ASSESSMENTS AND SERVICES FOR BOTH CARER AND PERSON CARED FOR

HC Deb 05 May 2000 vol 349 cc447-52

Amendments made: No. 29, in page 2, line 42, leave out "(1)" and insert "(2)".

No. 30, in page 2, line 43, leave out "(1A)" and insert "(2A)".

No. 31, in page 2, line 43, leave out "such an assessment" and insert— 'an assessment under subsection (1) or (2)'.

No. 32, in page 3, line 1, after "1", insert— 'or (Assessments: parents of disabled children)'.—[Mr. Hutton.]

Mr. Hutton

I beg to move amendment No. 33, in page 3, line 27, at end insert— '( ) The local authority's decision under subsection (4) is to be made without regard to the means of the carer or of the person cared for.'.

Mr. Deputy Speaker

With this it will be convenient to discuss amendment No. 48, in page 3, line 27, at end insert— '( ) The decision of the local authority under subsection (4) is to be made taking full account of the means of the carer or person cared for and determined appropriately.'.

Mr. Hutton

May I clarify, Mr. Deputy Speaker, whether we are also discussing amendment No. 34?

Mr. Deputy Speaker

We are discussing amendment No. 33. If it is of any help to the Minister, may I point out that we shall deal with amendment No. 34 after this group? We are now on amendment No. 33.

Mr. Hutton

Thank you, Mr. Deputy Speaker.

After discussion with my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) and in recognition of the fact that he is losing his voice, he is happy for me to move this amendment which stands in his name and that of my right hon. Friend the Secretary of State for Health.

During the first sitting of the Committee, my hon. Friend referred to a meeting that he and I had with representatives of carers and persons with parental responsibility for disabled children. One of the matters discussed was the concern to ensure that an opportunity is not created for councils to take account of who is best able to pay a charge when deciding whether to provide services as carer services under the Bill or as community care services under the National Health Service and Community Care Act 1990.

It was recognised that such an opportunity could in theory arise because the Bill offers the fullest flexibility to councils in the services that they may offer carers to ensure that the actual needs of individual carers are properly met. To tackle that point, the hon. Member for Sutton and Cheam (Mr. Burstow) tabled his elegant solution to the problem in the second sitting of Committee. His amendment forms the foundation of the amendment that I move today.

Amendment No. 33 will add a new subsection to clause so that it becomes possible to ensure that decisions made by councils about whether a service can be provided to the carer as a carer service or to the cared-for person as a community care service do not take account of the financial resources of the individuals concerned.

I am afraid that amendment No. 48, to which the right hon. Member for Bromley and Chislehurst (Mr. Forth) will speak shortly, has the opposite effect. It is entirely contrary to Government policy on social care. Let me explain to him why. We have already discussed the matter in part in relation to an earlier amendment, when he asked whether resources should be taken into account when needs are assessed or when liability to a charge is assessed.

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Councils' decisions about an individual's eligibility for community care services must be based on an assessment of their needs. The financial assessment of individuals as part of a council's charging policy is a subsequent step in the process. The level of people's resources should not, however, alter the assessment of the sort of help that they need with everyday tasks.

Amendment No. 33 is therefore entirely consistent with our policy. Once again, we have listened to carers and people with parental responsibility for disabled children. We are taking action—indeed, my hon. Friend the Member for Stalybridge and Hyde has already done so—to ensure that the Bill addresses their concerns. I therefore urge the House to accept amendment No. 33, but I strongly urge it to reject amendment No. 48.

Mr. Forth

I am the first to concede that, almost certainly, this is not an appropriate time to have a full-blown debate about what is crudely known as means testing. However, I do not want the occasion to pass without at the very least making a nod in the direction of the argument, as I have been bothered by the matter for some time. We need to return to the matter from time to time to ensure that we are all happy about where we are going.

Section 17(8) of the Children Act 1989 states: Before giving any assistance or imposing any conditions, a local authority shall have regard to the means of the child concerned and of each of his parents. Amendment No. 48 very much reflects the spirit of that. I make no apology for offering an argument made since the invention of the welfare state, and asking whether it is right or sensible to deliver a taxpayer-funded service to people who are well able to provide for that service themselves or for those for whom they have taken responsibility. That is an old argument covering familiar territory which, none the less, is relevant in the context of the Bill.

I therefore wish to ask the Bill's promoter and the Minister whether they are still satisfied that it is a proper and correct use of taxpayer-funded resources, services, personnel and so on to support people who are patently and demonstrably well able to look after themselves financially. I have always thought that that was the wrong way to go, and—if I can put it this way—have always been a means tester. I have always thought that taxpayers' money should be properly focused and directed at those who can demonstrate that they need such assistance.

I am therefore opposed to blanket provision, whenever it arises. I have always thought that giving taxpayers' money for whatever purpose—however laudable or justifiable—to everyone, regardless of their means, is absurd. We all know of people who are elderly or, as in this case, disabled, who have considerable resources. It looks odd to ordinary taxpayers if their money is channelled through taxation to provide services or benefits to such people who are much better off than them.

We are obliged to return frequently to that question, if only to reassert the view—which the Government take and which has been expressed today by the Minister—that it is perfectly proper to tax those who are not well off and give that money to people who are much better off than those taxpayers. It is difficult to defend that principle. Of course, I accept that my argument implies a certain degree of bureaucracy and intrusion—questions may need to be asked, and many people may find that unpalatable or unacceptable. However, to my mind, the greater good, or the greater justification, lies with those who say that we are entitled to ask before we part with taxpayers' money—either directly in the form of money, grants or whatever, or in the form of services and support—whether that person really needs that support, or is perfectly capable of looking after themselves in a financial sense. That is the question that I seek to pose in amendment No. 48.

I do not wish to divide the House on the matter at this stage. It would be inappropriate in the context of the Bill, but I would like to hear the promoter or the Minister say again, however briefly, why they believe that having no interest in the means of the person to whom the assistance is given remains the correct approach.

Mr. Burstow

As I understand it—indeed, we explored the matter in Committee—it is not a matter of not assessing means at all; it is a question of the sequence in which means are assessed. In that sense, the question is, who is the gatekeeper? What is the gateway through which the person travels?

Is it a gateway to assess the person's financial means, which the amendment of the right hon. Member for Bromley and Chislehurst (Mr. Forth) appears to describe, or is the gateway to assess a person's need for care? Once they have passed through the gateway to assess their need for care, there is an entirely legitimate debate to be had about assessing their financial means and the scale of charges that might be applicable for the provision of particular social care services.

I do not see how the amendment that has been tabled by the hon. Member for Stalybridge and Hyde (Mr. Pendry), or, indeed, the amendment that I tabled in Standing Committee, would invalidate the points that the right hon. Gentleman has made, but he usefully raises the question of means testing and whether provision of a free service, with no charge levied, may disproportionately benefit the better off.

That is a live and current issue in the context of the royal commission on long-term care. It seems that it reported a lifetime ago, but it was just at the beginning of last year. It is to be hoped that the Government will imminently give their final, determined view on its report; it is expected in July. Let us hope that it is their final statement and position on the matter.

That will bring into sharp relief the issue that the right hon. Gentleman has mentioned, but I do not think that that debate is relevant to the debate on these amendments, which is simply about the proper sequence in which those matters should be looked at. In my judgment, it makes sense to start by looking at the care needs of the person before considering their financial needs.

That is what the amendment that I moved in Committee sought to do. As I understand it, it is the purpose of amendment No. 33. I will support that amendment because it provides welcome clarification. It will reassure many outside the Hous—it will certainly reassure the Carers National Association and many carers, too.

From my own recent case work, I know that the introduction of charges and means tests is a cause of great anxiety and concern for carers. Only two weeks ago, I attended a meeting of my carers forum in Sutton, where the issue was explored in great detail because my local authority is considering extending charging to daycare services—a controversial proposal, although not unusual in many other local authorities, which already operate such charges. Nevertheless, carers and those whom they care for are very concerned. Therefore, it is right that the amendment clarifies that the need should be checked and assessed before the means are assessed. I support the amendment and hope that the House will do so, too.

Mrs. Spelman

I shall speak briefly, partly to do a bit of bridge building between the amendments which in many ways address different things. Throughout the Committee stage, members on both sides pressed for a distinction to be made between the process of needs assessment and that of financial assessment, so that one follows the other. The Committee was quite clear that there must be integrity in needs assessment.

I think, however, that my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) made a very good point, in relation to which I may be able to provide a good practical illustration. As newspapers often, even daily, report, courts are awarding very substantial sums to the parents of disabled children when medical negligence, for example, has been proved. Although, sadly, it often takes a very long time to establish that there has been negligence and to calculate damages, when the damages are calculated, I believe—I am not a lawyer, but the Minister is—that, in assessing them, the court will take into account the disabled child's care costs.

I therefore believe that my right hon. Friend made a good point. If a judicial assessment has been made and damages awarded, it would be quite legitimate for the local authority to make its case that, in awarding damages, the court had already recognised that quite considerable public sums are required to support the family of the disabled person. It could therefore be quite strongly argued that that award should be part of the financial assessment.

Mr. Hutton

The hon. Member for Meriden (Mrs. Spelman) attempted to build a bridge between amendment No. 33 and amendment No. 48. She will be lucky if she succeeds in doing so, as the amendments are diametrically opposed and would have completely opposite effects. Amendment No. 48 would effectively ensure that a means test was applied, not when assessing liability to a charge but when assessing even whether a person should benefit at all from a service. In view of the alleged compassionate conservatism being proclaimed by Conservative Members, the hon. Lady may not wish to adopt that policy.

All hon. Members who have spoke have, in one way or another, raised the issue of charging for social services. The hon. Member for Sutton and Cheam (Mr. Burstow)—as he is wont to do on such occasions—mentioned the royal commission's very important report. As he said, the Government will in the summer announce how we hope to achieve our objectives in relation to social services charging for non-residential care, to build greater equity and fairness into the system and reduce the scale of variation between local authorities in charging policy.

We are also awaiting with interest the publication of the Audit Commission's imminent report, which I am sure will throw some light on and provide valuable insights into the exact nature of the problem that we have to deal with and the precise scope of variations in charging regimes. I think that those variations are substantial, and that we shall have to take effective action to reduce them. The variations can have the type of effect mentioned by the hon. Member for Sutton and Cheam. However, that debate is for another occasion.

I should like simply to reassure the House about the purpose of amendment No. 33. The amendment is intended to ensure that councils do not consider the potential for raising charge income in deciding who—whether a carer or the cared-for person—should receive a service. In doing that, we are trying to proceed sensitively and carefully.

Amendment No. 33 ensures that in offering councils the fullest flexibility in determining the services that they may offer carers under the Bill, an opportunity is not created for councils to take account of who is best able to pay a charge when assessing need. The amendment therefore deals with users' and carers' valid concern that councils should not consider the potential for raising charge income when deciding who should receive a service.

The example that has been given—it is a perfectly fair one—is the case of a cared-for person who is not liable for a charge, and has been so assessed, but in which the carer may be liable for a charge. If the services are delivered by the council as a carer service, there will therefore be the possibility of shifting the caring burden on to the carer. Amendment No. 33 is designed to prevent precisely that from happening and to address that important issue. A valid concern has been identified, and my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) has tried very hard to deal with it. I think that we have done that entirely properly in amendment No. 33. The House should accept it, and confidently reject amendment No. 48.

Amendment agreed to.