§ Mr. Dismore
I beg to move amendment No. 27, in page 4, line 45, leave out clause 7.
455 This is a probing amendment; I do not necessarily want clause 7 to be removed from the Bill. However, the amendment provides the opportunity to discuss charging. I raised the matter initially on Second Reading when I referred to the briefing that I received from the London borough of Barnet, where my constituency is situated. The briefing outlined Barnet's policy on charging and the anxieties that had been expressed to it on the matter. In an intervention on my speech on Second Reading, the right hon. Member for Bromley and Chislehurst (Mr. Forth) referred to the vague explanatory notes, which did not provide much information on charging. He suggested incorporating the word "reasonable". That was a good idea.
Perhaps the best starting point is the view of Carers National Association on charging. It believes that carers should not have to pay for the services that they will receive under the Bill. On a point of principle, it opposes charging for non-residential community care services because carers already devote their time, energy and money to caring. The organisation asks why carers should pay for a service that helps them to continue to do that, especially when many families experience financial hardship and many disabled people refuse services because they cannot pay for them. It points out that carers save local authorities and the public purse money through the unpaid services that they provide for members of their families.
The Carers National Association also refers to the complications that arise from clause 2, which defines the services that are to be provided for carers. I mentioned that earlier in the context of transport to day centres and the risk of carers being charged for a service that is provided to the person who is being cared for. That matter should be tackled. There was no opportunity to do that earlier because of the way in which the debate unfolded. Perhaps those who reply to the debate could deal with the anxieties that the Carers National Association raised.
On Second Reading, my hon. Friend the Minister suggested that it was right that carers should be charged for services. I have dealt with that point in principle. I understand my hon. Friend's point, and that of the London borough of Barnet. Its briefing states that if it did not charge a reasonable amount for at least some services, they might not be provided. However, this brief debate gives the Government an opportunity to go a little further.
On Second Reading, my hon. Friend the Minister said that users and carers would be fully involved in consultation on the charging regime. Perhaps he will clarify the operation of clause 7, and tell us the extent to which charging for council services will be considered as part of the overall review of charging for services for carers and those who are cared for.
§ Mr. Pendry
As my hon. Friend the Member for Hendon (Mr. Dismore) says, the amendment would prevent carers from being charged for carer services. As my hon. Friend will know from our earlier exchanges, a private Member's Bill is not a vehicle for change in Government policy on charging; nor, I suggest, is this a time when charges are under consideration in Government. I therefore ask my hon. Friend to withdraw the amendment.
I also invite my hon. Friend the Minister, who I know wishes to speak, to repeat his commitment on Second Reading—which has already been mentioned—that the 456 Government will ensure that representatives of carers organisations will be involved in the forthcoming consultation on charging, which will follow the publication of the Audit commission's study of non-residential charges. I am sure the Minister will expand on that, either now or on Third Reading.
As my hon. Friend the Member for Hendon probably knows, this was the one real problem I encountered in promoting the Bill, but the Minister has assured me that the Government will take the issue seriously, and consider it sympathetically.
§ Mr. Barron
I was involved in neither Second Reading nor the Committee stage, but most of us who have spent any time in the House know that carers can lose a substantial amount over what we would term a potential working life, in terms not only of earnings but of retirement pension. Many carers have given up the opportunity of paid work or leisure time. Indeed, they save huge sums for local authorities and, sometimes, for central Government, via health authorities. Regardless of what my hon. Friend the Minister feels, and regardless of what past Ministers have felt, carers feel that they should not have to pay for these services.
I have received a certain amount of correspondence about the Bill. One of my constituents was unable to take work opportunities because he was looking after both his elderly parents for many years; now he is looking after one of them. He would probably find the idea of being charged for time away from work hard to accept. He wrote to me saying that, owing to restrictions on the type of work that he has been able to do, he will not benefit from, for instance, the retirement pension from which many of us benefit. We should consider the level of any charges that are made.
I am sure that my hon. Friend has noted what the Carers National Association has said in the past. The association now wants to know the likely level of charges, and also wants an update on the extent to which charging carers for services will be considered in the review of charging. We discussed earlier what would effectively be means-testing for the purposes of all charges. I do not think that my hon. Friend or anyone else is in favour of that, but it is important to know whether carers will be able to afford charges for respite care. Over the years, I have encountered many constituents who might not have taken the opportunity of respite care if charges had been made, because their incomes would have been too low.
Carers can be in need of care themselves. Although the amendment is only a probing amendment, it addresses important issues. We hope that the Bill will achieve the practical reality that it promises, by bringing help and assistance to people who, by caring, do much good work for their direct families—and indirect families, in some cases—and for taxpayers, by saving massive amounts of money on institutional care. My hon. Friend the Minister will recognise that and I hope that any proposal to levy charges in the future will recognise how much good work carers do. They need the respite care and should not be discouraged from taking advantage of it by overcharging.
§ Mr. Hutton
I thank my hon. Friend the Member for Hendon (Mr. Dismore) for tabling amendment No. 27 and 457 giving the House the opportunity to discuss these important issues. The issue of charging has come to light because the Bill will allow local authorities, for the first time, to provide carer services directly to carers. To maintain the existing balance between carers and cared-for people, it is obvious that we need to ensure that the present arrangements apply equally. To do otherwise would be to prefer one group above another. In this context, we would be treating carers more favourably than the cared for, and that would be inequitable and unfair and could not be justified.
Within Government and outside, we are discussing extensively the future policy on charging for non-residential services. To be coherent, that policy needs to be located within the context of the Government's response to the royal commission's proposals on residential care services. We must strike the right balance between residential and non-residential care services. There is a strong groundswell of opinion, which is backed up by much of the constituency experience and case work that we all have, that criticisms can be made of the charging regimes applied by many local authorities. The arrangements are set out in the Health and Social Services and Social Security Adjudications Act 1983, which simply requires local authorities to set charging policies that are reasonable. Under the existing legislation, the Government—in this case, the Department of Health—have limited powers to issue any effective guidance to local authorities about how they exercise the statutory discretion that they have been given to fix local charging arrangements and means tests, whatever policy they decide to adopt. Some eight or nine authorities do not charge for services at all.
The existing arrangements clearly give rise to the scale of variation that we see across the country, and that has fuelled a sense of injustice among many service users. The present arrangements are not working fairly. Why is it that a modest charge is made in one part of the country, but a much higher charge is made for similar services in another area? The Government have made a commitment to address those issues, and we will do so in the context of our response to the royal commission and in the light of the Audit Commission report on the scale of variation between local authority charging regimes.
My hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) was right to say that a private Member's Bill is probably not the appropriate way to deal with the substantial issues of social care policy that have an implication for the taxpayer in terms of the resources available to local authorities.
My hon. Friend the Member for Hendon knows that we are trying to make the Bill cost-neutral. That is entirely appropriate, but I would not want anyone in the House or outside to think that the Government are not addressing the wider issues that he has raised seriously and as a matter of urgency as we develop our response to the royal commission.
Towards the end of 1998, when we published our White Paper on the future of social services, we set out clearly our policy objectives in this area. We want to reduce the unacceptable rate of variation that clearly exists between authorities providing similar services. That does not lead to the national consistency that we are determined to achieve.
458 We are taking action to ensure proper consistency in standards throughout the national health service. Social care is a crucial partner to the NHS in providing effective support for carers and people who are being cared for. It is one care system that has health and social care as equal partners. As part of the drive for consistency in the NHS, it will obviously be important to address consistency in the standard and quality of social services, which we are taking action to improve, as well as issues relating to the charging regime that local authorities apply.
§ Mr. Burstow
On this occasion, I did not make the first reference to the royal commission. I welcome the Minister's outlining the initiatives that the Government are taking. In July, we shall learn what they intend to do. Although I entirely understand that the Minister cannot tell us what those proposals will be, can he give us some idea—as many outside the House want to know this—of how quickly the changes will be implemented, as we are already two years away from the White Paper to which he referred and it is more than a year since the royal commission reported? When will the proposals be implemented? Will it be in the lifetime of this Parliament?
§ Mr. Hutton
The hon. Gentleman is inviting me to make policy announcements, but I am not in a position to do so, so I shall decline that helpful request for what he described as clarification. Let me correct him on one point. The hon. Gentleman said that we were two years away from the White Paper and asked why the Government have waited so long before making our policy intentions clear in respect of reforming the local authority charging arrangements for domiciliary care services. I know that the hon. Gentleman is most diligent, so if he checks the White Paper he will see that, in November 1998, we made it clear that, before we announced any detailed proposals, we would await both the outcome of the royal commission's recommendations and the work of the Audit Commission. The Audit Commission's report has not yet been published and we need some of the data and intelligence that it is likely to contain to help us get some of the detail of the policy right.
Obviously, there is urgency, as I have said, but I hope that hon. Members understand that I am not in a position to announce detailed proposals against a particular time scale. It is not because I do not want to do so; I am simply not in a position to make such announcements. It is as simple as that.
My hon. Friend the Member for Hendon has drawn attention to a wide-ranging area of concern that has come to light in the context of the Bill because, for the first time, we are allowing local authorities to provide services directly to carers. Obviously, the issues in clause 7 have been brought into focus. For reasons that my hon. Friend has made clear, we need clause 7 in order to maintain the equity and balance between carers and those being cared for, when it comes to charging for non-residential services. To do otherwise would be to disadvantage disabled people. That would not be fair or equitable, and I am sure that no one in the House would countenance any such course of action.
In essence, I am asking the House to bear with us until we can announce more detailed proposals for reforming the local authority charging arrangements. As my hon. Friend knows, we are committed to looking at 459 that and to making sure that carers organisations and others have the opportunity to be fully involved in the work that we shall announce in the summer on making the system fairer and reducing the current scale of variation in local authority charging arrangements. That is no secret. We have always been very open about our intentions in those regards.
I am grateful to my hon. Friend for providing the opportunity for this debate. For reasons that he has made clear, we cannot accept the amendment, and I hope that, in the spirit of what he said earlier, when he described it as providing an opportunity for debate, he will not press it to a vote.
§ Mr. Dismore
In view of what my hon. Friend the Minister has said, I beg to ask leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.