent, in their own homes if they wish, and to extend their quality of life and years of life. It is important to set out what the Bill does. Its substantive clause will amend the Community Care (Delayed Discharges etc.) Act 2003 so that the Secretary of State is enabled, by regulations, to require local authorities to provide personal care free of charge indefinitely to people with the highest care needs living at home. The criteria for defining those with highest care needs will be set out in regulations, with further detailed workings of the scheme to be placed in statutory guidance. These regulations are intended to come into force from October 2010. We have had and continue to have a wide-ranging discussion about the Bill. A consultation process is taking place. A wide range of stakeholders have joined the debate and added their support to the Bill, and are working with us on the best way to implement it. We issued a consultation document in November which outlined the principles of our proposals. This week we intend to make available a working draft of the regulations, as they might look when laid, based on these proposals. These will assist stakeholders in their understanding of the details of the scheme. The draft regulations are subject to further change in the light of the stakeholder responses as we continue with the consultation process until the end of February. The consultation will close on 23 February, at which point the Government will analyse and consider those responses. We expect the final regulations to be laid soon after Royal Assent. The NHS was created to end the unfairness that people with the greatest needs faced the highest costs, and that people who had the least were in danger of going without their needs being met at all. Today we all agree that this unfairness exists in social care. If you develop dementia—rather than cancer or heart disease—in old age, you are yet to find the freedom from fear that was promised by the NHS. Reform of care and support is the only fiscally responsible strategy. Failure to reform will lead to huge unmet need and pressure on public finances, within both the NHS and local government for years to come. We all know that the demographic pressures are rising. Year by year, more people will come into a care system which cannot fully cater for their needs. When the NHS was created there were eight working adults for every person retiring. Today there are four. By 2050 that figure will have fallen to just two. We can expect that by 2026 there will be 1.7 million more adults who need care and support. One in five of us will need care that costs less than £1,000 during retirement. One in five will need care that costs more than £50,000 and, in the worst cases, it could exceed £200,000. We cannot predict our risk, so it is hard to protect ourselves against it. The need for bold, far-reaching reform is undeniable. That is why we have proposed to create a national care service, but this is a major reform and, while it is essential, the earliest possible date that this can be implemented is 2014. The Bill will enable us to do something—the right thing—now: to give real help to some of those with the highest care needs, and to take steps towards a greater reform. These steps follow the progress that has already been made in recent years with respect to social care. The Bill will build on that progress to create an unstoppable momentum as we move towards the greater reform of social care that is so clearly needed. For those who point to the rising costs of free personal care in Scotland, I point out that the situation there is not comparable to what we are proposing here. The Bill is a step towards greater reform of social care, but is also targeted at helping only those with the highest care needs. The first aim of the Bill is immediate action for 280,000 people with the highest care needs, including those with dementia or Parkinson’s disease. Many of these people will already have been paying large amounts out of their own pockets for a number of years to fund the cost of their care. Currently, an estimated 80,000 older people in the highest need receive free personal care, but 40,000 pay part of their costs and 50,000 pay all their costs. Among younger adults, an estimated 90,000 receive free care, while 20,000 pay all or part of their own costs. The Bill will help to end this lottery and remove the enormous and unfair financial burden on these people and their families. Take the example of an 89 year-old woman from Lowton, near Warrington, with very high personal care needs as part of her overall care package. She has a number of visits during the day and one later in the evening, with a care worker attending all visits to ensure safe moving and handling. The overall cost of the care package is extensive. Under measures enabled by the Bill, her personal care—the greatest proportion of that care, estimated at 85 per cent of home community care costs—will be free of charge. Currently, charges for all personal care at home are potentially means-tested, whereby local councils can determine the amount that people have to pay, in accordance with national guidelines. Community care assessments are carried out to determine the level of a person’s needs, based on the criteria laid out in guidance. Despite this, levels of support and charging vary widely across the country. The Bill is about trying to create a fairer system by continuing to provide support that people may use flexibly to support them in the way they want. The Bill does not in itself contain any provisions related to direct payments because it does not need to. The existing legislation ensures that this flexibility of support can continue in relation to free personal care at home, if that is what people want. We want to ensure that support goes to people who need it most. Those facing the greatest burden are often those on middle incomes who have savings which will last just a year or two. While these people who are currently funding their own care have relatively high incomes for their age group, they are by no means among the most well off in society. Indeed, the main beneficiaries will be those on middle and below-middle incomes. Typically, the people who require personal care services are likely to be more than 75 years old, live alone and be generally in poorer health. This measure is not just compassionate but progressive and redistributive. The second feature of the Bill is to encourage reablement support to help another 130,000 people after a fall, when their health deteriorates, or following a period in hospital. Reablement may mean physiotherapy and personal support to help people learn how to perform daily tasks again after an illness or injury. This could, in some cases, mean using technology such as alarms or electric pill dispensers to improve safety. Often such measures have significant outcomes. In other cases, there could be adaptations to make a person’s home more suitable for them to live there comfortably. In some places this work is already going on and showing its worth. I give an example from the Wirral, where a lead on reablement is being taken. A 77 year-old woman had been dependent on carers for two years when she was admitted to hospital for aortic valve surgery. She had become used to doing very little for herself. She was sleeping downstairs, and used a bowl of water in the lounge and a commode to meet her personal care needs. On discharge, she received three visits a day from the home assessment and reablement team to help with her personal care. They helped her to practise using the stairs and encouraged her to undertake daily tasks such as opening the curtains, putting on the washing and making her own lunch. Over a six-week period, the visits gradually decreased and she is now living independently with no interventions from social services. That intensive support has absolutely paid its way. In this way, the Bill aims to enable people to retain their independence and reduce costs, with potentially beneficial effects on their health. The Bill will ensure support for people to remain economically active by enabling the provision of support and control which families and carers need to balance work and their caring role. As we know, it is the carers who are often the unsung heroes. As someone’s mobility and general health deteriorates, it is they who step in to offer greater and greater support. We want to build on the invaluable work on prevention and intervention that many councils have already begun to support people to live independently in the community. This is a vital part of these proposals. It must rely on sensible and effective partnership and decision-making between local authorities, by people who need care services and with their care partners. The solutions must be dignified and not imposed insensitively. The research indicates that investment in interventions across the partnerships for older people pilot programme has produced an average £1.22 saving in emergency bed days for every £1 spent. These projected efficiency gains are on top of the £1 of additional service benefit from addressing older people’s presenting needs. By extending a hand to those with lower-level needs, we can help to reduce isolation and keep people active and, by doing so, we can prevent people slipping to the point where more intensive care and support is required. This will reduce the costs of care for individuals, including those who continue to fund their own care. It will help people to avoid hospital admissions—and, perhaps, a premature move to residential care—and to stay independent and well in their own homes. I turn to funding. There has been a great deal of speculation and misinformation about this Bill, particularly on funding. I should like to take this opportunity to explain our approach. We estimate that the measures will cost £670 million in the first full year, £240 million of which will be provided from the Department of Health’s central budget—not from the NHS—and the rest by local government efficiencies. We know, as many of your Lordships will, that the Association of Directors of Adult Social Services, or ADASS, has some concerns about that overall figure and has recently conducted a survey. The response that it received was from fewer than half of its members. We continue to have confidence in our estimated figures; perhaps I might set out why. First, our figures were the result of independent analysis undertaken by the Personal Social Services Research Unit at the London School of Economics. To reach those estimates, detailed modelling was undertaken across the population to try and estimate those people who are currently not receiving services. We have always been clear that it is an estimate and that, naturally, there have to be some inherent uncertainties with that. Indeed, in some areas there may be less of a cost impact than we are estimating; in other words, we have erred on the side of caution. For example, the ADASS survey shows that estimated hourly costs of care are lower than those that we have used. We also believe that there will be some reduced demand as a result of the reablement services that we are putting in place. Along with the scope for further efficiency gains, this will be considered as part of the normal spending review process. It is right that councils should play their part alongside central government to help deliver this commitment to free personal care, and they have been widely involved in the consultation and stakeholder events which have so far accompanied the Bill. I reiterate the point made by my right honourable friend the Secretary of State for Health in another place: it is completely incorrect to say that any of that money is coming from cutting disability benefits, nor is it coming from the cancer research budget. I should like to put that scaremongering to bed right now. The Bill is about putting more money into the social care system now. The funding is much needed, prudent and targeted at those with the highest care needs, helping them to live at home for longer, which is where the great majority of them tell us that they want to be.
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- Speaker
Earl HoweConservative- Quote
- I am sorry to interrupt the noble Baroness, but I may have misheard her. Could she clarify what she said about the central government contribution in the first full year? I think that she said it was £240 million and that she meant £420 million.
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- Speaker
- Baroness ThorntonLabour
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- The noble Earl is right; it is £420 million. I spoke that figure back to front, and £420 million will be provided from the Department of Health. The Bill recognises that those with the greatest needs cannot wait. This Bill is not the whole answer, but it is a bold first step and I commend it to the House.
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Baroness Gardner of ParkesConservative- Quote
- My Lords, this Bill has given me much to think about, which is why I have added my name to the speakers list for today’s Second Reading debate. I had intended to listen to other speakers and welcome the wide variety of points that had been raised, but speaking so early in the debate I am not in a position to do that. It was helpful to meet the Minister and her team last week to discuss the Bill, but that left me with a number of concerns. I intend to present my own personal view, as I have had some relevant experience through local and regional government. I declare a personal interest in that my eldest daughter was diagnosed with multiple sclerosis 28 years ago, so she has a long-term disability. It is easy to welcome the concept of free personal care at home, and I do so without hesitation. Everyone is in favour of motherhood and apple pie, so who could oppose the idea behind this Bill? To take any other view would be opposing kindness and humanity. What concerns me is that this is being brought forward in an ill considered way and that the money will simply not be available to honour the promises of the Bill and the expectations that are being raised for the people who stand to benefit. The timing and speed of the Bill are also unfortunate. Bringing it forward at the last moment of this Government raises my suspicions that it is just electioneering. A long time ago, I was chairman of social services at Westminster City Council and I represented the Greater London Council on the Association of Metropolitan Authorities’ Social Services Committee. The relevance of the Social Services Committee, in particular, was that it coincided with the first disabled persons’ legislation, championed and introduced by Alf Morris MP, now a Member of your Lordships’ House. We were faced with suddenly having to find all the people who would qualify for help under the new Act. It was clearly impossible for us to achieve this 100 per cent at once, as we had neither the staff nor the means. As a first move, we set out to survey 10 per cent of our residents, and during this time many people previously not known to us came forward. It took years and a large part of our budget even to begin the process. It is no different now. Ensuring that those who need help are the people who get it is a perennial problem. Today, many of the people who would benefit from the Bill would be known to social services, but not all. Those meeting their own costs at present may have been assessed years ago and their cases will have been filed away after it was decided that they did not qualify for free care. It will be a time-consuming process to trace these records, which could be long out of date. The cost for local authorities simply of determining exactly who is to be covered under the Bill will be high. I do not underestimate the work involved and I am concerned that local authorities’ budgets are already hard-pressed. Sadly, I am concerned that those who stand to benefit from the Bill will be let down when their expectations are not met. Members of the House will have had briefings from many different groups which will be closely involved in implementing the law. They mostly seem to welcome the concept, as I do, but they all seem to raise different concerns. I shall quote some of them. Age Concern says: “We are concerned whether local authorities will be able to achieve a further £250 million efficiency savings without any detriment to services for other people”. I heard on the radio today that it is believed that the cost will be double that estimate. The Royal College of Nursing seeks, “assurances that this potentially temporary measure will not adversely impact on the plans for longer-term reform which all parties recognise is needed”. On funding, the royal college asks, “which Department of Health budgets the contribution needed to fund the measures in the Bill will come from”, and adds that, “there is still no clear indication where the remainder of the money needed will be found”. It asks: “What will happen if local authorities, whose social care budgets are already under significant pressure, cannot find their share of the budget needed to deliver the Bill’s commitments?”. It also says: “The RCN is particularly concerned about the possibility of unintended consequences caused by the proposed joint funding arrangements”. Again, I recall very clearly from both my social services and my health experience that joint funding was one of the most difficult things ever on which to get agreement. The Equal Opportunities Commission puts forward 27 points. I shall not go through them all but point 6 states: “The Commission has some concerns about the practical issues that might arise”, and, “It is difficult to see how local authorities could meet the cost of this measure from efficiency savings, without any detriment to social care services and other local services”. It is also concerned about reablement, regarding it as unfair that, “making free personal care conditional on the take-up of a reablement package raise”— I think it should be “raises”, but I am quoting from its text, so I am using the word “raise”— “serious inequity issues”. Reablement is clearly a new word, as whenever I put that word into my computer, it rejects it as incorrect. In its point 12, the Equal Opportunities Commission urges the Government to ensure that the forthcoming White Paper covers, “how it will be properly funded”. I agree with its point 17, which states that, “some fundamentally hard decisions need to be made to achieve long-term solutions, and they can only be made through debate and consensus”. That is what I think is essential: debate and consensus. Why this rush now after so many years of this Government? I am less happy about the EOC’s point 23. It wants to ensure that, “persons with disabilities have the opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement”. I agree that it should be on an equal basis with others, but what exactly does that mean? Most people do not have unlimited choice as to where they live, so perhaps that phrase does not mean too much. People are constrained in their choice, often by their personal income and, sometimes by access to work or other reasons. Many people like to stay where they are, where they are familiar with their surroundings or have happy memories. Some of those people are now living alone in large properties which are not really suited to their needs. In some cases, the properties cannot have the necessary adaptations made to make them practical for a person in need of personal care. In London, in particular, there is a desperate shortage of family-sized social housing, and many, particularly older people, continue to live in large properties with very high costs for heating and maintenance. I suppose we could consider such persons as the equivalent of “bed blockers” in National Health Service hospitals. It is not easy to face moving after decades in a property, but it must be in the local authority’s and the community’s interest to provide suitably sized units adapted for disabled living or personal care, and ideally with warden supervision. I believe that many people would be willing to move if such alternatives were available. That would free up some of those large homes for families who desperately need them. I have met a number of people who are delighted with how much easier living is when the accommodation is suited to their needs. For those living alone, it is very reassuring to have someone check daily that you are all right. In Australia, I saw a number of properties where an individual could buy a lifetime occupancy of one such property in a sheltered community, which was bought back by the charity or other owning body on the death of the occupant at an agreed value according to the number of years of occupancy. There was quite a waiting list for those homes. There were similar schemes for rental homes, but some people who have owned their home are very reluctant to go somewhere where they feel that they would lose that ownership. I thought that that scheme was a good one. To cite Carers UK, “ this is the first time that people who have savings or assets such as a house, will be entitled to free care from the state … at a cost of £670 million per year”. Carers UK has called for greater clarity about the expectations placed on carers, as it believes that in many cases the assessment process makes assumptions about carers' availability and willingness to provide care. It makes the point that, “it is also important that local authorities do not now focus on personal care needs to the exclusion of the wider needs of the person receiving care and their family”. I frequently meet people whose family members are now in receipt of care. Although they appreciate the help that they are receiving, the often elderly person complains that their carer comes at six o'clock in the evening to help them get to bed. They really want to stay up until they have seen the 10 o'clock news, they have no wish to go to bed so early, but it is the only way to fit them into the crowded schedule of visits that the carer has each evening. A 24-hour service will be necessary to provide care to suit all receivers of care. If it is intended to help people to live in their homes in the way they wish to, and to satisfy the new extra demand, it will be necessary to have a large number of extra carers and nurses. How and when will these be trained? Who will meet these costs and how long will the training take? Carers UK asks, “will the process of assessment ensure that all people who need assistance with personal care receive the value of this care—either paid through a direct payment or through the delivery of free care—even if the family currently provides this care, but needs assistance with other services?”. The issue of assessment processes is raised by many organisations in terms of time, reliability and regular updates. It seems that even cases currently receiving benefit will have to be reassessed. How will the Government help local authorities to limit the number of times reassessment will be required? There are so many questions that can be asked and so much need to go into these matters more thoroughly. I have quoted briefly from organisations that have sent me their comments and I am sure other speakers will pick up different points from those briefings. One day in the Commons has not been enough to consider the Bill properly. I hope your Lordships will ensure that it gets the full and careful consideration that is essential.
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- 15:24
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Baroness Campbell of SurbitonCrossbench- Quote
- My Lords, I am pleased to contribute to the debate on this short but extremely significant Bill. Free personal care at home: who in their right mind would not support this fundamental principle? Indeed, free personal care at the point of delivery has been at the heart of independent living campaigns for more than 30 years. I declare a personal interest: without state-funded personal care support I certainly would not be here with you today. Moreover, I could potentially benefit from the Bill’s provisions directly—and, boy, I could do with the cash that I currently hand over in charges, which are massive. However, it is not about me today. For me, personal care is not only about getting up in the morning and going to bed at night; it is about my basic human right to live with dignity and equality among my peers—and even my noble Peers. Thousands of people require intense personal care to stay alive, in exactly the same way as they need healthcare. For people like us they are both equally vital to existence. When I am being put on my ventilator or assisted when I am choking, I do not consider whether it is a health or personal care need; it is just essential human support for me. I have never understood why one is free and the other is charged for; after all, we have no choice to say, “No thanks, I’ll manage without”. Often, to be severely disabled is to be poor, as we are expected to pay for the privilege of doing all the things that most people never even think about—eating, popping to the loo, scratching your nose and even breathing. Does any other noble Lord consider those acts every day? I do, probably about 10 or 12 times a day. We should welcome the principle in the Bill before we begin to criticise it because it is good and it is right. What else should we welcome—beyond, of course, the attractive free element? I am still thinking about what I might spend the extra cash on. The Bill demonstrates the Government’s commitment to enabling people with high support needs to stay in their own homes. It is hard enough dealing with advanced motor neurone disease or Alzheimer’s without having to leave the familiar surroundings of your own home and to move to a new and strange environment to get the care you need. Another reason I welcome the Bill is that it will make it easier for the NHS and local authorities to work together. Again, that line between health and social care really does not exist. Partnership working between health and local authorities has been a policy objective for many years under Governments of both persuasions, but means-testing for social care has remained the elephant in the room. It is an obstacle to joint provision and integrated working. For the group covered by this Bill, this barrier can begin to be removed and that is to be welcomed. Nevertheless, partnership has to involve a third party. May I ask the Minister what guidance or regulations will be put in place to make sure that such an integrated assessment will include service users? There is a strong history of user involvement, choice and control in social care assessments which has yet to take off in healthcare. I will now move on to a few concerns. From my reading of the Bill’s intent, people with critical levels of need will be divided into two groups: the critical and the critical-plus. I am still deciding what group I am in. Perhaps noble Lords might advise me. The second group will receive free care. The other may be charged for similar levels of support. There is great potential for discrimination to occur here between almost identical groups. Will the Minister seek advice from the Equality and Human Rights Commission on whether this approach contains an element of discrimination? As former chair of the Social Care Institute for Excellence and co-founder of the National Centre for Independent Living, I am also concerned that part of the assessment for free personal care will depend on how many activities of daily life you cannot manage without help. The institute and the national centre have been major supporters of the Government’s policies for independence and personalisation. They focus on the things disabled and older people can do and encourage them to be as independent as possible. This Bill, I am afraid, puts a financial premium on proving how incapable you are. I call this the “deficit model” because it creates perverse incentives to present as more dependent in order to be eligible for rationed services. I am now going to hand over to the noble Lord, Lord Wright, as agreed by the usual channels. At this point, Lord Wright of Richmond continued the speech for Baroness Campbell of Surbiton. Last year when I was a commissioner at the EHRC, I helped draft its policy statement on social care. We called it From Safety Net to Springboard and argued that the deficit model of assessment should be abandoned and replaced by one which promoted independence and autonomy for everyone in the caring relationship. We proposed assessments for support, which meant that carers and disabled people were no longer caught in a social-care safety net of dependency, but instead given support which promoted active citizenship, like working, volunteering, interacting socially, and so on. I do not think the springboard formula is reflected in this Bill. However, the Minister may say that the Government have anticipated the problem and plan to offer people with the highest levels of need a period of reablement before assessing their eligibility for free care. This may help them regain abilities that they have lost, but the formula would take them out of the group who would qualify for free care. What evidence do the Government have that shows that reablement works in these circumstances? If you fail to reable enough, would you have to repeat the programme? Would reablement monitors be appointed to make sure that the people with the highest levels of need were trying hard enough to regain their lost abilities? Perhaps the Minister could clear the fog on this one. Most people with progressive conditions such as motor neurone disease or my own condition are going only one way. Are we to be seen as reablement failures? I have one final question for the Minister before ending—some may call it my hobby-horse. The Government say that there will be a standardised assessment tool to assess eligibility for the new entitlement. Should I assume from this that the care package will be fully portable, following the recipient wherever they decide to live? I welcome some of the fundamental principles behind the Bill, but, for now, it throws up more questions than answers.
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- 15:36
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The Lord Bishop of NorwichBishops- Quote
- My Lords, we must be the first generation in human history in which a substantial number of people retire and then find themselves fully occupied both babysitting grandchildren and looking after even older parents. Last week, a man who is now 70 and well retired talked with me about the care of his mother in her late 90s, who was still in her own home and who valued her independence, but whose needs he was anxious about his own capacity to meet. There is a good side to this, of course, since those with no one to care for do not always feel liberated as a result, but caring for those in the greatest need can, as we all know, be emotionally, physically and spiritually exhausting. Yet people do it, frequently out of love and loyalty even more than duty. Those with advanced dementia or Alzheimer's, Parkinson's or motor neurone disease often become needier very gradually. That seems to be why their carers often do not receive the right degree of support; they often simply do more gradually. Then they find it impossible and the person being cared for has to give up the simple but effective therapy which comes from being at home. The distressing final year of my father's life might have been ameliorated if this Bill had been in place. I therefore welcome it, although not simply through personal experience. The moral status of any society must be judged by the way in which it treats its weakest and most vulnerable members. In ancient Israel, the care given to widows and orphans was unusual, but was derived from a belief that every human being was made in the image and likeness of God. In our own age, it is the way in which we care for those least able to help themselves, so that they can have some quality of life, which is the test of our common humanity. The people who care for those in greatest need must have some quality of life as well. Who could dissent from the direction of travel of this Bill? The moving testimony of the noble Baroness, Lady Campbell of Surbiton, illustrated why it would be cruel to those and their carers whose hopes have been raised by the publication of the Bill to reject its provisions. Why then can I raise only two cheers for the Bill? I think that it is because someone with a single, exaggerated virtue in their personality often seems lop-sided; and there is definitely something lop-sided about the Bill. Others will be able to judge much better than me whether the financial estimates add up or the efficiency savings are achievable without harming some other group of vulnerable individuals. Even if we get a more precise definition from the Government about the qualifying criteria for assistance and how those needing significant help are defined, there can still be perverse consequences arising from this Bill’s exaggerated virtue. It is a virtue to encourage people to remain living at home and to receive personal care in that environment. It is what most people want and what I would want. They often want it because it enables them to remain living with spouses or other close relatives. Receiving the cost of such care is not simply a financial blessing. It can be a strong incentive, perhaps even an inducement, to receive care at home. Faced with the choice between receiving free personal care at home or having to pay for such services somewhere else, who would not opt for the former? In those cases where carers, often close relatives, may really have to make that choice, what assurances are there that the most appropriate care setting will be provided for these vulnerable people? Remaining at home may not be the best setting for some people, but would it be right if leaving home would incur a financial penalty? That penalty might even be felt in the future by those who would benefit from the estate. It is appropriate to indicate from these Benches the perverse effect of human sin on virtuous aspirations. The proposed measures in this Bill could lead to a two-tier system in funding arrangements. I assume that the Government have concluded that universal funding is simply too expensive, and that would be understandable given the current experience in Scotland. It also seems that finding a suitable mechanism to manage both personal care at home and support for those in residential homes is simply too complex to offer at the present time. But in choosing to promote the real interests of a significant group of people, the needs of others may be left unaddressed. The Government have promoted this Bill as a first step towards a national care service, but it is not at all clear on what basis this has been chosen as that first step. Why exaggerate this virtue? Why not wait until other complementary steps can be put in place? The big care debate has scarcely been concluded. The valuable and varied contributions of its many respondents cannot surely have been adequately evaluated, so why such haste in bringing forward this one proposal? Issues of fair funding and the universal provision of services are immensely complex, as the outcome of the Royal Commission on long-term care demonstrated over 10 years ago. I fear that there will be a plethora of exaggerated virtues on display in the run-up to the next general election, and that is why I shall be supporting the amendment to the committal Motion in the name of the noble Lord, Lord Warner. In relation to the Bill, the task of this House must surely be to shape this legislation so that it does not have unforeseen and undesirable consequences, and so to assist in the valuable formation of a national care service with truly balanced virtues.
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- 15:46
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