Home Care Charges: Consultation (Hansard, 2 April 2001)

§ The Parliamentary Under-Secretary of State, Department of Health(Lord Hunt of Kings Heath)
My Lords, the Department of Health has received over 500 responses to the consultation paper and draft guidance. While some of the main principles of the draft guidance have been welcomed, concerns have been expressed over aspects of the proposed guidance, particularly on the treatment of earnings and possible disincentives for disabled people to take up paid employment. The Government are giving careful consideration to those responses.

§ Lord Clement-Jones
My Lords, I welcome the Minister's reply. I am glad that he makes no bones that 602 concerns have been expressed. The guidance in its current form would have a very harsh impact on disabled people in work. Fifty-five per cent of their earnings could be taken into account. Those on income support, those in receipt of disability living allowance, and even those in receipt of intermediate care services would be liable to pay charges. Does that not demonstrate the difficulty of the Government's determination not to make personal care free? Will they undertake also to examine the impact of the guidance with a view to avoiding the hardship that will be caused if it remains in its current form?

§ Lord Hunt of Kings Heath
My Lords, as the noble Lord knows, the decision on personal care was taken by the Government because they believed that resources should best be targeted, first, in ensuring that care provided or supervised by registered nurses in nursing homes was the appropriate way to spend our resources, alongside the millions of pounds that we expect to spend on intermediate care. The noble Lord will recall that the Government's decision to consult on the issue of statutory guidance was welcomed because of the widely differing policies of local authorities. The Audit Commission report said that local authority practice was wildly inconsistent, lacking rationality and often not related to service policies. Overall, I believe that the statutory guidance will lead to much greater consistency, but I give an assurance to the noble Lord that in relation to the specific issue he raised we will meet representatives of the people concerned. We are very interested in discussing these matters with them.

§ Baroness Greengross
My Lords, is the Minister aware that great concern has been expressed that partners, not just spouses, may have their income taken into account, not for their own care but for the care of their partner? Can the noble Lord reassure the House that when the Government reach their final decisions they will ensure that such a situation does not continue?

§ Lord Hunt of Kings Heath
My Lords, the draft guidance sets out largely the current legal position and the circumstances in which a partner's resources may be taken into account under Section 17 of the Health and Social Services and Social Security Adjudications Act 1983. In some cases it may indeed be to the advantage of a user to be assessed with his or her partner, as the draft guidance points out. But we are certainly willing to look at making the guidance clearer on this issue in the light of comments.

§ Baroness Carnegy of Lour
My Lords, for clarity, can the noble Lord tell the House precisely what freedom local authorities will have within the context of statutory guidance to do what they think is right?

§ Lord Hunt of Kings Heath
My Lords, Section 7 of the Local Authority Social Services Act 1970 provides that local authorities must in the exercise of their social services functions, including the exercise of any 603 discretion conferred by any relevant enactment, act under the general guidance of the Secretary of State. To act legally outside the terms of Section 7 guidance, a council would need to show that it had properly considered the guidance and had good reasons for acting differently; for example, because of particular local circumstances. However, I can reassure the noble Baroness that the statutory guidance that will be issued as a result of the consultation process can be regarded as the minimum requirement. It will be open to any local authority to be more generous in its charging scheme than that which is set out in the statutory guidance.

§ Earl Howe
My Lords, is the Minister aware that there is concern about the Government's seemingly ever-increasing use of setting national priorities and instituting ring-fenced budgets to go with them? While ring-fenced budgets have their place, they inhibit the freedom of local authorities to charge the kind of rates they might wish to charge, thereby putting an additional strain on what is an already tight social services budget.

§ Lord Hunt of Kings Heath
My Lords, the noble Earl's charge would have more strength to it were it not for the evidence of the Audit Commission report. It found a whole host of different charging mechanisms, which showed great inconsistency between local authorities. The charges often lacked rationality. Some local authorities applied a flat rate charge to all, irrespective of their circumstances. Some charged according to the user's means with no regard for the level of service. There was great concern among users and their representatives about how that impacted on individuals. I believe that statutory guidance is justified in this case. It was certainly warmly welcomed by most, if not all, representative organisations. The fact that local authorities can decide to be more generous than the guidance leaves them with a great deal of discretion. A further point is that Torbay council, whose model the statutory guidance has worked on, has shown that where a local authority operates a rational and fair scheme it will be to the benefit of many of its residents.

§ Earl Russell
My Lords, I note that the Minister made no response to the concern of my noble friend Lord Clement-Jones about people being required to pay charges out of income support. Would not a more informed discussion of this subject be possible if the Government were to commission research on the minimum income entitlement necessary to maintain good health?

§ Lord Hunt of Kings Heath
My Lords, I know that the noble Earl consistently raises the issue of good health and its relationship to wider social security benefits. It is certainly a matter that warrants consideration. The draft guidance clearly states that service users should not have their incomes reduced below basic levels of income support as a result of 604 charges. That principle has been widely welcomed by those responding to the consultation and will Improve the record of many local authorities.