Disabled People: Community Care Provision (Hansard, 12 January 1999)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hayman)
My Lords, the House of Lords' judgment in the Gloucestershire case did not change the law but confirmed the legal position to be that which the Department of Health always believed applied: namely, that authorities may take their resources into account in assessing the needs of a disabled person and deciding what services to arrange.

§ Lord Ashley of Stoke
My Lords, I am grateful to my noble friend for that reply. However, the fact that the Law Lords' absurd judgment ruled that local authorities can take account of their resources when assessing the needs of disabled people means that any local authority can say to a quadriplegic, someone who is totally blind and totally deaf or someone completely paralysed, "We have no money so you have no needs". It is hard to think of a more preposterous proposition. Will my noble friend therefore urge the Government to change the law so that disabled people receive these services as a right and not according to the whim of the local authority?

§ Baroness Hayman
My Lords, we are aware of the strength of feeling of my noble friend and others in this area. However, I must stress again that it is our belief that the House of Lords' decision did not change the law; it simply confirmed the legal position to be that which applies under the Act. Resources are only one of the considerations to be taken into account; other relevant factors must also be considered. Pressure on resources cannot be used as an excuse for taking arbitrary or unreasonable decisions. After the debate on my noble friend's Bill in 1997 the department issued guidance on the implications of the judgment, which clarified that local authorities have continuing responsibilities towards disabled people.

§ Lord Rix
My Lords, people with learning disabilities and their families are fearful of the ongoing erosion of local authority services, particularly with regard to day services and respite care. In view of the Minister's response, will she give an assurance that people with learning disabilities and their families will receive day services and respite care as an absolute priority in local authority service provision?

§ Baroness Hayman
My Lords, it is important to recognise the measures that have been taken, particularly those set out in the White Paper Modernising Social Services, which seek to promote independence, improve protection and raise standards in 80 order to benefit all disabled people. Extra resources are being made available and guidance will be drawn up under the Fair Access to Care initiative to be issued to local authorities in relation to how, in turn, they should draw up their eligibility criteria for social care. A whole range of work is being done, including work on a charter for long-term care setting out what users and carers can expect from health, housing, and social services. I hope, therefore, that the noble Lord will feel that people with learning disabilities and their families can be reassured that the Government are taking action across a broad range of issues to improve services for disabled people.

§ Baroness Pitkeathley
My Lords, does my noble friend agree that the essential question of funding on this issue and the increased co-operation between health and social services is improving the situation on the ground, but that nonetheless the recommendations of the Royal Commission on long-term care are awaited with interest? Is she able to give the House any idea as to when we may expect that report?

§ Baroness Hayman
My Lords, we are all looking forward to the publication of that report which will be tremendously important in terms of working out a fair system for funding care for elderly people, and which will lead on to consideration of how to improve the current system of discretionary charging for non-residential services. I am afraid that I cannot give my noble friend an exact date in that respect. However, we have made clear that we hope that publication will take place before too long. In the same way, when we have that, together with the new carers' strategy, it will be easier to assess how we can make real progress in the area.

§ Lord Pearson of Rannoch
My Lords, if a local authority takes the view that its resources are not sufficient to allow it to provide appropriate care for a mentally handicapped person or a person in care, can the Minister tell the House what mechanism exists to validate that local authority's decision? Alternatively, is it left entirely up to the local authority in question?

§ Baroness Hayman
My Lords, I believe that it is clear from the judgment and from the law that, once a local authority has decided that it is necessary in order to meet the needs of a disabled person to arrange a service listed in Section 2 of the Act, it is under a duty to arrange such a service. However, the measures that I outlined earlier, including the Fair Access to Care initiative—which will ensure that we do let local authorities know how they should draw up their eligibility criteria—will help. Moreover, in terms of improving the quality of care and ensuring that there is no unacceptable variance, the eight regional commissions for care standards, which will regulate domiciliary and residential care services, will be most important in this area.

§ Lord Marsh
My Lords, does the Minister agree that this is in many ways dodging the issue, which is not about new initiatives of one sort or another; indeed, it is 81 about the inability of both parties in government to finance, under the present basis, free medical healthcare for everyone? Therefore, is it not time that the whole question of financing the National Health Service was re-examined with a view to people who can clearly pay more—for example, in the case of prescriptions—doing so?

§ Baroness Hayman
My Lords, the noble Lord's question is well wide of the Question on the Order Paper. However, I shall answer it. No, I do not think that it is time for a fundamental reassessment of the funding of the NHS. I believe that we have ample proof that a publicly-funded, free at point of use service is both efficient and something which is envied throughout the world. Nearer to this question is the importance of how we fund long-term care for the elderly. That is why we set up the Royal Commission and why we are so anxious to see what it will recommend.

§ Lord Ashley of Stoke
My Lords, if the Government are adamant that local authorities must take account of their resources when identifying the needs of disabled people, can my noble friend say whether they are planning to ask doctors only to diagnose flu when the money is available to treat it? If that is not the case, and if the Government recognise the absurdity of that proposition relating to health, why do they not recognise the absurdity of it as regards community care?

§ Baroness Hayman
My Lords, I must disagree with my noble friend. Indeed, I do not believe that the analogy is applicable. Perhaps I may throw back to my noble friend an analogy which I believe to be more direct. Other community care legislation allows for resources to be taken into account. If resources were exempted from being taken into account when arranging services under Section 2 (which was the area covered by the Gloucestershire judgment), that would, in turn, create an anomaly which would be unfair to other social service users.