The Disabled: Care Charging Policy (Hansard, 21 March 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords. the Government expect local authorities to monitor the effect of introducing charges or of changes to existing charging policy.

§ Lord Stallard
My Lords, I thank the noble Baroness for that reply. But it is inadequate to push the matter back to local authorities to monitor. Is she aware that local authorities, faced with cuts in their budgets, are having to introduce increased charges for non-residential community care such as home care and day care? Is the Minister further aware that variations between areas pose another problem which means, in effect, that services are determined not so much by the needs of the disabled or the carers, but by where they live? In my view the whole arrangement makes a mockery of community care when the matter is considered along those lines. Will the Minister support the proposition that the Government announce a moratorium on local authority policies until such time as they have had a good opportunity to form clear operational guidelines after consultation with local authorities and voluntary organisations?

§ Baroness Cumberlege
My Lords, the vast majority of local authorities are having an increase in their funding for the coming year, especially for community care, where the Government have allocated an extra £1.2 billion. That is more than twice as much as for this year. It is wrong to have a centralised policy for charging. It is for local authorities to use their discretion and to make the best use of the resources available in terms of voluntary and other private organisations which can provide a good service. We believe that council tax payers should get value for money. There is no question of having a moratorium at the moment. We want local authorities to develop their services by introducing a wide range of different services, so that the people who need them can benefit.

§ Lord Dean of Beswick
My Lords, is the Minister aware that my noble friend Lord Stallard is right in that there will be unequal treatment depending on where one lives? Does the Minister agree that that dispenses with the idea that we still have a National Health Service? Will the Minister take into account what I said in the 492 debate last week; namely, that cities like Manchester have a disproportionate number of elderly people, which includes a considerable percentage of disabled people? Does she agree that the result is that the burden falls very heavily on the council tax payers of Manchester to provide an adequate service unless some recognition is given to increased weighting for those particular areas?

§ Baroness Cumberlege
My Lords, health authorities do not charge for care services, but they do for services such as prescriptions and eyesight tests where there is a national rate. We are talking about local authorities. As regards Manchester, that authority is receiving an increase in funding for this coming year of 2.3 per cent. When I go through the list there are very few local authorities which are not having increases in their budgets for next year, but that does not negate the fact that we expect them to charge where they feel it is reasonable and always to take into account the individual's ability to pay.

§ Lord Skelmersdale
My Lords, has my noble friend noted the implication contained in the last two questions; that is, that one would only get an equal service across the country if one brings community care into the health service? More importantly, does she agree with me that the whole point of local authorities is that they provide the services that they see fit for their area, but now and again the electors disagree with them?

§ Baroness Cumberlege
Yes, my Lords, I agree with my noble friend. But the National Health Service deals with issues concerning health. We expect local authorities to deal with those concerning social services.

§ Lord Ashley of Stoke
My Lords, is the noble Baroness aware that despite the increase in funding to which she has referred, many local authorities could not afford a moratorium because they need the money? However, does she agree that we need a moratorium very badly because the charges are upsetting and damaging ageing, fragile and disabled people and their carers? Does she further agree that the answer is emergency funding by the Government for a moratorium? Will the Minister consider that, please?

§ Baroness Cumberlege
My Lords, there is no question of a moratorium. We are very anxious to see community care develop. We want new services introduced and for local authorities to use their imagination, working with the voluntary and private sectors in giving a much wider range of services. Although the cost of services varies enormously between authorities, on average about 9 per cent. is recovered, which is a very low rate.

§ Lord Molloy
My Lords, is the Minister aware that many local authorities put out such work to private contractors? Is it right for me to interpret her answers as indicating that the stringent examinations will apply also to all ex-servicemen who have been wounded in battle while defending their country and serving this nation?

§ Baroness Cumberlege
My Lords, local authorities are using the private sector more. We are very keen that 493 they should do that, provided that they get value for money and good quality services. I am afraid that I did not quite understand the second part of the noble Lord's question.

§ Baroness Jay of Paddington
My Lords, will the Minister note that the issues that are raised by my noble friend's Question cover many of the same issues that we debated fully last Wednesday in our debate on community care, when there was widespread agreement in the House that we need some form of national evaluation of, and national standards for, community care? Will the Government please reconsider this matter, otherwise the system will persist whereby the community care that one receives will depend on where one lives and not on what one needs?

§ Baroness Cumberlege
My Lords, there was a lot of support in that debate for the close monitoring of community care and I gave an undertaking on that. There was much less support for national standards. The Social Services Inspectorate is about to carry out five studies of people with physical and sensory impairment. Among the things that it will consider is the effect of local authorities' charging policies.