Disabled Persons (Services) (No. 2) Bill [H.L.] (Hansard, 24 May 1993)

§ Lord McColl of Dulwich
My Lords, I beg to move that the Bill do now pass.

§ Baroness Hollis of Heigham
My Lords, as the only opportunity that we had to debate the Bill at length was on Second Reading I wish to make a few comments. The Bill was uncontroversial and therefore, apart from the formal amendments, no amendments were tabled in Committee or on Report. Perhaps the House will allow me to make a few comments on behalf of Members on these Benches as regards some of the issues which arose on Second Reading but which we were not able fully to explore.
First, I wish to congratulate the noble Lord, Lord McColl, on introducing the Bill and seeing it through the House. I also congratulate the Minister, the noble Baroness, Lady Cumberlege, on the charm if not the conviction with which she sought to rebut our arguments. I hope that even at this late stage, as we wish the Bill well in another place, we may seek to persuade her that at least in principle the Bill is right to be supported.
I wish to return to some of the issues that were debated on Second Reading and which the Minister sought to challenge. She then made the point that to introduce cash payments for local authorities to aid the disabled was to introduce a new principle which would blur the line between the DSS and the social services; or to use the Minister's effective phrase, to make a social security system of social services. That argument would be more plausible if local authorities were not making cash payments every day of the week to adults fostering children, to adults playing hockey or tennis, or to adults running arts, voluntary and caring organisations —except to those who happen to be in wheelchairs. What on earth is the moral difference between paying a monthly amount to a disabled person in cash or, as local authorities are permitted, paying a somewhat larger monthly amount to a charity which dispenses it as smaller monthly amounts to two disabled people? Of course, there is no moral difference but there is plenty of practical difference, such as the cost and the time wasted in bureaucracy. Frankly, that is somewhat insulting if one happens to be disabled. In other words, at present local authorities may not pay cash to the disabled but they can give money to a charity to give it to the disabled, which apparently is okay.
The second argument which the Minister offered in Committee was that paying the disabled in cash rather than providing services in kind might generate escalating costs. That is not so. The argument which came from all sides of the House was that this was a no-cost option. Indeed, I suggest that it is easier to control, to cap, a cash budget than a services budget where salary costs might rise higher than inflation 78 Cash is a straight alternative at the discretion of the local authorities if they believe that it offers better value for money. As a former chairman of the finance committee of a local authority I saw that it was much easier to control the cost of grants to voluntary organisations—for example, a sporting organisation —than to control the costs of a sporting organiser employed in-house by local government. That is undeniable.
It is also a limited option appropriate especially for younger clients and spinal injuries clients who are used to being in control of their lives. In the past, such clients turned to the ILF.
The Minister also suggested that local authorities might have problems in defining eligibility, but why should they? The social work assessment would steer clients into service-based or cash-based packages of care, whichever was the more appropriate and whichever represented better value for money. I seek to find words of support from the Minister in pointing out that the Bill will give local authorities a discretion in deciding which path to go down as regards the clients who they believe will be most advantaged, which is a discretion that they desperately want.
The third point—and I do not believe that we disagree about this—is that the cash payments can represent a more dignified option. The Minister rightly accepted in well-chosen words that issues of personal dignity and autonomy are at issue here. She said that there is no reason why a care assistant should not be personally chosen by the disabled person. We are talking about the need of a disabled person to have personal help in such intimate functions as toileting. Having led for the opposition party on a social services authority, for the life of me, I do not know how the Minister's assurance that a disabled person can chose his own care attendant, even though that person is a local authority employee, can operate. Perhaps the Minister will tell me how it can operate. In no way can clients choose who the authority employs nor can they determine how the local authorities do the rostering and so on which is essential if they are to maintain an effective and value-for-money personnel budget. Clients simply cannot pick and choose and I do not know why the Minister thinks that they can. That is precisely our complaint.
The fourth point that I wish to raise is that I was not sure whether the Minister in her remarks in winding up the debate on Second Reading had taken fully into account the implications of the Disability (Grants) Bill which was handled by the sister department, the DSS. The Minister will not need me to say that if someone needs £190 worth of care, that will be provided in the form of services from the local authority. However, if a package of £400 worth of care is needed, then the person will receive £200 worth in the form of services from the local authority and £200 in cash from the ILF.
Therefore, those two Bills are proceeding through your Lordships' House in parallel but it may be that no connection is being made, as there should be, between the two Bills. Will the Minister tell us how the combination of cash and services will work? Will the 79 local authority pay a person of its choice to go in and get somebody up in the morning, feed them and toilet them and then put that person to bed at night and toilet and feed them while in between, at lunch times and over night, somebody else would be employed and paid by cash from the ILF fund? That is the kind of boxing and coxing in personal care for the severely disabled which cannot be sensible.
As was said in that debate on the ILF, community care is about avoiding residential care. And yet people go into residential care not because their disabilities are worse but because their informal care arrangements have broken down. All research into ILF money shows that cash grants, because they are cash, buying perhaps 20 hours of formal care, allow their clients to leverage a further 60 hours or so of informal care out of the system because the money is spent on respite care, on additional paid hours, on reimbursing expenses, on travel costs and so on. In other words, cash payments, which is what the Bill seeks to empower local authorities to make when they believe it to be appropriate, can network and therefore stretch informal caring. By definition, formal professional services cannot do that. Permitting clients to receive only formal services from local authorities means that they are less able and likely to keep that informal net afloat. Therefore, disastrously, they end up needing even more formal services which, sadly, the local authorities are often financially unable to provide.
I do not believe that there is a difference of principle between us. The Minister Mr. Scott made clear in another place on 27th April that if local authorities can devise schemes which are lawful—for example, using local charities—he would not oppose them. He seems to be saying, "I will not change the law but you are welcome to get around it with my blessing. You bend it because I cannot or will not amend it". That is a curious base for social policy.
Originally I thought that opposition to the Bill came from the DSS and the Treasury. The Minister made it clear that the Bill receives no government support. However, it seems that provided costs are capped, which I believe they are, the DSS and the Treasury may be open-minded on the issue. Certainly a letter from Mr. Lamont to Jane Campbell, one of his disabled constituents who is active in the disability movement, makes it clear that he has no objection in principle to cash payments but says that the Department of Health has serious reservations about that. What is the line of the Department of Health? Why does it have such serious reservations? We have discussed the argument about blurring the lines but, as I have argued, the lines are already regularly blurred, and are blurred all the time in Scotland. We have discussed the argument about escalating costs and I have tried to argue that that is not the case. We have discussed the implications of the new Disability (Grants) Bill. What is the department's argument? Why is it that, despite the Treasury and the DSS apparently being open-minded, the Department of Health appears to resist the Bill?
As far as I can tell, the argument advanced by the Secretary of State and by the Minister is that 80 inevitably local authorities are heavily burdened with new care in the community responsibilities. Therefore, it is unwise and unkind to give them new responsibilities until care in the community has properly bedded down. Yet the research of Pauline Thompson, the director of DIG, shows that local authority directors of social services want the power to pay cash because they believe—and they are running the service on the ground—that it will free them, rather than encumber them, from some of their load. Why does the Minister insist that the cash payment is an additional load when those who must administer it say that it will lighten their load? What evidence will the Minister be willing to accept to the contrary? If there is no evidence, we are simply talking about ideology.
After all, local authorities can dower their clients with a cash assessment which could then be integrated by the ILF with its own financial packages and be monitored by the ILF. That would bring simplicity, clarity, autonomy and value for money. The Minister should find quite irresistible the arguments for giving a discretion to enable local authorities to make cash payments to the disabled, especially where those disabled are also receiving cash payments from the ILF. I am genuinely baffled that she does not do so. I ask the Minister what she would like for herself or her husband. I ask what the civil servants in the Box would like for themselves. Anything less than what they would like for themselves, within cost constraints, is not good enough for disabled people.
Finally, if the Department of Health continues to repeat the doctrine of unripe time while agreeing that cash payments may be acceptable in principle and may ultimately be made, will the Government indicate whether they might accept an amendment in another place giving the Secretary of State the power to determine when the Bill comes into force? In other words, the Bill would pass through both Houses and reach the statute book but it would be brought into effect only when the Secretary of State thought it appropriate. That would meet the Minister's objections that the Government do not wish to overburden local authorities at present. I do not share the Minister's views as to the argument but if that is a way of attracting government support for the Bill, that would be a welcome path to take. Such an amendment would allow that additional discretionary power for local authorities to come into being when the Secretary of State thought that the time was appropriate. It would not require further legislation. In such circumstances, will not the Minister, at last, indicate some support for the Bill?

§ Baroness Cumberlege
My Lords, I take this opportunity to congratulate my noble friend upon the clear and concise way in which he has expeditiously steered the Bill through your Lordships' House. Despite my noble friend's powers of persuasion, which are considerable, I regret to inform your Lordships that the Government's position has not changed since Second Reading. As the noble Baroness, Lady Hollis, said, no amendments have been tabled.
81 Local authorities are enablers, facilitators and providers of care services. It is not their core business to provide cash to support individuals in need. It would be difficult for them to manage a general system of cash payments, including defined eligibility and monitoring, to keep control over public funds. We believe also that now is not the time to add to the workload of local authorities.
We have listened carefully to the arguments put forward in support of direct payments, not least those put forward by noble Lords opposite. However, we believe that there is a significant risk that over time the link that the Bill makes between services and payments will be broken. There will be expectations of the going rate for particular conditions, irrespective of people's assessed needs and the services which would otherwise have been provided. That would put additional pressures on local authority resources which could be met only at the expense of other client groups and services.
The noble Baroness mentioned the arrangements that local authorities make with charities. That is a matter for them and for the Audit Commission. The Government would not wish to intervene. With regard to the users of services, local authorities are free to contract with anyone for the provision of care services, including individuals acting as personal care assistants. When the care plan is drawn up by the local authority, the independent living fund and the disabled person, we certainly expect the local authority to make sure that the person has as great a say as possible in the type of service to be provided and by whom it is to be provided.
We are at one in our motives, but not in our methods. It is with considerable regret that we cannot, therefore, support the Bill. However, I do not seek to oppose its Third Reading.

§ Lord McColl of Dulwich
My Lords, I am most grateful for the contributions made in this evening's debate. I should also like to thank the noble Baroness, Lady Hollis, for her spirited defence. I do not think that the guessing game of which civil servant was responsible for not supporting the Bill, or which particular department is responsible, is all that profitable. Any government has to be prudent as regards not letting public expenditure get out of hand.
Government is always much more complicated than it seems. It is always easy for those of us not in government to attack the Government at every opportunity. But, of course, I have to remind the noble Baroness, Lady Hollis, that one day she may become a Minister in a government, perhaps in about ten years' time—that is, if she changes party—so we must be prudent in how we attack, and so on.
Again, I should like to thank everyone for their support this evening.

Viscount St. Davids
My Lords, I beg to move that the House do now adjourn during pleasure until 8.25 p.m.