§ Mr. John Bercow (Buckingham)I welcome the opportunity to highlight the issue of alleged fairer charging for the receipt of home care services. The starting point for this debate, to which I welcome the Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), is the issue in November 2001 by the Department of Health of guidance to local authorities entitled "Fairer Charging Policies for Home Care and other non-residential Social Services". In practice, that has effectively entailed the extension of means-testing for the provision of and payment for such services, despite the pledge made by the right hon. Member for Dunfermline, East (Mr. Brown) when shadow Chancellor in 1995 to ensure that means-testing for elderly people would be brought to an end under a Labour Government.
Let us be fair and clear. There is what might be considered a positive side to such a policy: the very poorest and most vulnerable people in our community pay nothing for the receipt of services on which they depend. The negative side of the policy, which it is my business to highlight, is not merely that rich people end up having to pay substantially more for their home care services, but that a great many people who can in no sense be considered rich will face exponential rises in their costs. Even when they are not paying the maximum, which they do if they have savings over £19,000, they inevitably have to pay an enormous amount more. If they have substantial savings under £19,000, they still face big increases.
What is the effect of the policy in Buckinghamshire? Previously, the maximum charge was £38.50 per week. Bucks county council social services department estimates that 52 per cent. of adult social care clients now pay nothing towards their care because any charge would take their net income below the trigger for charges of £122.69 per week. Many who paid the old county council maximum of £38.50 now face astronomical rises of three, four, five, six or even seven times the level that they previously paid. The maximum in Buckinghamshire is £280 a week. It can readily be seen that people who previously paid under £40 per week now face a massive increase in bills.
Consequently, it is scarcely a surprise that I have been besieged with scores of letters from constituents from Lillingstone Lovell, Luggershall, Buckingham, Aston Clinton, Chearsley, Haddenham, Fairford Leys, Winslow, Ford, Lower Hartwell, Quainton, Long Crendon, Waddesdon, Stewkley, Drayton Parslow, Wing, Cublington and other areas besides. All are aggrieved about their increased costs, but I will highlight three cases.
First, a 92-year-old lady living in Buckingham who previously paid £38.50 a week is now confronted with a bill for £81 a week. For the benefit of the Chamber, I shall quote her:
Needless to say, I have never received a high wage, but despite this I have endeavoured to be careful with my money and saved as much as I have been able. I now find that I am being penalised for my thrift, as I now have to pay the maximum charge for my home care services, whilst many, who have not taken care of their money, have their care provided free of charge. That seems to be anything but fair and would be totally unnecessary if only the Government would increase the county's grant.56WH Secondly, a constituent in Stewkley informs me that her husband, having previously enjoyed relatively good circumstances, had a stroke 16 months ago. She says that it has affected his right hand sideand he is confined to a wheelchair. He now has a cancerous ear which has to be dressed every two days as grafts were not successful. He can only stand with support and cannot get to the lavatory unaided. He sleeps with a urine bottle between his legs at night which he manages to change with his left hand when full, hopefully not spilling the contents. Everything now depends on me. I am older than he is (80 on January 3), have an extremely painful hip which I am waiting to have replaced any time now and I am not in very good general health. I cannot sleep due to the pain.Previously, she and her husband paid £88 every four weeks for magnificent service from carers, whom we all admire. The cost is now to rise to £840 every four weeks which, not surprisingly, is beyond her means.Thirdly, I highlight the case of Sally Davis, MBE, from Quainton, which has been publicised in my local media and has become something of a cause celebre in the community. She suffers from multiple sclerosis and, as she has savings of more than £19,000, is eligible for the highest charge of all. Previously, she paid £38.50 a week. Initially, Buckinghamshire county council thought that she would have to pay £176 per week. Now it has been assessed that she is likely to face a bill of £264 per week for her home care services. She is wheelchair-bound. In order to enjoy the independence and dignity in her home that she is entitled to expect, she needs those services.
I appeal to the Under-Secretary to recognise the nature of the existence of people such as Sally Davis who suffer from serious disabilities. Everything costs. There is a cost for gardening, a cost for shopping, a cost for cleaning, a cost for the maintenance of a car, and a cost for a driver to take her in that car to the places where she needs to go. She has been consistently aided and supported by a neighbour, David Leeming, who on the strength of his experience has founded the Really Caring Group.
I stress that Mr. Leeming has legitimate concerns about, and criticisms of, Buckinghamshire county council and the way in which it has applied the policy. I am open-minded about those criticisms. It is vital not just that there should be an appeal system but that the county council should ensure maximum awareness of the opportunities that that system offers. In addition, there is a powerful argument for a very thorough—perhaps more thorough and exacting than hitherto—assessment of disability-related expenditures that such clients necessarily incur and which have to be factored into the equation when determining the costs that they should pay. Even taking account of those criticisms of the county council, we must recognise the fact that for it to cut the maximum charge from its present level of £280 per week to £100 per week would cost it £700,000 a year.
I want to put the essence of the problem to the Under-Secretary as fairly and concretely as I can. In order to maintain what is customarily described and readily understood as a standstill budget, in order to cover inflation, the Government's national insurance increases, rises in demand for services and some Government-imposed additional responsibilities, Buckinghamshire county council would have to impose a council tax rise of 4.1 per cent. In order to pursue the 57WH anti-waste policy of spend to save, of which the Government approve, the county has to incur further expenditure amounting to an additional 0.3 per cent. rise in council tax. Resource equalisation—shifting money from the shire counties to the Government's friends in the north—involves a massive increase of 7.5 per cent. in Buckinghamshire's council tax. As a result of largely inspector-driven improvements in social services—Buckinghamshire county council already spends significantly above its standard spending assessment—the council is required to increase council tax on a phased basis by 1.5 per cent. per year for some time. Furthermore, a 1.4 per cent. rise in council tax is required for the increase in expenditure on education from the council's chosen figure of £201 million to Ministers' preferred figure of £206 million. Buckinghamshire is spending 27 per cent. above its SSA, but has the second lowest allocation in respect of social services of any authority in the country. The reality of £126 per head contrasts with the shire county average of £149 per head—£23 below that average—and the national average figure of £180 per head.
The Government—both the Minister for Local Government and the Regions and the Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith) take this view—have argued that Buckinghamshire should have implemented the policy in two stages. The council's view is that that would imperil its finances, which are already under pressure as a result of its discriminatory and unfair treatment by the Government.
The royal commission on long-term care, which reported under the auspices of Sir Stewart Sutherland in 1999, recommended the provision of free personal care. I do not necessarily cavil at such a policy, which would certainly be widely popular with our constituents and would avoid means testing and the inevitable injustices that flow from it, but Buckinghamshire estimates that it would cost £4.5 million a year. The difficulty is that the Government want to pursue a policy whereby payment s based on needs, but people cannot afford these exorbitant and astronomical rises.
The Aylesbury Vale carers association drew attention to the real danger that people, fearful of being unable to cope, will opt for a short cut and, because they are worried sick about being plunged into debt—when an anti-debt culture defines their very being—will decide instead to reduce the care. I should like to refer, in all sincerity, to the moving and important letter that I received from Isobel Houlston, a carer support worker at the association, who highlights that very anxiety:
Some people receiving domiciliary care services are so concerned"—she is referring to the alleged fairer charging policy—that they are planning to reduce their care packages. One anxious carer says that her father may cut his homecare by half, but as he is totally dependent upon this care she will feel obliged to step in and fill the gap. As a result she will risk losing her job. It seems that the Social Services are unable to prevent people from reducing their care packages, even if this places them at risk of neglect or harm, or places unmanageable pressures on already overstretched caring relatives and friends.I do not doubt for a moment the good intentions behind the Government's policy. I have even gone so far as to concede—the world is not made up of all right on one side and all wrong on the other—a beneficial side to 58WH an aspect of the Government's policy. Those who pay nothing will gain: in many cases they pay nothing on account of their low incomes, which are nothing to do with fecklessness or improvidence. Such people are in low paid work and cannot afford the high costs, so they deserve to receive care for nothing—and I say that to the Under-Secretary without qualification or hesitation. However, I appeal to him to see the other side of the argument. People may suddenly face massive increases in their costs as a result of the local application of a nationally driven policy.The Under-Secretary may say simply—although I hope that he does not—"Well, it's up to the county to do it differently. It should phase the policy, make concessions, show compassion, and recognise the need to support people better." He should recognise that it is difficult for a council to do that if it does not receive adequate monetary support from the Government.
Let there be a partnership between the Government who are seeking, perfectly legitimately, to implement their policy at national level, and the councils that are expected to give effect to that policy at local level. If councils are to do so in a way that is fair and effective, they need the resources and the wherewithal. I appeal to the Under-Secretary for those resources, and I await his reply with interest.
§ The Parliamentary Under-Secretary of State for Health (Mr. David Lammy)I congratulate the hon. Member for Buckingham (Mr. Bercow) on securing a debate on an issue that is of great concern to his constituents, and that has aroused much interest in Buckinghamshire. I also congratulate him on the manner in which he opened the debate.
I will explain some of the reasons why we needed to introduce the guidance on charging for home care. When we came to power, there were considerable variations in charging policies between councils. The Audit Commission's report, "Charging with Care", published in May 2000, exposed the full extent of those variations. Many issues needed to be addressed.
Councils' policies were inconsistent across the board. That meant, for example, that a person in Birmingham might have to pay nothing for their home care, whereas someone in the same circumstances in a neighbouring council—say, Wolverhampton—might have to pay the full charge. Councils' policies were not transparent: users and carers often did not have an understanding of how charges were calculated. In some places, the systems and procedures that councils adopted were obscure. The policies had the effect, in many cases, of reducing income to unacceptably low levels.
The hon. Gentleman concentrated on the concerns of those with limited savings. It should however be emphasised that for many people in the previous system such unacceptably low levels of income were par for the course. Councils could charge people on low incomes or benefits, with the result that those people could be living on an income that was below basic income support levels.
The policies could also be a disincentive to work. If a council decided to take a user's earnings fully into account, there was little incentive for that person to seek 59WH or remain in work. Moreover, disability benefits could be taken in charges, without taking into account any disability-related expenditure.
Against that backdrop, and in the light of those problems, it was right for the Government to act. In November 2001, we issued guidance to councils entitled "Fairer Charging Policies for Home Care and other non-residential Social Services". It is worth mentioning that councils, users and others had been asking for guidance for some time. The context was that the councils asked and the Government responded, and it is right that that should be put on the record.
The new guidance will have a number of benefits. A user's net income will not be reduced below basic levels of income support, plus a 25 per cent. buffer. I am not sure that the hon. Gentleman mentioned that. Users will not be charged a flat rate without taking account of their resources. Councils must take into account ability to pay and disregard earnings, thus removing a barrier to work for disabled people. The overall approach of the guidance is that local councils will retain real responsibilities and some discretion in charging policies. For example, it will still be open to councils not to charge, and some across the country will decide not to do so. It is right that I place that on the record too.
If councils charge, they must decide what proportion of costs to recover through charges. The guidance sets out essential requirements to ensure fairness in assessing a person's ability to pay a charge and to ensure consistency with the Government's overall social care objectives and policy on social exclusion.
§ Mr. BercowThe Minister is right to highlight the 25 per cent. point, which I do not dispute. Does he however accept that it is intolerable that Mrs. Sally Davis, to whom I referred a few moments ago, should face a bill that is both £10,000 more than the previous bill and £10,000 more than her income?
§ Mr. LammyThe hon. Gentleman may not like my saying this, but a key determinant of what Mrs. Sally Davis faces are the conclusions reached by the local authority. In Buckinghamshire in the past, a flat rate was charged regardless of income—whether one was very poor, moderately well-off or very well-off. The authority then implemented the current system over a short period, which I shall come to. Mrs. Sally Davis finds herself where she is largely because of the way in which the system has been implemented.
I turn to the funding that the Government have made available to Buckinghamshire, which was a key part of the hon. Gentleman's remarks. Because councils retain substantial responsibilities, it is vital that they give proper priority to the key processes, including consultation, communication with users and reviews. The guidance includes advice on those issues and obliges councils to undertake effective consultation.
The hon. Gentleman referred to savings. The guidance states that councils may take account of a user's savings, but are not obliged to do so. Savings may be taken into account to calculate tariff income on the same basis as set out in charges for residential accommodation guidance. Currently, tariff income is 60WH assessed if the user has savings of between £11,750 and £19,000. Users with more than £19,000 may be asked to pay the full charge for the services. That is more generous than some previous policies, when a quarter of councils had saving limits as low as £3,000.
Providing incentives to work is an important issue. I want to make it clear that our policy is to encourage and enable people, including disabled people who wish to work, to do so. Charging policies should avoid creating disincentives to work. That remains our objective. Our intention in the draft guidance was to propose that councils treat earnings more generously than other income in order to ensure incentives for disabled people to work. The argument advanced during consultation for more generous treatment of earnings was convincing.
The guidance on disability benefits requires that they may be taken into account as income only if councils also assess a user's disability-related expenditure. That means a more sensitive test of the ability to pay a charge where a council wants to take benefits such as the disability living allowance and attendance allowance into account. That would ensure that charges do not reduce a user's net income to below basic levels of income support, plus a 25 per cent. buffer. That approach will allow disability-related expenditure at levels higher than the benefit concerned to be taken into account. The outcome would be that many users with high care needs would not pay a charge, or would pay a lower charge. Many users commenting on the draft guidance regard the proposals as a positive advance, although I acknowledge that some want us to go further.
I must say to the hon. Gentleman that it is a balancing act, and one acknowledges that some people may be dependent on the policy objective of a particular local authority. Nevertheless, we were right to issue that guidance; indeed, local authorities asked us to do so. It was right that we included safeguards for people, especially those on low incomes. It was also right that we had that 25 per cent. buffer and that it is up to the local authority to decide whether those that can afford to pay do so. How that should take shape clearly pertains to the implementation of the guidance.
We said that the guidance should be implemented in two phases: from 1 October 2002, users receiving income-related benefits will have their net incomes protected from charging, as already described. Users whose disability benefit is taken into account and who receive more than 10 hours' home care weekly will have their disability-related expenditure individually assessed. The guidance specifically states that councils should not introduce new policies to charge against disability benefits without also assessing their disability-related expenditure.
§ Mr. BercowI understand what the Minister says about phasing, but whether the policy is phased in over two, five or 25 years does not matter to my constituent who has to pay £840 every four weeks rather than £88 every four weeks, or to Mrs. Sally Davis who faces a 400 per cent. increase. Those constituents cannot, and will not, afford to pay it.
§ Mr. LammyThere are three issues. First, Buckinghamshire council was on a flat rate. Secondly, 61WH phasing is important. Had Buckinghamshire council followed the guidance, it is likely that the hon. Gentleman's constituent would not be in the situation that he describes until April 2003. Thirdly, I was about to explain the consultation process that needed to take place to ensure that proper benefits and assessments had been made that might also pertain to the eventual outcome of that constituent's costs.
From 1 April all other parts of the guidance will be implemented. That includes any users whose disability benefits are taken into account—including those who receive 10 hours or less home care weekly—having an assessment of their disability-related expenditure. Those parts of the guidance that provide for a minimum-required treatment of savings will also be implemented. All users who receive a charge assessment should also receive expert benefits advice.
Several practical difficulties have arisen from Buckinghamshire county council's decision not to implement the guidance in two planned phases. The approach is not mandatory, but there were very good reasons for proceeding in such a way. Any council that decides to implement the guidance more quickly than suggested needs to take care not to underestimate the amount of work that implementation will involve. The council would also need to take sufficient time to ensure that it anticipated and resolved any unforeseen problems of implementation. To that extent, I draw the hon. Gentleman's attention to what the guidance says at paragraph 20 or thereabouts. As seems to have happened in Buckinghamshire, a failure to consult properly could lead to inappropriate decisions and could be detrimental to users. The county council's decision—
§ Mr. Deputy SpeakerOrder.