My Lords, I shall also speak as briefly as I can to Amendments 88PA, 88PB and 88PC, on which my name also appears.
The purpose of Amendment 87H is to ensure that intermediate care and reablement needs are considered as part of the assessment process so that a holistic approach to meeting care and support needs is taken. In the White Paper of July last year, the Government promised that the new system would,
“promote wellbeing and independence at all stages to reduce the risk of people reaching a crisis point, and so improve their lives”.
As part of their vision for care and support, the Government accepted that they needed to move away from an approach that saw people as having to wait for a crisis before they could access care and support. The White Paper included a number of references to reablement, which the Government saw as helping people regain their independence at home.
The Bill, however, needs to be strengthened to take this perspective more fully on board and so that local authorities are clear about the steps they need to take to adopt a genuinely preventive approach to meeting needs for care and support, particularly as regards providing or arranging for reablement. At present reablement, for all the many promising words in the Caring for Our Future White Paper, remains conspicuously absent from the Bill. Whether it is enabling someone who has recently had a stroke to regain through their rehabilitation the skills they need for independent living, easing a person’s discharge from hospital, helping people when difficulties start to arise following a bereavement or after a fall, or providing aids and adaptations following the onset of sensory loss, reablement can be crucial in determining whether someone experiencing acute health problems goes on to develop long-term care needs or, on the contrary, feels confident enough to go on living independently.
There are a number of definitions of reablement, but broadly it refers to the relearning of self-care skills following a stay in hospital or the onset of an illness or disability. The aim is always to reduce the need for longer-term support. The social policy research unit and the personal social services research unit at the University of Kent and the LSE have analysed home care reablement services and found that reablement is associated with a significant decrease in subsequent use of social care services. The cost of the services they examined, used by a reablement group over 12 months, excluding the cost of reablement itself, was 60% less than the cost of the services used by those in a conventional home care group who did not receive reablement. To ensure that needs assessments properly factor in the potential health and well-being gains associated with a structured programme of reablement, Clause 9 needs amending to ensure that authorities assess the extent to which reablement or intermediate care would help people achieve the outcomes specified as a consequence of Clause 9(4)(d).
Amendment 88PB is the parallel amendment in relation to Clause 13, on eligibility. Its purpose is to avoid people who are judged ineligible for care packages also being denied intermediate care and reablement services or enduring unnecessary delays, by ensuring that the benefits of providing this help are considered when a local authority makes a determination on a
person’s eligibility for care. Too many people do not get offered this preventive support, with the result that many of them are left to struggle on their own. This merely delays the moment when their needs worsen and they require more expensive support.
A lot has been written about reablement over the past five years or so in Green Papers and White Papers, but not yet in statute. What intermediate care and reablement have in common is that they are time-limited interventions that can be provided to a person independently of their eligibility for longer-term care and support. Crucially, as we have seen, they are also cost-effective. Curiously, the Bill does not mention reablement by name, although Clause 2(4)(d) paves the way for it when it speaks of regulations making provision for,
“services, facilities or resources which … are provided for a specified period only”.
Reablement or intermediate care can make all the difference between a person going under and remaining independent. A report produced by Deloitte for Sense and four other charities estimated a net return of 52% to a local authority that invested in a communicator guide and a rehabilitation service for deafblind adults who need help gaining news communication skills. It is essential that local authorities consider whether, and if so to what extent, a person would benefit from the provision of these time-limited but effective services. This does not place them under a duty to provide intermediate care and reablement services but, at a minimum, it ensures that they consider the value of putting in place those services where this would help maximise independence and also save the council money in the long run.
Such a battery of heavyweights have their names on Amendment 88PA that I hardly need to say anything about it—they will make the case better than I ever could. The amendment slightly expands the duty on local authorities to consider preventive support following a determination on eligibility. It provides that local authorities must consider not only whether service users would definitely benefit from the provision of preventive services under Clause 2, or information and advice under Clause 4, but whether they “would be likely to” benefit from such services. We have to be wary of placing burdens on local authorities that they cannot meet but this amendment is careful not to do that. It just opens the gateway to preventive services a little wider and makes it more difficult for local authorities to use unreasonable justifications for refusing to provide preventive support.
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Amendment 88PC goes a bit further and would provide that a council must provide preventive services, facilities or resources whenever it determines that a person is at risk of developing an eligible need, they would or would be likely to benefit from such services, or the provision of such services would be likely to prevent or delay the development of an eligible need.
I understand why the Government do not want to create an individual entitlement to preventive services on grounds of cost. Clause 2 does not create an individual entitlement to preventive services. Individually enforceable rights to preventive services would be a
bridge too far and would place an unrealistic burden on local authorities. However, given that £3.8 billion has been announced for the integration and transformation fund, which includes the funding CCGs currently hold for preventive initiatives such as reablement and carers’ breaks, there is funding for providing an individual entitlement in the circumstances envisaged by this amendment—that is to say, where the authority determines that a person is at risk of developing an eligible need, they would or would be likely to benefit from such services or the provision of such services would be likely to prevent or delay the development of an eligible need.
The national eligibility threshold is likely to remain broadly equivalent to the “substantial” level. The Government envisage that people with ineligible needs will be able to access universal preventive services covered in Clause 2. However, preventive services are often not prioritised sufficiently by local authorities. A Scope survey showed that the vast majority of people whose needs do not meet the eligibility threshold are not being effectively picked up by universal services. Among the respondents, 63% with moderate needs, 43% with substantial needs and 50% with critical needs had to pay for their own care, leading to financial instability. This is why we need Amendment 88PC. I beg to move.