My Lords, these amendments under Clause 14 deal with the difficult area of charging for the care and support that we have established is required through assessment. The historic settlement of charging for social care but not for healthcare is being increasingly challenged and the obviously linked issue of funding for social care is ever present, as we have been reminded in today’s debates.
The common agreement about charges is that they should be fair and that the process for means testing should be as simple and as unintrusive as we can make it. Fairness in the eyes of the public means no postcode lottery, but the excellent work by my colleague Liz Kendall, our shadow Care Minister, has shown just how stark the variations are across local authorities today. This is something that we need this Bill to address. Why should charges for the same service be allowed to vary so much? This is seen as unfair and it is. I will be interested to hear from the Minister about this variability of charges and what actions the Government are taking to address it.
For many older people, claiming for any kind of help is hard. We need a system that is easy to use and we could do far more to integrate the various bureaucracies to minimise form filling and document checking and having to repeat the same information over and over again. We could use income information from the
Inland Revenue, for example, and we could unify all assessment frameworks and use passporting of entitlement to minimise bureaucracy and administration costs. Much of the detail is for the future in the regulations, but this is our opportunity to remind ourselves of key principles, such as fairness and simplicity, that should shape those regulations. Can the Minister tell us when the draft regulations relating to Clause 14 and charging will be published?
When they are published, the regulations themselves will inevitably be complex and disputes are likely. Dispute through judicial review or the courts is not the way. Will the Minister explain why there appears to be no response to appeal or conflict resolution processes contained in this part of the Bill? Why do many of the decisions made under provisions in Part 1 seem not to have some mechanism of appeal attached to them? The appeals system should be fair, easy to access and independent. Does the Minister acknowledge that this is needed?
On the specific amendments in the group, my noble friend Lady Pitkeathley has provided an excellent explanation of the importance of her two amendments, Amendments 89A and 89B. As usual, it is very hard to find anything additional to say when it comes to carers and carers’ rights after she has spoken. It is right always to underline our support for the provisions in the Bill providing statutory rights for carers, but there are still areas of concern that need to be addressed relating to means testing and local authority care charges, and the widespread fear among carers about charges as local authorities become increasingly strapped for cash.
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Amendment 89A aims to make the distinction between what is a disabled person’s service and what is a carer’s service by using the wording under the Carers and Disabled Children Act 2000, and ensuring that personal services provided for the disabled person in order to meet the needs of the carer cannot include services of an intimate nature. There are very real concerns that without this the Bill would not prevent the carer being charged for a respite care service which includes personal care that is provided to the person they care for.
My noble friend has set out some of what are presumably the “unintended consequences”, to quote the Select Committee on the gaps and risks in the Bill that need to be addressed. It would be particularly confusing when trying, for example, to work out whether a service would be accrued to the care account under the capped system and whether a direct payment can be spent on a replacement care service. We need clarity on what carers and disabled people’s personal budgets and independent personal budgets can be used for.
Amendment 89B again focuses on the position of carers caring for an adult in the community receiving support under NHS continuing care. The amendment that was tabled last week sought to clarify who was responsible in these circumstances for assessing the carer. Today, the concern is to ensure that the NHS meets the cost of support services provided to a carer. The noble Lord, Lord Low, raised important issues about the provision of, and payment for, aids and adaptations in the home. It is a complex issue that
causes deep frustration among those who are eligible in terms of knowing what is available, the bureaucracy involved, the time taken to assess and make adaptations, the availability locally of basic equipment such as grab rails, and, indeed, the different charging practices of local authorities. This issue also came to light around the bedroom tax, where properties which had been adapted were vacated and the new property then had to be adapted and the old one unadapted for the new tenants. Presumably, that was another unintended consequence. Adaptations of low cost can have a high value for the independence of older people and so again we should make it as easy as we can for them to get that support.
Finally, the amendment of my noble friend Lord Lipsey makes a strong case in relation to Clause 64 —this deals with a local authority’s powers to enforce debts owed to it—for trying to distinguish between people who deliberately supply fraudulent information on their finances and those who make mistakes or misunderstand what is required of them. The financial assessments for care and support are involved and complex and errors can occur with no intention to be dishonest or defraud. I hope that the Minister has taken note of my noble friend’s arguments and will consider how the Bill can be amended.