Long-term Care Costs (Hansard, 11 March 1997)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, local authorities have the responsibility to assess individual needs and, where appropriate, to arrange cost-effective support. The Department of Health does not give detailed guidance on these issues.

§ Lord Ashley of Stoke
My Lords, I am very sorry that the department does not do so. Does the Minister recall that, when the direct payments legislation enabled severely disabled people to live at home rather than be forced into institutions, disabled people were absolutely delighted? However, is the Minister aware that some local authorities are now insisting on a £500 limit and that very severely disabled people are apprehensive and even fearful that they will be forced back into those institutions?
Therefore, can the Minister, first, confirm that there is no government-ordained limit; and, secondly, despite what she just said, can she give advice to local authorities and urge them to be flexible on this issue with severely disabled people? I should stress that we are talking about the very small number of people and one must admire their intention to remain independent.

§ Baroness Cumberlege
My Lords, I regret that the answer to both of the noble Lord's requests is, no.

§ Lord Carter
My Lords, is the Minister aware—I am sure she is because the point has been made to her on a number of previous occasions—that standards in residential and domiciliary care around the country are a cross between a patchwork quilt and a lottery? Is there not, therefore, a very strong case for national care standards as regards domiciliary and residential care and for much greater regulation of domiciliary care?

§ Baroness Cumberlege
My Lords, I agree with the noble Lord that it is a patchwork. However, if one takes the average cost involved, the average cost of a private home is £246 a week while the average cost of a council-run home is £283 a week. It is quite interesting to see where the value for money is in that comparison. I should also point out that the Government will shortly be producing a White Paper on social services which will address the issue of regulation.

§ Lord Pearson of Rannoch
My Lords with reference to the costs of long-term care for the mentally handicapped, can my noble friend the Minister say 161 whether the Government will ensure that an accurate comparison is made between the costs for community care on the one hand and, on the other hand, the costs for residential and village communities? Above all, will they ensure that all departmental costs are included in that comparison?

§ Baroness Cumberlege
My Lords, it is up to local authorities to decide what is good value for money. However, guidance is also given to local authorities on the question of choice. Local authorities have to take into account the individual's choice as to where he or she wishes to be looked after, provided that that produces value for money.

§ Lord Boyd-Carpenter
My Lords, is my noble friend the Minister aware that many noble Lords are very anxious to have proper discussion on the costs of long-term care? Indeed, there is real anxiety as to its costing at present. It will be very helpful if my noble friend could give any lead whatever as to the future handling of this difficult and controversial subject.

§ Baroness Cumberlege
My Lords, my noble friend is absolutely right. I think the country is concerned. That is why my right honourable friend yesterday produced a policy paper, A New Partnership for Care in Old Age, which is a partnership between the Government, the private sector in terms of the insurance industry, and also those who need the care.

§ Baroness Farrington of Ribbleton
My Lords, can the Minister give information to your Lordships' House about staffing levels in local authority homes and staffing levels in the private sector and access to those with training and appropriate qualifications, including nursing qualifications where suitable?

§ Baroness Cumberlege
My Lords, they vary both in the private sector and in local authority homes. As I have pointed out, when one takes the average cost one gets better value for money in the private sector.

§ Lord Ashley of Stoke
My Lords, is the Minister aware that long-winded answers are not welcome in this House, but neither are monosyllabic answers especially on such an important issue for disabled people? Why cannot the Minister explain why the Government pass an Act—admittedly an enabling Act—and they do nothing about the twisting of it by some local authorities? They are failing to meet their responsibilities to severely disabled people. Setting an arbitrary limit is something that the Minister ought to say something about. To say simply no is not good enough. What is the explanation?

§ Baroness Cumberlege
My Lords, the question that the noble Lord, Lord Ashley, put to me was whether we were going to set limits. I have to tell the noble Lord that we are not going to set limits. He then asked if we would give advice to local authorities that they should be more flexible in their approach. As I have said, it is 162 up to local authorities. We passed the Act and all the advice is in that Act. We are not going to put out further advice to local authorities.

§ Baroness Turner of Camden
My Lords, is the Minister aware that, when approaching local authorities for care in the community, one is frequently told it is within available resources, but, if those resources are overstretched, the care that one expects is often not forthcoming?

§ Baroness Cumberlege
My Lords, local authorities have had their resources doubled in real terms since 1990–91 for the funding of community care services. They now spend £7.5 billion per year. That is a huge sum of money. We have invested enormously in social services and it really is up to them to use it to best effect.

§ Lord Richard
My Lords, the Minister, if I may say so, is being uncharacteristically unhelpful this afternoon. I wish to ask her a specific question: when is the White Paper coming out and will the report of the Audit Commission be with it? Will we have the opportunity of seeing the report of the Audit Commission on this matter at the same time as the White Paper is published?

§ Baroness Cumberlege
My Lords, I say, in danger of being monosyllabic, yes. I say in answer to the first question, as soon as possible.