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Social services departments up and down the country have varying provision for the disabled and the elderly. This is another example of our postcode lotteries. Where you live depends on all sorts of circumstances, but local authorities’ provision differs. As a former chair of social services in the London borough of Richmond, I know that if someone with a huge need, which can incur costs of hundreds of thousands of pounds a year, moves into an authority’s area, it can be very difficult financially to match the provision that that person received previously. This is a very serious issue, and with the best will in the world a social services department might want to match that provision but be unable to do so because it has a very small budget. Some local authorities will have a very low budget for social services due to their demography. The London borough of Richmond, where I was chair of social services, had a big budget because at that time we had the second highest proportion of people over the age of 85 after Worthing. We wore that badge with pride. However, provision can vary among authorities. Although I appreciate the need to sort this out, and clearly people’s needs have to be met if they move to a different area, we must also understand local authorities’ problems in seeking to make that provision.
I hope that the Minister will tell us that there is something in the pipeline, such as another discussion, a secondary regulation or a device whereby this matter can be addressed, thoroughly discussed and sorted out because it is a human rights issue for disabled and elderly people.
Lord Ashley of Stoke: My Lords, I congratulate the noble Baroness, Lady Campbell, and her colleagues on tabling this amendment and presenting it so coherently and persuasively. The need for it is paramount. It is the most important amendment for disabled people that the Government can address. Labour Peers lean over backwards to make things easy for the Government because we support them, but on this occasion we feel a bit perplexed because they do not seem to accept the powerful case for this specific provision. We have had delay so often in this area. I have been involved in politics for 40 years and there has always been an excuse why Governments cannot do this or that. Although this Government have a marvellous record on disability and other things, they have failed to rise to the occasion on this matter. We have heard Labour and Conservative Peers put their cases. What are we waiting for? All sides—Labour, Liberal and Conservative—support the amendment.
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An absurd piece of propaganda recently stated that the amendment would tie the hands of local authorities. That is preposterous. The compassion that would flow out of the amendment should not go to well heeled local authorities, but to poor, disabled and old people. So that advice was out of touch with reality. Noble Lords who have spoken on this, including the noble Baroness, Lady Campbell, and countless organisations support the amendment. Some 50, 60 or 70 of these organisations, which represent the blind, the paralysed and so on are unanimous in saying to the Government, “Please let us have this amendment”. These people are
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Although I am criticising the Government, I am aware that they have been kind to many disabled people and to me personally; but they are making a huge mistake if they fail to provide now for the measures in the amendment. I ask them to take this back and bring back a solution that will satisfy every disabled person in Britain.
Baroness Greengross: My Lords, I strongly support the amendment. I am delighted that my noble friend Lady Campbell was well enough to return and put the amendment so movingly. I am a commissioner on the Equality and Human Rights Commission and vice-president of the Local Government Association, which is worried about extra costs and burdens. I honestly feel that if this amendment is seen to be necessary, the Government’s role is to encourage local authorities to take it seriously and ensure that local authorities are given sufficient resources.
It is important that we enable older people and disabled people who live in this country to feel that the system is fair to them. It cannot be fair if you are caught just because you want to move from one locality to another. Everything that is said about different levels of care and service provision in different parts of the country militates against that feeling of fairness. That is quite wrong. It would cost very little in real terms and would enable disabled and older people who need services, educational opportunities and a proper family life to move without feeling that they would be terribly disadvantaged by doing so.
Baroness Masham of Ilton: First, I say to the noble Baroness, Lady Tonge, that this subject was discussed at Second Reading and an amendment was discussed in Committee. The amendment would stop a disabled person being in limbo while a new local authority assessed them yet again. This can take months, if not years. Would the Minister tell us how much it costs to do an assessment, or do they differ between local authorities? This amendment might, in the long term, save rather than cost money.
Baroness Howarth of Breckland: My Lords, the noble Baroness, Lady Campbell of Surbiton, has put her case most cogently. I am only sorry that she was not here at Second Reading. I feel that this is more of a Second Reading than a Report debate. Therefore, I beg leave to say a few more words than I would normally say at Report. That does not mean that I will speak at length; I seldom do. I simply want to make a few points.
A little while ago, we had a debate on the Floor of the House about disabled people’s needs which should have been led by the noble Lord, Lord Ashley. On that occasion, none of my friends with disabilities was able
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If this amendment were pressed, however, I could not go through the Division Lobby with my good friend, and I will tell noble Lords why. This is the broader point. As the Local Government Association—of which I, too, am a vice-president—has pointed out, funding for these services has already outstripped supply. Its worries are about the implications for existing services. That seems an extremely serious position for the nation to be in. It is particularly serious as I have also read documents in which residential services are being encouraged to provide quality care while faced with a framework that pays the minimum wage to people who will not only care for some of the most vulnerable in our society, but give them the opportunities that we have. That is the perceptual difficulty, which I hope the noble Baroness, Lady Campbell, and our other campaigning friends who have campaigned extremely actively, have made us understand. Being in a wheelchair and being disabled does not mean you are disabled in terms of what you can contribute to society overall. Despite that, I find it difficult to support this amendment because of the extraordinary complexity of the services that we need to look at.
The noble Lord, Lord Low, and I did not table yet another amendment about the transfer of funding for residential care between one authority and another, but that is another aspect that needs to be looked at. I have a sheaf of papers from Ministers in replies to queries that I have raised about the problem of people moving from residential care into housing, from housing into supported housing and, possibly, back into residential care. It is impossible, if your disability improves or gets worse, to move between services. Never mind that; what about the benefits system? When you transfer from one place to another, benefits become even more complex.
One area that has been hit on is assessment. People who move between one place and another have to undergo constant reassessment. The amount of person power that it takes to decide, for the third or fourth time, what the individual actually needs, is something that the Minister in the other place, at a meeting I was at recently, has undertaken to look at. I will ask the Minister, when we look forward to the Green Paper—as the noble Earl, Lord Howe, said, these issues can be looked at even sooner—for an assurance that someone will grasp the complexity of this issue. That person should be prepared to look at the detail, not put it into the “too difficult” box—difficult as it is—and come up with some real plans, so that people such as my noble friend Lady Campbell and many others I know like
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Baroness Thornton: My Lords, we debated a similar amendment in Grand Committee. I said at that time that I have every sympathy with its intention, as the noble Baroness knows. I fully understand the reason for returning to this issue again today. I join other noble Lords in welcoming back the noble Baroness in good health to the Chamber. I commend her for the eloquence with which she and my noble friend Lady Wilkins spoke to the amendment.
Noble Lords will be aware that, throughout the passage of the Bill, the Minister and I have sought on every occasion to listen to the experience and expertise in the various areas covered by the Bill. Together—that is, noble Lords and the Government—we have created a much improved Bill to send back to the other place. In the parts where it has not been possible or practical, for various reasons, to include provisions in the Bill, we have sought to engage in constructive discussion and provide reassurance and explanation. While it is with deep regret that I cannot support this amendment, as it is currently drafted—because it seeks to place a wholly new and rather fundamental provision in the Bill—I seek, in the spirit that has applied to the rest of the Bill, to discuss how we can take this issue further. I have spoken to the Minister responsible for this area of policy and I am able to give noble Lords more positive information about continuity of care than I could in Grand Committee. I hope to convince noble Lords that the Government are determined to resolve the issue. A Green Paper with white edges, as was mentioned by the noble Earl, is the right way to express that.
First, I make it clear that the issue that lies beneath this amendment—whether care and support services should be the same no matter where a person lives, as opposed to local authorities being able to respond to local needs and provide different kinds of services—is a strong theme of the engagement activity that the Government are currently leading, in preparation for a Green Paper on the future system of care and support in this country. When looking at national standards versus local flexibility, the issue of transitional arrangements is fundamental.
The Government accept that there are great challenges within the care system and have signalled their intention for radical reform with the announcement of the Green Paper. They have, for the first time, launched a public engagement process which specifically asks people whether care and support in the future should be based on the principle of devolved control and local flexibility, or on a more national basis where a person will be entitled to the same support no matter where they live. That is at the heart of this issue.
This question is explicit in our published discussion document, is on our website and is part of our current programme of engagement events. I can also confirm that the issue of portability, which the amendment raises, is being addressed as part of the debate on the Green Paper. This is a fundamental component of the
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The Green Paper will set out options for the future funding of care and support. I can confirm for the first time—I am happy to do so on the record—that these options will address the wider issue of local flexibility versus national standards, and the difficult problems that this presents to service users, as set out in the amendment. We will then hold a formal consultation on these options and decide, in the light of the responses, what the care and support system of the future will look like. I undertake to ensure that we pursue that with rigour and speed.
Among other things, the Green Paper will be informed by the review of the eligibility criteria for fair access to care services that the Commission for Social Care Inspection is conducting for us. In January 2008, my honourable friend Ivan Lewis asked the commission, in the context of the Government’s vision for adult social care, Putting People First, to undertake a review of the eligibility criteria, their application by local authorities with social services responsibilities and their impact on people. This followed a report from the commission that highlighted major inconsistencies in the way eligibility criteria were applied in different local authorities.
The commission has been asked to submit its review by 15 September. After Ministers have received it, we expect the commission to make the review public. We cannot say at this stage what the commission will recommend, but the aim is clear: to achieve greater consistency in eligibility criteria across local authorities. This is another activity related to the wider issue raised by the amendment, and further evidence of the Government’s willingness to tackle the issue as part of a coherent review of the whole system of eligibility for social care services.
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I turn briefly to the specific provisions of the amendment. It may be difficult to justify looking at these issues for people who recently moved out of a local authority without also considering those who have chosen to stay where they are. We should not tackle these far-reaching issues in a piecemeal fashion. Neither should we lightly dismiss the concerns expressed by local councils about this amendment.
There is no question that this issue must be looked at as part of a wider review of care and support services. However, I hope that the noble Baroness and other noble Lords who support this amendment will accept my assurance that the Government are not walking away; the issue is simply too far-reaching to address through an amendment to the Bill. The principles of the amendment may indeed be the future direction of social care provision. However, if that is the case, it is right that this should emerge from a review of the whole system, rather than from this single debate. Detailed negotiation and discussion with local government, and certainly time, would be required before changes were introduced.
I have one further announcement that may provide reassurance. On 11 June, the Law Commission announced that it was to draw up plans for the reform of adult
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Noble Lords will recognise that Ministers have tried extremely hard, throughout the debates that we have had in your Lordships’ House, to respond to concerns with positive action. We have taken every concern seriously; we take this concern extremely seriously. I assure noble Lords that I have taken it back to the department for careful thought on several occasions in the past few weeks. We have also brought forward amendments and made commitments on the record. We have clarified the role of social care within the Care Quality Commission; we have made it clear that the Human Rights Act extends to those who receive publicly arranged care in a private setting; we have addressed the issue of ordinary residence; and I have announced new proposals today. Wherever possible, we have sought to listen and respond constructively. However, I am afraid that we are not able to support this amendment. I hope that, with the reassurances that I have given, the noble Baroness will feel able to withdraw her amendment.
Baroness Campbell of Surbiton: My Lords, first, I thank all noble Lords who supported this amendment; they have been tremendous. I would mention them all by name, but I might run out of puff and I will save that for the Minister, whom I thank for her reply and her sincere endeavours to be helpful. I know that she is personally supportive of equality of opportunity for older and disabled people, and has great sympathy for this amendment.
It is a tough judgment call. On the one hand, my heart is heavy. I have heard how complicated this is and how we have to talk about it more and get to grips with it; yet I have been doing this for eight or nine years and feel that I have gone over the arguments ad nauseam. Therefore, it is difficult for me to see light at the end of the tunnel. However, today I feel that we have made some progress, even perhaps within the past hour. A combination of three announcements, some enthusiasm and clarity about going forward in a positive way and, frankly, sorting this matter out makes me feel that the journey could go in the right direction.
Naturally, I and others will follow this issue forensically as it progresses. However, I feel that we have a plan and that I may not now need to take the action that I
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Amendment, by leave, withdrawn.
Clause 170 [The appropriate authority by whom commencement order is made]:
Baroness Thornton moved Amendments Nos. 7 to 9:
“( ) section (Remuneration for persons providing pharmaceutical services: appointment of determining authorities) (2) (remuneration for persons providing pharmaceutical services: appointment of determining authorities in relation to Wales),”( ) the repeals in the National Health Service (Wales) Act 2006 (c. 42) in Part 4 of Schedule 15 (and section 165 so far as relating to those repeals),”On Question, amendments agreed to.
Schedule 1 [The Care Quality Commission]:
Baroness Thornton moved Amendment No. 10:
“( ) The Secretary of State must exercise the powers in sub-paragraph (1) so as to secure that the knowledge and experience of the members of the Commission (taken together) includes knowledge and experience relating to health care, social care and the Mental Health Act 1983 (c. 20).”
On Question, amendment agreed to.
Schedule 5 [Further amendments relating to Part 1]:
Baroness Thornton moved Amendment No. 12:
On Question, amendment agreed to.
Schedule 15 [Repeals and revocations]:
Baroness Thornton moved Amendments Nos. 13 and 14:
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“In section 164(5), paragraph (b) and the word “and” immediately preceding it.” |
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“In section 88(5), paragraph (b) and the word “and” immediately preceding it.” |
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