Clause 53 - Funding by resident etc. of more expensive accommodation
Health and Social Care Bill
9:30 pm
Mr John Hutton (Minister of State, Department of Health; Barrow and Furness, Labour)
The effect of the hon. Gentlemen's amendment would be to ensure that local authorities would meet a person's care needs, regardless of the cost. Some of his other points do not seem to relate to his amendment—he may have wanted to speak more widely about the purpose of the clause. Perhaps I should help him and his hon. Friends with that.
The clause in no way removes or alters existing provisions, which require a council to meet a person's assessed care needs, even where that might mean providing residential or nursing home care that exceeds the local authority's usual standard rate. The clause, as will be specified in regulations, will ensure that people who avail themselves of the three-month property disregard or use a deferred payment arrangement can choose more expensive accommodation than the council would normally finance. That is sensible and fair, as such residents are to all intents and purposes self-funders who have the resources to pay for more expensive accommodation, should that be their choice. I do not believe that we should restrict people's choice to use their resources in that way if they consider it appropriate. They should be able to exercise choice over the care home that they will enter. For many, that will be their final home, and it should meet their needs and be to their liking. It is particularly important for councils to use their resources efficiently and fairly.
Councils currently consider and make placements with two important principles in mind. The first relates to the choice of accommodation, direction on which was issued to them in 1992. A key principle is that people seeking council support may enter care homes of their choice where the home meets their assessed needs, a vacancy exists and the fees are in line with what the council would normally expect to pay.
The second key principle concerns the financial assessment. Once a council has assessed someone in need of residential accommodation who qualifies for council support, it will undertake a financial assessment. That assessment will take full account of a person's assets and income and, according to national regulations and rules, determine how much he or she should pay towards the cost of their care. The nub of the second principle is that once a council has made a fair and full financial assessment, it cannot ask the resident for a further contribution. Residents are not allowed a top-up from income and assets that the means test has disregarded, and the council should make up any difference between the fees charged by the care home to meet individual assessments and what the user can contribute.
If a resident wishes to enter a care home with higher basic care costs than a council would normally contract for, because of extra facilities, he or she may not expect the council to pay the difference. Instead, the resident may be able to turn to a third party, sometimes a relative, to make up the difference. I am aware that not all residents have someone to turn to in such circumstances.
Because we introduced the three-month property disregard and the deferred payment scheme in the NHS plan, to which I shall come in a moment, we have reviewed the rules on top-ups. As I said, those who take advantage of the measures are to all intents and purposes self-funders with sufficient resources to pay for the care that they want and need, but for the duration of the three-month property disregard or the deferred payment scheme, they will technically be council-supported residents. As such, they will technically not be able to enter homes of their choice if the fees are greater than the council would usually pay. Residents are forbidden to make up the difference with income and assets disregarded by the means test.
The clause provides a clear legislative framework—to be clarified in regulations—to enable residents in such situations to top up their contributions to care fees if the fees are greater than those that the council would normally meet for someone with those needs. The clause also provides a clear framework for the current practice of third-party top-ups, which allow family members, charities and others to contribute to care costs and bridge the gap between the care home's fees and the council's standard rate.
I hope that I have reassured the hon. Member for New Forest, West that the clause does not remove or alter existing provisions, which require councils to meet a person's assessed care needs, even where that means providing residential or nursing home care that exceeds the local authority's standard rate for that care. Councils have a duty to pay for care, no matter its cost, if it is essential to meet assessed needs. The fact that the legislation will not allow for top-ups for any situation other than the three-month disregard and deferred payment scheme indicates that the Government recognise that reform in that area is difficult and sensitive and that we need to proceed carefully.
I hope that, having heard what I have had to say, the hon. Gentleman will withdraw the amendment. He has raised several issues that go wider than that but I have tried to reassure him about why we are changing the top-up rules. We intend to preserve and extend choice and to make sure that the new schemes are not frustrated or resisted by other rules relating to top-ups. We want the whole system to work effectively, and changing the rules on top-ups will encourage both those schemes.