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Baroness Hollis of Heigham: My Lords, I thank the noble Baroness for giving way. I listened very closely to the debate, and I do not think that anybody argued that at all. Perhaps there has been some misunderstanding. The position that some of us sought to argue was not that local authorities should not exercise their discretion--although it should not be unreasonably exercised--but we were concerned about the Secretary of State's intention to limit the discretion of local authorities by restricting the eligibility of certain groups in advance.
Baroness Cumberlege: My Lords, that is the second point that I shall address. If I understood my noble friend Lord Swinfen correctly, he wanted this to be a universal requirement on local authorities since he was worried about the unevenness that there might be across the country.
The noble Baroness, Lady Hollis, is right that others are concerned about restricting the eligibility of different client groups, and many noble Lords expressed anxieties about that matter. That will be very much part of the consultation exercise that we shall undertake, and we shall consider it seriously when we receive the results of that consultation. We shall not be denying any group access to care. They will still receive that through the social services. What we are talking about here is access to direct payments. I understand the points made by the noble Baroness, Lady Darcy (de Knayth). But not to limit the client group would raise unrealistic expectations of what can be achieved in the short term and might, indeed, put the whole scheme of direct payments at risk.
This Bill is not about discrimination against certain groups of people. We are not prejudging who will be able to manage direct payments. We are simply saying that there are good reasons for starting small. As I said, we shall be consulting on which groups should be included and we will take account of the points raised.
My noble friend Lord Campbell of Croy asked about the extent of the regulations, as did my noble friend Lord Swinfen in suggesting that the eligibility restriction should be on the face of the Bill. We feel that defining it in regulations will ensure that it can be changed in the
Many noble Lords raised the question of resources. Local authorities will make direct payments only where they would otherwise have been providing or purchasing services for an individual. We are, of course, giving them a new power which they have been asking for. It will give them more flexibility in how they fulfil their existing community care responsibilities.
I do not accept that social services departments lack the resources that they need in order to use this new power. Just a week ago my right honourable friend the Secretary of State for Health announced that local authorities are to receive an extra £418 million to fund community care services in 1996-97. The money will be ring-fenced and it cannot be used for any purpose except community care. That will be the fourth tranche of extra money that has been provided since the start of the new community care policy. It will bring the total extra resources for community care to £2¼ billion since 1993-94, so just in six years since the start of this decade we will have doubled in real terms the amount of money provided for community care.
In Scotland, the final figures for 1996-97 have yet to be announced, but local authorities can expect to receive nearly £40 million extra for these services, with further allowance for the care gap and infrastructure costs. That will bring the total extra resources for community care in Scotland to £280 million since 1993-94.
These are substantial increases by any standards and amply demonstrate the Government's commitment to funding this new policy fairly. I doubt whether any other area of government spending can boast increases on that scale. But it will not stop there. We plan to inject still more funds in subsequent years, and by 1998-99 the total extra resources will rise to nearly £3 billion. So for every £1 spent on community care at the start of this decade, we plan to provide £3 by the end of the decade.
I can assure my noble friend Lord Swinfen and the noble Baroness, Lady Seear, that local authorities will make direct payments only with the individual's consent. Local authorities will not be able to force them to accept cash for services that local authorities would rather not provide directly. So there really is a voluntary element here. It is up to people to decide whether they want to receive these payments.
The noble Baronesses, Lady Darcy (de Knayth) and Lady Hollis, and other noble Lords asked about the relationship between the independent living fund and the Bill. The extension fund of the independent living fund is a closed fund which now supports about 14,000 clients. That support will continue regardless of whether those clients continue to receive community care services or begin to receive direct payments in lieu of those services. The second fund, the independent living 1993 fund, is open to new clients. It will continue to be
The noble Baronesses, Lady Hollis and Lady Darcy (de Knayth), also asked how charging would work. How should local authorities decide how much to charge? This will be for the local authorities to decide, just as they currently decide how to charge for domiciliary services. Then there was the question of how charging would work. Will the charge be deducted at source or will someone pay a charge? The Bill's provision is that the payment would be made net of the financial contribution the individual makes. This, we feel, is much less bureaucratic than giving a sum of money, only to require some of it to be returned later.
The noble Baroness, Lady Hollis, asked about floors and ceilings. Again, we will leave that to local authorities to decide. But I can assure her that other cash benefits through the social security system will not be affected, and nor will the principles embodied in the National Health Service. Direct payments will be made available only in lieu of community care services which would otherwise have been arranged by the local authority, not for continuing health care, which is a health authority responsibility.
The noble Lord, Lord Addington, felt that there was a need for very comprehensive support services. We intend to put out guidance and that will stress the importance of support services. We shall be interested to hear about current good practice so that that can be incorporated in the guidance that we put out.
The question was also raised by the noble Baroness, Lady Hamwee, as to whether people will be able to use direct payments to buy community care services from local authorities. People who receive direct payments will not be able to use them to purchase services from local authorities because local authorities are not permitted to sell services in that way. However, if someone wishes to receive services from a local authority, they can choose to receive those services instead of direct payments. They can also receive a mixture of services and direct payments. So direct payments do not create a bias against local authority provision.
There was also concern that local authorities would leave people to sink or swim and not give them the support that perhaps they need when they enter the scheme. But a local authority which makes direct payments to someone will not then be able to wash its hands of that person. It will certainly not make direct payments to someone who does not feel able to manage. As I said earlier, the person's consent is crucial.
The noble Baroness, Lady Hamwee, asked about the regulation of providers of domestic care. We do not propose to use the regulation-making power in Clause 1(3) significantly to restrict the individual's choice of provider. This Bill is a measure to give users more choice and control. What many of the disabled people who have been calling for this legislation want to do is to use direct payments to employ their own personal assistants. We would not want to exclude that alternative. Each local authority will have to decide what monitoring arrangements it puts in place to be absolutely sure that the needs to which direct payments relate are being met. The local authority will have a responsibility to step in, as I said, and arrange services if the arrangements which someone makes using their direct payments are not adequate to meet their needs.
My noble friend Lord Campbell of Croy was very anxious to ensure that we review the scheme and how it is working. Local authorities must publish community care plans; from April 1996 they should publish community care charters. We would expect local authorities to use plans and charters to give information on direct payments.
My noble friend also asked whether we intended to have pilot schemes. We do not intend to run pilots in the geographical sense; all local authorities will be able to offer direct payments. He also asked whether in this Bill the definition of "community care services" and "disabled people" would be different from the definition in other legislation. Clause 1A explains that the definition of "community care services" is the same as in the National Health Service and Community Care Act 1990. We have not offered a definition of "disabled people", but if we did we would ensure that it was consistent with existing legislation.
The noble Baroness, Lady Seear, asked whether it was fair to exclude informal carers from receiving these payments. We believe that excluding informal carers from being paid to provide care using direct payments does not mean that we do not recognise their role. It is a very, very important one. But it is different from that of paid employees who provide care on a formal contractual basis. Direct payments will be an alternative to services that people would otherwise receive from the local authority and, as I said in my opening remarks, they are not to replace existing support networks within families and communities. We do not want to create pressure for families to formalise informal arrangements. We feel that it would be bound to place
The noble Baroness also asked whether we intended to give people assistance in their role as employer. As I said, we shall be issuing guidance to ensure that people are aware of their responsibilities as employers. I am sure that the local authorities will wish to help those who are undertaking this new responsibility.
My noble friend Lord Pearson raised the whole question of choice and village communities. Perhaps I should explain that we intend to use the regulation-making power in subsection (4) of Clause 1 to exclude the use of direct payments to pay for permanent residential care. We feel that suitable arrangements to provide choice in permanent residential care are already in place; to make direct payments available for this purpose would simply add to the bureaucracy. That is the same for all client groups.
I know that my noble friend is very concerned about the lack of choice, as he sees it, being offered by local authorities. We have a direction on choice. If people feel very frustrated by that and feel it is not working, especially with regard to village communities, they have a right to use the complaints procedures. But, as I think the noble Lord knows, we are having an evaluation at the moment to examine the various forms of residential provision, including that in village communities. Indeed, the booklet, Made to Care, that my noble friend quoted is very much part of that review. The whole review will be completed in about six months' time.
My noble friend Lord Pearson also asked about authorities flouting the 85 per cent. rule. All local authorities are required to submit to the Department of Health returns on their compliance with the 85 per cent. rule. These returns are audited by the independent and expert district auditors. For 1993-94, the only year for which audited returns are yet available, almost all authorities met the 85 per cent. condition. The Secretary of State is considering whether to take action in regard to those that did not.
The noble Lord, Lord Rix, asked whether the families of people with learning disabilities would be able to manage direct payments on their behalf. Direct payments are intended to give the user more control over the way in which care is met. This benefit will not be realised unless the user is in control of the direct payments, but there is no reason why they should not get help from their families or others in managing the payments.
We have said that we will consult on the detail to be contained in the regulations under this Bill. As I said earlier, that consultation paper will be published shortly. Many of the issues raised in this debate will be considered further during the consultation and no doubt throughout the Committee stages. Whatever our conclusions at this stage on those issues, the power to specify these points of detail in regulations will enable us to adjust the framework for direct payments in the light of experience.
I wish to conclude, not with my words but with the words of those involved with existing payment schemes. Terry Butler, Director of Social Services in Hampshire, said of the scheme that his council has operated for over 10 years: