Committee stage in the Lords
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Earl HoweConservative- Quote
- I shall speak also to Amendments 12, 31, 35 and 43. We come to an issue which I personally find extremely troubling and difficult. That is the impact which this Bill and its regulations will have on those people who, by any criteria, have care needs that are of the most acute kind, but who nevertheless will be deemed ineligible for free personal care under the proposed assessment criteria. I refer specifically to people who are deafblind. Deafblindness much surely be one of the most isolating and burdensome of disabilities, but it is important to understand that the kind of care which deafblind people typically need is quite different from the care usually given to a frail, elderly person. Deafblind people are often able to wash and dress and feed themselves, but without support in communication and mobility, many of them are effectively condemned to a life of solitary imprisonment in their own homes. It can be impossible for them to have access to food or basic information, and they are prevented from interacting with other people. Taking exercise, going out to the shops, visiting the doctor, dealing with household bills—all those things which we take for granted—are out of reach without physical help. Indeed, deafblind people are at extreme risk of having to go into residential care if their care needs are not addressed—exactly the imperative which has motivated the Government to bring forward this Bill. Yet this Bill will be of no use to those suffering from deafblindness, despite the fact that under the current FACS guidance, deafblind people are frequently assessed as having a critical need under the category that relates to involvement in family and wider community life. The Bill in its current form will undermine FACS guidance because it prioritises the provision of personal care over other types of care, such as communications support—the one form of help above all others that gives deafblind people a lifeline to the wider world. As such, the Bill appears discriminatory. Sense, the voluntary sector organisation which champions the interests of deafblind people, has submitted a paper to the Joint Committee on Human Rights in which it argues that the Bill violates the Human Rights Act. In particular, it says that a failure to provide adequate social care for deafblind people can result in a breach of Articles 3, 5 and 8 as well as Article 1, Protocol 1. I am not in a position to offer a legal opinion on the case that Sense has advanced. However, it needs to be taken most seriously. The Government justify the Bill’s discrimination on the grounds that there are limited resources available. In saying that, they argue that their policy is directed to reach those who have the highest needs. The counter argument to that is that the policy is neither reasonable nor proportionate because deafblind people with the highest care needs will not receive care under this policy. Amendments 9, 12, 31 and 43 are designed to address these issues by broadening the definition of the kind of care that will be covered by the Government’s policy. Amendment 35 takes a different approach deliberately distinct from that of Amendment 9 and the others. It is a much narrower amendment which would ensure that those deafblind people who have the greatest need and who are at most risk of needing residential care if their needs are not met may qualify for free care and support. I hope the Government will look at this. There is no doubting the recognition that Ministers have given to the unmet needs of deafblind people. Only in June last year they reissued the guidance document, Social Care for Deafblind Children and Adults. This guidance is aimed above all at social services staff. The case studies that Sense has provided to me, and I believe to a number of your Lordships, are of the most heartrending character. The noble Lord, Lord Low, has asked me to say how sorry he is not to be able to be present to support these amendments and to give the Committee a more graphic picture than I could ever give of the gravity of the disability that deafblind people have to endure. I am in no doubt that the needs of deafblind people should be factored into any revision of social care policy. Therefore, I beg to move.
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Baroness ThorntonLabour- Quote
- Again, I have a very long note about all the different issues that I thought the noble Earl might raise to do with Scotland and all sorts of other things which I will not inflict on the Committee at this point. I will deal with the very important deafblind issue that he raised and make one or two comments about the generality of the other amendments in the group. I absolutely accept the point that the noble Earl made about the gravity of the situation of deafblind people and the problems that they face. It is very important that their needs should be recognised. There is no doubt about that at all. The services concerned are clearly of high importance to people who are deafblind or have multiple sensory impairments. As the noble Earl said, specific guidance, updated and published in June 2009, advises local authorities that they must ensure that services provided to deafblind people are appropriate and that deafblind people are able to access specifically trained one-to-one support workers if they are assessed as requiring them. For that reason we published statutory guidance on that issue. I have an assurance that the guidance that we will produce will cross-reference with that guidance. However, between now and Report I will have discussions with Sense and its supporters to ensure that we are doing that in the right way because this is very important. I reassure Sense that we are taking these issues very seriously and that they are taken into consideration, if not in the Bill at least in the guidance that we will produce. I undertake to do that because, apart from anything else, I want to reassure myself that this is okay. Amendments 9, 12, 31 and 43 seek to allow regulations on local authority functions and reablement to relate to overall care packages to individuals free of charge, and not, as the Bill intends, provision of the personal care element only without charge. I understand the intention of this is to ensure that the financial burdens for those in the highest needs are reduced as far as possible, but this falls outside the scope of this Bill and outside the cost envelope which has been allocated. It is fair to say that it is our intention to reform the care and support system so that it is fairer for all in the longer term, and we will be setting out in detail in the White Paper how we intend to do this. However, full care provision through taxation and free of charge at the point of need is something that we know is not sustainable now, or for the longer term, and was ruled out in the Green Paper. That is why we cannot accept Amendments 9, 12, 31 and 43, and ask that they are withdrawn.
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- Earl HoweConservative
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- My Lords, I am grateful to the Minister. The reason for tabling amendments omitting the word “personal” was not to widen the scope for delivering free services to those living at home; it was rather to highlight the importance of defining “personal” in a way that did not exclude deafblind people. While I note what she said in relation to the guidance, I am a little doubtful that it will of itself be sufficient because the definition of “personal care” in the draft regulations that the Government have promulgated does not to my mind include the kinds of tasks and activities with which deafblind people typically require help.
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- Baroness ThorntonLabour
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- As I think I have said to other noble Lords, I regard this Committee stage as feeding into the consideration that will be given to the issue. As the Committee knows, the closing date for consultation on the regulations is tomorrow. We will need to look at this discussion and the doubts that the noble Earl has expressed about the regulations.
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- Earl HoweConservative
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- My Lords, I very much welcome that assurance. I know that Sense will be very pleased that it will have the opportunity to make its case to the Minister. In the light of her assurances, it is appropriate for me to beg leave to withdraw the amendment.
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Lord LipseyLabour- Quote
- My Lords, one thing that has come out very clearly from the debate is the extreme doubt about the cost to local authorities of what is proposed in the Bill. Wide-ranging figures have been suggested but I will not go into that now. Local authorities have asked that if the estimated cost is exceeded the Government should agree to pick up the whole of the bill. It cannot be asking much of the Minister kindly to give them that assurance this evening since it is in accordance with the new burdens doctrine. That led me on to another thought which relates back to a debate we had earlier this afternoon—should we be imposing this scheme on all local authorities at once in one go? We have learnt a lot from the Scottish experiment. Some people think that it has worked well, some do not, but we have learnt a lot from it. Would it not be best to try this scheme in a few local authorities as part of a holistic package addressing the long-term care issue? Should we not try it in a few local authorities, see how the cost works out, and give them incentives from the Government to try it out? We would then be running a kind of pilot experiment, rather than imposing in one great movement a whole package which we would have great trouble untangling should the fears that I and other noble Lords have expressed here and elsewhere prove to be justified. Why are the Government determined on a national scheme?
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Baroness Gardner of ParkesConservative- Quote
- I support the idea of a pilot scheme, but if it is introduced, it is important that it covers widely differing areas. I am told that, for example, in Buckinghamshire, the majority of people meet their own costs and yet, perhaps, in Dagenham, they do not. It is very important that any pilot scheme should cover a wide range of areas, to give an assessment of the different situations that occur.
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- Baroness ThorntonLabour
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- Amendments 11 and 15 in the names of my noble friends Lord Warner and Lord Lipsey and the noble Baroness, Lady Murphy, focus on the discretion of local authorities in providing personal care at home. Before I come to the specific amendments, some of which are, of course, against the spirit of the Bill’s principles, I say to noble Lords that we recognise that, when determining people’s care needs, local authorities are best placed to judge what is appropriate in their own situations, depending on their clients and on the availability of services. However, we want to move towards greater consistency of care provision and, as noble Lords know, we will soon have a White Paper. We believe—I know that my noble friend Lord Lipsey disagrees with this—that this is a stepping stone towards greater consistency of care provision. The Bill requires all local authorities to offer free personal care at home to those with the highest needs in order to end the postcode lottery which this House has discussed on and off for many years. It will allow councils to have elements of continuing discretion so that they can provide the most appropriate services, which will be dependent on them knowing what works well in their community. We think that it is right that the Bill proposes that functions imposed on local authorities relating to eligibility for free provision should include the exercise of that discretion, so that they can effectively manage the provision of free personal care in their area. There will be a need for some cases to be considered in light of other healthcare services being provided to an individual and we have already discussed that. There is sometimes confusion about continuing care and what it means. It is care provided over an extended period of time to a person aged 18 or over to meet physical or mental health needs that have arisen as a result of disability, accident or illness. If an individual has primary healthcare needs, NHS continuing care should meet this and the individual’s package of care would be provided by the NHS and not by the local authority. It is important to recognise that if an individual needs continuing care to meet needs which do not include a significant health component, this will be provided by the local authority—it is right that they should be able to receive their personal care free of charge, if they qualify for it. It is important that NHS continuing care and free personal care are recognised as different ways of delivering health and social care where the balance between health and care may differ.
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Baroness MurphyCrossbench- Quote
- I apologise profoundly that I was not here at the beginning of this debate—I was whipping through the previous group. Amendment 15 deals with the exercise of a discretion. Can the Minister tell me whether that refers to the reablement clause? I am not sure, from reading the Bill. My understanding is that the local authority might have a discretion when or not to insist on the reablement. If it does, I am not sure how that might relate, for example, to a stroke patient returning home with profound disabilities, who would probably not reach his maximum potential for several years, but whose carers might feel it was inappropriate to subject to reablement at that point. Can the Minister reassure us about how the discretion could be exercised in relation to reablement?
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- Baroness ThorntonLabour
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- My understanding on the discretion with regard to reablement is that, indeed, the local authority has the power to use its discretion. We addressed this issue, I think, when I was asked about people receiving palliative care and whether subjecting them to reablement would be appropriate. At that time, as I recall, I said that it would depend. You would not necessarily say that someone who is receiving palliative care should not have reablement, but it may not be appropriate. The local authority would have the discretion to decide whether that was the right course of action. I will write to the noble Baroness in detail if I need to, but my understanding is that this discretion covers reablement.
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Baroness Masham of IltonCrossbench- Quote
- Would it cover people with cancer and motor neuron, where reablement might make them worse rather than better?
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- Baroness ThorntonLabour
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- That is the point—you have to look at each person’s issues and problems. With cancer, reablement might be appropriate, because someone might be in remission for a long time, so reablement might be exactly the right thing to offer. On the other hand, it might not be, because the illness is terminal and what is needed is palliative support as an end-of-life strategy.
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- Baroness Masham of IltonCrossbench
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- That is another example of flexibility.
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- Baroness ThorntonLabour
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- That is exactly the point, yes.
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- Lord LipseyLabour
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- My Lords, of course I regret my failure to seduce the Minister: I shall bear it with as much equanimity as I can muster. Therefore, I beg leave to withdraw the amendment.
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