I am standing here to speak in the place of my noble friend Lady Wheeler, because—as irony has it—she is a carer and has had to go home to care for her husband. I find that an irony. My noble friend wanted to speak at this point because we are very keen to make our points in the debate on clause stand part. First, I congratulate the noble Baroness, Lady Bull, who tabled Amendment 233, which leads the discussion on this highly controversial clause. She spoke with clarity and precision—and, of course, I thank her for her support of the other amendments.
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This clause sets the care cap too high to benefit the majority of people who need to be protected. It abandons the key safeguarding Dilnot principle of enabling local authority care costs to count and to accrue towards the cap. It also abandons the consensus on implementing Dilnot that was so painstakingly and carefully worked through and agreed under the Care Act 2014, with cross-party consensus in both the Commons and the Lords.
On top of this, in the process of dismantling the Care Act provisions, the government amendments tabled in your Lordships’ House introduce a new set of even more complex technical charging rules for local authorities, which, to stand any chance of working it all out and administering and implementing the new arrangements, will have to develop costly new systems and accounting rules procedures, and employ more staff—IT specialists, accountants and auditors.
I thank the supporters of my amendment—the noble Baroness, Lady Campbell, and the noble Lords, Lord Warner and Lord Lansley—and, indeed, other noble Lords who kindly said they would have signed the amendment had it not already been full. I look forward to their contributions.
I am also grateful for the many expert briefings—in particular from the Alzheimer’s Society, Age UK, the MS Society and a group of 10 charities, including Mencap, that support working-age disabled adults and people with learning difficulties. Between them, these key stakeholder briefings spell out graphically,
with full costings and actual person examples, the full impact of the Government’s care cap proposals on millions of people either receiving social care or in desperate need of it.
I am sure noble Lords will draw further on those examples today, as we have already heard in the contributions so far. Despite the pledge that nobody should have to sell their home, the fact is that someone with assets of £100,000 will lose almost everything, yet someone with assets worth £1 million will keep almost everything.
The deletion of Clause 140 is therefore vital, because it would enable the care cap provisions in the Care Act to remain in place, including ensuring that local authority costs count and accrue towards reaching the care cap. Labour strongly supported this negotiated package in 2014, and the costs involved, for implementation in 2016, in the full expectation that the Government would stick by it. Sadly, we know what subsequently happened with the staged annual postponements until final cancellation in 2019.
Labour’s support for the care cap has always been in the context of seeing it as part of a much wider social care reform that is needed to build long-term sustainability and growth, which the Government have yet to address. What the cap does not do, as summed up by Age UK, is improve access to care services by lowering the threshold or broadening the “eligible needs” definition. It does not increase the amount of care available. It does not provide increased funding to the system in terms of overall total expenditure. It does not improve care quality, develop the workforce or promote innovation, and it does not stabilise the care market by addressing the local authority funding problem
We know that what the Government are now proposing was discounted by the Dilnot commission as unfair, because it will result in people with low levels of wealth spending the largest proportion of their assets on care costs. That is clearly what the modelling shows, particularly in some of the most deprived areas across the country. The health think tank the King’s Fund has joined the call for the removal of Clause 140, labelling the £86,000 cap as “regressive” and running counter to the levelling-up ambition.
The cap level must be brought down and be set at a cost that achieves the fairness and equity that Dilnot was aiming for. Amendment 235, tabled by the noble Baroness, Lady Greengross, which would place the cap at the equivalent of the original Dilnot level by uprating its present value to £50,000, and which would be implemented under the current Care Act legislation, is a clear way forward to replace the Government’s Clause 140 proposals, and we strongly support it. I look forward to hearing from the noble Baroness in due course.
The Nuffield Trust supports this amendment and underlines that the simple removal of Clause 140 would create a more generous form of cap. In his Second Reading response speech, the Minister justified the £86,000 cap and the charging restrictions and said that
“nobody will be worse off in any circumstances than they are in the current system, and many people will be better off. The reforms mean that the Government will now support an extra 90,000 older care users at any given time.”—[Official Report, 7/12/21; col. 1888.]
But when we searched we found that the Build Back Better paper breaks this down as an additional 30,000 benefiting from the higher means test threshold and 60,000 from the cap, so could the Minister explain where this information is fully contained and analysed as it does not appear to be covered in the impact assessment or the related social care document? What are the overall estimates when the younger care population and people with learning difficulties are included?
The Age UK detailed case-by-case analysis of the impact on older people does not bear this out and the Alzheimer’s Society modelling shows that just 19% of people with dementia would reach the cap, and that is disproportionally detrimental to dementia sufferers in the north of England, the Midlands and some areas of London. With 900,000 people currently living with dementia in the UK especially likely to need social care rather than medical care, can the Minister tell the House what the Government’s estimate of the cap’s impact on dementia sufferers is and how this has been taken into account in the proposals before us today?
In summary, Clause 140 must be deleted so the Commons can think again about the proposals we have before us. What is presented in the clause is not a strategic plan needed for social care. It does not solve the existing funding crisis, which has been reinforced by social care playing second fiddle to the allocation of the health and social care levy and being virtually ignored in October’s spending review.
What we have instead is a last-minute, hastily drawn-up proposal, tacked on to a Bill that is mostly NHS-focused, forced through the Commons without notice—without a proper debate—and presenting us with a confusing mishmash of amendments on how councils must go about ensuring that the money they spend on social care packages does not get calculated in any assessment of need.
For these reasons, we wish to delete Clause 140. It should be replaced with the wording set out in Amendment 235 from the noble Baroness, Lady Greengross. I also need to say to the Minister that we do not expect him to move the government amendments tonight because a much wider discussion is needed in your Lordships’ House. I thank noble Lords for allowing me to speak at this point in the debate.