Community Care: Charging Policies (Hansard, 25 May 2000)

Lord Campbell of Croy
asked Her Majesty's Government:
What action they are taking to rationalise the uneven incidence of charges made by local authorities for community care services needed by some disabled and elderly people, described in the recent report of the Audit Commission.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the current charging methods of some local councils for home care are unacceptable. We intend to propose an amendment in another place to the Care Standards Bill to allow guidance to be issued under Section 7 of the Local Authority Social Services Act 1970.

Lord Campbell of Croy
My Lords, I thank the noble Lord for that welcome reply and news. As about one-third of local authorities charge for these services without exempting those on low incornes—described by the commission as unacceptable—will the Government not only introduce the amendment but also make sure that severely disabled people who are hard up are not tempted to give up services which they certainly need but cannot afford?

§ Lord Hunt of Kings Heath
My Lords, I take the noble Lord's point. While some local authorities have very good charging policies, many do not and there is a great deal of inconsistency between them. It is hard at times to see why one local authority has arrived at one decision and a neighbouring authority has arrived at a completely different one. I understand the noble Lord's point about people on low incomes or in receipt of benefits. I assure him that those issues will be considered as part of the consultation on the statutory guidance.

§ Lord Ashley of Stoke
My Lords, does my noble friend accept that community care services should be free if they are essential for disabled people, but that they are in fact subject to widely varying contributory charges, ranging from £1 to £120 for 12 hours' care? That leaves some people with an amount that is below the income support poverty level. It is absolutely outrageous. Although national guidance would be helpful—I hope that my noble friend will be able to give a positive answer on that—for the time being will he announce a moratorium on all charges, given the 870 present shambles? Until the situation is sorted out, that moratorium should apply to charges throughout the country.

§ Lord Hunt of Kings Heath
My Lords, I take my noble friend's point. It is our intention to consult on the draft statutory guidance in the summer. It is my hope that, as a result of the consultation and the amendment that is to be introduced in another place, we shall be able to issue guidance to local authorities as soon as possible. In the meantime, we expect individual local authorities to take careful note of the contents of the Audit Commission report and to review their current charges on that basis.

§ Earl Howe
My Lords, is the Minister aware that there are perverse incentives for some local authorities to move people out of their own homes and into residential care before they need to go, because once someone has sold his or her house, the cost to the council of providing care is often very much lower? Does the Minister agree that, until the larger issue of funding long-term care is resolved, those perverse incentives are likely to remain?

§ Lord Hunt of Kings Heath
My Lords, in examining services in this area, it is important that we review situations which may give rise to perverse incentives. So far as concerns the long-term funding of care, the Government have considered carefully the recommendations of both the majority and minority reports within the Royal Commission, and we shall produce a White Paper in the summer.

§ Lord Addington
My Lords, will the Minister give an assurance that, under the new national guidance—which is well overdue—the effects of individual disabilities will be worked into the costing? That would provide people with a well-informed, coherent idea from the centre about the costs of individual types of disability and at least where to look for those costs?

§ Lord Hunt of Kings Heath
My Lords, I do not want to be drawn any further than I have stated in relation to how these issues are to be dealt with. We have committed ourselves to full consultation with all interested parties and will ensure that the kinds of issues raised by the noble Lord will be considered.

§ Lord Morris of Manchester
My Lords, will the very welcome amendment referred to by my noble friend recognise that it is just as inhumane and self-defeating for local authorities to charge people on income support as much as £l8 a week for local services—on which they rely for their independence—as it is for the Independent Living Fund to charge a severely disabled young man, who has to ventilate at night in order to stay alive, £310 a week for the personal assistance without which he will no longer be able to work, thus forcing him onto the scrap-heap? Do we not very urgently need to address the whole rag-bag of charging policies that now confront disabled people?

§ Lord Hunt of Kings Heath
My Lords, in relation to home care services, I certainly agree that the Audit 871 Commission report indicates a wide variation in charges that is wholly unacceptable in many cases. I believe that it is right to leave some discretion with local authorities. It is worth making the point that some local authorities make no charge at all, and any national guidance needs to be able to allow them to continue that policy. However, I am convinced that the right way to approach the matter is to provide statutory guidance to make it much clearer to local authorities what is acceptable and what is not.

§ Baroness Platt of Writtle
My Lords, does the noble Lord agree that for both disabled and elderly people it is most important that they remain in their homes surrounded by neighbours who often provide a good deal of help? Does the Minister also agree it is important that local authorities should have a sliding scale of charges and that, while these services should be provided free to people who cannot afford them, those on middle incomes are willing to pay in order to stay at home rather than go into residential care which, after all, is much more expensive?

§ Lord Hunt of Kings Heath
My Lords, all of these matters need to be taken into account by local authorities when they formulate their charging policies. One of the aims of the statutory guidance will be to enable each local authority to develop a much more transparent system of charging so that the rationale behind it is well understood by users of these services. I very much agree that the best approach is prevention. If by intervention in home care services we can prevent people from being admitted to nursing or residential care homes, everything must be done to encourage it.

§ Baroness Wilkins
My Lords, does my noble friend agree that the report of the Audit Commission demonstrates that no account is taken of the true long-term cost of charging policies? The report points out that few councils even quantify the cost of collection of the charges and for those that do the cost can be as high as 40 per cent of the money raised. More importantly, no account is taken of long-term effects which can lead to health breakdown and far higher NHS costs. Not only is there stress arising from the assessment of cost and trying to meet charges out of meagre funds, but many people do not take up the services they need because they cannot afford them, which leads to breakdown of health in the long term. Will the Minister reconsider the suggestion of my noble friend Lord Ashley that there should be a moratorium on charges while the true cost of long-term effects is taken into account?

§ Lord Hunt of Kings Heath
My Lords, at the moment the local authority has absolute discretion in deciding its charging policy. For that reason we shall move an amendment in another place to give us power to issue statutory guidance. However, I have no doubt that individual local authorities should be encouraged to review their current policies and prepare for changes. I agree with my noble friend it is striking that not only is 872 there a variation in charging policies among many local authorities but the commission reports that many of them provide poor information to users and control of costs in terms of levying charges. Most importantly, there is lack of strategic management and vision as to the impact of charges on care provision generally.