Clause 29
1:00 pm
Jonathan R Shaw (Parliamentary Under-Secretary (Disabled People; Minister for the South East), Department for Work and Pensions; Chatham and Aylesford, Labour)
I thank the hon. Members for Forest of Dean and for Rochdale for raising these issues. There is a consensual spirit on the right to control. By talking about his constituent going to university, the hon. Member for Rochdale gave us a helpful illustration of the benefits that people could derive from such a scheme. He advised me in the margins that his constituent is now in his second year, and we wish him every success. The hon. Gentleman showed us how the measure can be practically applied, and the difference that it can make. His constituent is now in the driving seat; he is the one with the power. That may have been inconceivable only a few years ago, when we focused on what the producer provided. Public policy has shifted, and now there is a consensus that we want to empower the individual.
The hon. Gentleman talked why social care was not on the face of the Bill. I will come to that point later, but it is important to note that he talked about the primary care trust, which is about the health budget, rather than the social care budget that goes to the local authorities. I will explain later what we are doing about that. One can envisage its being easy to identify particular parts of a health budget that an individual is receiving. For example, one can see how chiropody services could be personalised. Dialysis, on the other hand, might be more difficult. I am talking here about providing that service to a particular community. The hon. Gentleman and I had a discussion about that outside the Committee. If a dialysis operation is to be economic, the number of people receiving the operation must be sufficient to allow expertise to be built up. I think people can understand the practical differences. That is why the Health Bill, which is now passing through the House of Lords, will provide opportunities for those pilots. In comparison with social care, it is a little less tangible and a bit more difficult to identify particular funding streams within the PCT budgets that one can put into a right to control individualised budgets.
We have experience in relation to social care. The hon. Member for Forest of Dean mentioned the pilots that we have already undertaken and we have had some evaluation of those, which in the main has been positive. It is not the promised land for everyone and we should not get too heady and think that this is the solution for every single one of our constituents, because it is not. In the pilots, a number of elderly people in particular found it difficult to manage such budgets. We perhaps need to find other ways to ensure that they are still in the vanguard in terms of shaping services. Again, there is a consensus in terms of public policy that that is what we want to do. So there is provision within existing legislation that allows us to direct for personal social care budgets. It is important for me to get some points on the record. Those were the immediate issues that arose from the hon. Gentleman’s contribution, but I will make some further detailed remarks. Of course, I would welcome any interventions from hon. Members.
As I mentioned in the evidence that I gave on 12 February, to which the hon. Member for Forest of Dean referred, the exclusion of community care in the Bill is to ensure that we do not duplicate or cause confusion with existing powers. The Bill makes provision for disabled adults and therefore excludes community care and other care services that apply to people under the age of 18, as we discussed this morning. Disabled children have different needs.
Legislation relating to community care services is defined in the National Health Service and Community Care Act 1990, which is an Act that I remember well because I was completing my training as a social worker at that time. Indeed, an interesting parallel between that piece of legislation and the Bill is that there is a political consensus. That bodes well for the people who are recipients of services. However, although we celebrate some consensus in terms of ensuring that the services are better delivered and of a higher quality for our constituents, it is important to remember that the Bill does not suit everyone. One of the criticisms of the 1990 Act was that there was perhaps too much of a consensus and not enough questions were asked—the hon. Gentlemen may consider that an invitation.
The Government set out their vision of the personalisation of public services generally in the cross-government concordat, “Putting People First”. Local Authority Circular DH/2008/1 set out what that would mean specifically for adult social care. It states:
“Everyone, with support if necessary, will be able to design services around their own needs, within a clear personal financial allocation”.
The circular recognises that
“With self-directed support, people are able to design the support or care arrangements that best suit their specific needs”.
The circular also sets out the system of personal budgets that will deliver choice and, importantly, control. The changes detailed in that local authority circular mirror the changes that the Bill sets out in order to achieve better public services. The right to control and the current changes to the delivery of adult social care will together enable the implementation of the Government’s commitment to empower disabled people, and ensure that choice and control are recognised as a right.