My Lords, it is a great pleasure to follow my noble friend Lady Wheeler, who has achieved the rare feat of matching the Minister in both her knowledge of the subject and the eloquence with which she expressed it. I shall raise one or two points on just two of today’s regulations. The first is the market oversight criteria regulations—which, in principle, I strongly support. A few alarm bells began to ring in my skull when I saw that the body to be responsible for this is the CQC. My mind drifted back nearly a decade, I suppose, when we were in this Room debating the amalgamation of three regulators, proposed by the then Government, into the CQC. I remember speaking with all the eloquence that I could muster to explain why this was going to be disastrous, and the
noble Lord, Lord Darzi, the then Minister, explaining with great eloquence why I was completely wrong. After that, the noble Lord and I would go outside and he would say, “I totally agree with you, David; this is an act of absolute madness”. I am afraid that for years so it proved.
I regard the CQC as on probation. It has new management. David Behan, the chief executive, is a man for whom all of us, I think, have the greatest respect. There are examples in which the CQC is improving its practice but it is still only on probation, which in itself does not provide me with the complete reassurance that I should like. More seriously, it is all very well having market oversight, but you need the resources to do it. I have done a little back-of-the-envelope calculation based on the Explanatory Memorandum, which suggests that the CQC will spend £6,000 per chain monitoring whether it is in financial trouble. Frankly, £6,000 does not buy much of a top accountant’s time. So while I should like to think that the CQC will pick up readily in advance of crises that there are problems, I doubt whether it is resourced to do so. The Minister and the Government should satisfy themselves that this job will be done and is not just a paper exercise so that, if something goes wrong, they can say that they did something about it. In practice, that will not be effective.
It is not entirely accurate to say that the eligibility criteria regulations translate into legislation the present criterion of substantial. Indeed, it has been argued that this is a slightly more liberal definition than the present substantial definition of what creates eligibility. But it is also not wholly inaccurate. I do not have any objection to this. I have read the useful briefing provided by the Care and Support Alliance but I am not convinced that, given the shortage of finance, to which I shall return in a moment, it would make sense to impose a much looser definition of eligibility and substantial, as recommended by Dilnot—particularly in view of the financial situation in social services.
I know that figures get bandied about for ever on this. I chose to take one from the Department of Health’s publication of March 2014 in which it said that spending on adult social services had fallen by 8% in the previous two years. Since the Government say that that is true, it must be true. Incidentally, we are seeing a folly in public finance which deserves to be highlighted. When you ring-fence one bit of public finance or guarantee it in real terms, that leads to more pressure on other forms of public finance. Because healthcare is ring-fenced and maintained in real terms—I am not arguing about whether the numbers are right—social services ends up taking more of the brunt.
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I know that ingenious methods have been used by the Government to try to transfer money from one to the other without being caught doing so in terms of a breach of their health commitments, but it makes it all more complicated. Whatever approach you take to the necessary closer integration of health and social care, one budget has always seemed to me to be the absolute secret of it—and nothing here moves us greatly towards that.
My second concern is that it appears that one is setting here—indeed, I think the Minister almost said as much—some sort of national standard where, wherever you live in the country, you are bound to get a certain amount of help if you have these substantial care needs. However, I refer back to a report of the Audit Commission. I am afraid I do not have it to hand; it is a number of years old, but it was very striking at the time. Whether you get help from your local council depends not so much on which council you live under, but on who the council happens to send round to see you. To caricature it: if you get a social worker who was brought up, as my wife was in the good old days, when social workers were advocates for their clients, and their job was to argue for the most money possible for them, you may get help despite having only relatively minor impairments; if you get one of the modern breed who has been told that their career prospects depend entirely on denying as many people as possible the help they need, you might get another verdict. This gives the illusion that it is removing national disparities across the nation. It is removing the geographic postcode lottery, but it is not removing the social-worker-you-get lottery—and that, according to the Audit Commission, is a more serious lottery.
Also, these verdicts will be even more significant in future than they are at present. At the moment, yes, the assessment determines whether you get local authority-supported help with your needs—whether you have to contribute towards the cost of that through the means test or whether you get it free is a separate issue—but, under the new regime, it will determine another thing, too: it will be what decides whether you start the meter ticking for eligibility towards the £72,000 Dilnot care-cost cap. Old people will have much more at stake in these assessments even than they do now. Their families will have a huge amount at stake, because if they are turned down and the meter does not start running, it will be longer before their care costs are paid for.
All this will come out in the wash, but it will be a very painful wash. There will be an awful lot of appealing going on; an awful lot of people who feel very ill treated because they do not get rated as having substantial needs, when they feel that their needs are substantial; a great many cross relatives; a great many older people feeling unfairly treated. Of course, there will be mistakes and anomalies and problems.
We all know the problems that arise with an old person when a social worker comes round. The person can hardly drag themselves out of bed and toilet themselves or whatever, but when the social worker comes, they think, “Christ, if I’m not careful, I might get taken into care”. So they say. “I am fine. I can bounce about my flat under my own steam with no difficulty at all”. Well, of course, the social worker then fills out the forms saying that no help is needed, whereupon the old person flops back into bed and stays there without the help they actually need for another year or two until someone tries again. I put it in simple and no doubt over-flamboyant language, but this is a reality that we need to face up to.
Although I have no substantial objection to these regulations, this is the beginning of the story, not the end of the story. There is a great deal to be worked
through here and a great deal to be thought through by the Government, by local government and by the organisations that represent those in need of care. I am sure that it will need to be debated in the House—and further action taken as the months and the years go by.