My Lords, I declare an interest as one of the usual suspects referred to by the noble Baroness, Lady Pitkeathley. Like many of the speakers in today’s debate, I am a veteran of more care Bills than I care to remember. I wish to put on record my admiration not just for my colleagues Paul Burstow and Norman Lamb, who did a remarkable job getting this Bill to where it is now, but also to a number of people—not least of whom are the noble Lords, Lord Lipsey and Lord Sutherland of Houndwood—who over the whole of the last decade started the debate which has got this Bill to where it is today. An awful lot of work has gone on in the last decade that has shaped this legislation. It has to be clear, coherent and consistent; people and their carers need to know what they are entitled to receive from social care, what they will be expected to contribute and what their entitlements will be. That has been a long process, but it is a relief that we have finally got there.
A lot in this Bill is admirable and it starts for me at the third sub-heading in Part 1, which talks about the purpose of assessment. Assessment is key to all of this Bill: the extent to which it is possible to assess a person’s needs, means and support networks and the extent to which social care, health and private insurance have a common assessment process are the keys to whether the aspirations that we all have for joint care can really and truly be achieved. At the heart of it all is housing. We have known for some considerable time that the care that an older person receives in later life depends upon whether they own a property and the extent to which they can use that to fund their care. This Bill goes a long, long way to ensuring that other people—those who do not have properties at their disposal—get the help that they need as well.
There is much detail in here about the assessment process and much of it is extremely welcome. However, there is one subsection—Clause 9(4), which looks at how one’s need for support is assessed—which talks about the need to look at what a person can do and the sources of support around them in their family before an assessment for eligible needs can be carried out. We need to be clear by the time this Bill finishes all its stages that people and their families are being assessed on what it is that they are able to provide by way of support and care, rather than what they are expected to provide to make up for some of the deficiencies of the care system at the moment. We do not wish to see people and their families pressurised into providing more than they possibly can.
I welcome Clause 11, which talks about the enduring responsibility of a local authority to care for an older person even if they refuse to have an assessment. All of us who have worked with older people know that horrible moment when a carer finds that their mum has gone for her assessment and sworn blind that she can do lots of things which on the her very best day she might be able to do, but routinely she cannot. Here I also make the point that the noble Lord, Lord Hunt of Kings Heath, and I always raise on occasions such as this, in memory of Lord Weatherill. There are some people, particularly Christian Scientists, who do not lack capacity but who wish to refuse to have assessments and so on. Their views need to be upheld. I am
extremely pleased that the need to assess somebody’s financial resources is in the Bill. It is quite clear that that assessment happens separately and after their needs have been assessed.
Clauses 15 and 16 talk about the cap on care costs and implement Andrew Dilnot’s report. Again, there is much in this that is extremely welcome. It is welcome that there are some things for which local authorities will not be able to charge. The whole process of how one gets from the point of an assessment of need to the point of eligibility is much more complicated than many people realise. There will be things such as care costs that people have already paid for in their own homes which are not taken into account. The same is true for payments for their daily living costs. We also know that the current system whereby local authorities will pay up to what they call the usual rate—which may be well below what an older person and their family believe they need—will continue to endure under this new system.
It is absolutely critical that this whole part of the Bill is scrutinised in great detail, because there is a danger that this could end up like the fares for a budget airline. You have an upfront figure, which by the time you finally get to the airport, turns out to have so many add-ons that it bears no resemblance to the original fare. If, at the end of our process of scrutiny, that is what we end up with, then the whole system will become discredited. We really need, above all else, to emerge from this legislation with everybody knowing in detail, with some certainty, what their costs are going to be.
One of the issues on which the Government’s response to the joint scrutiny committee was slightly disappointing was about drawing the boundaries between health and social care. Those of us who have been involved in working with older people for any length of time know that when resources are tight, the ability of the NHS and local authorities to withdraw and start pressuring people from pillar to post gets tempting. There was an attempt in the draft Bill to differentiate clearly between healthcare and social care. In the Bill that has emerged now, it is less clear than it was originally. That will not help anybody; it will simply set the basis for ongoing court cases about what constitutes continuing care. Again, one of our main duties in the passage of this Bill is to ensure that there is clarity on that point.
Turning to deferred payments for social care, we currently have a system of deferred payments and we have some case law already on the way in which that works. It is welcome that the Government wish to extend that and to make it more consistent across the country. However, I hope that in doing so, they have paid attention to the existing case law about when people’s properties can be taken into consideration when other members of their family are living in those houses. I have to ask the Minister what financial modelling has gone into this part of the Bill, because we are talking potentially about the deferment of a lot of money for a lot of care for a very long time. Given the state of finances of local government at the moment, we could be talking about a policy of quantitative worsening of social care, rather than quantitative easing of it.
I move on quickly to safeguarding. It is very welcome that we are finally getting a statutory power to investigate the potential abuse of older people. People such as the noble Baroness, Lady Greengross, have been working for 20 years towards a time when we put the abuse of older people on as serious a statutory footing as the abuse of children. However, the changes to Section 47 of the National Assistance Act—the power to remove older people from unsanitary conditions—without a power of entry when a third party is withholding access to somebody who may be being abused, may mean that we have a statutory power that is not going to protect people. I agree with the noble Lord, Lord Patel of Bradford, that Section 117 support for mental health is important, and we must make sure it is not weakened.
We have within our grasp a system that will deal with the biggest problems with which we have been grappling for more than 20 years: how to make our social care systems, our health systems and the rest of our public finances work together, so that individuals, their families, their communities and the National Health Service all know where they stand in relation to each other. We are not quite there, but with some concerted effort, and using our combined experience, we will get there by the end of this Bill.
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