Community Care: Discretionary Charging (Hansard, 11 January 1995)

Lord Campbell of Croy
asked Her Majesty's Government:
Whether they will issue further guidance to local authorities on discretionary charging for community care services for disabled and elderly people.

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the Social Services Inspectorate sent advice to all directors of social services in England and Wales 12 months ago. The advice concerned the factors that they should consider when reviewing or devising a charging system. There are no plans to issue further advice.

Lord Campbell of Croy
My Lords, I thank my noble friend for her reply. As local authorities have had that responsibility for the new community care system for a short time only, and in order to set general standards on a national scale, should not more guidance be issued in addition to what was really only an outline issued by the Social Services Inspectorate a year ago?

§ Baroness Cumberlege
My Lords, social services departments have had the power to charge for domiciliary services since 1948, so that is not a new element in the way in which they run their business. We sent out the guidance and we are monitoring very carefully what is going on. At the moment we feel that that is sufficient.

§ Lord Ashley of Stoke
My Lords, is the noble Baroness aware that those charges are inequitable and unfair? They are inequitable because they vary widely throughout the country for the provision of precisely the same service. They are unfair because local authorities take account only of the income of disabled people and not their expenditure, and some disabled people incur very heavy costs because of their disability. Therefore, the guidance issued by the Government and by the inspectorate is being ignored. Will the Minister please consider recommending to the Government that they should set national standards and insist on realistic assessments?

§ Baroness Cumberlege
My Lords, no, we shall not consider that. We believe that local authorities should have discretion. Different services are provided in different parts of the country. Local authorities are best placed to identify the strengths in their areas and indeed to provide flexible systems. If we introduce something 168 which comes from the centre, it would be rigid and, in some places, inappropriate; we wish to trust local authorities in that instance to use their own discretion.

§ Baroness Faithfull
My Lords, what is the position with regard to people who are still ill but who have been discharged from hospital and therefore need to go into a nursing home? Who is responsible for the financial costs of the nursing home?

§ Baroness Cumberlege
My Lords, this Question is about domiciliary services. Local authorities do not have discretion with regard to residential care. The way in which the charges are made is laid out quite clearly. I shall go into the detail if my noble friend wishes me to, but it takes into account the capital of individuals, the costs of the home and their income; and in some cases quite a lot of assistance is given through income support.

§ Lord Molloy
My Lords, what is the situation with regard to those ex-servicemen and women who were disabled as a result of being badly wounded in wars?

§ Baroness Cumberlege
My Lords, they have special circumstances; they are considered differently and I believe that the noble Lord is aware that we look after them in a different way.

§ Lord Dean of Beswick
My Lords, is the Minister aware that when that responsibility last rested with local authorities—and I was involved—there was a specific component within the rate support grant for that particular service for elderly and disabled people? That was identified quite clearly. The component granted was based on the needs of the area. Why cannot the Government revert to that and save all this trouble, because they would then target the assistance on areas of greatest need?

§ Baroness Cumberlege
My Lords, all local authority expenditure works on a formula —the standard spending assessments. A great deal of consultation takes place with local authorities on how those assessments are drawn up year on year and the formulae required to do that. Charges for services are not part of the assessment. It is for local authorities to charge as they wish. Many of them accrue quite a lot of income from that, which enables them to give services to a wider range of people. We have no problem with the proposition that people who can afford to pay for services should pay for them.

§ Lord Carr of Hadley
My Lords, does not another matter underlie the question of such services? I refer to the great variability in the efficiency of the staffing methods and services provided by different local authorities. I do not believe that I am alone in feeling that the system leaves a lot to be desired and that there needs to be a great deal of improvement if we are to provide those vitally important social services on the scale and with the humanity which we should all like to see.

§ Baroness Cumberlege
My Lords, my noble friend is quite correct. When one looks at how local authorities manage their business, there is a great variation between those which provide high quality, efficient services at lower cost and those which do 169 not. Indeed, the Audit Commission today produced its report on the running and efficiency of local authorities and social services departments, looking particularly at staffing. The report says that there is a very wide variation in rates of pay. It says that one-third of the authorities surveyed were unable or unwilling to give information on their pay bills and staffing levels; and that only a minority of councils set clear objectives and tasks for their staff. Clearly in a number of councils there is room for improvement in efficiency.

§ Baroness Jay of Paddington
My Lords, is the Minister aware that I am very pleased that she was asked such a Question by her noble friend? It precisely reflects the concerns that have been expressed many times from these Benches, not least by my noble friend Lord Ashley of Stoke in introducing earlier debates on community care. Is the Minister also aware that the base of those concerns is the worry that there are no national eligibility criteria for where free health care and means-tested social care starts? Why cannot the Government find a way to define national eligibility criteria? After all, they are firm in their belief and in their expressions that the National Health Service should remain a national concern.

§ Baroness Cumberlege
My Lords, we have had long debates on the subject. The noble Baroness will know that a consultation paper has been sent out to the National Health Service, to local government and to a wide range of people on the differentiation between health care and social care. Responses to the consultation paper are now being considered by the department. We have had a range of responses—many of them very helpful—and we shall be producing a firm document very shortly.

Lord Campbell of Croy
My Lords, I entirely accept a system of charging, because some elderly people are very well off and can contribute; but they also need care. However, is my noble friend aware that in other cases charging may discourage people from continuing in or seeking employment, as earnings would be reduced or nullified by the present system?

§ Baroness Cumberlege
My Lords, I am sure that many people would like a free service and would prefer not to have to pay towards it. However, as I said, we believe that local authorities must consider whether a reasonable charge should be made. They have to consider the cost of the service and the ability to pay. There is an appeals procedure when people feel that they are not being properly treated. Those considerations are all part and parcel of the Acts under which local authorities work. In that regard, we wish to give them discretion. However, there is no discretion in respect of residential care, where there is a statutory formula.