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Lord Hunt of Kings Heath: I do not really want to intervene in what has been a remarkable debate. I am most grateful to my noble friend Lord Lipsey for his intervention on the amendment. I am also grateful that it is only on this amendment that he is has intervened, since he is in such sparkling form. I see that he is not overwhelmed by the Bill.
I need not go over the ground much more extensively than my noble friend has done. We decided some years ago that if we were to spend additional resources, they would be much better spent on services that truly focus on those who need them rather than using a huge sum for what, as my noble friend suggested, is very dubious output.
We have made good strides in other areas, such as introducing new home care charging guidance and requiring a review of councils' eligibility criteria. Both measures were taken to make charging regimes more reasonable. We have taken a sensible decision on nursing care. We took a sensible decision that it is best for a qualified professional and nurse with the most complete knowledge of a patient's needs to determine the necessary care.
We have had to make a choice about where to spend our resources. We chose to spend the new resources on improving the quality and range of services provided for older people, in particular to promote independence support for people in their own homes and avoid unnecessary stays in hospital.
There is no getting away from choice. If we made personal care free as listed in the schedule, the 6 per cent growth in social services investment for the next three years to which we are committed would not be possible. I have not studied what has occurred in Scotland to the extent that my noble friend clearly has, but from time to time I observe the various cuttings and the comments coming from local authorities in Scotland that they do not have enough funds to pay for free personal care. Those who argue for free personal care never talk about the opportunity cost. It is plain to me that more important and relevant services are having to be robbed to fund free personal care.
The problem with free personal care is that it became a mantra. Suddenly, it would solve all the problems of looking after older people. It has proved to be the complete opposite. It is a cul-de-sac, it is costly, it is wasteful and we want nothing to do with it.
Lord Clement-Jones: I thank the two noble Lords who have engaged in this debate. I must thank the noble Lord, Lord Lipsey, in particular. He has come to this Committee holding his nose, in a sense. The rest of the Bill is clearly unacceptable to him, but only this amendment has tempted him out, retiring and shy as he is, to make a splendidly broad-ranging speech. Declamatory is probably the best description of the style. I thought Birnam wood had definitely come to Dunsinane during his performance.
The noble Lord, Lord Lipsey, clearly has strong views on this matter, but I thought he lifted his skirts somewhat in the course of his speech. He seems so anxious to make sure that those who have any assets at all have to pay for free personal care, that he is treating it as an alternative form of personal taxation. That is the nub. This is a Treasury-inspired issue. The Minister ranged fairly broadly, mainly painting a rosy picture of the Government's original proposals and the changes in the thresholds, and so on, but effectively the case is based on cost.
I fail to recognise the description of the situation in Scotland from what the noble Lord, Lord Lipsey, had to say. To my knowledge, only one councilI think it is the Highlands and Islands councilhas complained in a major way about the resources available, which were based on its own assessment. Negotiations took place subsequently. The scheme in Scotland is expensive, but the political priorities of the Scottish Executivea joint partnership executive of Labour and Liberal Democratswere such that they believed that was a priority for their expenditure.
Lord Lipsey: What is the noble Lord's explanation of the report in The Times of 18th November, which describes three councils by name on top of the Highlands and Islands councilEast Dunbartonshire, Argyll and Bute and West Lothianwhich had warned that their budget had run out?
Lord Clement-Jones: I believe that the noble Lord, Lord Lipsey, asked a Starred Question on that matter at the time. I specifically checked with Liberal Democrats in Scotland. Those issues had already been resolved by the time the article in The Times came to fruition.
Lord Clement-Jones: It all depends on whose information is more up-to-date. If the information comes from the Scottish Parliament and the Scottish Executive, one would normally think that it is reasonably authoratitive. The noble Lord, Lord Lipsey, has made an extravagant claim about the experience in Scotland. When it comes to evaluation, I am confident that the Scottish system, which arranges for support for personal care to go direct to the individual, will be vindicated. I hope evaluation will take place, whether by the Audit Commission or another inspection and audit body. There are legions of bodies which I am sure could carry this out.
The experience in England has been that the care homes have put up their charges and, by and large, have absorbed the nursing care fees. I believe that is wrong. I believe it was not what the Government intended. If we compare the two systems over a period of time, I think that the Scottish system of free personal care will be greatly vindicated. No one expected it to be a cheap option. It was done with everybody's eyes open and the Scottish Executive has had to make some difficult decisions about funding.
Lord Hunt of Kings Heath: In suggesting that free personal care will turn out to be the most effective option, does the noble Lord accept that any evaluation will also have to take the opportunity cost into account? In other words, what will have to be restricted in order to fund personal care? I suspect that
Lord Clement-Jones: I do not believe that it is a zero-sum game. I believe that domiciliary care and personal care at home are extremely important. Such a system does not create perverse incentives to stay in care homes, but it does encourage people to stay at home. I also think that we can achieve a great deal with prevention. This is not a matter of spending on care homes as opposed to spending on domiciliary care. We have to see it as a totality. One of the mistakes people make is to look at this as simply a matter of ring-fencing money for each activity.
We are clearly not going to agree. I do not believe that "other services will be robbed"which is the phrase that I think the Minister usedif we have free personal care. We have to look at this in totality. I believe that it is still too early simply to rely on articles and reports in The Times to see whether the Scottish experience is a good one. However, I am confident that that will stand the test of time and that the comparison with England will be favourable. Meanwhile, since the amendment has had such a tremendous reception, I beg leave to withdraw the amendment.
The noble Baroness said: In the full knowledge that the noble Lord, Lord Lipsey, is still with us, I move on to another group of amendments that he may wish to attack with similar vigour, although I hope that he will not. At first glance, these amendments may seem somewhat simplistic and even invite mockery in some quarters, but I hope that they do not. The amendments deal with what happens daily to old people who are discharged from hospital. They deal with the very small things that can make a difference between a successful discharge and life being made unbearable. Due to the lateness of the hour, I shall not detain the Committee with anecdotes. I wish that I had the time to do so. I shall confine myself to making two distinct sets of points, the first on the definition of free equipment, and the second on intermediate care.
The Explanatory Notes list only a few items, ranging from walking sticks to grab rails to shower mats. That is not a very clear indication of the types of equipment likely to benefit older people. I ask the Minister for an assurance that the guidance will make it clear that, at the minimum, the equipment listed in the Guide to Integrating Community Equipment should be free. The Government should indicate what will be free in order to avoid wide variations between local authorities and a lack of understanding among staff
The regulations link community equipment to Section 2 of the Chronically Sick and Disabled Persons Act and Section 2 of the Carers and Disabled Children Act. The regulations also define "minor adaptations" as something which costs less than £1,000. How was the £1,000 figure reached? What types of adaptations will the £1,000 cover? What adaptations will it not cover? What are the Government's plans to uprate the limit, or will it be one of those limits that stands for ever? Is the figure intended to be inclusive or exclusive of the cost of fitting adaptations, or does it apply solely to the cost of the equipment?
Some equipment and adaptations are provided by the NHS and are therefore free regardless of expense. We need clarity about when the NHS will provide an adaptation as a part of meeting an individual's healthcare needs and when the individual will have to apply for it to social services or a housing department. Will the guidance also make clear which equipment is provided by nursing care and which by the NHS? The provision of such equipment should be reflected in the fees charged by those homes. Although there is guidance on the matter, there is still a lack of clarity.
I turn finally to the limit on intermediate care. At Report stage in the Commons, the Minister absolutely and firmly slammed the door on the issue of six weeks' intermediate care. The draft regulations say that if intermediate care has to be provided for longer than six weeks, the first six weeks are to be free of charge. That might imply that local authorities have the discretion to continue providing intermediate care, for which they will charge after six weeks. Can the intermediate care time limit be extended at the discretion of the professionals involved in looking after the person? If not, after the absolute deadline of six weeks, will people be told that intermediate care is no longer free? At that point, will there be an assessment of their ability to pay the costs?
I notice that the noble Lord, Lord Lipsey, seems happy with that approach. I look forward to the Minister's reply. I think that those points go right to the basis of the Bill. I beg to move.
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