 House of Commons |
Session 2008 - 09 Publications on the internet Public Bill Committee Debates Welfare Reform Bill |
The Committee consisted of the following Members:Liam Laurence Smyth,
Committee Clerk † attended
the Committee Public Bill CommitteeThursday 26 February 2009(Afternoon)[Mr. David Amess in the Chair]Welfare Reform BillClause 29Relevant
services Amendment
proposed (this day): 24, in
clause 29, page 37, line 14, at
end insert— ‘(h) the
provision of care services and community care for
P.’.—(Mr.
Harper.) 1
pm Question
again proposed, That the amendment be
made.
The
Chairman: I remind the Committee that with this we are
discussing the following: amendment 25, in
clause 29, page 37, line 20, leave
out subsections (5) and
(6). Amendment
70, in
clause 29, page 37, line 20, after
‘services’, insert
‘, unless such exclusion would
prevent P from achieving the matters set out in subsection
(2)’. Amendment
49, in
clause 29, page 37, line 21, leave
out paragraph
(a). Paul
Rowen (Rochdale) (LD): Amendment 70 seeks to deal with the
situation in which all the services are not totally devolved. In the
case that I quoted of someone going to university, it obviously made
great sense for direct payments from the health authority, the local
authority and the university to be put in one pot to provide a service.
That worked out cheaper in the end, and also meant that only one group
of people was looking after his needs. I welcome what the Government
are
planning. Mr.
Mark Harper (Forest of Dean) (Con): The hon. Gentleman
outlined a particular constituency case of his in which a great deal of
effort was taken to get organisations working together. One of my
concerns stems from a point that was raised during an evidence session
in which Paul Davies specifically talked about the difficulties that
his organisation had had in integrating Access to Work funding. He said
that the officials that he works with in the Department for Work and
Pensions “worked
their socks off to make it
work.”——[Official Report, Welfare Reform
Public Bill Committee, 10 February 2009; c. 8,
Q4.] Therefore,
there was no lack of desire to make it work. It was simply that within
the rules and regulations, it could not be done. That is why I want to
ensure that the Bill gives Ministers the power to set the regulations
so that officials, despite wanting to make it work, are not hamstrung
by rules and regulations.
Paul
Rowen: I agree with the hon. Gentleman. There are two
scenarios. In the previous clause, we dealt with a situation in which
an authority is not willing to allow direct payments to be introduced.
When it comes to clause 29, where we are talking about relevant
services, the question is how we ensure that the various packages are
available. As I have said, the process will not be appropriate for
everyone—not everyone will want to access direct
payments—but we must ensure that where there are circumstances
in which someone needs to do something, the Minister, through the
pilots and hopefully on to the general, has the wherewithal to ensure
that that happens. I look forward to the Minister’s
response.
The
Parliamentary Under-Secretary of State for Work and Pensions (Jonathan
Shaw): I thank the hon. Members for Forest of Dean and for
Rochdale for raising these issues. There is a consensual spirit on the
right to control. By talking about his constituent going to university,
the hon. Member for Rochdale gave us a helpful illustration of the
benefits that people could derive from such a scheme. He advised me in
the margins that his constituent is now in his second year, and we wish
him every success. The hon. Gentleman showed us how the measure can be
practically applied, and the difference that it can make. His
constituent is now in the driving seat; he is the one with the power.
That may have been inconceivable only a few years ago, when we focused
on what the producer provided. Public policy has shifted, and now there
is a consensus that we want to empower the individual.
The hon.
Gentleman talked why social care was not on the face of the Bill. I
will come to that point later, but it is important to note that he
talked about the primary care trust, which is about the health budget,
rather than the social care budget that goes to the local authorities.
I will explain later what we are doing about that. One can envisage its
being easy to identify particular parts of a health budget that an
individual is receiving. For example, one can see how chiropody
services could be personalised. Dialysis, on the other hand, might be
more difficult. I am talking here about providing that service to a
particular community. The hon. Gentleman and I had a discussion about
that outside the Committee. If a dialysis operation is to be economic,
the number of people receiving the operation must be sufficient to
allow expertise to be built up. I think people can understand the
practical differences. That is why the Health Bill, which is now
passing through the House of Lords, will provide opportunities for
those pilots. In comparison with social care, it is a little less
tangible and a bit more difficult to identify particular funding
streams within the PCT budgets that one can put into a right to control
individualised budgets.
We have
experience in relation to social care. The hon. Member for Forest of
Dean mentioned the pilots that we have already undertaken and we have
had some evaluation of those, which in the main has been positive. It
is not the promised land for everyone and we should not get too heady
and think that this is the solution for every single one of our
constituents, because it is not. In the pilots, a number of elderly
people in particular found it difficult to manage such budgets. We
perhaps need to find other ways to ensure that they are still in the
vanguard in terms of shaping services. Again, there is a consensus in
terms of public policy that that is what
we want to do. So there is provision within existing legislation that
allows us to direct for personal social care budgets. It is important
for me to get some points on the record. Those were the immediate
issues that arose from the hon. Gentleman’s contribution, but I
will make some further detailed remarks. Of course, I would welcome any
interventions from hon.
Members. As
I mentioned in the evidence that I gave on 12 February, to which the
hon. Member for Forest of Dean referred, the exclusion of community
care in the Bill is to ensure that we do not duplicate or cause
confusion with existing powers. The Bill makes provision for disabled
adults and therefore excludes community care and other care services
that apply to people under the age of 18, as we discussed this morning.
Disabled children have different needs.
Legislation
relating to community care services is defined in the National Health
Service and Community Care Act 1990, which is an Act that I remember
well because I was completing my training as a social worker at that
time. Indeed, an interesting parallel between that piece of legislation
and the Bill is that there is a political consensus. That bodes well
for the people who are recipients of services. However, although we
celebrate some consensus in terms of ensuring that the services are
better delivered and of a higher quality for our constituents, it is
important to remember that the Bill does not suit everyone. One of the
criticisms of the 1990 Act was that there was perhaps too much of a
consensus and not enough questions were asked—the hon. Gentlemen
may consider that an
invitation. The
Government set out their vision of the personalisation of public
services generally in the cross-government concordat, “Putting
People First”. Local Authority Circular DH/2008/1 set out what
that would mean specifically for adult social care. It
states: “Everyone,
with support if necessary, will be able to design services around their
own needs, within a clear personal financial
allocation”. The
circular recognises that
“With
self-directed support, people are able to design the support or care
arrangements that best suit their specific
needs”. The
circular also sets out the system of personal budgets that will deliver
choice and, importantly, control. The changes detailed in that local
authority circular mirror the changes that the Bill sets out in order
to achieve better public services. The right to control and the current
changes to the delivery of adult social care will together enable the
implementation of the Government’s commitment to empower
disabled people, and ensure that choice and control are recognised as a
right.
Mr.
Harper: The Minister refers rightly to the steps that were
taken in the adult social care area in relation to personal budgets and
direct payments. One of the striking facts—I know he is aware of
this—that came through in the evidence that we had from Paul
Davies from Oldham metropolitan borough council was that of the 1.75
million people across the country who use adult care services, only
10,000 have a personal budget. The Minister is quite right: a personal
budget, and the direct payments that may or may not go with it, is not
the solution for everyone. However, only 10,000 people out of that 1.75
million have a personal budget, the evidence shows the benefit to many
people of having one, and fully one fifth of those 10,000 people were
in
Oldham. So, with the legislation that is already in place and the
welcome concordat that he discussed, does he think that we are going at
the pace whereby, although those disabled people may never want to use
the right, they will have the right—that those who want to use
it will genuinely be able to exercise it under the current legislative
arrangements?
Jonathan
Shaw: The hon. Gentleman makes an entirely reasonable
point. My constituents have individualised budgets, and I was speaking
to a constituent recently. He fired his carers and got some new ones,
whom he has had for the past 18 months and for whom he is full of
praise. That is inconceivable for the majority of people who will not
be in that advantageous position, so I say to all local authorities
that if they can get on with such work, they should. A balance must
always be struck, because there is a consensus around devolving power,
and around authorities making those decisions for the people whom they
represent, while the Government work in partnership with
them.
The hon.
Member for Rochdale talked about the PCT and health budgets, and the
hon. Member for Forest of Dean referred to the Access to Work budgets
and to the budgets for disabled children, so there is quite a lot going
on. By finding out what works best, we shall be in a strong position to
show the overall picture. If we do not play our part and adopt the
approach that we have advocated, things will happen more slowly. We do
not want example after example of the cases to which the hon. Member
for Rochdale referred; we want everyone—not just local
authorities, but disabled people and their organisations—to be
very clear about the situation. I shall talk more about the health
budgets in a minute.
Mr.
Harper: The Minister referred to the balance between
directing local authorities to do things and giving them the powers,
and we touched on it during the evidence-taking sessions. He is quite
right that there is an emerging consensus around the importance of
localism, but that is not an end in itself; it is a means to an end. It
is about whether we believe that if central Government give local
authorities more control, individuals will receive better services,
because that is the end goal. It is all very well giving local
authorities the powers to do things, but if disabled people want
something to happen but the local authority is not very keen to get on
with it, we must ensure that the disabled person gets the powers and
the local authority does not stand in the way. How does the Minister
think that the balance will be best achieved, remembering that the goal
is to benefit the citizen, not necessarily the local
authority?
Jonathan
Shaw: I agree with the hon. Gentleman that it is the
consumer’s interests not the producer’s that I have at
heart, but we believe that instituting pilots for the different funding
streams will give us a better picture, so that all the arrangements
that one can envisage being available to everyone in a few
years’ time will be available more completely and readily. I do
not go to the Department every morning thinking, “How can I stop
this measure?” and I am sure that the hon. Gentleman knows that;
I go to the Department to work with my colleagues across Government to
deliver it as quickly and speedily as
possible, but with the complete picture, so that we do not experience
the frustrations that the hon. Member for Rochdale mentioned.
It is
important to talk about health budgets, but they are separate from
social care budgets. We should also accept that the way that we
organise society and the institutions that provide such services are
not really the preoccupation of our constituents: the
consumer, the individual, the citizen—call them whatever you
want. Their preoccupation is how they live their lives, the care and
support that they receive and access to employment or college, for
example; they rely on a number of different
services. 1.15
pm So
we want flexibility to be available through a range of services, and
that means exploring options available in many areas. The Department of
Health is currently introducing legislation to pilot health budgets
that will allow people to take direct payments, with patients being
given a budget to manage themselves, with regulations providing clear
guidelines. That is important. Personal health budget money may be
spent, for example, on social care where it is likely to improve health
or well-being. I think that all Committee members would support
that. With
the right-to-control trailblazers we will be exploring the more
flexible use of funding streams, too. People will be able to have more
choice and control over how they achieve their outcomes. We will be
looking for alignment or collocation with other similar pilots, such as
on individual budgets for children and health budgets. We hope to
present as seamless a provision of services as possible for
people—for the customer—receiving social care direct
payments, personal health budgets and a right to control
services.
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